NR 361 Discussion Trends in Informatics

I’m going to choose telenursing for a discussion topic this week. I don’t know why I didn’t realize this before now but I manage a whole telenursing program. We have 3-5 dedicated nurses to phones each day. I never made the connection that this is a form of telehealth always assuming that was strictly video chats with providers. Hebda tell us that telenursing uses similar processes as traditional nursing; it just does them through electronic means. These means could involve the internet, telephones or other digital assessment tools (Hebda, 2019). Pretty much all of my experience with telenursing has been done over the phone but given COVID-19 we are looking at using other forms of technology to perform telenursing. I want to explore what that might look like. Telehealth is one trend the whole world is jumping on right now.

I often tell training nurses that assessment via the phone is a new ball game because your assessment is limited to what the patient tells you. You are relying entirely on their perceptions of sight and feel. An example I often use is that you cannot see that the whites of a patients eyes are yellow when discussing total body itching over the phone, you must ask the patient or even better yet have the patient ask someone who is with them if the whites of their eyes are yellowing and trust their response. But what if we didn’t have to just trust what the patient says. What if, through advancing technologies we could also see the patient while they are describing their rash? Imagine how much better our assessments would be!

The need for such telenursing practices has long been established, Elizabeth Moore and Brooke Trainum state “nearly 20% of Americans living in rural areas suffer from a shortage of providers and healthcare facilities. This scarcity of services is detrimental to the nation’s health.” (2019, p.7). This is very true for my service area. We often must force patients to travel from 200 miles away for them to receive proper oncology care and then when they need even more specialized care, we ask them to travel even further. As nurses we need to help accelerate telehealth practices so that we can provide a high quality of care. The implications for nursing practice are vast. As it stands in my current practice we speak to patients on the phone and ultimately comes down to three outcomes: patient can be managed entirely over the phone by the nurse, nurse decides that patient needs in person assessment by nurse or provider, or nurse recognizes emergent care is needed and patient is directed to ED. I don’t imagine that incorporating video into our telenursing program will prevent ER trips but it certainly could prevent patients from having to come into the office. If I could actually see the rash, I could likely rule out the possibility of it being shingles without bringing the patient in for a visit. This would intern save the patient time and money. Often, we come across the scenario where we feel a patient needs to be assessed but the patient cannot get to us so they end up in urgent care. Video telehealth certainly has the potential to reduce those visits.

There are some obstacles to consider when looking at a virtual telenursing program. One that comes immediately to mind is privacy. If you are performing a video interview anyone walking by could potentially view what is happening on the screen both on the patient side and the nurse’s side. Before my particular office could put something like this into place, we would have to look at getting the nurses private offices (which we do not currently have). Another consideration is the “hackability” of all of these wonderful devices that help us assess patients. If our e-mails are hackable then are our video chats as well? (Hoglund, 2017). The uneasiness regarding security may make patients less like to give us all of the information over a video chat. There are definitely some hurdles to consider and rushing into a telenursing system, as many practices are right now, could have some negative effects down the line, particularly in regard to protected health information and privacy.

Reference:

Hebda, T., Hunter, K. & Czar, P. (2019). Handbook of Informatics for Nurses & Healthcare Professionals 6^th edition. Pearson. New York, NY.

Hoglund, D. (2017). Secure and Reliable Wireless Medical Device and Mobile Connectivity. Biomedical Instrumentation & Technology. Vol. 51(2). P. 130-134. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.2345/0899-8205-51.2.130Links to an external site.

Moore, E. & Trainum, B. (2019). Connected Health. American Nurse Today. Vol. 14(12). P. 7. https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/detail/detail?vid=6&sid=a910cdbd-0f15-49d8-b011-3adfbb48d14f%40sessionmgr4007&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=140299006&db=ccmLinks to an external site.

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I to provide telenursing already through work. In Case Management, 80% of our position is work from home and so we do communicate with patients through telephone and video chat. (This has been a blessing during a time of pandemic as many hospitals in my area are laying nurses off and offering severance packages). I find it to be successful. I don’t feel that it will decrease ER visits either, but I do see a continuity of care. Many questions I receive are medications, signs and symptoms of simple things like a cold, and many patients want direction on how to manage their health at home and information on providers. I also do phone visits for home health. The agency I work for has implemented phone visits to save money with recent Medicare reimbursement changes. Phone visits are less expensive and therefore this is how they are filling the gap with their reimbursement loss. Patients are very receptive to the phone visit. Without being able to physically see them (as in a video conference) does make me nervous as I am relying on them to tell me the truth! I also would like to share that last year, I used telehealth and video conferenced a NP through my insurance. I was suffering with poison ivy. Within 5 minutes, she diagnosed me, gave me education, and sent a script to the pharmacy for prednisone. (Before contacting her, I had contacted my regular PCP and they would not prescribe without a visit and their next available visit was a week out.)

Many nurses in the home health agency worry that telenursing is going to replace our jobs. They feel if patients can be treated telephonically, there will be less demand for hands on positions. An article by Balenton & Chiappelli (2017), explores telenursing and concludes that nursing is being enhanced with today’s technology and the continuous generation of bioinformational developments and advancements; trends establish that telenursing is an evolving bioinformation-based tool that improves the nursing practice by bringing the nurses’ skills and knowledge to patients who are out of physical reach.

Reference:

Balenton, N., & Chiappelli, F. (2017). Telenursing: Bioinformation Cornerstone in Healthcare for the 21st Century. Bioinformation, 13(12), 412–414. https://doi.org/10.6026/97320630013412

Wearable technology is technology that is worn on the body and uses sensors to connect to the person, while making use of a web connection to connect wirelesslly to a device. (Hebda, 2019) Wearable technology includes, but not limited to physical activity monitors like smart watch, shoes, cloths, and other smart devices that give the user the ability to connect to the internet.

With the development of the smart wearable technology, the most benefit would be increasing the patient centered care by helping patient to reach their goal and decrease the risk factors of safety. For example, I had a clinical rotation at a specialty rehab hospital. They had a smart device called “Exoskeleton” (Ekso) which is a wearable, portable suit that helps individuals with lower-body paralysis or any amount of weakness resulting from a spinal cord injury, MS, or stroke to stand upright and walk. The advantage is to help individuals re-learn proper step patterns and weight shifts necessary for walking. Individuals benefit from increased exercise and function, and with the use of special software called Variable Assist. This device can improve patients’ strength by fine-tuning the amount of assistance needed to help walking for either leg. With the help of Ekso, patient has taken their steps to their goals. During the walking, Variable Assist will keep assessing patient’s ability of movement, and alarming when the patient is reaching a point of fall. (1902)

Hebda stated that “anytime data is sent from one device and received at another there is a security concern.” (Hebda, 2019) When a wearable device has the ability to interact with the outside devices, the security concerns that arise with that functionality. In addition, the adoption of smart technology is a challenge among older adults. For example, personal emergency alarms are adopted by less than 5% of older Americans who could benefit from such systems. (Lee, 2013)

Lee, C. (2013). Adoption of Smart Technology Among Older Adults: Challenges and Issues. Public Policy & Aging Report, 24(1), 14-17.

Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.

Gaylord Hospital. (1902) Spinal Cord Injury TechnologyLinks to an external site.

I chose to discuss the topic of smart hospital beds. Smart hospital beds use wireless sensor networks to alleviate pressure on different body parts for patients who are bed-ridden. The smart beds are capable of doing the repositioning on their own, without the assistance from humans. According to the article, A review on equipped hospital beds with wireless sensor networks for reducing bedsores, bed sores or decubitus ulcers affect more than 1.3 million adults in the world (Ajami & Khaleghi, 2015). From a legal perspective, I believe the implementation of smart hospital beds would benefit the hospital since it could prevent bed sores in patients and possibly prevent injuries in employees who would no longer have to physically move patients. There are no privacy considerations to be made since these smart hospital beds do not use patient information. The ethical consideration for this piece of technology would be that this would eliminate one the the duties of CNAs. Our textbook states that these technological advances in healthcare are doing work that used to be done by ancillary staff (Hebda, Hunter, & Czar, 2019, p. 6). Technology may one day advance to the point that ancillary staff may be no longer needed, but on the other hand, the increase in technology in healthcare will increase the need for individuals in IT and informatics.

References

Ajami, S., & Khaleghi, L. (2015). A review on equipped hospital beds with wireless sensor networks for reducing bedsores. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 20(10), 1007–1015.

Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.

With the advancement of medical technology, many healthcare facilities are being introduced to the use of Smart Pumps, for supplemental feedings and administration of intravenous medications. With the use of Smart Pumps, we have constructed a safer and time efficient environment for all patients ranging from pediatrics to geriatrics. Smart Pumps improve patient safety through preventing medication errors, applying appropriate and accurate dosage of high alert drugs. When using Smart Pumps, it ensures that the user selects the correct drug under the available catalog, once it has been selected, one must verify and input the intended dose per hour. This machine has the ability to catch human error, prevents providers from accidentally overdosing or underdosing their patients. This system that is in place assures the patient and the nurse that the right dose that has been ordered by the doctor is always correct and avoids costly medications errors.

According the assigned reading, “health information systems are required to provide access to accurate and complete client information to legitimate users, while safeguarding client privacy and confidentiality”. (Hebda, Hunter, Czar, 2019). One legal issue that is a concern, is the confidentiality aspect where our pumps at work display the dosage, the name of the medication and time left for infusion. Anyone can enter or walk by the patient’s room and can see the name of the medication currently being infused.

Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.

Health Information Technology. (2014) https://www.nursingcenter.com/pdfjournal?AID=2505886&an=00005721-201407000-00011&Journal_ID=54021&Issue_ID=2505454Links to an external site.

NR 361 Discussion Trends in Informatics