Nurse Practitioners in Telehealth: Bridging the Gaps in Healthcare Delivery

Experiences of nurse practitioners with telehealth during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic brought many changes to the way nurse practitioners (NPs) provided care for patients, including the explosive and instantaneous use of telehealth in lieu of face-to-face services to maintain safe health care access and provision for patients and providers.

PURPOSE

Although the literature abounds with patient perspectives and benefits of telehealth, little is found about the perceptions and experiences of NPs providing telehealth services during this time when telehealth was the primary care mode of providing nonacute care.

METHODOLOGY

This mixed-methods, descriptive, exploratory study describes demographic and quantitative data about telehealth experiences collected from NPs across the nation early in the pandemic during fall 2020, and similar quantitative data collected later in spring 2021 from NPs in one state.

RESULTS

Significant findings between the 2020 national and 2021 state NP data include years of NP experience and the NP perceived barriers in the provision of telehealth services.

CONCLUSIONS

Major patient-centric telehealth barriers were patient comfort with and accessibility to telehealth software. Major NP perceived telehealth barriers were regulatory laws, difficulty including telehealth visits into workflow when seeing patients in person, and comfort using telehealth software.

IMPLICATIONS

Specific strategies can help to overcome identified telehealth barriers.

The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review

BACKGROUND

Telemedicine has become more convenient and advantageous due to the rapid development of the internet and telecommunications. A growing number of patients are turning to telemedicine for health consultations and health-related information. Telemedicine can increase access to medical care by removing geographical and other barriers. In most nations, the COVID-19 pandemic imposed social isolation. This has accelerated the transition to telemedicine, which has become the most commonly utilized method of outpatient care in many places. Telehealth can assist resolve gaps in access to healthcare services and health outcomes, in addition to its primary function of boosting accessibility to remote health services. However, as the benefits of telemedicine become more apparent, so do the limitations of serving vulnerable groups. Some populations may lack digital literacy or internet access. Homeless persons, the elderly, and people with inadequate language skills are also affected. In such circumstances, telemedicine has the potential to exacerbate health inequities.

AIM AND METHODS

In this narrative review (using the PubMed and Google scholar database), the different benefits and drawbacks of telemedicine are discussed, both globally and in Israel, with particular focus paid to special populations and to the telehealth usage during the Covid-19 period.

FINDINGS

The contradiction and paradox of using telemedicine to address health inequities yet sometimes making them worse is highlighted. The effectiveness of telemedicine in bridging access to healthcare inequities is explored along with a number of potential solutions.

CONCLUSIONS

Policy makers should identify barriers among special populations to using telemedicine. They should initiate interventions to overcome these barriers, while adapting them to the needs of these groups.

Telemedicine and Health Equity During COVID-19 in Pediatric Gastroenterology

INTRODUCTION

Telehealth (TH) services rapidly expanded during the COVID-19 pandemic. This rapid deployment precluded the opportunity for initial planning of implementation strategies. The purpose of the quality improvement project was to understand the needs of nurse practitioners and examine TH procedures and interventions designed to promote high-quality, equitable health care for pediatric patients with gastrointestinal concerns.

METHOD

The Plan-Do-Study-Act model was used. Survey data from providers and families were collected and analyzed. They were further illuminated through iterative dialog across the research team to determine the quality and efficiency of TH.

RESULTS

A toolkit of strategies for promoting the quality and efficiency of TH was created according to the three domains of health equity: availability, accessibility, and acceptability.

DISCUSSION

TH will be used in the postpandemic era. Institutions need to implement evidence-based strategies that ensure health equity across TH platforms to ensure excellent patient care.

Economics of Using Telemedicine to Supplement Hospice Care in Rural Areas

Background: Hospice care in rural areas is often characterized by provider shortages and vast geographical service areas to cover, making access to quality end-of-life care challenging. Telemedicine, broadly, is the utilization of interactive televideo (ITV) technology to provide health services over a distance. For over 25 years, telemedicine has been proposed as a solution to address access issues. In 2015, the University of Kansas Medical Center (Kansas City, Kansas) partnered with Hospice Services, Inc. (HSI) (Phillipsburg, Kansas), to augment traditional, face-to-face (FTF) hospice care with hospice care delivered through mobile tablets. Objective: This work examines the costs of TeleHospice (TH) (telemedicine use in hospice care) when compared with the costs of FTF hospice services. Design: Detailed administrative data from July 1, 2018, to December 31, 2018, were analyzed to estimate the costs of service after TH use was inculcated into routine practice. Results: his, which averages a daily census of 34 patients, conducted 257 calls, averaging 28 hours a month. The average time for a TH call was 18 and 17 minutes for nursing and medical director calls, respectively. Through various hospice functions, including administrative, patient, and nonpatient-related connections, HSI saved over $115,000 in staff travel time and mileage reimbursement. Administratively, by hosting their weekly 15-member interdisciplinary meeting through ITV, HSI saved $29,869 of staff travel time and mileage reimbursement. Conclusions: Our estimates indicate substantial cost saving potential with the use of TH services. Further research is needed to assess the effects of TH utilization on the experiences and subsequent cost of hospice care.

Using telehealth for diabetes self-management in underserved populations

Diabetes self-management is a complex process and central to well-being of patients with this chronic disorder. A patient-centered telehealth program may potentially meet needs of those in underserved populations to reduce socioeconomic disparities. Achieving this goal requires a focused concentration on health behaviors and practices of individuals in underserved populations.

Leadership Opportunities for Nurses in Telehealth: A King Perspective

Advanced practice registered nurses (APRNs) are in an excellent position to provide leadership for advancing telehealth initiative. King's social system concepts of role, status, authority, power, and decision-making may be explored in this context. The authors of this article provide insight into the leadership opportunities in telehealth that exist for APRNs in current healthcare systems through a King perspective. The authors discuss some of the major challenges for APRNs in telehealth and how leadership may overcome some of those challenges.

Using Simulation to Teach Telehealth Nursing Competencies

BACKGROUND

The use of telehealth to provide care to millions of patients who have difficulty accessing care through traditional means is growing exponentially. Nurse educators must prepare students to meet the challenge of managing this mode of care delivery.

METHOD

A simulated telehealth experience was designed using the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: Simulation^™, student learning objectives, and telehealth competencies. The design promoted active participation in a telehealth visit with a standardized patient.

RESULTS

The simulation provided students with the opportunity to demonstrate use of telehealth equipment and become familiar with telehealth competencies. This hands-on experience increased student engagement related to telehealth as a health care delivery option and was an effective objective structured clinical examination.

CONCLUSION

Integration of telehealth into the nursing curriculum is a necessity as health care technology advances. Simulation is one strategy available to expose students to telehealth and increase student engagement. [J Nurs Educ. 2018;57(10):624-627.].

Comparing Outcomes of Genetic Counseling Options in Breast and Ovarian Cancer: An Integrative Review

PROBLEM IDENTIFICATION

Genetic counseling is vital in helping people at high risk for hereditary breast and ovarian cancer (HBOC) make informed decisions to undergo BRCA testing. Many people, particularly those in rural locations, lack access to these services. This review examines evidence to determine if remotely delivered genetic counseling via telephone or telemedicine is an effective alternative to in-person counseling for people who are at high risk for HBOC.
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LITERATURE SEARCH

A literature review was completed by searching PubMed, SCOPUS, and CINAHL® databases.
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DATA EVALUATION

151 articles were identified from the search, and 7 were included in the review.
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SYNTHESIS

Patients' BRCA knowledge acquisition, cancer-specific distress, anxiety, depression, and satisfaction with mode of counseling delivery were equivalent between in-person and remotely delivered counseling groups. Genetic testing rates were significantly higher in participants receiving in-person counseling. Remotely delivered genetic counseling was more convenient and less expensive. Mixed outcomes existed regarding counselor-patient communication. 
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IMPLICATIONS FOR PRACTICE

The demand for genetic counseling will grow as advances in cancer genomics reveal genes that may contribute to cancer predisposition. Innovative delivery models are necessary to ensure that all people have access to care.

The influence of technology in nursing education

The complexity of the relationship between nursing and technology is not new. The complexity has increased with the advent of new technology and technological devices. For faculty who are in the clinical area on a limited basis, and for nurses who are not involved in decisions related to the adoption of technology, terms and concepts related to technology can be misconstrued or misunderstood. An overview of some major terms used in reference to technology and technological approaches can only enhance the intricate relationship between nursing and technology.