TELEHEALTH NURSING PRACTICE

AAACN Viewpoint, Jan/Feb 2007

In the early stages of telehealth nursing, according to certain assumptions, nursing practice using the telephone was not considered to be "real nursing." However, because of its application and widespread use in the managed care environment, it rapidly gained recognition as a significant field of nursing in the health care industry. Along with this came the realization that similar to nurses in other areas, nurses engaged in telehealth also use the nursing process to establish a therapeutic nurse-client relationship when providing patient care. Since that time, telehealth nursing practice has advanced to become what the American Academy of Ambulatory Care Nursing (AAACN) organization, among others, considers to be a subspecialty of nursing. As a result of this recognition, telehealth nursing practice has developed its own set of specialized knowledge and skills. Therefore, in order for nurses to successfully practice telehealth nursing, it is imperative that competencies specific to telehealth nursing practice be incorporated into the orientation process to provide for a safe as well as an effective medical legal practice.

The specific telehealth nursing competencies that should be addressed during the orientation processes are:

* Technical skills.

* Professional knowledge.

* Interpersonal skills.

* Documentation.

* Professional development.

* Resource management.

* Practice and administrative issues.

In meeting these competencies, the nurse/individual:

* Adapts to equipment and demonstrates efficient use of technology devices to perform role (technical skills).

* Is expected to use clinical judgement and effective interventions to enhance patient/caller outcomes (professional knowledge).

* Is required to establish a trust relationship to illicit accurate patient/caller information and use effective interpersonal skills to engage in, develop, and disengage in a therapeutic interaction (interpersonal skills).

* Documents telecommunications that reflect care specific to the actual or potential health care needs of the patient/caller (documentation).

* Accepts personal responsibility for maintaining and improving the knowledge and skills necessary to assess, triage, and manage patients (professional development).

* Locates and utilizes appropriate resources to meet the needs of the patient/caller (resource management).

* Practices in accordance with an ethical, legal, and organizational framework that ensures that the patient's/caller's safety, interest, and well being are met (practice and administrative issues).

Key components of each of these topics have been defined, and examples are provided in Chapter 5 of the Ambulatory Care Nursing Orientation and Competency Assessment, which is available on the AAACN Web site at www.aaacn.org

Charlene Williams, MBA, BSN, RN,C, BC

The Cleveland Clinic Foundation

Cleveland, OH

Finally - The Perfect Resource For Triage Nurses!

The Telehealth Nursing Practice chapter in The Guide to Ambulatory Care Nursing Orientation and Competency Assessment recognizes the unique features of telephone triage and provides direction for the training and evaluation of staff. The table format of the information presents a clear and comprehensive overview of the distinct dimensions of telehealth as well as the key elements of each dimension. As with other specialty areas of nursing, the practice of telehealth nursing is guided by the nursing process and is well outlined in this chapter. This will be the only telehealth manual on my shelf!

Gina Tabone, RNC

Medical Concierge Triage Department

Global Patient Services at The

Cleveland Clinic

Cleveland, OH

Chapter 5, Telehealth Nursing Practice Guidelines in The Guide to Ambulatory Care Nursing Orientation and Competency Assessment were very easy to follow. They provided a practical approach in the work setting. It was an effective tool for orienting new staff and a useful monitoring tool for experienced staff.

Julie Shainoff, RN

Cleveland Clinic Nurse - On Call

Cleveland, OH

Telehealth Pearl of Wisdom

Patient Assessment

Nurses know that patient assessment includes both subjective and objective parameters. While subjective assessment is the "meat and potatoes" of a telephone assessment, it is possible (and necessary) to do an objective assessment as well. Objective parameters fall into two categories: signs and symptoms the nurse can hear and information that is self-reported by the patient.

Signs and symptoms the nurse can hear include:

* Respiratory (wheezing, coughing, hoarseness, tachypnea, etc.).

* Neurological (slurred speech, confusion, disorientation, inappropriate verbalization, etc.).

* Affect (calm, excited, flat, crying, etc.); Note: Although it's difficult to interpret affect, it can be observed.

* Background noises (oxygen, taking a drag off a cigarette, a baby's weak or inconsolable cry, etc.).

Information that is self-reported by the patient includes:

* Quantitative measurements (temperature, weight, blood pressure, blood sugar, urine ketones).

* Anything the nurse could observe using her or his eyes, hands, or nose could be assessed by the patient (urine output and color, character and amount of emesis, description of rash, etc.).