Telehealth Nursing: Technology in Health Care

Technology in health care has evolved in myriad ways over the years. One advancement in the medical field seeing an incredible surge of growth is telehealth.

"The telehealth landscape is exploding," says Anna Jarrett, an acute care nurse practitioner and associate professor of nursing at the University of Arkansas Eleanor Mann School of Nursing. However, this method of serving patients is far from new. Jarrett recalls when telehealth was possible only through a traditional telephone line.

"Telehealth has been around for many, many decades. I remember as far back as 1978 that patients in rural Arkansas could access certain specialists in Oklahoma City, Tulsa or Little Rock by phone," she explains.

We talked to Jarrett about the demand for telehealth in general, the rise of telehealth nursing jobs and how nursing programs prepare future nurses, nurse practitioners and even patients for the evolving technology of health care.

 

What Is Telehealth, and Why Is It Important?

"Telehealth is a way to evaluate a patient and communicate knowledge when you can't meet face to face," Jarrett explains. "Sometimes, this is simply a matter of patient choice, and other times it's the only way someone can make an appointment."

Telehealth can take several forms. While videoconferencing is perhaps most associated with remote care, telehealth also encompasses remote patient monitoring to collect clinical data, mobile health communication and even storing and transmitting medical information. Additionally, the collaborative nature of telehealth tools, such as electronic health record systems, helps support a team-based approach to care.

Telehealth played a significant role during the global COVID-19 pandemic. With lengthy lockdowns and social distancing requirements or recommendations in many areas, remote access to health care providers became a temporary norm. However, the benefits of telehealth long preceded the pandemic, especially in communities with a shortage of primary care options.

Telehealth is sometimes called telemedicine or telemed. While these terms are often used interchangeably, they are distinct. The Office of the National Coordinator for Health Information Technology explains that telemed refers specifically to remote clinical services, while telehealth encompasses a broader scope of services, including non-clinical and administrative services.

 

How Does Telehealth Work?

The earliest forms of telehealth focused on "phone triage," where nurses would provide basic health care information by telephone. An example of this might be the services accessed by calling the "nurse hotline" number listed on many health insurance ID cards.

Today, telehealth is both audio and visual – and encompasses a few overarching areas of care:

• Diagnosing common illnesses
• Triage for injuries or acute illness
• Managing chronic conditions
• Monitoring care after discharge from the hospital
• Mental health therapy

At a typical in-person acute care appointment, a primary care physician or nurse practitioner will assess symptoms, provide care plan recommendations and prescribe or refill medication.

Jarrett explains that today's technology makes all these steps (and more) possible remotely. Sometimes, however, an effective virtual visit requires access to the proper devices ahead of time.

"Patients need to have equipment at home – and the knowledge to use it," she explains. This could be a Bluetooth-enabled heart monitor or a tiny camera that allows a provider to closely examine a part of the body (such as the throat or inner ear).

In many cases, telehealth nursing is also an alternative for monitoring a patient after being discharged from the hospital. In some instances, this could also allow a patient to return home sooner following a procedure or illness, which also frees up beds for other patients.

"The process is the same; the conveyance is a little different," says Jarrett.

For example, she explains how a bedside critical care nurse is tasked with listening to a patient's heart and lungs hourly. They'd document what they hear and notify or page the attending physician if the patient needs immediate attention. When the situation allows, telehealth technology makes this practice possible remotely, whether provided at the patient's home or even as an on-site option during staff shortages.

Telehealth combined with technology in health care also makes certain tests and observations possible from afar. For example, a simple sleep study may require transmitting heart sounds and rhythm data that could work remotely with the appropriate technology tools.

While telehealth isn't a replacement for emergency medicine, Jarrett explains how telehealth can allow nurse practitioners to provide assistance or guidance while someone waits for an ambulance.

"If you're having chest pains, you'll, of course, dial 911," she says. "However, a telehealth nurse could make sure you're sitting down, ask ‘Are you alone?' or ‘Do you have an aspirin?' and do what they can to help you stay calm."

Jarrett points out the ability to provide compassionate guidance in dire moments of need is a regular part of a nurse practitioner's toolbox, whether they're present when someone collapses in public or helping someone on the other end of the line.

Benefits of Telehealth for Patients and Providers

There are many benefits of telehealth for both providers and patients. Jarrett believes telehealth adds a level of efficiency to the day-to-day operations of many practices.

"I don't think every medical appointment must happen in person," she says, adding telehealth can prevent "wasted time" traveling and sitting in waiting rooms for the patient. Moving initial consultations or routine appointments to a telehealth option also allows providers to give adequate attention to the patients who need more in-office time.

Jarrett also points out telehealth could sometimes lead to a more attentive visit with a provider, which could also result in increased patient satisfaction and improved outcomes.

"Sometimes, during an in-person visit, the face is the last thing providers look at," Jarrett says. She explains how during the medical history part of an appointment the physical arrangement of an exam room may require the practitioner to look at a screen much of the time or be positioned in a way that gives them only get a profile view of the patient. "But during a telehealth visit, you are up close and personal with the patient."

However, Jarrett adds that the limited physical contact, such as observing the patient's gait as they enter the room or their posture after taking a seat, makes it crucial to ask the right questions during a telehealth appointment.

"Health history and information about daily life become much more important in telehealth," she says. "We might suggest nurse practitioners ask patients to get up and walk around in their space."

 

Benefits of Telehealth in Rural Communities

Telehealth grew in demand during the COVID-19 pandemic by necessity. However, the benefits of telehealth have long been recognized in rural communities and other areas with limited access to primary care physicians. For instance, without the barriers presented by the need for transportation or child care, and lost wages from having to miss work to travel for medical appointments, telehealth allows many more patients to have greater access to medical care.

With its ability to help doctors and nurse practitioners monitor chronic conditions, telehealth options are especially meaningful to underserved populations. According to the Centers for Disease Control and Prevention, people who live in rural areas of the United States are more likely than urban residents to die prematurely from all five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke. Jarrett adds telehealth is also a way to deliver health promotion and education programs – preventive measures that benefit individuals and overall population health.

"Access to smoking cessation, weight management, and alcohol and substance disorder recovery programs can be provided through telehealth," she says. She adds that developing strategies to cope with or combat the opioid crisis in rural Arkansas is a major focus of the University of Arkansas ONLINE Doctor of Nursing Practice (DNP) program.

Other benefits of telehealth, especially in rural communities, include maximizing access to pharmacy consultations, mental health services, home health care and even end-of-life care.

However, there is a challenge in providing access to certain telehealth services. While some routine appointments could work solely as a voice call on a mobile device or landline, other virtual visits may require an internet-enabled phone with a good Wi-Fi connection, something that may be lacking in many rural areas. As mentioned earlier, patients might also need specific devices to help their doctor, nurse practitioner or other health professionals assess an issue.

Jarrett believes the future success of telehealth involves providing standard instrumentation, at no charge, to medically underserved patients. This way, they're equipped and ready with devices that can transmit their temperature, heart rate and rhythm and other necessary readings to health care providers.

 

Professional Development and Training for the Telehealth Nurse and Other Providers

Today's nurses will likely be involved with telehealth in one form or another, so Jarrett says it's essential for nursing bachelor's degree programs and their graduate counterparts to address this delivery method throughout the curriculum.

"Nurses have always used technology. Now, in a physical assessment course, we'll teach them the standard way, and then we'll show them how to do it using telehealth," she says, using the stethoscope as an example.

"Nurses use a stethoscope to listen to heart and lung sounds," she says. "It's pivotal for nurses to know how to get an accurate reading using telehealth equipment – and then communicate information clearly to other providers in real time."

Nurses don't just provide telehealth-related services; Jarrett says they're also pivotal to the overall success of any telehealth program.

"Nursing plays a big role in integrating telehealth," she says. This means it's becoming commonplace to integrate aspects of telehealth at all levels of nursing education, including training nurses on how to teach patients and providers to use telehealth tools and technology.

Jarrett adds that students in the University of Arkansas doctor of nursing practice program can immediately apply their telehealth skills and knowledge to their current work environment or clinical rotation sites.

"If a location doesn't yet have an established telehealth program, our DNP students can use what they're learning to help the clinical site assess its telehealth needs," she says. In fact, developing or improving a telehealth program could make for an excellent project for the DNP's capstone requirement.

A modern Doctor of Nursing Practice program should address telehealth technology throughout its curriculum. But what about health care professionals who have been in the field for a long time? They might be experts at what they do, but still relatively new to telehealth and its related tools and technology. The same could be said about helping longtime nurse educators stay up to date with telehealth technology.

Jarrett says the Eleanor Mann School of Nursing at the U of A has developed ways to train health sciences faculty members across the university on both telehealth techniques and the latest technology in health care.

"We created an online telehealth course for our nursing faculty so they can do it on their own time, even track their progress," explains Jarrett, adding that she has held live in-person and online workshops. "I hope to spend significant time working with our faculty to make sure they're comfortable with teaching telehealth."

In addition to covering technical aspects of training, such as how to use and connect USB and Bluetooth devices, Jarrett says U of A's training for future and current telehealth professionals includes telehealth etiquette and best practices for safety and security.

"For example, we'd recommend a provider use an unadorned area in their home or office to conduct telehealth appointments – or to use a solid color filter for a background," she explains. Not only does this help the patient remain focused, but it also adds an element of privacy for the provider and the patient.

 

Telehealth Jobs for Nurse Practitioners

With the proper training and experience – and a level of comfort with health care technology and being on screen – you could pursue a variety of telehealth jobs for nurse practitioners. This could be delivering care via telehealth as part of your overall DNP role at a hospital, private practice or health care network. Or it could be a 100% telehealth nurse position within a traditional health care environment or for a telemedicine app or telehealth network.

Jarrett says that telehealth jobs for nurse practitioners go beyond providing care from afar.

"Someone must teach patients how to use the equipment. We also need to show people how to teach others to use the equipment – to train the trainers," explains Jarrett, of potential telehealth nursing jobs with medical supply or software companies. Product management or technical sales roles within the telehealth space may also benefit from someone with a nursing background.

With increased interest in telehealth, nursing from home career opportunities is also on the rise. Aside from working directly for a hospital or practicing as a telehealth nurse, you could work in a variety of hybrid or remote roles within the emerging and burgeoning telehealth app scene.

There's also room for advancement in this field, as there's a growing need for telehealth supervisors and directors of telehealth.

Telehealth Advancements: The Evolution of Technology in Health Care

As telehealth becomes even more prominent, new software, instrumentation, security measures, best practices and health care policies will develop and evolve. Advancements in the health care field mean continued advancement in health care education. Existing medical professionals of all kinds must keep up, whether through professional development or even pursuing an advanced degree.

The best DNP programs keep their curriculum current and relevant; in April 2021, the updated AACN DNP Essentials was approved to include required competencies to address telehealth nursing. Jarrett says things are underway.

While telehealth is addressed throughout the University of Arkansas' undergraduate and graduate nursing curriculum, the university has also started to develop specific telehealth nursing courses and clinical experiences. It has even secured funding to help with program development.

In 2021, Jarrett and her colleague, Marilou D. Shreve, submitted a proposal to the Women's Giving Circle Awards, an annual project that funds innovative programs and research across the university. Their proposal, "Integrating Telehealth Patient Management in the Doctor of Nursing Program," was selected as one of eight recipients, and their $13,000 grant was the largest award that year.

"I'm really excited for what the future holds in telehealth technology," says Jarrett, adding that she's particularly eager to see how nursing education will evolve to keep up. "We're going to help catapult telehealth to the next generation of users – and nurses."

One thing, however, will remain the same as it ever was.

"Nurses are connectors," says Jarrett. "They always have been and always will be."

Visit our DNP program page to learn more about earning your Doctor of Nursing Practice degree at the University of Arkansas ONLINE.

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