Telehealth nursing practice SIG adopts teleterms

AAACN Viewpoint, Jan/Feb 2003 by Greenberg, Mary Elizabeth, Espensen, Maureen, Becker, Carole, Cartwright, Julie P

The focus of the AAACN Telehealth Nursing Practice Special Interest Group (TNP SIG) is to advance telehealth nursing and promote it as a specialty practice.

The Clinical Practice/Quality Improvement (CP/QI) Workgroup is one of four strategic committees whose members work toward meeting the SIG's overall goals. The CPQI workgroup is comprised of 12 SIG members, all TNP experts. Four members of the workgroup, the co-authors of this article, constitute the core workgroup.

The 2002-2003 goals of the CPQI workgroup are to define and clarify telehealth terminology and to develop a glossary of terms relevant to telehealth nursing practice.

Clarifying the Terminology

Last year, the CPQI core workgroup identified five key terms: telehealth, telemedicine, telehealth nursing, telephone nursing, and telephone triage. These five terms are currently and historically the primary terms used in telehealth practice, publication, education, and research. They were selected, defined, and described because of their prevalence; inconsistent use; public and professional confusion; and evidence that even telehealth practitioners had difficulty differentiating between the terms (Greenberg & Espensen, 2001).

Based on a thorough review of the literature, the five terms were defined and described and are shown below (also see Table 1). Broad, nonrestrictive definitions were used to differentiate among the terms and accommodate the continually evolving changes in telehealth.

Telehealth

"Telehealth" is the inclusive term used to describe the wide range of services delivered, managed, and coordinated by all health-related disciplines via electronic information and telecommunications technologies.

The term telehealth has replaced "telemedicine" and represents the provision of health care beyond diagnosis and treatment to include services that focus on health maintenance, disease prevention, and education.

The three primary functions of all telehealth services are to increase access, improve outcomes, and contain or reduce the costs of health care. The prefix "tele," meaning "at or over a distance," is affixed to terms describing health care services that use telecommunication technology (such as the telephone, Internet, interactive video, remote sensory devices, and robotics) to transmit information from one site to another. Distance and telecommunication technology therefore are the common denominators of telehealth services.

Telemedicine

"Telemedicine" is a subset of telehealth that focuses on the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of medicine.

Specialty applications of telemedicine currently include teleradiology, telecardiology, telepathology, telepsychiatry, teledermatology, and teleoncology; however, it is important to remember that within telehealth, changes occur at a phenomenal rate (existing services grow and new services and issues emerge).

Telehealth Nursing

"Telehealth Nursing" (also known as "telenursing") is a subset of telehealth that focuses on the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing.

Recognized by both AAACN and the American Nurses Association (ANA, 1998), telehealth nursing is defined as nursing practice using the nursing process to provide care for individual patients or defined patient populations over a telecommunication device (AAACN, 2001).

Telehealth nursing is a broad term encompassing practices that incorporate a vast array of telecommunications technologies (telephone, fax, electronic mail, Internet, video monitoring, interactive video) to remove time and distance barriers for the delivery of nursing care.

The continually evolving telehealth nursing interventions encompass the delivery of nursing care other than direct, hands-on patient care. Guided by nursing standards, the major components of telehealth nursing practice include assessment, triage, health education, consultation (information, advice, and symptom management), disposition, surveillance, and follow-up.

Some established applications of telehealth nursing are currently telephone nursing, telehomecare, case management, disease management, and utilization review.

Telephone Nursing

"Telephone Nursing" refers to all care and services within the scope of nursing practice that are delivered via telephone or POTS (plain old telephone system).

As a component of telehealth nursing, telephone nursing practice relies on the nursing process to provide care to patients and is also guided by nursing standards (AAACN, 2001). It is currently the largest subset of telehealth nursing.

Telephone Triage

"Telephone Triage" (TI) is an interactive process between nurse and client that occurs over the telephone. Tr is used to identify the nature and urgency of the client's (patient's) health care needs and determine the appropriate disposition for the client (AAACN, 2001). Although health education plays an essential role, the focus of TT is on prioritization and disposition. TT is the largest and most well-known component of telephone nursing.