دورپرستاری
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Telenursingand Remote Access Telehealth
Bonnie Westra, PhD, RN, FAAN, FACMI
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Objectives
•Define telenursing/ telehealth and the use in various settings •Identify populations served by telehealth •Describe the role of the telehealth nurse •Explore various types of systems/ equipment •Examine teaching methods
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Definitions of TelehealthNursing
Telehealthnursing is the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing.
(American Association of Ambulatory Nursing 2004)
Telehealthnursing is the use of telecommunications technology in nursing to enhance patient care. It involved the use of electromagnetic channels (e.g., wire, radio, and optical) to transmit voice, data and video communications signals. It is defined as distance communication, using electrical or optical transmissions between humans and/or computers.
(Skiba, D.J. & Barton, A.J.,2000)
Telehealthnursing is the practice of nursing over distance using telecommunications technology.
(National Council of State Boards of Nursing, 1997)
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Use of Telehealth
•Home health care ?monitoring, education, support •Nursing home ?specialty consultations •Ambulatory care ?specialty consultations •Hospital consultations ?stroke care •Prison settings –mental health services •Mentoring –i.e. wound care specialists •ICU monitoring –neonatal intensive care, cardiac care •Health promotion –obesity, exercise/ fitness
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Role of Telehealth Nurse
•Nurse presenter –ambulatory •Nurse case manager –i.e. diabetes care •Public health nursing–Text4babies, Text2Quit •Health coach •Tele?ICU nursing •Clinical tele?health coordinator
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Example –Nurse Presenter
•Planning telehealth program i.e. specialty consultations in rural clinic/ hospital •Coordinate scheduling patients •Evaluating and preparing equipment •Assessing patients •Presenting patient •Facilitating remote exam •Documentation •Follow up care
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Telehealth Methods
•Real?time •Telephone?based –limited to education/ counseling •Web?consults (two?way audio and video) •With or without peripheral devices •Store and forward –images, audio, video •Combination
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Telehealth Equipment
•Phone lines/ internet •Phone/ computer with or without camera/ microphone •Cell phones •Life line •Sensor Technology •Peripheral devices PeripheralDevices •Blood pressure •Scales •Glucose monitoring •EKG/ cardiac monitoring •Dermascope •Otoscopes •Pedometers
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Email consults
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m?Health Will Transform Healthcare
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Monitoring ?eICU Care
Baptist ?eICUeight ICUs for a total of 142 beds 4 nurses/ shift –average 19 years experience Real time vital signs and cardiac monitoring Entire electronic record Alerts if any change that could be a problem Activation of camera and speaker from eICUfor visual assessment and communication with the floor staff or patient
http://ram.aetn.org/ark_champions_of_change/baptist_eicu
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Mr. Smith’s House is Calling
Caregiver Alerts Voice Prompts Floor Sensors Safety Features Smart Beds Video Monitors Vital Sign Monitoring Medical Condition Monitoring
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Smart Homes
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Ethical/ Legal Issues
•Competent Care •AAACN ?Scope and Standards of Telehealth Nursing •ATA –Standards and Guidelines •Devices •Center for Telehealth and eHealth Law •License to practice
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Safety Issues
•Assess appropriateness of telehealth for the patients ability and status •Know equipment •Evaluate reliability and effective use of equipment •Infection control •Information safety •Compliment with nurse judgment
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Benefits of Telehealth •Health care access •Financial return •Coordination of care •Quality of care
Challenges of Telehealth •Expansion of usage •Technology infrastructure/interoperability •Financial investment •Licensure and credentialing •Reimbursement •Evaluation/outcomes
Benefits and Challenges
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Teaching Activities
•Briefing on telehealth ?Select a target population i.e. CHF, MCH, other about the use of telehealth •Population, technology (ies), benefits, barriers •Interview 5 older adults about their use of technology, preferences, and willingness to receive care via telehealth •Simulate telehealth visit using Skype •Explore nursing roles in telehealth •Describe regulator issues related to telehealth •Debate –barriers and strategies for overcoming barriers using telehealth •Compare telehealth center websites –similarities and differences in services
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Telehealth Jeapardy
•Have students create a Jeopardy game about telehealth CategoryWhat is?ConceptResource EquipmentdermascopeWhat is a skin surface contact miscroscope? http://www.amdtelemed icine.com/ Nursing roles Methods of telehealth Populations Legal Issues
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Explore Research Funded by AHRQ http://healthit.ahrq.gov/images/dec08telehealthreport/telehealth_issue_paper.htm
•Describe potential implications for nursing practice realted to AHRQ funded research Grant Creating Online Neonatal Intensive Care Units (NICU) Networks to Educate, Consult & Team HIT?based Regional Medication Management Pharmacy System Home Heart Failure (HF) Care Comparing Patient?Driven Technology Models Implementing Technology to Transform Quality in SE Kern Measuring the Value of Remote ICU Monitoring Project ECHO (Extension for Community Healthcare Outcomes) Technology Exchange for Cancer Health Network (TECH?Net) TelewoundcareNetwork Valuation of Primary Care?Integrated Telehealth
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Bonnie Westra, PhD, RN, FAAN, FACMI
Associate Professor & Co?Director Center for Nursing Informatics University of Minnesota, School of Nursing
W ?612?625?4470 westr006@umn.edu