Going the Distance: Telehealth and Patient Satisfaction

Introduction

Telehealth has been a healthcare practice practically since the foundation of the Internet. However, it seems to remain on the table interminably, a practice and ideation of healthcare that is constantly up for debate. The proponents of telehealth point to the practice’s obvious advantages, such as reduced cost of care and increased monitoring abilities. However, as with any major development in science, medicine, or technology, telehealth comes with a set of costs that are easily pointed out as fundamental drawbacks by the critical eye. So what are these benefits and costs? What are the advantages and disadvantages of the practice of telehealth, telemedicine, and, more specifically, telenursing? Do the benefits outweigh the costs or vice versa? This paper very briefly addresses these questions by examining the origination, development, and technical and ethical issues related to the practice of telenursing. There is quite a bit of literature on the practice of telenursing, and this paper will use these normative and empirical discussions for its conclusion.

Before turning to the relative advantages and disadvantages of this specific health practice, it is worthwhile to briefly discuss telenursing itself. Hebda and Czar (2013) define telehealth as the “use of telecommunications technology and electronic information to exchange healthcare information and provide services to clients” (p. 505). This includes many types of technologies, including the Internet, video conferencing, and shared documents. As Hebda and Czar (2013) go on to say, “Telehealth uses computers, video, and audio equipment to allow for consultations, assessments, education, and improved quality of patient care without the need for travel” (p. 505). This definition makes it clear that telenursing does not change the role or function of nursing practice. Instead, it merely takes existing practices and existing technologies, combining them to create new opportunities for both nurses and patients. This means the better the technology, the better the practice.

Hebda and Czar (2013) also discuss the history of telehealth, which originated with telephone-based consultations between nurses, patients, and other healthcare professionals. The practice was originally designed to benefit those who were geographically removed from nursing facilities. As such, telehealth really began to grow as a practice after the passage of the Rural Development Act in 1991 (Hebda & Czar, 2013, p. 507). Five years later, the expansion of the so-called ‘information highway’, which allowed for the development and far-reaching distribution of Internet technologies, meant an equal development of telehealth practices and abilities.

In more recent years, the expansion of telehealth has reached unprecedented growth, with billions of dollars being invested in the practice globally (Hebda & Czar, 2013, p. 509). It is this most recent development of telehealth more generally and telenursing most specifically that has the practice standing at a crossroads. Healthcare professionals and students alike must face these developments, examining the advantages and disadvantages of the technologies for nursing practice. Only an internal examination – and, as a potential consequence, adoption – of telehealth will make for the most efficient and beneficial telenursing practices and patient satisfaction in the future.

Telenursing: Advantages and Disadvantages

As mentioned in the introduction, there are various advantages and disadvantages to the practice of telehealth. Three major advantages and three distinct disadvantages are examined here, in as objective a fashion as possible (after all, Manuel needs the best information for his decision). The three advantages are nurse retention, continuity of nursing care, and reduction in the cost of nursing care. In contrast, the three major disadvantages are concerned with the possibility of decreasing the quality of care, issues related to patient autonomy, and the prevention of harm. After discussing each of these relative advantages and disadvantages, the paper then presents an overall conclusion regarding the practice of telenursing in regards to the practice of the professional nurse. This includes a recommendation for Manuel’s potential career move to telenursing practice.

One of the advantages of telenursing not directly related to patient satisfaction or nurse-patient relations is that of nurse retention. While telenursing may have many benefits for patient satisfaction directly, nurse satisfaction (and, consequently, nurse retention) is perhaps the most advantageous of telenursing’s benefits. In a phrase, happy nurses mean more nurses, which means better nursing practice. It follows that if a nurse is able to take more patients in less time by utilizing telenursing technologies, nurses as a whole will not be spread so thin. This expanding circle of nursing ability will make the job less stressful overall. Furthermore, telenursing leads to nurse retention is in job satisfaction itself. A study released several years ago found that telenurses had a greater degree of job satisfaction than other professionals in their field (eHealth, 2005). The inherently less stressful nature of telenursing (i.e. being able to work from home) means that nurses will remain in the field longer. This, in turn, means better long-term nurses.

The second major advantage of telenursing is the continuity of nursing care. In other words, telenursing allows nurses and patients to consult more often, pinpointing needs, opportunities, and goals for care (McGonigle & Mastrian, 2009). As Hebda and Czar (2013) point out, telenursing includes services such as consultation, diagnosis, disease prevention, health education, health promotion, and therapy (p. 507). Telenursing is rarely limited in what it can practice. Telenursing then provides the opportunity to give almost constant care to those patients who are in need of it, and timely and regular follow up for those who cannot rely on regular visits to nursing facilities. In addition to bringing the ‘location’ of nursing closer to home, telenursing provides better continuity of care by ensuring centralized health records and further collaboration among healthcare workers (Hasman, 2002). The combination of these three factors is what makes telenursing desirable for the client, specifically. Essentially, it means better health care.

A final major advantage of the practice of telenursing is the reduction in the cost of nursing care. This is similar to the continuation of nursing care but holds its own set of unique benefits. This is the benefit that is most obviously and directly advantageous to the patient. As discussed above in terms of the continuation of care, telenursing offers many of the services offered in traditional health care practice, with one distinct difference: these practices are cheaper for the patient. As a result, patients are less restricted in the continuation of their care based on economic or geographic factors. For patients who cannot afford in-home care or live too far away from nursing centers to make regular visits practical, telenursing offers its most obvious advantages.

In contrast, one of the major disadvantages of telenursing is the possibility of decreased quality of nursing care. One of the major aspects of a nurse’s role is to provide personal, one-on-one, professional interaction with their patients. Some argue that relying on technologies inherently takes this aspect of the nurse-patient relationship away from nursing practice. While patients may be able to see and hear their nurse, the personal interaction and quality of a personal touch are taken away. However, as technologies continue to advance, this disadvantage shows promise of fading. As Sandelowski (2002) states, “the design intentions behind distance technologies are to overcome the effects of distance and electronic mediation; that is, to simulate lifelike and full-bodied encounters in proximate space that close the distance between people and allow users to feel as if they were,...reaching out to touch someone” (p. 65). As the quality of technology increases, so will the quality of care in telenursing.

A secondary drawback to telenursing is the threat of transgressing patient autonomy. Verifying consent, preserving patient privacy, and considering the maintenance of patient confidentiality are all major concerns within the health care profession. When information is shared across networks, some of this autonomy is put into jeopardy (Hoglund & Holmstrum, 2008). In order to overcome this potential shortcoming, both nurses and patients who engage in telenursing must at least have a basic understanding of the technologies they are using.

The final major disadvantage of telenursing is the lack of assurance of prevention of harm. If a nurse is not present in a patient’s caring facility, a nurse cannot ensure their wellbeing. The question of responsibility then becomes an unclear one. Institutional and legal issues, such as accountability and malpractice, which used to be quite clear under institutional standards, become difficult to address under the practice of telenursing (Hasman, 2002). This is something that must continue to be addressed by health care professionals as the future of telehealth unfolds.

Conclusion & Recommendation

The above paper examines the nature of telenursing, as well as its most apparent advantages and disadvantages. Despite the potential difficulties of engaging in telenursing as a professional practice, I recommend that Manuel should accept the position if it is offered to him. The advantages of telenursing – both for the nurse and for the patient – seem to far outweigh the disadvantages. The disadvantages discussed above can be done away with when addressed by a knowledgeable and competent healthcare professional – such as Manuel. Ultimately, the promise of telenursing far outweighs the potential disadvantages of the practice, and the future remains bright.

References

Hasman, A. (2002). Textbook in health informatics: A nursing perspective. IOS Press.

Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals. Upper Saddle River, NJ: Prentice Hall.

Hoglund, A., & Holmstrom, I. (2008). Ethical issues in telenursing. IHE-Online. Retrieved from: http://www.ihe-online.com/index.php?id=2695.

McGonigle, D., & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.

Sandelowski, M. (2002). Nursing, technology, and the millennium. Nursing Inquiry, 3(6): 65.