CHAPTER 4

Patient/Client Perspective on Telehealth Nursing

LEARNING OUTCOMES

Upon completion of this chapter, the nurse will:

PATIENT/CLIENT IDENTIFICATION

Nurses who work in telenursing will not be “looking for” or “finding” clients. Patients (or in some situations, clients or enrollees) will be provided from contracts with health care providers or employers. The contracting organization will most likely provide the individual’s:

It is on the health issue or concern that the nurse will focus when contacting the client. Before making the first contact, the nurse needs to become familiar with the information provided. For example, if a client has been repeatedly hospitalized for infections, the nurse may have access to information from his or her:

The purpose for being enrolled in the telenursing program must be identified. If the intention is to prevent hospitalization or rehospitalization, documentation should be provided about the health concern. The nurse needs as much information as possible about the health problem before making the first telephone call.

Another scenario would be clients who have a chronic health problem. The health plan likely identified the individual as someone who would benefit from counseling or teaching telephone calls. The intention here would be to discuss:

The last possible scenario for patient participation would be an employer-sponsored wellness program. In this situation, the individual would not be referred to as “patient” but rather as an “enrollee” or “participant.”

Individuals enrolled through an employee-sponsored program may be offered a list of services all designed to improve the employee’s health. Examples of services offered include:

The employer may decide which teaching materials, websites, or agencies to use for the services. If this is the case, the nurse will need access to these items in order to conduct an effective telenursing call.

IDENTIFYING BARRIERS

In an ideal world, every client who is contacted telephonically by a nurse will be eager to talk and find value in the conversation. Unfortunately, this is not always the case. The bad news is the patient may immediately hang up. The good news is the first call is often the most difficult to complete.

Oftentimes, the first questions that a potential patient or participant will ask are:

People are naturally skeptical of receiving any telephone communication if it is concerning personal health information. Consider yourself fortunate if the person does not immediately hang up. There is a window of opportunity here where the nurse can engage the person and gain support and cooperation.

Another issue that potential patients will have is the cost. Patients will immediately think that you are “trying to sell” them something. It is essential to know how the patients are identified for the organization in which you are providing telenursing care and how the care is being paid for.

Patients will also be concerned about the amount of time each of the telephone calls is going to take. Today people are very busy. Depending on the age and health problem, a patient may be working, caring for children, or supporting aging family members. Time can be as important to someone as cost.

OVERCOMING BARRIERS

A variety of strategies can be used when faced with patient/client engagement challenges. These strategies may be interchangeable but have been divided according to patient situation.

Patient/Client Who Was Previously Hospitalized

A cold call to a recently discharged patient is probably the least difficult one to make. The patient may have been informed that follow-up phone calls can occur and be provided by the hospital or health care provider. However, the patient might not expect a telephone call from the health insurance plan. Explaining how the health insurance plan has gotten involved might be the greatest challenge.

When placing a call to a recently hospitalized patient, keep the following in mind:

For the recently hospitalized patient, the first telephone call might be referred to as a posthospitalization call. Besides validating the patient’s demographic information, telephone number, and best time to call, the actual work of the call focuses on the reason for the hospitalization and the plans for care and recovery at home. Things to keep in mind when engaging with a patient recently hospitalized include:

Patient/Client With a Chronic Illness

Health plans follow or track expenses by enrollees for specific health issues. Individuals who repeatedly use health plan benefits may be “red flagged” for a disease management program. A disease management program is one in which specific actions or interventions are used to ensure that the particular “disease” is managed appropriately. Some of the most frequently created disease management programs include:

When contacting a patient to participate in a disease management program, the contracting organization will most likely ask for specific information to collect during the first call. This is oftentimes done to ensure that the enrollee truly belongs in the program. For example:

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