Patient/Client Perspective on Telehealth Nursing
Upon completion of this chapter, the nurse will:
1. Summarize the methods in which patients/clients are identified to participate in telenursing care
2. Recognize barriers for patient/client participation in a telephonic nursing care program
3. Strategize approaches to overcome patient/client barriers to participation in a telephonic nursing care program
4. Examine the importance of confidentiality and adherence to Health Insurance Portability and Accountability Act (HIPAA) legislation when providing telephonic patient/client care
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:
Diagnostic test results
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 chronic health problem
Adherence with prescribed medications and treatments
Frequency of follow-up examinations with the health care provider
Actions to reduce exacerbations of the chronic health issue
Additional ways to manage the chronic health issue
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:
Participation in physical activity
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.
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:
How did you get my phone number?
Why are you calling me?
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.
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:
The patient is recovering from an illness or exacerbation. They might be easily fatigued with talking on the telephone.
The patient may be starting new medication and not totally aware of the actions, purpose, and expected effects. You might be doing quite a bit of medication teaching.
The patient might be expecting or receiving home care. A challenge might be explaining the different roles and the importance of the patient’s participation in both.
The patient might be “turned off” from so much talk about illnesses that they just do not want to be bothered. You might be challenged with persuading them that the calls will help prevent hospitalizations for the same or similar problem in the future.
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:
The length of this telephone call might be 20 to 30 minutes.
Do not rush the patient.
Follow the patient’s lead. If the patient wants to talk about the illness for a short while encourage them to do so. Gently guide the patient away from the hospitalization and refocus on actions that can be taken to prevent additional hospital care in the future.
Ask about support in the home environment.
Be sure that the patient has had all posthospitalization medication prescriptions filled.
Find out if follow-up care needs have been met or obtained such as home oxygen, sleep apnea devices, hospital bed, and assistive devices.
Conduct a home safety assessment to include safety in the kitchen and bathroom and if all smoke detectors have been checked with fully charged batteries.
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:
Chronic obstructive lung/pulmonary disease (COLD/COPD)
Coronary artery disease
Gastroesophageal reflux disease (GERD)
Irritable bowel syndrome (IBS)
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:
The health plan flags that a patient has had repeated blood glucose testing completed and immediately places the patient into the diabetes management program. When asking how many years the patient has been treated for diabetes, the patient may respond with the number of years or argue that diabetes has never been diagnosed.
The health plan flags a patient after having a breast biopsy to be placed in the cancer disease management program. The nurse may learn from the patient that the biopsy was negative and the patient does not belong in the program or the patient is scheduled for surgery and further treatment in which case the patient referral to the program is legitimate.