CHAPTER 3

Professional Preparation for Telehealth Nursing

LEARNING OUTCOMES

Upon completion of this chapter, the nurse will:

RECOMMENDED EXPERIENCE

Most organizations that advertise for telenursing positions ask for a minimum of 1 year of direct hands-on clinical experience. Some organizations ask for 3 to 5 years, depending on the health problems of the patients/clients to be contacted. The type of experience, though, is important to note. The vast majority of patients who will be receiving telenursing care are middle-aged to older adults. Because of this, the nurse should have experience caring for adults with some type or form of chronic illness.

Experience should be in medical–surgical or geriatric nursing. Nurses who have worked in intensive care areas or surgical suites and postanesthesia care areas might be interested in the telenursing role; however, their experience communicating and teaching patients about long-term health promotion and preventive actions may be limited.

The experience that most closely relates to telephonic nursing is community or public health services provided through home care. Nurses who have worked extensively with patients or clients who are not hospitalized have had opportunities to master communication skills and provide wellness/disease management teaching.

At times, an employer or health insurance agency contracts or hires nurses to provide telephonic care to employees or enrollees. In these situations, the age of the patient may be less than middle age, and there is a chance that the patient may be a child. Because of this, many telenursing providers will have on staff a few nurses with pediatric experience. Keep in mind, though, when providing telenursing care to a minor, communication will most likely occur through the parent or legal guardian. The ability to effectively communicate with an adult is essential.

The nurse desiring a telenursing role should have expert or outstanding verbal and written communication skills. This includes the ability to problem-solve and troubleshoot health care questions, issues, and patient concerns. During the course of a routine care call, the patient may ask a question about another health issue that is not documented or has just manifested. The nurse must have the flexibility to change the course of the call in order to meet the patient’s needs.

When initially contacting a patient for telenursing care, most of the first encounter will be invested in data collection. Depending on the sponsoring organization, the nurse may need to follow a specific set of questions or criteria to determine the patient’s eligibility to participate. For example, a patient may have had a routine serum glucose level drawn as part of an electrolyte panel during a recent health care provider office visit. The health insurance plan receives a notice of billing to pay for the laboratory services, and health plan software tagged the serum glucose as a test that was performed. According to the health plan’s algorithm for patient selection, a serum glucose level is used when caring for patients with diabetes. The patient is then identified as being a member of the diabetes disease management program. When the nurse places the first call to the patient, one of the eligibility questions might be “how long have you been diagnosed with diabetes?” At this point, the patient may respond with a certain number of years or adamantly deny having the diagnosis. If the patient has not been diagnosed with diabetes, they are deemed ineligible for the program and would be deleted from the nurse’s future care call panel.

It is important for the nurse to recognize “teachable moments” throughout the assessment process. For example, the nurse learns that a patient with diabetes works in a home garden as a primary leisure activity. The nurse should deviate from the assessment or criteria and ask the patient what type of footwear and gloves are worn while gardening because it is important for the patient to avoid cuts and scrapes to either the hands or feet. From here, the nurse can then redirect the call back to the original assessment/criteria process.

One of the major issues identified by patients who receive telenursing care is the amount of time spent assessing is far greater than receiving any valuable teaching. In other words, the nurse is to do more than collect data. The data are to be used to provide care to address the patient’s needs or support health promotion activities. Nurses might be overheard going through a list of assessment questions, sounding like they are reading from a script. This approach is not welcoming or inviting, and the patient may choose to not participate in the future.

TELENURSING SCOPE OF PRACTICE

In 1995, the American Academy of Ambulatory Care Nursing (AAACN) decided that telephonic patient/client care was a subspecialty of ambulatory care. After careful study, this organization published the first set of telenursing standards in 2001. Subsequently, these standards were reviewed and updated with the most recent revision published in 2011.

The standards of practice for professional telehealth nursing are divided into two domains: standards of clinical practice and standards of professional performance.

Standards of Clinical Practice

The standards of clinical practice are aligned with the nursing process and include:

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