Just over 10 years ago, I had my first article published. Telehealth nursing was the topic. I guess that was a bit of foreshadowing to the direction my writing career would take. Now, a decade later, I’m here learning and writing about the wide world of health information technology, and telehealth has grown by leaps and bounds.. A decade later there are subspecialties of telehealth nursing including ambulatory care, home health and tele-ICU.
When I first wrote about telehealth nursing, one of the sources I interviewed told me that, while patients usually embraced telehealth, providers were often leery of it because they felt it was “cold.” I guess not everything has evolved because Health IT and EMRs still get that critique from some health care providers.
Personally, I think telehealth makes a lot of sense for many reasons. Its biggest strength, as I see it, is the ability to connect patients with nursing expertise. Nursing practice is becoming highly specialized and the saying “a nurse is a nurse” doesn’t really hold water anymore. Nurses can now become experts in a specific component of patient care. Often this is done through nursing specialty certification but, as someone who worked alongside nurses who were twice my age and had careers that had spanned decades, life and work experience is also worth its weight in gold.
I always wanted to have one of the more seasoned nurses as a resource to ask questions, get advice from and act as a second set of eyes. Telehealth is a way to share expertise beyond one unit or one hospital. Through telehealth, a new nurse in a suburban hospital can tap into the the knowledge of a wise, experienced nurse who is states away.
The American Association of Critical-Care Nurses, the largest specialty nursing group in the world, also sees the value in telehealth. In 2010, it established a Tele-ICU Task Force to assess and define the subspecialty of tele-ICU nursing and to develop standards and criteria to help nurses give optimal patient care. In March, the organization, issued its first set of tele-ICU practice guidelines.
The AACN defines tele-ICU nursing as critical care nursing practiced over distance using telecommunications technology. Tele-ICUs are also known as virtual ICUs, remote ICUs and eICU. No matter what they are called, they all follow the same model where a remotely based critical care team connects with a bedside critical care team through audiovisual communication and computer systems. For example, nurses in a tele-ICU in Texas could monitor patients and work virtually with nurses in “bricks and mortar” ICUs as far away as Maine, Oregon or Missouri.
In addition to the knowledge and skills all critical-care nurses must have, the AACN says tele-ICU nurses must also have “high-level skills in communication, collaboration, decision making, systems thinking and computer literacy.” They have to be able to quickly analyze patient data and be able to clearly communicate changes in a patient’s status to bedside nurses who are sometimes hundreds of miles away.
AACN’s guidelines on and essential elements of tele-ICU nursing are:
1. Tele-ICU leaders and nurses must establish and sustain an environment that promotes effective communication, collaboration, and collegiality to ensure optimal quality outcomes.
Essential elements of guideline one include:
- Be an equal partner in fostering collaboration
- Health care organizations recognize tele-ICU nurses’ contributions to patient care and quality outcomes
2 .Tele-ICU nurses must demonstrate proficiency in specific knowledge, skills, and competencies to contribute maximally to patient outcomes and nursing practice.
Essential elements of guideline two include:
- Translate evidence into usable, relevant and accessible knowledge
- Demonstrate the knowledge and ability to work with multiple computer applications and audiovisual tele-ICU monitoring systems
3. Tele-ICU leaders and nurses must be actively engaged in measuring and analyzing outcomes to ensure ongoing improvement in patient care and tele-ICU nurses’ contribution to care.
Essential elements of guideline three include:
- Study and reflect on the emerging practice of tele-ICU nursing to identify, measure and express tele-nurses’ contribution to patient care.
Tele-ICU leaders help nurses make video assessment and patient rounding critical components of their practice
AACN also offers a specialty nursing certification focused on adult tele-ICU nursing care.
The organization says that the number of tele-ICUs in the U.S has increased. More than 40 tele-ICU programs reach over 250 hospitals. Tele-ICU staff provide care to more than 10 percent of the nation’s ICU patients.
The AACN isn’t alone in its desire to promote and enhance telehealth nursing practice. The American Academy of Ambulatory Care Nursing offers a certification in telehealth nursing and the University of Southern Indiana offers a certificate in home telehealth nursing.
With so many changes in health care delivery and reimbursement and the industry’s renewed focus on improving patient outcomes while decreasing health care costs, telehealth is likely to grow. Establishing standards and markers of excellence in telehealth nursing practice shows the nursing profession sees telehealth as a valuable specialty that can positively affect patient care.
Jennifer Thew, RN, MSJ
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