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Telehealth Nursing Utilized for Nurse to Nurse Report

Amanda Smith

Delaware Technical Community College

Nursing Informatics NUR 410 5W1

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Abstract

Telehealth nursing is an important function and segment of nursing workflow and processes.

Informatics in healthcare makes it entirely possible for communication between two healthcare

professionals and patients in different locations. This paper states the nursing workflow process

of nurse to nurse report could be improved with telehealth nursing. Research articles are used as

evidence for the improvements telehealth provides. Ethical and legal issues associated with

telehealth nursing are discussed. A workflow map is included to further illustrate the benefit and

process of telehealth nurse to nurse report, specifically as it applies to admissions from another

facility and transfers.

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Telehealth Nursing Utilized for Nurse to Nurse Report

Introduction

A workplace process that can be enhanced with telehealth nursing is the shift report for

hospital transfers. Nurse to nurse report is an area that needs to be improved, especially between

hospitals. During report information can be accidently omitted, and it is easier to be engaged

with the other nurse when you can see them, not just listen to them on the phone. Physicians and

nurses use telehealth to communicate with patients who are outside of the hospital and this

functions as a bridge between the gap in healthcare services. Telehealth reporting between nurses

can be the bridge that covers the gap between facilities.

Support of Telehealth Report

Telemedicine is already an integral part of patient care outside of the hospital. In a mixed

method study reported by Day, Millner, and Johnson (2016), patients were given devices for

self-monitoring and video conferencing at home. Telehealth equipment was also given to nurses

who monitored the patient’s self-care, conducted teaching, and supervised patients during acute

exacerbations of their illness. The study concluded that the patients felt like they had more

control of their care, became more involved in their self-care, and had a greater understanding of

when to report symptoms or changes in their health (Fathi, Modin, & Scott, 2017). Partners

Healthcare conducted a study about the use of telehealth and patients with congestive heart

failure. The study included 3,000 patients with a diagnosis of CHF. In the study, in-home

monitoring of weight, blood pressure, heart rate, and pulse oximetry was uploaded daily and the

system identified which patients needed attention from a provider or nurse. Three to four nurses

cared for a daily panel of 250 patients and this approach dropped hospital readmissions by 44%.
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The program saved about $10 million over a six year period and showed how telehealth can

extend the reach of healthcare providers, especially nursing attention (Kvedar, Coye, & Everett,

2014). Informatics has changed remote monitoring and access to healthcare for many patients in

this country. The Nursing Practice Committee (NPC) suggests that nurses use the American

Nurses Association (ANA) suggested model of assessment, diagnostics/ problems, outcome

identification and planning, implementation, and evaluation during communication (Lavin,

Harper, & Barr, 2015). This communication is a simple, electronic workflow that helps improve

communication during handoff at change of shift, admissions, transfers, and discharges (Lavin,

Harper, & Barr, 2015). Without the use of informatics in healthcare patients may experience a

delay in care, and experience complications because of the delay. Telehealth, telemedicine, and

telemonitoring are changing the scope of patients that can be seen by providers and is reducing

costly travel and missed days at work. In its most basic form, telehealth allows verbal and video

access to nurses and physicians no matter the person’s location. Education and monitoring have

become just a phone call away.

Legal and Ethical Issues

There are ethical and legal issues associated with telehealth nursing. The Code of

Ethics for nurses is a valuable guide when discussing ethical issues (ANA, n.d.). The Code of

Ethics has nine provisions and all are beneficial for a professional practice to institute so its

members are able to follow the same guidelines of ethical practice (ANA, n.d.). Legal issues

in nursing are typically precluded by laws that exist to benefit society, and any variation of

those laws would be a legal issue. An example of laws that may pertain to telehealth nursing

is the Healthcare Insurance Portability and Accountability Act of 1996, the Nursing Licensure
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Compact, and the Health Information Technology for Economic and Clinical Health Act of

2009 (Sewell, 2016).

An existing or potential ethical and legal issue is the licensure of nurses in each state

they are practicing. Sarhan (2009) describes this issue as the “jurisdictional issues associated

with cross-border consultation.” In telehealth, a nurse may be working for a company in

Virginia but they may be telecommunicating with a patient who lives in South Carolina. This

telecommunication is acceptable because under the Nursing Compact Licensure the nurse

practicing with a Virginia license can practice in South Carolina (Nursing Licensure Map,

2018). The Compact opened the door for telehealth and the allowed the use of one multistate

license to practice in all participating states (Landi, 2017). However, the nurse must be

familiar with further state rules and regulations for nursing that may differ from Virginia and

South Carolina.

Another existing or potential ethical and legal issues is the right to confidentiality for

each patient. Telehealth is not conducive to every patient being seen behind closed doors with

only members of the patient’s healthcare team. The nurse cannot guarantee that the patient is

in a private area when they made the phone calls to follow up with the patient. The patient

also has to trust the nurse is in a private area. The phone lines the nurse and patient, or nurse

to nurse, were talking through may not have been the most secure to discuss private health

information. There are ways for computer viruses to hack into the webcam of a a computer as

well, which is particularly distressing for nurse to nurse report using telehealth and webcams.

Confidentiality can be likened to provision three of the nursing code of ethics, in which the

nurse is required to advocate, promote, and protect the rights, health, and safety of the patient
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(ANA, 2015). The patient has a right to confidentiality and the nurse must protect and

promote that right through every medium of patient care.

Policy

The policy that should be implemented for healthcare facilities and healthcare

professionals are telehealth conducted reports. Evidence shows that nurse reporting is wide open

for errors or accidental omission of patient care details (Friesen et al, 2008). In fact, Friesen,

White, & Byers (2008) stated in their book Patient Safety and Quality: An Evidence-Based

Handbook for Nurses that the Institute of Medicine reported “it is in inadequate handoffs that

safety often fails first”. Nursing in particular is a good candidate for such a revision to workflow

because nurses are constantly reporting the condition of their patients and often have contact

with many aspects of patient care. There are many types of nursing handoffs that require report.

Some examples of handoffs are intra-facility transfers, discharge and inter-facility handoffs,

nursing unit to diagnostic or surgical area, and emergency department (Friesen et al, 2008). Inter-

facility handoffs can be particularly error prone and difficult because the facilities are

geographically separated, and once the transfer has taken place getting additional information

can be challenging (Friesen et al, 2008). Nurses working on different floors within a hospital, or

nurses in different facilities would be better served with webcam nurse to nurse report, especially

if a portable webcam can be used to conduct report at the bedside. Bedside shift reporting has

been researched to be a very effective way to conduct report (Friesen et al, 2008). There is

already some support for electronic assistance during handoffs. Research has indicated that

computerized clinical documentation systems (CDS) for nursing handoffs was perceived more

positively than without it (Friesen et al, 2008). There will be less patient errors and greater

patient and healthcare professional satisfaction if telehealth assisted reporting is utilized by

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healthcare facilities. As with all telehealth the use of informatics is essential to its function and

healthcare facilities would need a workflow process change to integrate telehealth assisted

handoffs.

Workflow Map

The workflow process of telehealth nurse to nurse report does improve the care of

patients. If a nurse is able to utilize telehealth reporting the report can be done at the bedside of

the patient. This gives the nurse receiving report the opportunity to identify the patient and

allows the patient to see their receiving nurse, and the patient can be an effective reminder to

address forgotten information. Telehealth nursing report may save the facility employee’s time

because the report is thorough and there is less necessity to have to call back the facility the

patient came from for clarification. The nurses can go through the discharge or transfer

summary together and identify any errors before the patient leaves the hospital. It is also helpful

for the receiving nurse to be able to see any prescriptions for narcotics the patient has ordered

and be sure the hospital physician has signed a script so the medication can be ordered from the

pharmacy. I have identified in my own care that during a transfer if the nurse is searching for

prescriptions and there is a delay in narcotic pain medication administration it can be physically

and emotionally detrimental for the patient in severe pain. The map attached below the

conclusion demonstrates the nursing workflow needed to replace the current workflow for an

increase of telehealth nurse to nurse reports.

Conclusion

In conclusion, telehealth nursing is a great asset to modern nursing practice and

without informatics telehealth would not be a possibility. Nursing informatics has come a
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long way since it was first introduced. Paper charting has now been replaced with electronic

health records and electronic charting that can be easily accessed by healthcare professionals.

Nurse to nurse report continues to be an error prone and time-consuming part of patient care,

especially if the patient is being transferred, admitted, or discharged. Nurse to nurse reporting

satisfaction and safety could be greatly improved with the use of telehealth medicine. Nurses

should be doing bedside report (even among different facilities) and be much more engaged

during report. Those changes can be achieved by using the webcam services on a portable

computer. Visualizing the reporting nurse and patient is much more involving and would

reduce errors and time-intensive clarifications between facilities. Telehealth reporting and

nursing informatics are a smart and effective option for patient transfers, admissions, or

discharges.

Workflow Map

Start

Admission

Notify Supervisor

Receive telehealth Greet patient

bedside video report through webcam
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Patient
Fill out nurse to
arrives
nurse report

Conduct patient
assessment Ask questions and
clarify patient care

Enter orders and

assessment in electronic Ensure narcotic
health record prescriptions are
coming with paperwork

End
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