Thereis increased an increased interest in the benefits of telecare healthcare services, especially among patients who require long term care.It is projected that the number of elderly and terminally ill patientwill continue to increase in the near future. This will result intoincreased demand for health care since it is not accompanied by anincrease in health care providers. Thus, telecare will evolve into animportant aspect of health care. Telecare is not a new phenomenon inhealth care industry. The changes in social and demographic dynamicsand technological development in the modern world have enhanced therole of telecare medicine in the modern health care system (Hendersonet al, 2014). Some of the important challenges facing telecarenursing include inadequate knowledge on evidence based practices,lack of professionalism and poor teamwork. However, there aresignificant changes in behaviors and skills after the program. Thetelecare nursing have enhanced knowledge on evidence based practices,are more professionals, and are able to effectively work ininterdisciplinary teams.
Evidencebased practice in telecare
Thegoal was to access and educate telecare nurses in evidence basedpractices and how they can benefit hospice patients. This includesevidence on how information was assessed, measured, and implemented.During the assessment, it was established that telecare staff did nothave strong knowledge on evidence based practices and how it isbeneficial to hospice patients. Evidence based practice in medicineis an approach to practice that emphasizes of the use of evidencefrom research studies in the decision making processes. Evidencebased practices in nursing and medical care aims at ensuring that thecurrent knowledge and findings are hardwired into basic decisionmaking processes. This results into improved processes, patientoutcome and patient safety. There is no doubt that major deficits anderrors in nursing are as a result of harm which is significantlypreventable. The use of evidence based practices in all aspect ofmedical care has been an important recommendation to all health careworkers (Stevens, 2013).
Theapplicability of evidence base practices in telecare is supported byadopting of the practices by individuals nurses and health careproviders, systems within a facility, nursing leaders and policymakers at the organizational, local, state and federal level. Thismeans that every individual involved in telecare, directly orindirectly must have adequate knowledge on evidence based practices.Nonetheless, the nurses have a more to do with the successfulapplication of evidence based practices in telecare for hospicepatients. Surveys have indicated that nurses have a positive attitudetowards evidence based practices in nursing. Additionally, they wishthat they had more knowledge on evidence based practices. Despitethis, inadequate knowledge remains the most important barrier toapplication of evidence based practices in telecare. Studies suggestthat adequate preparation and training of nurses on evidence basedpractices is critical in the implementation of evidence basedpractices in telecare. In the current situation, there is a need torestructure nursing education to be more focused on evidence basedpractices and in-service training of the current nurses (Stevens,2013).
Althoughthe telecare nurses were competent, they were unaware of how evidencebased practices can be applied in their daily routine. Afterproviding the telecare nurses with handouts, they acquired basicknowledge on evidence based practices. There was a significantimproved on the evidence based practices knowledge for hospicepatients. For example, the telecare nurses were able to appreciatethe importance of patient based care in hospice. This includesrespecting the identity and diversity of patients values andpreferences. Additionally, the telecare nurses were able to work moreeffectively in interdisciplinary teams, integrate best practices intheir daily duties and apply quality improvement strategies.
Thegoal was to access professionalism of telecare nurses on how theytreated Triage calls. The assessment involved two Triage calls thatrequired further patient assessments by the interdisciplinary teamthe next day. In both cases, the telecare nurse did not makefollow-ups in the next day resulting into poor patient’s outcomes.Triage calls are very effective in the management of hospicepatients. As a result, health care organizations have adequatesystems that ensure that Triage calls are beneficial to the clients.The failure of the telecare nurses to follow up the two cases did notfollow the laid down reporting mechanism procedures in theorganization. This raises professionalism and ethical issues.
Dueto the advancement in communication technology, especially universalaccessibility of mobile telephones, triage systems have importantimpacts on the health care systems. Triage system is aimed atassisting patients deal with health care concerns and determinesappropriate interventions without necessarily visiting the healthcare facility. In the United States, over 35 million people had anaccess to triage services by 2000. This accounted for up to aquarter of all patient encounters with medical care workers. Thefigures have changed significantly in the last 15 years, especiallydue to the increased need for hospice services. There are manybenefits that can be derived by both the patients and health carefacilities from triage systems. Triage calls significantly reduceunnecessary visits to the health care facility resulting into reducedcost of healthcare. The timely access to medical care services andreferral has a direct impact on the quality and outcome of healthcare services. The reduced out of pocket costs as a result of triagecalls increased patients satisfaction and convenience. However,professionalism among telecare nurses has a huge impact on itseffectiveness. For example, documentation and follow-ups of telephoneassessment is critical for the success (Coons et al, 2009).
Dueto human weakness or lack of professionalism, some telecare nurses donot follow organizational guidelines in relation to triage calls.Health care organizations that have implemented triage call systemshave well developed after hour reporting mechanism procedures.Failure to follow these procedures risks the lives of the patient andnegatively affects the reputation of the health care facility. It istherefore important for health care organization to establishmechanisms that promotes ethics and professionalism among telecareprofessionals. For example, adequate training on handling after hourpatients’ calls and close supervision of telecare workers may benecessary.
Thegoal was to access and implement changes to telecare situation withteam dynamic deficiency. Incidences of telecare health care workersgiving conflicting messages to clients due to poor coordinated teamsare very common. However, streamlining the telecare servicesprocedures and promoting communicating in dynamic working teams caneffectively deal with this challenge. A team can be defined as agroup of people interacting dynamically and working independentlytowards the achievement of a common goal. Each member of the team isassigned a specific task, although it affects the performance ofother members of the team. The effectiveness of a team in telecaremedicine has a direct impact on the patient outcome and safety. Thisis largely influenced by the team dynamic, structures within theorganization, and leadership of the team. Team dynamics can bedetermined by how individuals within the group communicate,coordinate and cooperate in team processes and making decisions(Kalisch, 2008).
Atthe end of the program, telecare nurses should be able to communicateand coordinate with each other to increase the effectiveness of thegroup. Basically, a nurse should be an advocate of the patient. Thisrequires telecare nurses to effectively communicate with the primarynurse, attending physicians and other professionals in the workingteam. This is essential in ensuring that appropriate interventionsand support is given to the patient during call hours and in followup visits. The team leaders and health care organization managementhave an important role in promoting teamwork in telecare medicine.This is by ensuring that the standard operating procedures promoteadequate communication between after hour telecare personal and otherpersonal in the team.
Advancementin technology has had a huge impact on provision of health careservices. Due to technological advancement, patients are able toaccess diverse health care services. Communication technologies haveenabled the provision of telecare services, especially amongterminally ill patients. However, lack of professionalism,ineffective teams and inadequate knowledge and application ofevidence based practices can negatively affect the positive impact oftelecare nursing in enhancing patient outcome. Despite this, nursingleaders and management in organizations can effectively deal withthese challenges.
Coons,K. et al (2000). TelephoneTriage,American College of Physicians–American Society of InternalMedicine,https://www.acponline.org/acp_policy/policies/telephone_triage_diagnostic_techniques_procedures_2000.pdf
Cullen,L., & Adams, S. (2010). What is evidence-based practice? Journalof Perianethesia Nursing,25(3), 171-173. doi:10.1016/j.jopan.2010.03.004
Henderson,C. et al (2014). Effect of telecare on use of health and social careservices: findings from the Whole Systems Demonstrator clusterrandomised trial. AgeAgeing(2014) 43 (6): 794-800, doi:10.1093/ageing/afu067
Kalisch,B. et al. (2009). An Intervention to Enhance Nursing Staff Teamworkand Engagement, Journalof Nursing Administration,37(2), 77-84.http://journals.lww.com/jonajournal/Abstract/2007/02000/An_Intervention_to_Enhance_Nursing_Staff_Teamwork.10.aspx
Stevens,K., (2013) "The Impact of Evidence-Based Practice in Nursing andthe Next Big Ideas" OJIN:The Online Journal of Issues in Nursing,18(2), Manuscript 4. DOI: 10.3912/OJIN.Vol18No02Man04