Application of telenursing in nursing practice: an integrative literature review

Use of tele-nursing in primary care: A qualitative study on its negative and positive aspects

OBJECTIVE

To analyze the opinions of nursing professionals on the current limitations and future potential of digital tools in healthcare.

DESIGN

Qualitative and descriptive study.

LOCATION

The study took place during an asynchronous MOODLE course on the use of ICT in healthcare, specifically aimed at nursing professionals.

PARTICIPANTS

The number of nurses enrolled in the course was 150.

METHODS

A qualitative study was conducted focusing on the positive and negative aspects that telenursing can offer in the context of a Moodle training in new technologies for nurses. A thematic analysis was carried out following the method proposed by Braun and Clarke.

RESULTS

In the end 68 nurses participated in the forum. Their statements, opinions and perceptions were analyzed and 28 descriptive codes were obtained and subsequently categorized into positive and negative aspects.

CONCLUSIONS

Nurses positively value the usefulness of digital tools and identify a wide range of benefits of telenursing in daily practice. At the same time, they point out crucial limitations that may slow down the adoption of telenursing, pointing to areas for improvement such as training and digital literacy of both patients and professionals. They consider that telenursing can humanise care, but insist on the need to prevent its use from increasing health inequalities.

Communication and empathy of nursing students in patient care through telenursing: A comparative cross-sectional study

BACKGROUND

Phone calls and videoconferences are the most widely used systems to interact with patients in real time. Patient care through phone calls or videoconferences is different from an in-person meeting. Interpersonal communication skills, self-confidence communication skills and empathy with the patient may be affected during phone calls or videoconferences.

AIM

The objective of this study was to describe the interpersonal communication skills, self-confidence communication skills and empathy of nursing students during patient care through phone calls or videoconferences.

DESIGN

A cross-sectional study.

PARTICIPANTS

A total of 170 nursing students participated from the University of Almeria. The subjects were randomly assigned to the phone call group or videoconference group.

METHODS

The students contacted standardised patients through phone calls or videoconferences. Questionnaires were used to assess interpersonal communication skills with patient, empathy, and self-confidence in communication skills. Data collection was carried out between March and May 2022.

RESULTS

No statistically significant differences were found between self-confidence in communication skills with the patient and the type of consultation, nor were statistically significant differences found between the empathy of the nursing students and the type of consultation. The students who used videoconference reported higher patient interpersonal communication skills than the students who made phone calls. Finally, the participants who made videoconferences obtained a higher score in dimension therapeutic use of self than those who made phone calls.

CONCLUSIONS

Nursing students have shown a high level of empathy and interpersonal communication skills with patients and a moderate level of self-confidence in communication skills, both when interacting with patients through phone calls and videoconferences. Finally, differences were found in interpersonal communication skills with patient and type of consultation. In particular, interpersonal communication skills with the patient are greater when the nursing students make a videoconference.

The effect of telephone counseling based on Orem's model on adherence to treatment and resilience of patients with coronary angioplasty: a randomized clinical trial

BACKGROUND

This study aimed to determine the effect of telephone counseling based on Orem's Self-Care Model on adherence to treatment and resilience of patients with coronary angioplasty.

METHODS

This randomized clinical trial was performed on 80 patients in the Cardiac Intensive Care Unit of Shiraz University of Medical Sciences. Patients were randomly divided into two groups of 40 (intervention and control). Questionnaires on adherence to treatment of chronic patients and resilience for patients with cardiovascular and respiratory diseases were filled out before and 8 weeks after the intervention. In the intervention group, the telephone call schedule consisted of three calls per week for 8 weeks.

RESULTS

Before the intervention, no significant difference was found between the groups about adherence to treatment and resilience. However, after the intervention, a significant difference was found between the groups as to adherence to treatment and resilience (P < 0.001).

CONCLUSION

Nursing consultation using telephone calls based on Orem's model increases the adherence to treatment and resilience of patients undergoing coronary angioplasty. Telephone counseling can help the patients adhere to their treatment plans and develop resilience skills.

Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale

AIMS AND OBJECTIVES

Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability.

METHODOLOGICAL DESIGN AND JUSTIFICATION

This psychometric study was based on cross-sectional data.

RESEARCH METHODS, INSTRUMENTS, AND/OR INTERVENTIONS

Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Cox's Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations.

RESULTS

The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99), and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales.

STUDY LIMITATIONS

The study design did not allow drop-out analysis.

CONCLUSIONS

The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.

Telehealth Needs and Concerns of Stakeholders in Pediatric Palliative Home Care

Pediatric palliative home care (PPHC) provides care for children, adolescents, and young adults with life-limiting illnesses in their own homes. Home care often requires long travel times for the PPHC team, which is available to the families 24/7 during crises. The complementary use of telehealth may improve the quality of care. In this pilot study we identify the needs and concerns of patients, teams, and other stakeholders regarding the introduction of telehealth. As a first step, focus groups were conducted in three teams. For the second step, semi-structured interviews were conducted with patients and their families (n = 15). Both steps were accompanied by quantitative surveys (mixed methods approach). The qualitative data were analyzed using content analysis. A total of 11 needs were identified, which were prioritized differently. Highest priority was given to: data transmission, video consultation, access to patient records, symptom questionnaires, and communication support. The concerns identified were related to the assumption of deterioration of the status quo. Potential causes of deterioration were thought to be the negative impact on patient care, inappropriate user behavior, or a high level of technical requirements. As a conclusion, we define six recommendations for telehealth in PPHC.

Experiences of Telenursing in Overcoming Challenges and Applaying Strategies by COVID-19 Patients in Home Isolation: Qualitative Study in Primary Care

During the first wave of the COVID-19 pandemic, there was a significant increase in the use of telenursing to provide care for patients at home. However, the quality of the patient experience when nurses rely on technology instead of personal contact has not been thoroughly investigated. This study aimed to understand the perspectives of COVID-19 patients in home isolation who received telenursing from primary care nurses during the initial phase of the pandemic. A qualitative study was conducted that employed purposive sampling and involved semi-structured interviews via videoconference with fourteen COVID-19 patients from two primary health centers in Catalonia (Spain). Thematic analysis was used, and the study adhered to the COREQ checklist. The findings revealed three themes related to the challenges faced by COVID-19 patients in home isolation: physical symptoms, emotional and social difficulties, and a lack of information. Three themes emerged regarding the strategies patients employed to overcome these challenges and the role of nurses: self-care, emotional support, and personal commitment. The patients reported having achieved strategies to improve their physical, psychological, and situational well-being despite the unprecedented situation. The study highlights that telenursing is a valuable resource for delivering patient-centered care, which could lead to changes in organisational policies and the development of best clinical practices.

Telenursing: The view of care professionals in selected EU countries. A pilot study

Background

With the growth of digital nursing, several studies have focused on recording patients' views on remote care, or specialised nurse staffing aspects. This is the first international survey on telenursing focused exclusively on clinical nurses that analyses the dimensions of usefulness, acceptability, and appropriateness of telenursing from the staff point of view.

Methods

A previously validated structured questionnaire including demographic variables, 18 responses with a Likert-5 scale, three dichotomous questions, and one overall percentual estimation of holistic nursing care susceptible to being undertaken by telenursing, was administered (from 1 September to 30 November 2022) to 225 clinical and community nurses from three selected EU countries. Data analysis: descriptive data, classical and Rasch testing.

Results

The results show adequacy of the model for measurement of the domains of usefulness, acceptability, and appropriateness of telenursing (overall Cronbach's alpha 0.945, Kaiser-Meyer-Olkin 0.952 and Bartlett's p < 0.001). Answers in favour of telenursing ranked 4 out of 5 in Likert scale, both globally and by the three domains. Rasch: reliability coefficient 0.94, Warm's main weighted likelihood estimate reliability 0.95. In the ANOVA analysis, the results for Portugal were significantly higher than those for Spain and Poland, both overall and for each of the dimensions. Respondents with bachelor's, master's and doctoral degrees score significantly higher than those with certificates or diplomas. Multiple regression did not yield additional data of interest.

Conclusions

The tested model proved to be valid, but although the majority of nurses are in favour of telenursing, given the nature of the care, which is mainly face-to-face, according to the respondents, the chances of carrying out their activities by telenursing is only 35.3%. The survey provides useful information on what can be expected from the implementation of telenursing and the questionnaire proves to be a useful tool to be applied in other countries.

An Evaluation of a Web-Based Crisis Management Training Program for Nurse Managers: The Case of the COVID-19 Crisis

OBJECTIVE

The effective management of nursing services, the main power in patients' care and treatment in the front line of the fight against the COVID-19 pandemic, and nurse managers' effective leadership behaviors in the fight against the pandemic have been important key factors. It is thus critical to support nurse managers, strengthen them through training, and increase their competency so that they can successfully manage crises, disasters, or pandemics. This study aims to assess the effect of a web-based training program on the knowledge levels of nurse managers who worked during the COVID-19 pandemic.

METHODS

This is a randomized controlled experimental study. The study population consisted of the members of the Nurse Managers Association. The intervention group had 30 participants, and the control group had 31 participants in the final.

RESULTS

There was no statistically significant difference between the intervention and control groups' mean number of correct pre-test responses (P = 0.843). However, the intervention group's mean number of correct post-test responses was statistically significantly higher than the control group's after the web-based training program (P < 0.001).

CONCLUSIONS

Web-based training programs can effectively increase nurse managers' knowledge levels. Therefore, web-based training programs should be developed in ordinary times for the management of crisis situations.

Symptoms of Acute Myocardial Infarction as Described in Calls to Tele-Nurses and in Questionnaires: A Mixed-Methods Study

BACKGROUND

Patient-reported symptoms of acute myocardial infarction (MI) may be affected by recall bias depending on when and where symptoms are assessed.

AIM

The aim of this study was to gain an understanding of patients' symptom description in more detail before and within 24 hours after a confirmed MI diagnosis.

METHODS

A convergent parallel mixed-methods design was used to examine symptoms described in calls between the tele-nurse and the patient compared with symptoms selected by the patient from a questionnaire less than 24 hours after hospital admission. Quantitative and qualitative data were analyzed separately and then merged into a final interpretation.

RESULTS

Thirty patients (median age, 67.5 years; 20 men) were included. Chest pain was the most commonly reported symptom in questionnaires (24/30). Likewise, in 19 of 30 calls, chest pain was the first complaint mentioned, usually described together with the symptom onset. Expressions used to describe symptom quality were pain, pressure, discomfort, ache, cramp, tension, and soreness. Associated symptoms commonly described were pain or numbness in the arms, cold sweat, dyspnea, weakness, and nausea. Bodily sensations, such as feeling unwell or weak, were also described. Fear and tiredness were described in calls significantly less often than reported in questionnaires ( P = .01 and P = .02), whereas "other" symptoms were more often mentioned in calls compared with answers given in the questionnaire ( P = .02). Some symptoms expressed in the calls were not listed in the questionnaire, which expands the understanding of acute MI symptoms. The results showed no major inconsistencies between datasets.

CONCLUSION

Patients' MI symptom descriptions in tele-calls and those reported in questionnaires after diagnosis are comparable and convergent.

Maximizing Pharmacological Treatment Adherence of Children and Adolescents: A Randomized Controlled Study

The aim of the current randomized controlled study was to evaluate treatment adherence of children and adolescents who visited an outpatient psychiatry clinic and started medication for the first time, with telehealth application. This study was performed with parents of patients who visited the clinic from October 1, 2020, to March 31, 2021. Data were collected using a personal information form, Medication Control Form, and Morisky Medication Adherence Scale via telephone after verbal and written consent were obtained. It was found that 96.7% of participants in the experimental group had high medication adherence, whereas 93.3% of participants in the control group had low medication adherence. Results show that telehealth application is effective in maximizing adherence to treatment among children and adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 16-24.].

A scoping review of feasibility, cost, access to rehabilitation services and implementation of telerehabilitation: Implications for low- and middle-income countries

Objective

To scope all published information reporting on the feasibility, cost, access to rehabilitation services, implementation processes including barriers and facilitators of telerehabilitation (TR) in low- and middle-income countries (LMICs) and high-income countries (HICs).

Methods

A comprehensive electronic search of PubMed, Scopus, PEDro, Cochrane library, EBSCOhost (Academic search premier, Africa-wide information, CINAHL, Eric, MEDLINE, Health sources - Nursing/Academic edition), Africa online, as well as ProQuest databases were conducted. To maximise the coverage of the literature, the reference lists of included articles identified through the search were also screened. The analysis included both descriptive summary and inductive thematic analysis.

Results

Twenty-nine studies were included. TR was reported to be feasible, cost-saving and improved access to rehabilitation services in both HICs and LMICs settings. Asynchronous methods using different mobile apps (Skype, WhatsApp, Google meet, Facebook messenger, Viber, Face time and Emails) were the most common mode of TR delivery. Barriers to the implementation were identified and categorised in terms of human, organisational, technical and clinical practice related factors. Facilitators for health professionals and patients/caregivers’ dyads were also identified.

Conclusion

TR could be considered a feasible service delivery mode in both HICs and LMICs. However, the mitigation of barriers such as lack of knowledge and technical skills among TR providers and service users, lack of secure platform dedicated for TR, lack of resources and connectivity issues which are particularly prevalent in LMICs will be important to optimise the benefits of TR.

Role of interaction for caller satisfaction in telenursing-A cross-sectional survey study

AIMS AND OBJECTIVES

The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls.

BACKGROUND

In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls.

DESIGN

Cross-sectional survey study with a deductive approach.

METHODS

A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist.

RESULTS

Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller.

CONCLUSIONS

Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls.

RELEVANCE TO CLINICAL PRACTICE

This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.

Early access to a cardio-oncology clinic in an Australian context: a qualitative exploration of patient experiences

Background

Dedicated cardio-oncology services are emerging rapidly around the world in order to provide cardiovascular care (CV) for cancer patients. The perspectives of patients regarding their experience of cardiac surveillance during their cancer journey has not been qualitatively evaluated.

Methods

An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with a diverse range of community dwelling patients who attended a newly established cardio-oncology clinic in a large regional city in Australia. Data were analysed using an inductive thematic approach.

Results

Key themes were identified: (1) Access to a cardio-oncology clinic promotes information and understanding, (2) The experience of early CV intervention, (3) Factors promoting integrated care, (4) Balancing cancer treatment and CV symptoms and (5) Managing past and emerging CV risk factors.

Conclusion

As cardio oncology clinics continue to emerge, this study confirms the benefit of early access to a cardiologist for management of existing or emerging CV risk factors and diseases in the context of cancer treatment. Participants valued the opportunity for regular monitoring and management of CV issues that enabled them to continue cancer treatment. However, we identified gaps in education and support towards making positive lifestyle changes that reduce the risk of CV diseases in cancer patients.

Evaluating the effects of telenursing on patients' activities of daily living and instrumental activities of daily living after myocardial infarction: A randomized controlled trial study

AIM

This study aimed to assess the effects of telenursing on patients' activities of daily living and instrumental activities of daily living (ADLs and IADLs) following a myocardial infarction (MI).

METHODS

This randomized, parallel-group, controlled trial was conducted on 95 patients post-MI from 2018 to 2019. Patients were randomly assigned to the intervention (telenursing) and control groups using permuted block randomization. Through telephone calls, telenursing was performed twice a week during the first six consecutive weeks, then once a week until week 12. ADL and IADL questionnaires were completed by both groups before intervention and 12 weeks later. The CONSORT 2010 checklist was used to report the study protocol.

RESULTS

The mean age of patients was 56.8 ± 11.07 and 54.2 ± 9.8 years in the telenursing and control group, respectively. The mean ADL and IADL scores in the telenursing group were substantially greater than in the control group [4.57 (3.18, 5.97); P < 0.001 and 4.40 (3.06, 5.75); P < 0.001, respectively]. The odds of a higher degree of independence (no disabilities vs. mild disabilities and disability as well as no disabilities and mild disabilities vs. disability) regarding ADLs and IADLs were significantly greater in the telenursing group as compared with the control group (P < 0.001 and P < 0.001, respectively).

CONCLUSIONS

Our findings suggest that the use of telenursing intervention may increase patients' ADLs and IADLs after an MI and may enhance their independence. Geriatr Gerontol Int 2022; ••: ••-••.

Providing telenursing care for victims: a simulated study for introducing of possibility nursing interventions in disasters

Introduction

Uncertainty occurrence of disasters requires special attention and a shortage of health care specialists is a challenge for health care systems; therefore, the use of telenursing care during a disaster is an appropriate way to provide care. This study aimed to investigate telenursing operational possibilities in disasters.

Methods

A cross-sectional study was performed by implementing a functional exercise (Drill) for the possibility of nursing interventions in the response phase to disasters at Kerman University of Medical Sciences in 2021. Two evaluators examined and scored the possibility of providing telenursing care using a researcher-made checklist and we surveyed Inter-rater agreement between two evaluators by Cohen's kappa coefficient. Data were analyzed using descriptive tests and SPSS 20 software.

Results

Findings showed that implementation of telenursing care would be helpful in future disasters. The scores received from assessment of the evaluation checklist for this simulated exercise program by the first evaluator was 83.25 and for the second evaluator was 72.00. The results of the study showed that the mean score of the possibility of telenursing in disasters was at a high level 77.50. Thus, the quality of the telenursing care in simulated conditions was satisfactory.

Conclusion

Today, disaster management is almost impossible without using new technologies. This study found that due to the lack of specialized nursing staff in the deprived areas affected by disasters, the most important way to provide health care for a large group of the population is to develop effective health services so that everyone can use these services equally and fairly.

The patient experience of telehealth access and clinical encounters in Australian health care during COVID-19: implications for enhancing integrated care

Purpose

Telehealth consultations are likely to continue while living with COVID-19 and the risk of other pandemics. Greater understanding of patient perceptions is important in order to inform future integrated care models involving telehealth.

Design/methodology/approach

An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with diverse range of community dwelling patients who attended outpatient clinics at The John Hunter Hospital, Newcastle. Data were analysed using an inductive thematic approach.

Findings

Key themes were identified: (1) telehealth is valuable in a pandemic; (2) telehealth accessibility can be challenging; (3) there are variations in care experiences, especially when visual feedback is lacking; (4) telehealth for acute and complex care needs may lead to gaps and (5) considerations towards the future of telehealth, beyond a pandemic.

Research limitations/implications

There is a shortfall in evidence of the patient experience of integrated care within a telehealth framework. The results provided practical insights into how telehealth services can play a greater role in integrated care.

Practical implications

Apart from the need for affordable access to high-speed data for basic Internet access, the author posit the need for patient and clinician training towards promoting communication that is underpinned by choice, trust and shared decision-making.

Originality/value

Telehealth is important towards keeping patients safe during COVID-19. Key findings extend knowledge of the practical implications need to promote integrated telehealth systems. While there is a benefit in extending telehealth to more preventative activities, there is also a need for greater service coordination and sharing of information between treating clinicians. Overall the results highlight telehealth consultations to be an effective means of treating well-known conditions and for follow-up rather than for acute conditions.

The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy

Background

Adaptive models of healthcare delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential healthcare services during the COVID-19 pandemic. However, there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region, and general practitioners (GP), including barriers, enablers and opportunities.

Methods

An interpretative qualitative study involving in-depth interviews explored the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region of Australia, and GPs, including barriers, enablers and opportunities. Data were analysed using an inductive thematic approach with constant comparison.

Results

Individual interviews were conducted with 10 specialists and five GPs. Key themes were identified: (1) transition to telehealth has been valuable but challenging; (2) persisting telehealth process barriers need to be addressed; (3) establishing when face-to-face consults are essential; (4) changes in workload pressures and potential for double-up; (5) essential modification of work practices; and (6) exploring what is needed going forward.

Conclusions

While there is a need to rationalize and optimize health access during a pandemic, we suggest that more needs to be done to improve telehealth going forward. Our results have important policy implications. Specifically, there is a need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation

BACKGROUND

The coronavirus disease 2019 pandemic caused an unprecedented surge of patients presenting to emergency departments and forced hospitals to adapt to provide care to patients safely and effectively. The purpose here was to disseminate a novel program developed under disaster conditions to address advance care planning communications.

METHODS

A program development and initial evaluation was conducted for the Remote Goals of Care program, which was created for families to communicate patient goals of care and reduce responsibilities of those in the emergency department.

RESULTS

This program facilitated 64 remote goals of care conversation, with 72% of conversations taking place remotely with families of patients who were unable to participate. These conversations included discussions of patient preferences for care, including code status, presence of caregivers or surrogates, understanding of diagnosis and prognosis, and hospice care. Initially, this program was available 24 hours per day, 7 days per week, with gradual reduction in hours as needs shifted. Seven nurses who were unable to work in corona-positive environments but were able to continue working remotely were utilized. Lessons learned include the need for speed and agility of response and the benefit of established relationships between traditionally siloed specialties. Additional considerations include available technology for patients and families and expanding the documentation abilities for remote nurses. A logic model was developed to support potential program replication at other sites.

DISCUSSION

Upon initial evaluation, Remote Goals of Care Program was well received and demonstrated promise in decanting the responsibility of goals of care discussions from the emergency department to a calmer, remote setting. In future iterations, additional services and technology adjustments can be made to make this program more accessible to more patients and families. Other facilities may wish to replicate our Remote Goals of Care Program described here.

Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial

ABSTRACT Objectives: to analyze the effects of a multiprofessional remote intervention and telenursing in the treatment of obesity. Methods: pragmatic clinical trial of intervention, conducted with obese adults. The multiprofessional remote intervention with a nurse occurred for 16 weeks through a messaging application. The application analyzed body composition, hemodynamic and laboratory variables, comparing the results obtained with the group that participated in face-to-face multiprofessional intervention without a nurse. The study investigated the effects of the intervention comparing the intervention groups and the moments through the ANOVA test for repeated measures. Results: Group 1 obtained significance in the variables: percentage of body fat (p = 0.008); blood glucose (p = 0.014); insulin (p = 0.001); abdominal and waist circumference; and HDL cholesterol (p = 0.000). Conclusions: the effects of multiprofessional remote intervention and telenursing significantly decreased the risk variables for metabolic syndrome in the treatment of obesity.

A non-randomized clinical trial to examine patients' experiences and communication during telemonitoring of pacemakers after five years follow-up

Patients with pacemakers need regular follow-ups which are demanding. Telemonitoring for pacemaker can provide a new opportunity to avoid follow-up visits. On the other hand, in-person visits could help patients with pacemakers to cope better with the anxiety linked to their condition and maintain better communication with their doctors than simple remote control of their device status. Therefore, our objective was to analyze the experiences and communication comparing telemonitoring (TM) versus conventional monitoring (CM) of patients with pacemakers. A single-center, controlled, non-randomized, non-blinded clinical trial was designed. Data were collected five years after implantation in a cohort of 89 consecutive patients assigned to two different groups: TM and CM. The ‘Generic Short Patient Experiences Questionnaire’ (GS-PEQ) was used to assess patients’ experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. Additionally, an ad-hoc survey including items from the ‘Telehealth Patient Satisfaction Survey’ and a ‘costs survey’ was used. After five years, 55 patients completed the study (TM = 21; CM = 34). Participants’ mean (±SD) age was 81 (±6.47), and 31% were females. No differences in baseline characteristics between groups were found. The comparative analyses TM versus CM showed some significant differences. According to GS-PEQ, TM users received adequate information about their diagnosis or afflictions (p = .035) and the treatment was better adapted to their situation (p = .009). Both groups reported negative experiences regarding their involvement in their treatment decisions, the waiting time before admission, and perceived a low-benefit. According to HCCQ, the TM group experienced poorer consultation management by the healthcare provider (p = .041). Participants reported positive overall communication experiences. The study provides insights into the experiences and communication in PM monitoring services as well as specific areas where users reported negative experiences such as the consultation management by clinicians.

Trial registration: ClinicalTrials.gov NCT02234245.

Implementation of COVID-19 telemonitoring: repercussions in Nursing academic training

OBJECTIVE

To report the repercussions of implementing the monitoring of suspected and confirmed cases of COVID-19 in Nursing academic training.

METHOD

A descriptive experience report by 14 students and four professors of a Nursing course located in the South of Brazil, in the monitoring of COVID-19 cases throughout June and August 2020.

RESULTS

Monitoring was performed by phone, and it provided repercussions on academic training in the following dimensions: care, managerial, educational and research; such dimensions fostering teaching-service integration and providing opportunities for the development of work tools that promote access to services and qualification of the nurses' clinical practice.

FINAL CONSIDERATIONS

Monitoring reinforced the importance of the technological and technical-scientific development of nurses, focusing on the use of new devices for monitoring and supporting users, seeking to promote comprehensive health.

Attitudes of nursing faculty members toward technology and e-learning in Lebanon

BACKGROUND

Our transition to an "information society" means that Information and Communication Technology (ICT) has become integral to our lives. ICT has also become an essential aspect of medical institutions and healthcare settings. Healthcare professionals, especially nurses are required to use ICT in their daily work. In Lebanon, however, due to political factors, many universities have not introduced technology or any form of ICT in their curricula. Institutions of higher education do use technology in various ways, however, successful incorporation of ICT in education requires acceptance by instructors who are expected to use ICT in teaching practices. Although international findings reveal that ICT should be used in nursing education, some faculty members experience difficulty integrating it.

METHOD

A mixed methodological research approach was used to investigate the attitudes of nursing teaching staff toward the use of ICT in nursing education.

RESULTS

Our findings revealed three categories of faculty with differing attitudes to the use of ICT in teaching and learning: pioneers, faculty members who have developed positive attitudes toward ICT usage; followers, faculty members with neutral attitudes; and resisters, faculty members with negative attitudes.

CONCLUSIONS

Identification of the nursing faculty members' attitude toward ICT and the challenges faced by them contributes to the integration of ICT into nursing curricula and further development of educational practices.

Developing the First Telenursing Service for COVID-19 Patients: The Experience of South Korea

This study aimed to examine the process of establishing a telenursing service for COVID-19 patients with mild or no symptoms admitted to a community treatment center (CTC). The process of establishing the service was reviewed, and the degree of satisfaction with the provided service was investigated based on the medical records the patients submitted at their discharge from the CTC. A total of 113 patients were admitted; the patients themselves entered the self-measured vital signs and symptoms of COVID-19 infection to the electronic questionnaires and mobile application. The nurses implemented remote nursing based on the patients’ input data. The educational materials, including the video for self-measuring vital signs and the living guidelines, were prepared and arranged in advance. The telenursing protocol regarding the whole process from the patients’ admission to their discharge was used and applied to five other CTCs. The non-contact counseling service’s satisfaction and convenience scores were 4.65 points and 4.62 points, respectively, out of 5 points. The non-contact nursing counseling service played an important role in monitoring patients’ medical conditions during the spread of COVID-19. This experience of establishing telenursing services to the CTC provides a clear direction to innovate healthcare services in future disasters.

Perceptions of adults with obesity about multiprofessional remote monitoring at the beginning of the COVID-19 pandemic

OBJECTIVE

To understand the perception of adults with obesity about remote monitoring at the beginning of the pandemic of COVID-19.

METHODS

A descriptive-exploratory, qualitative study with participants in remote monitoring of a multi-professional treatment program in southern Brazil. Data was collected through digital platforms with interviews in written or audio-recorded records. The results were submitted to content analysis, thematic modality.

RESULTS

26 women participated, emerging the thematic category "Difficulties and potentialities in adherence to lifestyle changes during the pandemic. Among the difficulties are the change of routine and increased anxiety; and, among the potentialities are the multi-professional accompaniment, decreased tension, and weight control.

FINAL CONSIDERATIONS

The participants' perception showed considerable weaknesses in adhering to the program, caused by social distance. Studies with remote interventions are essential to improve the quality of this type of health care.

Exploring Nursing Students' Perspectives on Telenursing Using Q-methodology

With the rapid development of information and communications technologies, the medical care paradigm has been transformed, making telenursing a reality. Along with the introduction of telenursing, new changes are anticipated in the following central nursing domains: "human," "environment," "nursing," and "health." Current nursing students living in a hyperconnected world are expected to expand telenursing and foster changes in nursing. Therefore, it is important to understand nursing students' perceptions about telenursing to prepare innovatively for this changing field. This study explored nursing students' subjective perceptions about telenursing in South Korea using Q-methodology. Forty Q-statements, which reflected the nursing metaparadigm, were extracted from 175 generated statements; then, 40 nursing students-recruited purposively through snowball sampling-ranked the set of Q-statements. The data were analyzed using the PQMethod program. Five perceptions concerning telenursing were identified: "concerns and suggestions for telenursing," "complete support for telenursing," "inevitable acceptance of telenursing," "distrust and criticism regarding telenursing," and "optional acceptance of telenursing." This study provides strategies for introducing and implementing telenursing services in countries with commercial 5G coverage and informs policies related to nursing education.

Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial

BACKGROUND

End-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients.

METHODS

This is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA).

RESULTS

The results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p < .001). The results also indicated a significant difference in the mean scores of four dimensions during the four-time points of measurement in the intervention group (P < 0.0005). Therefore, the level of treatment adherence in the intervention group was higher than in the control group. Moreover, there was a significant difference in the mean score of laboratory values between the two groups after the intervention, except for the level of serum sodium (P = 0.130).

CONCLUSION

Implementation of the patient education program and nurse-led follow-up can lead to better adherence to hemodialysis in four dimensions of HD attendance, medication use, fluid restrictions, and dietary recommendations in HD patients.

TRIAL REGISTRATION

IRCT registration number: IRCT20190127042512N1 ; Registration date: 2020-09-12; Registration timing: retrospectively registered: Last update: 2020-09-12.

Iranian Clinical Nurses' and Midwives' Attitudes and Awareness Towards Telenursing and Telehealth: A cross-sectional study

Objectives

This study aimed to examine the attitudes and awareness of Iranian clinical nurses and midwives towards telenursing and telehealth also referred to as e-health.

Methods

The cross-sectional study was conducted from February to August 2019 in Iran. Nurses and midwives were randomly recruited from hospitals affiliated with Mashhad University of Medical Sciences in Mashhad, Iran using a stratified cluster random sampling method. Data were collected using a reliable and valid Persian-language questionnaire consisting of 32 close-ended survey items to examine Internet/computer access, daily Internet use and awareness of and general attitude towards telehealth and telenursing; statistical analyses were performed.

Results

A total of 523 nurses and midwives were included in this study (response rate: 94.4%). The mean age and duration of clinical practice were 33.36 ± 7.46 and 8.88 ± 6.73 years, respectively. The majority of participants recognised the definition of telenursing (66.7%) and telehealth (80.1%). A positive attitude towards telenursing and telehealth was reported by 73.0% of the participants. Clinical nurses and midwives with a master’s degree were more aware of the definition of telehealth compared to those with undergraduate bachelor degrees (P = 0.03). Additionally, midwives significantly more frequently presented a positive attitude towards telehealth and telenursing compared to nurses (86.2% versus 71.2%; P = 0.01).

Conclusion

The positive attitude of the current participants was an important factor in the promotion of telenursing and telehealth. The implementation of educational and infrastructure developmental programs can help speed up executional processes in these fields.

Nurse-led telephone outreach for a COVID-adapted suspected colorectal cancer pathway

Background:

COVID-19 has brought about unprecedented challenges to healthcare services in the UK. The pandemic led to the cessation of colonoscopy and outpatient clinics. A bespoke COVID-adapted cancer pathway, using computed tomography (CT) scanning and the quantitative faecal immunochemical test (qFIT), was introduced to mitigate the risks of patients referred with potential colorectal cancer.

Aims:

This study aims to evaluate the workload of patient telephone calls undertaken by nurses and their impact on the operation of the pathway.

Methods:

Data were collected prospectively and analysed to assess the volume of patient flow, number of calls made and content of conversations.

Findings:

During a 2-month period, 975 patients (56.6% female, median age 63 years) were registered on the COVID-adapted cancer pathway. The 45.9% (n=448) of patients who did not return qFIT tests in a timely manner were contacted. Of these, 9.4% (n=42) requested to postpone or declined an appointment. Most were appreciative of the opportunity to clarify the rationale of the pathway and address any concerns.

Conclusions:

Phone calls made and received by nursing staff were helpful to discuss patient concerns and increase patients' understanding of the alternative treatment options available during the pandemic.

Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive - comparative case study

Background

Medical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010.

Methods

The study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33).

Results

Telephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010.

Conclusion

The proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.

Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial

As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.

Telephone nurses' strategies for managing difficult calls: A qualitative content analysis

Aim

To describe telenurses' strategies for managing difficult calls.

Background

Telenursing is a growing and complex area and places great demands on telenurses' knowledge and skills and on their ability to communicate and listen. To become emotionally concerned is central to telenurses' experiences of difficult calls.

Design

A descriptive qualitative study.

Methods

The data were collected during February 2017 through individual interviews with 19 telenurses at call centres and primary healthcare centres. Data were analysed with qualitative content analysis.

Result

The analysis revealed an essential strategy illustrated by the theme “to be calm and secure in themselves.” Further categories described telenurses' strategies to manage difficult calls, labelled as: “to show commitment and interest,” “to have structure in the call and use support systems,” “to pause the call” and “to reflect on difficult calls.” The results show that telenurses need multiple strategies to help them to navigate difficult calls.

[Telemedicine in rheumatology]

Der Ausbruch der COVID-19-Pandemie geht mit tief greifenden Einschnitten im Alltag und im Berufsleben einher – sowohl gesamtgesellschaftlich als auch speziell im Gesundheitswesen. Im Fokus der Pandemieeindämmung haben sich vielerorts rheumatologische Routineabläufe verändert. Um den entsprechenden Infektionsschutz der Patienten und des medizinischen Personals gewährleisten zu können, wurde hier verstärkt Telemedizin (insbesondere Telefon- und Videosprechstunde) eingesetzt. Weiterhin stehen durch die Digitale-Gesundheitsanwendungen-Verordnung (DiGAV) voraussichtlich in den kommenden Monaten neue, abrechnungsfähige telemedizinische Anwendungsmöglichkeiten wie Apps und Wearables zur Verfügung. Der Artikel soll einen Überblick über telemedizinische Versorgungsmöglichkeiten in der Rheumatologie (mit besonderem Fokus auf die Videosprechstunde) geben. Weiterhin wird Bezug auf die vorhandene Evidenzlage sowie Chancen und Limitation der Telemedizin im Fachgebiet genommen.

Effect of nursing telemonitoring on the knowledge of obese women: clinical trial

OBJECTIVE

To assess the effectiveness of remote monitoring in the knowledge of overweight women.

METHOD

Randomized clinical trial with 101 women, randomly assigned to the control group (CG=50) and to the intervention group (IG=51). The IG received educational intervention over the telephone, during three months and routine follow-up in the service, while the CG only received conventional follow-up. The knowledge was assessed by a specific questionnaire. Data were analyzed by the Robust Linear Regression Model, adopting a statistical significance of 5%.

RESULTS

In the intragroup assessment, an increase in the correct answers with a statistically significant difference was observed only for the IG in the domains: "Concept and causes of overweight," "Complications of overweight" and "Eating habits." In the intergroup comparison, an increase in the average knowledge was verified in the same domains for the IG (p≤0.005).

CONCLUSION

nursing telemonitoring contributed positively to the improvement of women's knowledge.

A New System to Assist Elders' Self-Care and Their Informal Caregivers

The ageing of a population increases the number of elders dependent in self-care. Thus, being dependent in a home context is a fact that deserves attention from social support entities integrated into the community, such as nursing homes, which play a central role in supporting the families involved. In this sense, this study is aimed at seniors dependent in self-care, their informal caregivers, and health professionals from Portuguese nursing homes and emerged to assist elders' self-care and their informal caregivers and to strengthen the communication strategies between the different elements of the target audience. Therefore, the design and development of an archetype of a new system is proposed, which main objectives are to accompany, teach, and share information between its users, taking into account safe medical validation and ethical issues, through emerging health ICT technologies. This archetype is a reinforcement, that is, a way to promote and complete the knowledge and skills to deal with elders' well-being and health, as well as their informal caregivers' welfare.

Healthcare utilisation and health literacy among young adults seeking care in Sweden: findings from a cross-sectional and retrospective study with questionnaire and registry-based data

AIM

The objective of this study was to examine young adults' healthcare utilisation and its possible association with health literacy.

BACKGROUND

Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20-29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor.

METHOD

This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischer's exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation.

FINDINGS

Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002).

CONCLUSION

Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults' reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.

Telenurses' experiences of monitoring calls to parents of children with gastroenteritis

AIMS AND OBJECTIVE

To describe telenurses' experiences of monitoring calls in telephone advice nursing to parents of children with gastroenteritis.

BACKGROUND

In previous studies, making monitoring calls is mentioned as a method used by telenurses to assess the need for care. MonitoringTHE terms 'care-seekers', 'care-seeker' and 'careseekers' are used inconsistently in the article. Please suggest which one to follow. We suggest Care-seeker calls in telephone advice nursing have been described as when telenurses call care-seekers back once or twice after an initial call. Calls from parents of children with gastroenteritis are common, and many of these calls result in telenurses providing self-care advice.

METHODS

Nineteen telenurses from two healthcare call centres in Sweden were interviewed. Data were analysed using inductive qualitative content analysis.

RESULTS

One main category, four generic categories and eleven sub-categories emerged. The telenurses described how working with monitoring calls aimed to provide self-care at home in a patient-safe way. Their focus on the parents aimed at increasing their feeling of security and focus on the child aimed at ensuring patient safety. Monitoring calls also provided a learning opportunity for parents and telenurses, and the possibility of relieving pressure on healthcare services. The findings indicate that the use of monitoring calls aims to provide a patient-safe form of telephone advice nursing.

CONCLUSION

This study shows that many parents feel insecure when their child has gastroenteritis, and the use of monitoring calls may be an effective approach to help them feel more secure at home with their sick child.

Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)

Background

Caller satisfaction with telephone advice nursing (TAN) is generally high, and the interaction is essential. However, a valid questionnaire exploring caller satisfaction in TAN with focus on perceived interaction is lacking.

Objective

To develop and assess content validity and test‐retest reliability of a theoretically anchored questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ), that explores caller satisfaction in TAN by focusing on perceived interaction between the caller and the telenurse.

Methods

The study was performed in three stages. First, variables relevant for patient satisfaction in health care were identified through a literature search. Variables were then structured according to the Interaction Model of Client Health Behavior (IMCHB), which provided theoretical guidance. Items relevant for a TAN context were developed through consensus discussions. Then, evaluation and refinement were performed through cognitive interviews with callers and expert ratings of the Content Validity Index (CVI). Finally, test‐retest reliability of items was evaluated in a sample of 109 individuals using intraclass correlation coefficients (ICC).

Results

The TISQ consists of 60 items. Twenty items cover perceived interaction in terms of health information, affective support, decisional control and professional/technical competence. Five items cover satisfaction with interaction and five items overall satisfaction. Remaining items reflect singularity of the caller and descriptive items of the call. The TISQ was found to exhibit good content validity, and test‐retest reliability was moderate to good (ICC = 0.39‐0.84).

Conclusions

The items in the TISQ form a comprehensive and theoretically anchored questionnaire with satisfactory content validity and test‐retest reliability.

Evaluation of nurse’s performance in telemedicine

ABSTRACT Objective: Describe the nurse’s role in the Telemedicine Program in Cardiology implanted in Pernambuco, Brazil. Methods: Qualitative study, with a target audience of nurses, performed between July and December 2016 at the Emergency Care Units. Data were collected through an online instrument, consisting of open and closed questions, performed with 19 professionals. The data were analyzed through the discourse of the collective subject by QuantiQualisoftware. Results: The sample consisted of 19 nurses, mostly female (80%), with a mean age of 30 years old. Two central ideas were constructed: nurses’ knowledge about the Telemedicine Program in Cardiology; and actions developed by nurses. Also, a flow of the program’s assistance was built. Final considerations: The nurse in Telecardiology performs functions of assistance and continuing education of monitoring and training for patients.

To feel emotional concern: A qualitative interview study to explore telephone nurses' experiences of difficult calls

AIM

To describe telenurses' experiences of difficult calls.

DESIGN

A qualitative approach with a descriptive design was used to gain a deeper understanding of the telenurses' experiences.

METHODS

The data were collected in spring 2017 through semi-structured interviews with 19 telenurses at call centres and primary healthcare centres and were analysed with qualitative content analysis.

RESULTS

Becoming emotionally concerned is central to the telenurse's experiences of difficult calls. Difficult calls are accompanied by feelings such as inadequacy, uncertainty and anxiety, which can be described as emotional tension. Emotional tension refers to situations when the caller's expressed emotions were conveyed to the telenurses and altered their state of mind. The telenurses stated that difficult calls that cause them to become anxious remain in their thoughts and go through their minds repeatedly, making a deep impression.

Interaction between tele-nurses and callers with an evolving myocardial infarction: Consequences for level of directed care

BACKGROUND

Rapid contact with emergency medical services is imperative to save the lives of acute myocardial infarction patients. However, many patients turn to a telehealth advisory nurse instead, where the delivery of urgent and safe care largely depends on how the interaction in the call is established.

PURPOSE

The purpose of this study was to explore the interaction between tele-nurses and callers with an evolving myocardial infarction after contacting a national telehealth advisory service number as their first medical contact.

METHOD

Twenty men and 10 women (aged 46-89 years) were included. Authentic calls were analysed using inductive content analysis.

FINDINGS

One overall category, Movement towards directed level of care, labelled the whole interaction between the tele-nurse and the caller. Four categories conceptualised the different interactions: a distinct, reasoning, indecisive or irrational interaction. The interactions described how tele-nurses and callers assessed and elaborated on symptoms, context and actions. The interaction was pivotal for progress in the dialogue and affected the achievement of mutual understanding in the communicative process. An indecisive or irrational interaction could increase the risk of failing to recommend or call for acute care.

CONCLUSION

The interaction in the communication could either lead or mislead the level of care directed in the call. This study adds new perspectives to the communicative process in the acute setting in order to identify a myocardial infarction and the level of urgency from both individuals experiencing myocardial infarction and professionals in the health system.

Effect of remote nursing monitoring on overweight in women: clinical trial

OBJECTIVE

to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women.

METHOD

controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study.

RESULTS

in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group.

CONCLUSION

the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.

Laying the Foundation for the National TeleNursing Center: Integration of the Quality-Caring Model Into TeleSANE Practice

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.

Aconselhamento telefônico: identificação de sintomas em pacientes com linfoma em quimioterapia antineoplásica

Resumo Objetivo Identificar os sinais e sintomas apresentados por pacientes com Linfoma de Hodgkin submetidos ao protocolo quimioterápico composto por Doxorrubicina, Bleomicina, Vimblastina e Dacarbazina (ABVD) por meio de aconselhamento telefônico e comparar os escores de gradação dos sinais e sintomas apresentados nos ciclos do protocolo. Métodos Descritivo, prospectivo, quantitativo. Sete pacientes receberam aconselhamento telefônico, em 24 tempos de chamadas programadas e não programadas, correspondentes a 6 ciclos de quimioterapia com protocolo ABVD. Utilizou-se o Inventário de Sintomas do M.D Anderson e o Critério Comum de Terminologia para Eventos Adversos, para a gradação dos sintomas e um protocolo de condutas. Realizou-se análise descritiva e analítica. Resultados Duzentas e oitenta e seis chamadas telefônicas geraram1.870 queixas sintomáticas. Nas chamadas programadas, as queixas com maior prevalência foram fadiga, preocupações, falta de apetite, vômitos e náuseas. Quanto a interferência nas atividades de vida diária, os itens relacionados a atividades em geral, no trabalho e dificuldade para caminhar, além de alterações no humor foram relatados em maior frequência. Nas chamadas não programadas, a falta de apetite e desregulação menstrual foram as queixas mais recorrentes. Na análise da progressão dos sintomas, observou-se aumento de náuseas e vômitos (p=0,02), diminuição da fadiga e falta de ar (p≤0,03), melhora do sono (p=0,02) e diminuição do estresse (p=0,02). Conclusão A fadiga, náusea, vômito e alteração nas atividades de trabalho foram relatados frequentemente. Houve progressão de náuseas e vômitos, mas regressão da fadiga e do estresse. O aconselhamento telefônico permitiu a comunicação e o manejo rápido de um número expressivo de sintomas.

Comparing the effects of face-to-face and telenursing education on the quality of family caregivers caring in patients with cancer

BACKGROUND

Taking care of patients with cancer is often done at home and by family caregivers. However, these groups do not receive the necessary education regarding care at home.

OBJECTIVES

The present study aimed to compare the effects of face-to-face and telenursing training methods on the quality of services provided by the family caregiver for patients with cancer.

MATERIALS AND METHODS

A total of 103 family caregivers of patients with cancer were randomly divided into 3 groups: control (N = 35), face to face (N = 34), and telenursing (N = 34). The control group only received the routine training, and the face-to-face and telenursing groups were trained for 12 weeks. Quality of care was measured using a questionnaire before and after intervention. Chi-square, Fisher's exact, and analysis of variance tests were used for data analysis.

RESULTS

After intervention, the average total quality score for the care of patients in face-to-face (166.13 ± 13.91) and telenursing (157.76 ± 17.24) groups was significantly higher than the control group (82.51 ± 16.84) (P < 0.001). In addition, the average psychosocial care score for face-to-face group (49.06 ± 6.05) was significantly higher than telenursing group (43.83 ± 6.15) (P < 0.001).

CONCLUSION

The results of the study showed that the two methods of training were effective on the quality of care among family caregivers of patients with cancer to a similar extent.

Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia

Background

Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back.

Methods

We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a “communication skills” study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses’ experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016.

Results

In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back.

Conclusions

Our theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training.

Trial registration

ACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2956-6) contains supplementary material, which is available to authorized users.

Telenursing manual for providing care to patients using clean intermittent urinary catheterization

Abstract Objective: To develop and evaluate apparent and content validity of a telenursing manual to support nurses in the care delivery of patients using clean intermittent urinary catheterization. Methods: Methodological study addressing the development and validation of a telenursing manual. The expert group who validated the telenursing manual was composed of 11 nurses. An inter-rater level of agreement of 70% was considered for each aspect of the instrument. Results: The following levels of agreement were obtained for each aspect: Language 97%, Content 97.7% and Objectives, Relevance, Functionality and Usability 100% each. Conclusion: The manual is available for access and represents an important initiative for the field of telenursing in Brazil, assisting nurses in the telecare provided to patients using clean intermittent urinary catheterization.

Children's postoperative symptoms at home through nurse-led telephone counseling and its effects on parents' anxiety: A randomized controlled trial

PURPOSE

The objective of this study was to evaluate children's postoperative symptoms at home after outpatient surgery through nurse-led telephone counseling and the effects of the nurse-led telephone counseling on parents' state-trait anxiety scores.

DESIGN AND METHODS

In this prospective randomized controlled study, nurse-led telephone counseling was provided every day to parents in the intervention group until they came for the follow-up visit. Parents of children (n = 54) ages 3-17 years who had undergone outpatient surgery for appendicitis, cholecystectomy, or ovarian cysts were eligible to participate in the study. On the first postoperative day and at the follow-up visit, the Spielberger State-Trait-Anxiety Inventory (STAI) was administered to parents who were randomly allocated to the intervention (n = 24) and control groups (n = 30).

RESULTS

The parents reported on postoperative symptoms such as pain, activity levels, excretion, sleep, nutrition, and wound infection. While there was no difference in STAI scores for parents between the groups at the first postoperative day, there was a significant decrease in STAI scores in the intervention group versus the control group, with parents in the intervention group reporting lower anxiety scores.

PRACTICE IMPLICATIONS

Our results suggest that nurse-led telephone counseling is effective at reducing anxiety in parents of children after outpatient surgery.