One of my co-workers recently accepted a position at a start-up telehealth business. My interest in what telehealth is and how nursing relates to it has grown ever since. As is my custom when I want to explore a topic I am unfamiliar with, I tried to find reliable information from reputable sources to quench my curiosity.
Before addressing the specific article that I found on the topic, I’d like to briefly introduce the idea of telehealth. The American Telemedicine Association defines telehealth (also known as telemedicine) as the delivery of healthcare via technology. Yes, a very broad definition. It has been common for healthcare professionals to use phones to communicate with patients in the past (e.g. deliver lab results), but now medical providers have the ability to use video conferencing to meet with patients for a virtual appointment and/or monitor patients remotely using monitoring devices.
The article I found most interesting and helpful was written by two Registered Nurses and recently published in April 2019 (see link below). I thought the unique perspective of these authors would be interesting to discuss more in-depth since it specifically addresses how telehealth interacts with nursing. Most of what follows is a summary of the article and deeper discussion incorporating my own thoughts and experiences.
Pros of Telehealth
There are a lot of arguments in favor of telehealth nursing. Some of the pros include increased availability of care services outside of normal work hours and reduced burden for on-call physicians. Nurses cannot only deal with easier patient needs such as education about proper medication administration, but they can also help assess a patient’s status and determine if the patient should be seen in-person by a provider. Often, telehealth is convenient for the patient, allowing him or her to converse with a doctor from a car, home, or workplace. Another benefit of telehealth is that it reaches many people quickly and efficiently, which helps with the predicament of the ever-present nursing shortage.
Telehealth nursing seems to have particular benefits for those suffering from chronic conditions such as diabetes. Using video communication or virtual messages, nurses can send encouragements to the patient to take positive self-care actions, remind them to perform necessary duties like checking blood sugar and counting carbohydrates, and visualize the patients’ feet to ensure foot care is adequate. Telehealth nursing can have a profound impact on those who suffer from long term conditions because it offers an easier, more affordable alternative for health maintenance rather than waiting until a dire health emergency is present to seek care. The goal and hope of telehealth are to ultimately reduce ER visits by promoting healthy lifestyles on a regular, daily basis.
The article I read discussed the importance of properly training telehealth nurses, and I couldn’t agree more. One of the dangers of telehealth is the physical distance between healthcare professionals and patients. Without the ability to perform a hands-on assessment of the patient, a telehealth nurse must be particularly attuned to asking the patient the correct questions in order to analyze a situation correctly with the acquired information. The article mentioned the acronym SCHOLAR as a helpful triaging tool for telehealth nurses to use when assessing a patient (symptoms, characteristics, history, onset and duration, location, aggravating factors, and relieving factors). Hitting all these points will help the triage nurse accurately respond to a situation.
The benefits of telehealth nursing are profound, no doubt. But what about the pitfalls – the cracks in the foundation that could affect the integrity of healthcare as we know it today?
I think a huge problem with telehealth nursing is the lack of physical contact between patient and nurse. Even if a telehealth nurse has monitors on the patient to assess vitals and video imaging to see the patient, there is still the component of touch that is missed. In my office, I often get incorrect readings on the monitor and have to adjust a sensor or change a blood pressure cuff or manually take vitals because the automatic measurer is simply not reading accurately. When I have to take measurements without the use of automatic machines, I find my results are more true to reality. With telehealth, it would be difficult to truly assess a patient without spacial proximity.
Additionally, telehealth nursing is assuming that patients are able to accurately describe their symptoms and story. In my experience, many patients have difficulty expressing exactly how they are feeling. When a patient comes into an office, a culmination of nonverbal and verbal cues can help providers understand what is going on with a patient, but telehealth makes it all the more difficult to put all the pieces of the puzzle together.
And what about the problem in pediatrics, when a parent might set up a telehealth visit with a nurse and describe a child’s status much more dramatically than the actual situation? I spent many days triaging patients in our pediatric office, and it was common for parents of sick children to describe symptoms that sounded extremely concerning over the phone but turned out to be relatively mild once the patient was seen in the office. It would be difficult for telehealth nursing to navigate overly concerned parents who are calling in with health concerns.
The majority of telehealth nursing jobs require at least several years of face-to-face experience with patients before transitioning to a virtual healthcare environment. I understand this line of thinking, but at the same time, I can’t help but think, “Every patient is different. Even if you have two years of hands-on experience with patients, how will you be able to accurately assess every patient that seeks medical advice through telecommunication?”
Maybe I’m just old fashioned, but I believe that the human interaction component of healthcare is a crucial part. It might just be that the convenience of telehealth comes at the cost of quality healthcare.