Telenursing: clinical nurse consultancy for rural paediatric nurses

Videoconferencing is increasingly being accepted as a medium for health-care. Telenursing is in its infancy in Australia but has enormous potential for nursing care in remote areas. The Child and Adolescent Psychological Telemedicine Outreach Service (CAPTOS) began in 1997 and in its first evaluation recommended more support for paediatric nurses. CAPTOS telenursing began as a new initiative in late 2001. The telenursing project aims to link ward nurses to CAPTOS and local community teams, and to provide both clinical consultancy on nursing and interdisciplinary issues and locally based professional development Telenursing supports nurses via site visits, videoconferencing sessions, an interactive Website and sabbatical opportunities. Telehealth works with existing services to enhance the nursing care of young people with a complex mixture of psychological and physical health problems.     

An analysis of the suitability of home health visits for telemedicine

To determine what percentage of traditional home health nursing visits could be done by telemedicine, we carried out a retrospective review of nursing charts (clinical records). Data of two types were recorded. The objective data, which were abstracted from the records, included demographic information, patient assessments, teaching activities and interventions. The subjective data were the opinions of four observers as to whether the visit could have been done using currently available telemedicine technology. Records were sampled randomly for patients who had received home nursing care from three home health agencies in rural and urban areas during the winter and summer of 1996. A 54-item coding instrument was applied to 906 different charted home nursing visits. For 412 (46%) of these, the on-site nursing could reasonably have been replaced by telenursing. Significant factors determining the possible use of telenursing included primary diagnosis, number of interventions and patient age. Among the 10 most common primary diagnoses, the most amenable to telenursing care were chronic airway obstruction and joint disorders; the least amenable were coagulation disorders and anaemia. Telenursing visits could substitute for a substantial fraction of on-site home nursing visits. This has important implications in terms of reducing the cost of home nursing care.     

A randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators

This trial compared 3 post-hospitalization nursing care models for reducing congestive heart failure (CHF) readmission charges during 180-days of follow-up. Subjects received in-person visits at baseline and 60 days plus 1 of 3 care modalities in the interim: (a) video-based home telecare; (b) telephone calls; and (c) usual care. CHF-related readmission charges were > 80% lower in the telenursing groups compared to usual care, and these groups also had significantly fewer CHF-related emergency visits. In-person visits were more than 3 times longer than telenursing visits (p < 0.0001), only partially due to added travel time. Patient self-care adherence, medications, health status, and satisfaction did not significantly differ between groups. Telenursing can reduce CHF hospitalizations and allow increased frequency of communication with patients.     

Telenursing for the elderly. The case for care via video-telephony.

As most elderly people prefer home care to residential care, the nursing profession must change its current practice. New models of care are necessary. Information and communications technologies, such as video-telephony (i.e. any form of face-to-face video-communication), allow elderly people to maintain their autonomy by strengthening their emotional, relational and social abilities. Experiments in a variety of settings have tested a range of interventions based on video-telephony, from the simple giving of information to the provision of therapeutic procedures. The elderly have appreciated the opportunity to use video-telephony to communicate with a nurse about their needs, expectations and feelings. After some initial scepticism, nurses have concluded that telenursing complements traditional nursing practice. Although technology is no panacea for the problems of ageing, when applied judiciously it can bolster the position of vulnerable ageing citizens.     

Identifying nursing roles, responsibilities, and practices in telehealth/telemedicine

The intent of this study was to describe the roles, responsibilities, and practices of telehealth/telemedicine nurses and to identify and validate that nurses are working in telemedicine. This brief report about nurses employed in telehealth/telemedicine proves that nurses are actively involved in the delivery of health care via telemedicine. Broad roles, responsibilities, and practices of telemedicine nurses were identified and a baseline was established for future research in telenursing. As health care continues its transformation through technology into the next century, telemedicine will continue to affect nurses. Whether these effects will create more collaborative or autonomous roles is yet to be determined.     

Magnetic direction

In April 2005, the American Nurses Association (ANA) awarded St. Joseph Hospital, Nashua, NH, its highest honor for excellence in nursing: "Magnet Recognition." The Magnet Recognition Program was developed by the ANA's American Nurses Credentialing Center in the early 1980s to recognize health care organizations that provide the best in nursing care and uphold the tradition of excellence in professional nursing practice. St. Joseph began pursuing Magnet status more than three years ago, starting with a number of enhancements to nursing practices. The hospital worked hard to improve nurse-to-patient staffing and included many of its nurses on the nursing quality council, division advisory, and cultural diversity committees. Magnet program appraisers visited the hospital this January to conduct an intensive, on-site three-day examination. They interviewed patients, staff nurses, physicians, hospital employees, administrators, board members, and nursing leadership to evaluate St. Joseph's nursing care, services, and delivery of care to patients and their families. Soon after, Magnet status was bestowed.     

Nursing care planning: proposal for a software prototype

This study aims to develop a software prototype to help hospital nurses plan nursing care, and carry out nursing interventions and all documentation in a computerized way. The methodology is based on the life cycle of system development, particularly the prototype concept, involving two phases: definition and development. The definition phase began with the planning stage, followed by the definition and analysis of requirements for the construction, and culminated with the specification of the software requirements. The development phase translated the group of requirements into a computerized model, structured in 10 modules, regarding the nursing care system process. The performance of this innovative resource in the different stages of the nursing care system process will be analyzed in future studies.     

Development of a telenursing system for patients with chronic conditions

We have evaluated the feasibility of a telenursing system for patients with a chronic condition who are in receipt of home care services. The Internet-based system allows patients (equipped with a laptop computer), nurses and physicians to access information from a central database through a wireless network (128 kbit/s). Email and video-mail messages as well as vital signs data can be sent daily by the patient to a server at a regional health-care centre, and can be accessed by a nurse or physician, who can then decide on appropriate care. The system was tested by a male patient with type 2 diabetes mellitus, to see whether it would enhance his own management of his condition. During a 73-day baseline introductory period, no specific educational material was provided on the system Website about the management of diabetes (during this time the technical operation of the system was tested). During a second, 71-day period, educational material was provided. The telenursing system helped the patient to manage his condition, as shown by significant improvements in his levels of blood glucose and glycosylated haemoglobin (HbA(1c)) and in his blood pressure. Our findings suggest that the system is feasible.     

Developing a protocol for the use of telenursing in community health in Australia

As the first step in developing a protocol for the use of video-phones in community health, we carried out a feasibility study among clients with a range of health needs. Clients were equipped with a commercially available video-phone connected using the client s home telephone line. A hands-free speaker-phone and a miniature video-camera (for close-up views) were connected to the video-phone. Ten clients participated: five required wound care, two palliative care, two long-term therapy monitoring and one was a rural client. All but two were aged 75 years or more. Each client had a video-phone for an average of two to three weeks. During the six months of the study, 43 client calls were made, of which 36 (84%) were converted to video-calls. The speaker-phone was used on 24 occasions (56%) and the close-up camera on 23 occasions (53%). Both clients and nurses rated the equipment as satisfactory or better in questionnaires. None of the nurses felt that the equipment was difficult to use, including unpacking it and setting it up; only one client found it difficult. Taking into account the clients responses, including their free-text comments, a judgement was made as to whether the video-phone had been useful to their nursing care. In seven cases it was felt to be unhelpful and in three cases it was judged helpful. Although the study sample was small, the results suggest that home telenursing is likely to be useful for rural clients in Australia, unsurprisingly, because of the distances involved.     

Nursing specialization program: residential model: experience of establishing oneself in a teaching hospital

This is a report about the experience of setting up a Specialization Program for Nurses in a "Residence" format, at the school-hospital of the Federal University of S?o Paulo, which mixes the traditional structure of specialization programs in Brazil with the model of the resident physician practical training. It began on February 1995, with the following objectives: 1) to qualify nurses, in different specialities, by an intensive training program, on a full-time schedule; 2) to contribute to improve the process of nursing care and; 3) to increase the quality of nursing assistance in our hospital. The results of our experience allow us to suggest that's a good way to qualify nurses for the best nursing practice, and to increase nursing research in a very practical basis.     

Public health nursing: in sickness or in health?

Public health nursing began in the United States as a small undertaking in which a few wealthy women hired one or two nurses to visit the sick poor in their homes. By 1910, the work of these nurses had expanded to include a variety of preventive programs. While most preventive programs originated with voluntary organizations, such as the visiting nurse societies, they were eventually taken over either by boards of education or health departments. As a consequence of the new division that resulted, sick nursing would increasingly become the sole domain of the voluntary organizations, while the teaching of prevention would become the responsibility of public agencies. By examining the history of public health nursing between 1900-30, this article considers why a movement that might have been significant in delivering comprehensive health care to the American public failed to reach its potential.     

Influences of the culture of science on nursing knowledge development: Using conceptual frameworks as nursing philosophy in critical care nursing

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person‐centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions.     

Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing

We investigated satisfaction with a Swedish telenursing service and the health-care-seeking behaviour among callers who received a less urgent level of health care than they expected. A postal questionnaire was sent to a random selection of callers (n = 273) to Swedish Healthcare Direct in October 2008. The 'cases' were 18 callers where the telenurse recommended a lower level of health care than the caller expected and who were not in complete agreement with the nurse. The 'controls' were 22 callers who either received a lower recommendation, or were in disagreement with the recommendation. There were no differences between cases, controls and other callers regarding background factors or the telenurse classification of emergency. However, both cases and controls considered their need for health care as more urgent than the other callers. An independent test of the nurses' reception, ability to listen and to take notice of the callers' health problem, showed that nurses who had served cases, had received a significantly lower rating than other nurses. For nurses who had served controls, there was no such difference in rating. Cases and controls had fewer subsequent care visits than other callers, in the three days following the call, although the proportion of emergency visits was higher among cases and controls compared to other callers. If the caller and the nurse disagree about the nurse's recommendations, the consequence can be a dissatisfied caller and more visits to unnecessary high levels of health care. Further training of the nurses may improve the telenurse service.     

Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh

In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.     

The pace of change. New roles and challenges redefine the nursing profession

The speed at which a profession is changing can be gauged by the number of new roles its members play. By this measure, nursing has undergone a revolution over the past decade. Although nurses continue to devote much of their time to direct patient care, most of them also have roles as care planners, managers, educators, and even counselors. In many cases, moreover, nurses today do work and address problems that few would have identified as part of "nursing" 10 years ago. This photo essay presents three examples of nontraditional roles in nursing.     

A model for empowerment of nursing in Iran

Background  

While the Iranian nursing profession tries to reach to its full capaCity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors. The concept of empowerment is frequently used in nursing and the health services, particularly in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness. When considering the importance of nursing services in any health system, the 54th World Health Assembly recommended that programs be designed to strengthen and promote the nursing profession. Since empowerment is crucial to the role of nurses, a qualitative study was conducted and aimed at designing a model for empowering nurses in Iran.     

Authentic intention: Tempering the dehumanizing aspects of technology on behalf of good nursing care

The nursing profession has a responsibility to ensure that nursing goals and perspectives as these have developed over time remain the focus of its work. Explored in this paper is the potential problem for the nursing profession of recognizing both the promises and pitfalls of informational technologies so as to use them wisely in behalf of ethical patient care. We make a normative claim that maintaining a critical stance toward the use of informational technologies in practice and in influencing the thought patterns of the younger generations of nurses is a moral imperative of the discipline, because without this practice can become subverted from professional goals in various ways. We use a synthesized concept we call “intentional authenticity” derived from the writing of Heidegger and Feminist care ethics to provide a foundation for the development of nurses who understand the importance of the nurse‐patient relationship and how the unthoughtful use of informational and other technologies can militate against effective or good nursing care.     

Work environment issues and intention-to-leave in Portuguese nurses: A cross-sectional study

This study extends the Registered Nurses Forecasting (RN4CAST) study evidence base with newly collected data from Portuguese nurses working in acute care hospitals, in which the measurement of the quality of work environment, workload and its association with intention-to-leave emerge as of key importance. Data included surveys of 2235 nurses in 144 nursing units in 31 hospitals via stratified random sampling. Multilevel multivariate regression analysis shows that intention-to-leave is higher among nurses with a specialty degree, nurses aged 35–39, and in nursing units where nurses are less satisfied with opportunities for career advancement, staffing levels and participation in hospital affairs. Analysis with moderation effects showed the observed effect of age and of having a specialty degree on intention-to-leave during the regression analysis is reduced in nursing units where nurses are more satisfied with opportunities for career advancement. The most important finding from the study suggests that promoting retention strategies that increase satisfaction with opportunities for career advancement among Portuguese nurses has the potential to override individual characteristics associated with increased turnover intentions.     

The potential for telemedicine in home nursing.

We assessed the proportion of home nursing visits that could be replaced by home telenursing in the UK. A retrospective review of nursing notes in the UK was undertaken using an abstraction instrument developed and tested in the US. A total of 1951 episodes of patient care at home were reviewed: 1450 from Liverpool and 501 from Belfast. A total of 1626 (83%) of the episodes involved 'hands-on' interventions. In Belfast two observers estimated that 14% of home nursing visits could be done via telemedicine while in Liverpool two more observers gave an estimate of 16%. Inter-rater agreement was high (kappa = 0.93 for the Belfast observers and 0.79 for the Liverpool observers). Pilot trials of an analogue video-phone in Belfast suggested that even relatively low-quality compressed video might be useful for home nursing. These findings suggest that telemedicine may have a significant role in the delivery of home health care in the UK.