Unlocking the Future: The Transformative Impact of Telehealth on Nursing Care

Since Florence Nightingale’s time, the nursing profession and its place in patient care have experienced exponential growth and transformation. It’s hard to fathom exactly how Florence would feel about all that has changed since that time, but it’s reasonable to assume that she would value the principles behind patient-centered care and the related technology. Watch this space to learn about telehealth nursing, one of the latest patient-centered technologies.

The Genesis of Telehealth

Today, we would typically envision most telemedicine scenarios as having flat-screen, high-definition monitors, with peripheral devices that help with physical examinations of patients. Patients can schedule a telehealth consultation from an app on their phone, and within minutes they can be virtually face-to-face with a healthcare provider.

Telehealth has long been associated with providing healthcare in a home setting. Some of the first mentions of telehealth appeared in an 1879 Lancet journal article, in which it was suggested that the newly invented telephone might be utilized for reducing unnecessary physician office visits.

Later, a physician providing a diagnosis over the radio was featured in a 1925 issue of Science and Innovation magazine, published by Hugo Gernsbeck, an early innovator in communications technology. In an article within this issue, Gernsbeck envisions an instrument that would eventually enable doctors to conduct video examinations with their patients over long distances. This predicted device, he named “Teledactyl,” would allow physicians to view their patient on a monitor of sorts, while a connected device in the patient’s home would be able to transmit the audio and video, but also have “arms” to touch or palpate the patient in the examination. Though homes today do not have devices such as this, it does bear some resemblance to what has been attempted with robotic surgeries.

Following that, during the WWII era, the first radiologic images were transmitted in Pennsylvania over telephone lines, which undoubtedly triggered later advances in teleradiology and imaging diagnostic services.

However, the first examples of telehealth that more closely exemplify today’s versions date to 1959, when clinicians at the University of Nebraska used two-way television to transmit neuro exams to medical students across campus. From that point forward, there have been numerous advances and applications in telehealth and health information transmission.

Modern-Day Telehealth

Today’s applications of telehealth are nearly limitless. Moving beyond landline telephone services, high-speed internet, and cellular capabilities have expanded the reach of health services to communities and populations that have historically been underserved. It is also important to note the impact that the COVID-19 epidemic had on telehealth, as care delivery underwent a paradigm shift borne out of necessity. Here are some ways that telehealth is used today:

Home and Community-Based Care

One of the largest areas of health-related needs and expenditures is in treating chronic disease. Aging populations are living longer and ultimately getting sicker. In response to this problem over a decade ago, the VA developed a care management model that incorporates frequent patient contact and regular physiologic measurement. This care management model provides education, observation, and feedback from a remote support team for disease management for patients in their own homes.

Using these technologies for the care management of chronic diseases has been linked to improved physiologic measurements, higher ratings of patient satisfaction, better adherence to prescription regimens, shorter hospital stays, fewer readmissions, and overall improved health expenditures.

At the forefront of home and community-based telehealth services are the nurses. Nurses engage with the patients, taking the physiologic measurements, providing education, and aiding in their adherence to medication regimens.

Office-Based Care

Nurses have long been involved in care models that link remote care to a primary or specialty care physician’s office. Nurses providing patient care remotely may perform some of the following tasks on behalf of a physician’s office or clinic:

• Discuss health-related issues with patients, such as medication regimens and diagnostic results.
• Describe possible courses of therapy and respond to inquiries about drugs.
• Teach patients how to take care of themselves at home by teaching them how to bandage wounds or cure minor burns.
• Assist with appointment scheduling.
• Provide remote assessments via phone or video.
• Assist patients before appointments and provide post-procedure follow-up.
• Triage patient conditions based on symptom severity and direct patients to seek the appropriate care.
• Monitor patient physiological conditions with smart devices such as glucose monitors, ECG monitors, blood pressure cuffs, pulse oximeters, and more.

Hospital-Based Care

Traditionally, in the hospital setting, you’d find that nurses are the backbone of bedside and procedural patient care. However, nurses can also play a major role in patient care delivery without ever touching their patients. Some examples include:

• Remote Case Management or Nurse Navigation: a virtual or telehealth nurse that guides the patient care pathway based on health, emotional, social, and financial needs.
• Virtual Nursing: a care model designed to assist bedside nurses. A virtual nurse might assist with completing admission and health history documentation, medication history, and discharge teaching.
• Remote Bed Management Nurse: A nurse who may work in a remote and centralized location for a large organization who assists with hospital throughput by arranging and assisting with patient transfers, admissions, and bed assignments.
• ED Phone Triage: Triage patient conditions based on symptom severity and direct patients to seek the appropriate care to reduce readmissions and unnecessary ED visits.
• Remote ICU Nursing: A nurse may conduct virtual rounding on each patient to identify needs or risks, facilitate visits with specialists, and coordinate visits with family members for patients in isolation.

Nursing’s Future with Telehealth

The future of telehealth looks promising for nurses and the patients they care for. The Connect for Health Act of 2023 guaranteed the expansion of telehealth services’ coverage under Medicare while permanently granting pandemic-related flexibilities. This guarantees that the specialty of telehealth will continue to expand, and concurrently, the opportunities in nursing care will also increase.

Conversely, the pandemic demonstrated that while nurses rose to the challenges presented before them, they weren’t prepared to handle the nuances and intricacies of telehealth care. Patient privacy, cultural considerations, and overall telehealth etiquette were concepts relatively unknown prior to the pandemic. Nursing school simply does not prepare nurses to deliver patient care through remote technological means. However, there is a push for telehealth nursing frameworks to be incorporated into the curriculum, though it has yet to be mandated.

Though there are many hurdles for the nursing profession to overcome as technology advances, some possible future applications might include:

• AI and Robotics: AI-assisted and remote nursing care, as well as bedside or procedural robots.
• Mobile Health: Use of health-related applications using mobile devices.
• Expanded Mental Health Services: Nurses can provide patient education, assist with program compliance, and conduct well-being checks remotely.

Telehealth will continue to move forward, providing positive impacts such as patient-centered care, expanded reach beyond traditional settings, and increased healthcare accessibility. As nurses, we must continue to educate ourselves, embrace technology, and engage in the development of new technologies to ensure that we can offer the best care possible in ways that are beneficial to the nursing process.