Nursing Infomatics-Tele-Nursing Essay
Nursing Infomatics-Tele-Nursing Essay
Introduction Tele-nursing is the use of telecommunications technology such as videos, computers and tele-monitoring technologies to provide nursing care and advice at a distance. This growing technology offers many advantages in the delivery of healthcare information, disease monitoring, health promotion and disease prevention services, as well as nursing diagnosis, treatment and education to patient at home from a centralized location.
Tele-nursing can be instrumental in helping patients and families to be active participants in their care, particularly in the self-management of chronic illness such as congestive heart failure. It is a service that is currently offered by a growing number of hospitals and health maintenance organizations (HMOs), medical practice groups, and even primary physicians. One of the interesting components of tele-nursing is the modes of delivery of care. New technologies such as service-delivery programs and monitoring systems can configure to connect the patient to a nursing call center or to a specific practitioner. Nursing Infomatics-Tele-Nursing Essay.
One example is the Carematix Wellness System (CWS) which is based on advanced, patent-pending, wireless and internet technologies that are integrated into everyday health monitoring devices such as a blood-pressure monitor, weight scale, and glucose monitors. Furthermore, enables nurses to provide accurate and timely information and support online. Another advantage of tele-nursing is the continuity of care which can be enhanced by encouraging frequent contacts between health care providers and individual patients and their families.
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Furthermore, tele-nursing is cost effective in reducing the requirement for or the length of hospital stays. It also facilitates increased access of services to widely dispersed and remote populations. Telenursing is a growing trend and is expansion in the field of nursing informatics. Bibliography Resources Resource 1 Suttenfield, K, Tokarski, C. & Kilbride,J. ( 2002). Highlights From the ATSP Telehealth Conference 2002: Briefings on Telemedicine Activity in the US and Abroad During the Past 12 Months. Retrieved August 3, 2008 from Medscape technical Medicine eJournal.
The researchers met to identify innovative way to advance telehealth. There researchers were well respected in the field of telemedicine from the Association of Telehealth . This conference identified various telecommunication methods that can transcend distance barriers while providing an effective and cost-efficient alternative to face-to-face encounters. The information was intended for health care provider for use on patients at home. The latest funding, reimbursement activities, legislative and regulatory issues, home telehealth and tele-nursing were some of the new advancements that needed refining.
As cost and time considerations force consumers, providers, and insurers to examine alternative ways of providing healthcare services, telehealth transactions was found to gain acceptance into the mainstream of traditional medicine.Nursing Infomatics-Tele-Nursing Essay. New and emerging technologies were identified such as home telehealth- using telemedicine to care for elderly patients at home, disease management- patients’ answers are stored in detailed Web-based records that analyze the data and identify clinical indicators over time and telepharmacy.
Other methods were electronic health record and voice diagnostic and tele-nursing. A growing need to promote the methodology of telehealth as a financially viable and widely acknowledged method of healthcare delivery was the underscoring principle mentioned. Resource 2 Renee Slater, M. , Phillips, D. , & Woodard, E (2008) Cost-Effective Care a Phone Call Away: A Nurse-managed Telephonic Program for Patients with Chronic Heart Failure. Nursing Economics, Gale Group, Farmington Hills, Michigan. Retrieved August 3, 2008, from http://www. accessmylibrary. om/coms2/summary_0286-34213677_ITM The authors consisting of three nurses investigated the management of chronic heart failure (CHF) case through a telephonic program. It was identified that the challenge of providing care for CHF case was not cost effective and methods to reduce the cost of care was investigated. There was 50% readmission rate within 6months of being discharged. The main reason for readmission was failure of the patient to identify warning signs of heart failure exacerbation such as shortness of breath and weight gain.
The researchers used a 24hrs health information line called Vitaline to the patients to reinforce education received in the hospital on discharge. Through Vitaline 854 CHF admission between 2002 to 2005 dropped to 200 at the completion of the program. The cost of care was also analyzed and it resulted in a 57% reduction in cost due to a decrease in the length of stay. In closing the program has shown excellent outcomes using the limited, though expert, resources.
The research is relevant to tele-nursing as it shows that patients care can continue outside the walls of a hospital or nursing home and that there can be a reduction in the readmission of chronically ill patient. Resource 3 Hutcherson, C. (2001). “Legal Considerations for Nurses Practicing in a Telehealth Setting”. Online Journal of Issues in Nursing. 6,(3), 3. Retrieved August 3, 2008 from www: nursingworld. org/ojin The author Carolyn Hutcherson , RN, MS, specializes in health care regulatory issues with special emphasis on licensure and credentialing, telehealth and e-health. Nursing Infomatics-Tele-Nursing Essay.
She examines the complexity of the legal and regulatory bodies to understand and develop standards that is safe and effective to the practice of telehealth. She raises many important issues to the practice such as whether there is a need for certification or additional credentialing for telehealth practice, the place of care since the providers are in different geographical location,, the crossing of state line and the laws that govern, whether it is the law that covers provider or the law of the stat that the patient is in. urthermore other issues involved are whether telephone and electronic nursing are within the scope of nursing practice as authorized by the state nurse practice acts. Although many legal issues were questioned and identified, the author still sees tremendous possibilities for patients on remote locations. Resource 4 Allen,A. , Doolittle,G. , Boysen, C. , et al( 1999) An analysis of the suitability of home health visits for telemedicine, Journal of Telemedicine and Telecare 5:90-96. Retrieved August 3, 2008 from www: medscape. om The researchers examine the percentage of traditional home health nursing visits that could be done by telemedicine. Here a retrospective review of nursing charts clinical records were use. Two types of data were recorded. The objective data, which were extracted from the records, included demographic information, patient assessments, teaching activities and interventions. Furthermore the subjective data were the opinions of four observers as to whether the visit could have been done using currently vailable telemedicine technology. There were 906 home nursing visits and a 54-item coding instrument was applied to it. It Ws found that for 412 visits, 46 could have been replaced with tele-nursing. These included the common primary diagnosis of airway obstructions to least life threatening as anemia. The research concluded that tele-nursing can be used to substitute some of the home nursing visits thus reducing the cost of providing home care services. Resource 5 Ades, P. , Pashkow,F. , Fletcher, G. , Pina, I et al(2000).
Controlled Trial of Cardiac Rehabilitation in the Home Setting Using Electrocardiographic and Voice Transtelephonic Monitoring. American Heart Journal 139(3):543-548, Mosby-Year Book, Inc. Retrieved August 3, 2008 from www: medscape. com The authors of this article are researchers from the Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont. The study design was a multicenter, controlled trial done over a period of three months. The outcome variables were peak aerobic capacity and quality of life, as measured by the Health Status Questionnaire cardiac rehabilitation.
The goal of this study was to compare the effectiveness of home-based, transtelephonically monitored cardiac rehabilitation with standard, on-site, supervised cardiac rehabilitation. The sample group included 83 people who were home-based transtelephonically monitored from home and 50 patients who were monitored from a standard on site rehabilitation program. Nursing Infomatics-Tele-Nursing Essay. The results showed that patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site (18% vs 23%).
Quality of life such as physical and social functioning, physical role and emotional role limitations, bodily pain, and energy/fatigue improved similarly in both groups. The conclusion was that patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs Resource 6 Russo, H( 2001). “Window of Opportunity for Home Care Nurses: Telehealth Technologies”. Online Journal of Issues in Nursing. 6 (3), 4. Retrieved August 3, 2008 from : www. nursingworld. org/ojin Holly Russo is a egistered nurse with a Masters of Science degree in clinical evaluative studies from Dartmouth College. Russo provided examples of telehealth nursing in home care, and discuss the future of telehealth technologies in nursing. One of the example is Kaiser Permanente who has also pioneered telehealth nursing in home care. In a study by Barbara Johnson (2000), 100 patients received cardiopulmonary, cancer, wound, and/or diabetic home health care in the traditional face to face fashion, and 100 patients received some of their visits via a video system staffed 24 hours a day by trained home care nurses.
In this study, Kaiser utilized a device called the Personal Telemedicine System, produced by American Telecare, Inc. , which allows home health nurses to see the patient in real time, listen to heart and chest sounds, and check to see if that patient is taking his or her medications properly. Johnston reported that cardiopulmonary disease patients received the greatest benefit from the system caregivers. Resource 7 Buckley K. ,Tran,B (2001) Receptiveness, Use and Acceptance of Telehealth by Caregivers of Stroke Patients in the Home Online Journal of Issues in Nursing. (3); Available: http://nursingworld. org/ojin The authors are professors in the School of Nursing at The Catholic University of America. They specialized in telehealth and advanced telecommunications systems for remote delivery of nursing support for caregivers of stroke survivors. A qualitative exploratory descriptive study was conducted through randomized selection. The sample size was 75 caregivers. The purpose of the study was to determine factors that influenced caregivers’ receptiveness, use and acceptance of telehealth videophones by 21 families of stroke patients in the home setting.
According the study, family receptiveness toward telehealth appears to be dependent upon caregivers’ concerns about privacy and home security, proper timing of services offered, perceived need by caregivers for support, and the level of caregiver burden. However, the research also conclude training of nurses and caregivers to develop the skills appropriate to the technology and helping them to feel comfortable with telehealth is essential to its use and effectiveness. Search Strategies: The source of material was found using keywords as the subject and the content. The search for tele-nursing, telehealth, telemedicine, emote monitoring device and telehome care was used in the Google search engine. The relevancy of the information was screened as well as the reliability and credibility was examined. Selected journal from scholarly sources were examined. Nursing Infomatics-Tele-Nursing Essay. The Medscape site was also used after subscribing to it. The search resulted in many articles, some of which were scholarly and relevant to the topics. Nursingworld was also a source of reference. Conclusion -Reaction to the citation- the information obtained was a collection of relevant research materials for scientific journals obtained from online sources.
The sources were primary and accuracy and relevance to the topic was maintained to reduce biases. The citations mentioned above, draw from the information available for tele-nursing and show its importance in the health care community. Furthermore tele-nursing is shown to be a growing field that will change the way health care is delivered to remote areas. The references identified strongly agree with the new technology as it will reach many of the underprivileged, the indigent and the elderly. It will also expand ways in which nurses care for patients and in the quest for disease prevention and follow up care.
References Ades, P. , Pashkow,F. , Fletcher, G. , Pina, I et al(2000). Controlled Trial of Cardiac Rehabilitation in the Home Setting Using Electrocardiographic and Voice Transtelephonic Monitoring. American Heart Journal 139(3):543-548, Mosby-Year Book, Inc. Retrieved August 3, 2008 from www: medscape. com Allen,A. , Doolittle,G. , Boysen, C. , et al( 1999) An analysis of the suitability of home health visits for telemedicine, Journal of Telemedicine and Telecare 5:90-96. Retrieved August 3, 2008 from www: medscape. com Buckley K. Tran,B (2001) Receptiveness, Use and Acceptance of Telehealth by Caregivers of Stroke Patients in the Home Online Journal of Issues in Nursing. 9 (3); Available: http://nursingworld. org/ojin Hutcherson, C. (2001). “Legal Considerations for Nurses Practicing in a Telehealth Setting”. Online Journal of Issues in Nursing. 6,(3), 3. Retrieved August 3, 2008 from www: nursingworld. org/ojin Renee Slater, M. , Phillips, D. , & Woodard, E (2008) Cost-Effective Care a Phone Call Away: A Nurse-managed Telephonic Program for Patients with Chronic Heart Failure.
Nursing Economics, Gale Group, Farmington Hills, Michigan. Retrieved August 3, 2008, from http://www. accessmylibrary. com/coms2/summary_0286-34213677_ITM Russo, H( 2001). “Window of Opportunity for Home Care Nurses: Telehealth Technologies”. Online Journal of Issues in Nursing. 6 (3), 4. Retrieved August 3, 2008 from : www. nursingworld. org/ojin Suttenfield, K, Tokarski, C. & Kilbride,J. ( 2002). Highlights From the ATSP Telehealth Conference 2002: Briefings on Telemedicine Activity in the US and Abroad During the Past 12 Months. Retrieved August 3, 2008 from Medscape technical Medicine eJournal. Nursing Infomatics-Tele-Nursing Essay.
The promotion and use of telenursing can be beneficial to hospitals and other healthcare organizations because “The American Recovery and Reinvestment Act of 2009 provides billions of dollars in stimulus funding for research, operations, and grants in the telemedicine, telehealth and informatics sector. (Hebda & Czar, 2013)” There are however many adversities and uncertainties revolving telehealth and telenursing. Issues related to licensure and reimbursements are two of the major setbacks in telehealth. Medicaid does not recognize telehealth as a specific medical service and leaves reimbursement options up to individual states to define reimbursement options. Some states mandate that private insurances cover teleheatlh services but most others are left to the discretion of the insurance company. Specialized technologists who have to be specifically trained in health care technologies will need to be employed around the clock for possible issues that may arise on either the provider or patient end. Many uncertainties come from liability concerns. Patients tend to feel that they have been cheated out of a fair visit because no provider provided hands on care to them during their visit. Nursing Infomatics-Tele-Nursing Essay. Providers as well may be uncomfortable with the idea of treating patients without face-to-face contact. Nurses face issues of liability when information given via telephone or teleconferences is misinterpreted by the patient and
Abstract
In today’s dynamic health systems, technology plays an important role in education and nursing work. So it seems necessary to study the role of nurses and highlight the need for appropriate information technology educational programs to integrate with the ever-increasing pace of technology. A review accompanied by an extensive literature search in databases and a library search focused on the keywords were used. The criteria used for selecting studies primarily focused on nursing informatics and the importance of expertise in the effective use of information technology in all aspects of the nursing profession. In a critical assessment of emerging technologies, the key elements of nursing informatics implementation were considered as healthcare promotion, advanced systems, internet and network. In view of the nature and the development of the information age, it is required to receive necessary IT training for all categories of nurses. Due to the fast development of technology, in order to effectively take advantage of information technology in nursing outcome and quality of health care and to empower nurses; educational arrangement is recommended to set short-term and long-term specialized courses focusing on four target groups: studying, working, graduate, senior undergraduate, and graduate doctoral. The result of this study is expected to assist educational providers with program development.
1.1 History and Definition
Nurses has been working in the field of informatics near four decades, the term “nursing informatics” has been considered a specialization in nursing resources since 1984 (Guenther & Peters, 2006). Many aspects such as data recovery, ethics, patient care, decision support systems, human-computer interaction, information systems, imaging informatics, computer science, information science, security, electronic patient records, intelligent systems, e-learning and telenursing have been added to the field. Hana has defined Nursing Informatics as the application of IT in the nursing duties including education, management & practice in 1985. Integration of information science, computer science and nursing science to support nursing practice and knowledge management was the definition offered in 1989 by Graves and Corcoran. The American Nurses Association (ANA) published its aim and standards in 1994-1995 and presented the Nursing Informatics as a specialty that integrates nursing science, computer and information science to provide data communication management, knowledge and nursing work in 2001. Now most of nursing professionals believe that it is defined as the integration of information technology and all aspects of nursing such as clinical nursing, management, research or education (Guenther & Peters, 2006).
1.2 Competencies
The competency of nursing informatics specialists was determined through studying three categories including computer skills, informatics knowledge and informatics skills. It investigates four levels of nursing practice: beginning nurse, experienced nurse, informatics specialist, and informatics innovator.
The following competencies were rejected: diagnostic coding, desktop publishing, managing central facilities to enable data sharing and writing an original computer program (Staggers et al., 2002). Some components of accepted competencies are shown below in brief. Nursing Infomatics-Tele-Nursing Essay.
1.2.1 Computer Skills
Selected computer skill competencies contain computerized searches and retrieving patient demographics data, the use of telecommunication devices, the documentation of patient care, the use of information technologies for improving nursing care, and the use of networks and computer technology safely.
1.2.2 Informatics Knowledge
Selected informatics knowledge competencies are the recognition of the use or importance of nursing data for improving practice, and the recognition of the fact that the computer can only facilitate nursing care and that there are human functions that cannot be performed by computers, the formulation of ethical decisions in computing, the recognition of the value of clinicians’ involvement in the design, selection, implementation, and evaluation of systems in health care, the description of the present manual systems, the definition of the impact of computerized information management on the role of the nurse and the determination of the limitations and the reliability of computerized patient monitoring systems.
1.2.3 Informatics Skills
Informatics skills competencies includes the interpretation of information flow within the organization, the preparation of process information flow charts for all aspects of clinical systems, the development of standards and database structures to facilitate clinical care, education, administration or research. It also includes the development of innovative and analytic techniques for scientific inquiry in nursing informatics and new data organizing methods and research designs with the aim of examining the impacts of computer technology on nursing, and the conducting of basic science research to support the theoretical development of informatics. Information literacy skills, competencies, and knowledge are investigated among educators, administrators and clinicians of nursing groups nationally.
1.3 The Importance of Nursing Informatics
The history, definition and competencies of nursing informatics indicate the importance of this field. It shows nurses are integrated into the field of IT automatically. So they should be able to deal with it successfully to improve quality of care outcome. In this regard it is required to study the influence of nursing informatics on health care and make bold the appropriate information technology educational needs for nurses.
2. Method
An extensive literature search was performed by using databases Pubmed, Google Scholar, Ovid, Science Direct and SID. Search terms were “education, nursing”; “quality of health care”; “nursing informatics” and technology. The study was carried out from January to April, 2014.Nursing Infomatics-Tele-Nursing Essay. A library search was also performed. As many as 135 articles were retrieved. With a critical point of view, 40 articles in English were selected that specifically focused on nursing informatics education and its influence on nursing outcomes and the quality of health care (Staggers et al., 2002).
3. Results
The study mentions the followings as the key elements of nursing informatics implementation:
3.1 Health Care Promotion
The advantages of applying information technology in all aspects of nursing, including clinical areas, management, education and research and its influence on health care have been reviewed. Today, the subjects of clinical nursing information systems, decision support systems and medical diagnostic systems are associated with collecting patient information. Regarding the technology-rich environment, health care and hospital information systems developers, the quality of care is improving. For increasing patient safety and its leading to an evidence-based nursing, nursing informatics has been enhanced for students and graduates by Columbia school of nursing. The study has proved that informatics competence is a prerequisite to improving patient care (Bakken et al., 2003). Technology and using multimedia integrated into nursing curriculum can promote the use of informatics tools as an integral practice component and increase patient safety (Norton et al., 2006). Managers can improve efficiency and performance through information systems and new technologies. In addition, several studies have confirmed the impact of careful shift planning and efficient management on nurse’s work and the quality of health care. Information is the source of all management activities. Nursing care is an industry service and its product is patient care. Information technology can promote the nursing management outcome. Internet-based nurse scheduling systems are mostly designed according to the self-scheduling model and need refining by the manager who overviews proper distribution, it causes uniform resource allocation in scheduling and increases patient direct care time (Pierce et al., 2003). Implementing information systems can provide better access to evidence; it can affect the patient care quality and support evidence-based nursing. Software tools to facilitate research are available in all medical fields (Kardan & Darvish, 2008).Nursing Infomatics-Tele-Nursing Essay. Nursing information system had an influence on clinical patterns and decreased the time nurses spent on indirect care (Darvish & Salsali, 2010). This is critical to the health care professionals to assess, apply, report and manage data by the help of new tools of the information age (Hall, 1995).
3.2 Advanced Systems
Although using decision support systems can lead to a safer care, it may impair critical thinking. The need for excessive working time could cause some delay in the nursing job and reduce the quality of health care (Norton, 2006). Researchers recommended considering the following:
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-Involving nurse managers in the system selection and designing process
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-Designing a simple and efficient process
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-Recording a system-compatible guideline
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-Improving the system speed
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-Selecting hardware which can encourage nurses to use them
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-Upgrading the system through innovation in information technology
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Decision support systems have been defined to assist physicians to solve problems that require specific decisions since 30 years ago. It is replacing the role of human knowledge by formulating the knowledge in the system (Ting et al., 2008). Expert systems are the most common types of clinical decision support systems and have applications in show notes, diagnostic support, critical treatment plans, decision support, prescriptions, recovery and the identification and the interpretation of pictures, however, as stand-alone tools, are not able to replace human expertise. These systems should be integrated with knowledge management. Several studies have shown that the integration of implicit and explicit knowledge and management of different types of knowledge will help to determine the best treatment plan. Logical design is required for the success of these systems and seems to hardly have been considered. The application of guides and easy access to up-to-date clinical evidence and the cutting of duplicate tests could reduce medical mistakes and improve quality of care, but there are some limitations (Montani & Bellazzi, 2002). To increase the usefulness and acceptability of such systems, the ease of use, support and maintenance combined with the ability of systems hardware, software applications, integration with hospital information systems and patient records should be considered (Holbrook et al., 2003). Including smart and intelligent tools in diagnosis and treatment methods can reduce medical errors and harm as well as financial loss for humans. Artificial intelligence and expert systems are used to help the diagnosis. Nursing Infomatics-Tele-Nursing Essay.
3.3 Internet and Network
The first internet-based Nursing Informatics courses were offered by Duck University in 1997. Represented advantages were clearly defined and measurable learning outcomes and real-world problems were introduced as the main component of instructional strategies. There were some disadvantages like hardware and software problems, deficiency in prerequisite skills, troubleshooting difficulties, and low internet access speed and poor time management to master the material (Goodwin, 1997). The evaluation of an innovative consumer health informatics intervention proved that the patient and nurses are satisfied with the use of electronic and communication devices and home care (Kossman et al., 2006). Nurses can have networks such as AJN and AMN now. In the world wide web, it is possible to have a common network for nursing organizations and develop a forum to discuss nursing issues and design online meetings (Rizzolo & DuBois, 1995). The other aspects of nursing practice potential in the new decade are offering services from distance through telemedicine or telenursing. In this regard, easy remote diagnostic software and hardware are designed to facilitate E-health services. Tele-nurses can provide various services such as education, patient monitoring and counselling through Internet facilities. Telenurses are satisfied with their role. They care remotely using special skills and knowledge. It can cover nurse shortages and the global demand for nurses (Darvish & Salsali, 2010). In a telenursing Survey most of nurses believed that it is better to design educational programs for nurses to be able to work as telenurse (Grady, 2007). Using online library resources and outreach programs would be beneficial and produce positive outcomes for nurses (Wozar & Worona, 2003). Information and communication technology progress provided the possibility of improving health through e-education irrespective of time and place. Nursing Infomatics-Tele-Nursing Essay. Patient education systems on the internet can increase patient satisfaction and influence their self-care behaviour. E-health educational programs make people aware of disease management and increase coordination with the health care professional team. It influences the life style and the prevention of diseases such as cancer, HIV and chronic diseases. On the other hand, it empowers medical groups by enhancing and upgrading their knowledge. The web-based computer simulation educational program in crisis decreased medical errors in emergency departments. Information technology application refers to providing simultaneous access to education in specified locations which require huge spending. It decreases cost loss (Kardan & Darvish, 2007). Online access to journal articles prevents repeated research programs and makes assessment easy. Online databases provided up-to-date article access and informed nurses about new technologies, easy software and the results of investigations (Darvish, 2010).
3.4 Related Organizations Activity
National advisory council on nurse education and practice addresses nursing practice challenges; and mentions electronic health records, patient monitoring systems, bar code medication administration, computerised provider order entry, data capture tools, care planning tools and telehealth; and the need to consider nursing shortage, reducing medical errors, improve tracking of patient data, improve efficiency of data collection, improve access to care, support national surrveilance capabillities. These are also mentioned as ways to address nursing education challenges: E-learning to deliver education, simulation to deliver education, inclusion of Health Care IT in curricula, and faculty development for health care. It centeralizes these as solutions which can improve capacity of nursing schools, reduce faculty shortage, and increase health IT skills of graduating students. There are many group projects and organizations which support nurses’ involvment for optimal use of IT in their job. Some are introduced in the following:
Nursing Infomatics-Tele-Nursing Essay
