E-NURSING AND TELENURSING

INTRODUCTION

Nurses all around the world have risen to the challenges of new technology. Today, the nurses
work in a variety of E-Health programs. They access online libraries and databases of clinical
practice guidelines from computer in their work places. Nurse in specialized area of practice
now interact with their peers in discussion groups over the internet. Nurses also involved in
standards development for the implementation of electronic health records and many nursing
educational programs are now offered online.

DEFINITION OF E-NURSING

E –learning involves the use of a computer or electronic device ( e.g a mobile phone ) in some
way to provide training, educational or learning material. – Derek Stockley 2003

GOALS OF E-NURSING

To enhance nurses to benefit from all developments in information, communication and

technology, to improve nursing and client outcomes.

PURPOSES OF E-NURSING

To guide the development of ICT initiatives in nursing so that nursing practice and client
outcomes are improved.

TYPES OF E-NURSING:

 Smarter decision making: ICT initiatives such as electronic health records, telehealth,
database, e-mail and internet resources enhance the decision making process. They
give nurses access to timely, evidence-based and expert information, enabling them to
make swifter, better-informed judgements on behalf of their patients. The result is
safer patient care and better health outcomes.
 E-Nursing work outs: nurses reap the full benefits of technology into their daily
practice. Health care organizations are beginning to acknowledge the necessity of
providing nurses with access to information, communication and technology that
supports nursing care, yet the implementation of such tools needs to be accelerated.
METHODS:

E-learning methods may include the following:

 Computer-based training
 Web-based lectures and presentations
 Virtual classrooms in which learners are logged on to an online classroom
environment at different times (asynchronous) or at the same time (synchronous) as
the learning activities are happening.

E- NURSING STRATEGY FOR PROFESSION:

Nurses in clinical practice:

 Participate in ICT initiatives, identify needs and evaluate possible solutions

 Increase competence in use of ICT
 Access multiple source of information for evidence-based practice

Employers and administration:

 Recognizes ICT as a tool of professionals nursing practice

 Supports involvement of nurses in ICT initiatives
 Encourage adoption of ICT that supports nursing practice.

Educators and researchers:

 Incorporate ICT competencies into curriculum

 Develop research programs to optimize nurses’ use of ICT

Nursing organizations:

 Provide leadership for nurses’ involvement in ICT

 Recognizes ICT competencies as part of entry-level and continuing competencies
requirements.

ADVANTAGES OF E-NURSING:

 Integration of information, communication and technology

 Improved information and knowledge in the nursing practice
  Human resource planning will be facilitated
 New models of nursing practice and health services delivery will be supported
 Nursing group will be well connected
 Improves the quality of nursing work environments

DISADVANTAGES:

 High expense
 Decreases manual contribution
 Increases dependence on ICT
 Misuse of the technology provided

TELENURSING

Telenursing is a component of telemedicine.Telenursing is the branch of telehealth that involves

actual nursing and client interaction through the medium of information technology. Offers
health related activities at a distance between two or more locations using information and
communication technologies (ICT). Tele “at a distance” Telenursing –“care of patients at a
distance”.

Evolution:

 In the 1970s, several health maintenance organizations began utilizing nurses to give
telephone advice—in the role that physicians once served.
 Beginning in 1974 with Mary Quinn, who documented her care with patients at Logan
Airport via telemedicine while she worked from a hospital in Boston, Massachusetts.
 Since that time, creative nurses have used technology to advance healthcare in a variety of
ways. Many advanced practice nurses are now leaders in telenursing practice.

DEFINITION:

‘ Telenursing refers to the use of telecommunications and information technology for providing
nursing services in health care whenever a large physical distance exists between patient and
nurse, or between any numbers of nurses’. – Wikipedia
Tele -nursing is the delivery of nursing care and services using telecommunications, increases
access to nursing care interventions for clients in remote or distant locations. – Chaffee , 1999;
Helmlinger & Miholland, 1997; Yensen, 1996

Types

 Remote monitoring:
 The nurse monitor the patient remotely from his/her house
 Patient transmit data to nurses; the nurse plans the intervention
 Used for handling chronic diseases like heart disease, diabetes, asthma etc
 Interactive telenursing services:
 It involves series of interactive sessions with client via phone conversation and online
communication
 Used to obtain history, physical test, psychiatric assessment, ophthalmology evaluation
 Store and forward telenursing:
 Used to obtain medical images, audio or video data that can be forwarded to a nurse at
a suitable time for evaluation offline
 Areas utilized are dermatology, radiology and pathology
 Specialist and primary care consultations
 Patients sees a nurse over a live video connection or using diagnostic images/video along
with patient data to a specialist for viewing later
 Imaging services
 Used in radiology, pathology and in cardiology

Telenursing technologies include activities such as

• Videoconferencing

• Medical imaging and

• Data transfer.

Mobile telemedicine

Videoconferencing uses telecommunications of audio and video to bring people at different

sites together for a meeting.
 This can be as simple as a conversation between two people in private offices (point-to-point)
or involve several sites (multi-point) with more than one person in large rooms at different sites.

Videophone calls (also: 'video calls' and 'video chat') differ from videoconferencing in that they
expect to serve individuals, not groups.

Webcams are popular, relatively low cost devices which can provide live video and audio
streams via personal computers, and can be used with many software clients for both video calls
and videoconferencing.

How a videoconferencing can benefit people around campus:

• Faculty member keeps in touch with class while away for a week at a conference.

• Guest lecturer brought into a class from another institution.

• Researcher collaborates with colleagues at other institutions on a regular basis without loss of
time due to travel.

• Schools with multiple campuses can collaborate and share professors.

• Faculty member participates in a thesis defence at another institution.

• Administrators on tight schedules collaborate on a budget preparation from different parts of

campus.

• Faculty committee auditions a scholarship candidate.

• Researcher answers questions about a grant proposal from an agency or review committee.

• Student interviews with an employer in another city.

• Tele -seminars.

Factors promoting the requirement for Telenursing:

• Increasing shortages of nurses.

• Costs of health care.

• Need to provide Cost effective, timely and quality healthcare (remote, rural people).

• Rise in Aging and chronically ill population.

APPLICATION:

Home care

One of the most distinctive telenursing applications is home care. For example, patients who
are immobilized, or live in remote or difficult to reach places, citizens who have chronic
ailments, such as chronic obstructive pulmonary disease, diabetes, congestive heart disease,
or debilitating diseases, such as neural degenerative diseases (Parkinson's
disease, Alzheimer's disease or ALS), may stay at home and be "visited" and assisted
regularly by a nurse via videoconferencing, internet orvideophone. Other applications of
home care are the care of patients in immediate post-surgical situations, the care of
wounds, ostomies or disabled individuals. In normal home health care, one nurse is able to
visit up to 5-7 patients per day. Using telenursing, one nurse can “visit” 12-16 patients in the
same amount of time.

Case management

A common application of telenursing is also used by call centers operated by managed care

organizations, which are staffed by registered nurses who act as case managers or perform
patient triage, information and counseling as a means of regulating patient access and flow
and decrease the use of emergency rooms. McKesson is a leading telephone health service
provider in the United States of America, as well as in Australia.

Telephone triage

Telephone triage refers to symptom or clinically-based calls. Clinicians perform symptom

assessment by asking detailed questions about the patient's illness or injury. The clinician's
task is to estimate and/or rule out urgent symptoms. They may use pattern recognition and
other problem-solving process as well. Clinicians may utilize guidelines, in paper or
electronic format, to determine how urgent the symptoms are. Telephone triage requires
clinicians to determine if the symptoms are life-threatening, emergency, urgent, acute or non-
acute. It may involve educating and advising clients, and making safe, effective, and
appropriate dispositions—all by telephone. Telephone triage takes place in settings as diverse
as emergency rooms, ambulance services, large call centers, physician offices, clinics, student
health centers and hospices.
 Advantages of tele-nursing:

• With all of the new diseases and health issues emerging this is a way to learn faster in an effort
to save lives and minimize risk or discomfort to the patient.

• Helps to keep patients out of hospital.

• Sharing valuable medical information with doctors and nurses in other countries around the
world and in all areas of the profession.

• Greater job satisfaction among tele-nurses.

• Help solve increasing shortages of nurses.

• Telenursing is cost efficient, timesaving and increases patient‘s ability to self-care.

• Minimises the length of hospital stay.

• Reduce distances and save travel time.

• Improvement of resource and time allocation.

• Another valuable way telenursing can be of use is for military personnel. They are often times
located in areas of the world that telemedicine is the only way to diagnose and treat them.

• The fact is that telenursing can go anywhere. It is both versatile and effective.

Disadvantages of Tele-nursing

• First of all, one problem is that many fear that it will take away from personal one on one time.

• Conferences and video can‘t replace valuable time between nurse and patient or more personal
discussion that nurses and clients might otherwise have with each other.

• Legal complications are raising another red flag. Laws and a set code of rules and ethics will
first need to be applied before telenursing can be used regularly in various capacities. This alone
might take some time.

• Services and how nurses get paid for them will all need to be resolved as telenursing becomes
a more fluent practice. This can prove to be a difficult determination.

• Technical problems in 3-D imaging

• Lack of standardisation and legislation

• Problems in assessing qualifications

• Problems with security and identification

• Missing clinical anamnesis and examination

• False diagnosis

• Lack of ability to touch or direct delivery of care to a patient by nurse.

• Technical skill is needed by nurses.

• Network connection error / failure / delay.

• Reliability of networks

• Then we have clinical risk and over dependence on this telenursing system.

• Due to the risks involved with what is reliable vs. unreliable information and over dependence
or over use of telenursing can easily get out of control until more uniformed strategies and
procedures are put into play.

• Telemedicine is not yet all worked out where it can be utilized constantly or flexibly.

• But, it has enormous potential to be a tremendous asset to the world and all its civilizations.

• More time and effort will be needed to organize telenursing for it to be confidently accepted.

• Telemedicine Infrastructure Telemedicine (more than 400 platforms)

ROLE OF NURSE IN TELENURSING:

 Ensure proper and accurate documentation in electronic or paper format

 Carry out only the activities you are competent and authorized to perform
 Ensure the privacy, security of patient information
 Established client-nurse relationship so as to establish duty of care
 Take into account client’s spiritual and psychosocial needs and preferences as
everybody is unique
 CONCLUSION:

Telenursing is a component of telemedicine. Telenursing is the branch of telehealth that involves

actual nursing and client interaction through the medium of information technology .A
telemedicine system can be as simple as a computer hook-up or as advanced as robotics-surgery‖
facility. Therefore as a nurse we must always give importance to patient care and by helping
them meet their needs as soon as possible and with the use of information and communication
technology.
 REFERENCES:

1) Deepak N, Sarath CC, Mithun BP. A comprehensive textbook on nursing management.

Bangalore: EMMESS Medical Publishers; 2013.p.420
2) Clement I. Management of nursing services and education. 2 nd ed. India: Reed Elsevier Pvt.
Ltd; 2015.Pp: 241-42.
3) Brar K.N. Textbook of advanced nursing practice. 1st ed. New Delhi: Jaypee Brothers
Medical Publishers(p) Ltd; 2015. p.190-200
4) Brian N. The Emergence of Telenursing . Available at
blog.diversitynursing.com/blog/the-emergence-of-telenursing
5) Vati Jogindra .Principle and Practice of Nursing Management and Administration.1st
ed.Kundli Haryana: Jaypee Brothers Medical Publishers(p) Ltd;2013.p.664-674
6) Telenursing. Available at https://en.wikipedia.org/wiki/Telenursing
7) X.S Blessing Nimasjai. A Study to Evaluate the Effectiveness of Telenursing Programme on
Immunization among B.Sc. Nursing Students. International Journal of Healthcare
Sciences.2017;4(2) 1459-1473.Available from www.researchpublish.
 ABSTRACT
“A Study to Evaluate the Effectiveness of Telenursing Programme on Immunization
among B.Sc. Nursing Students”

Mrs. X.S. BLESSING NIMASAJAI

Abstract: Immunization triggers an immune system response by which the vaccine develops
long-term protection (immunity) that would normally follow recovery from many naturally
occurring infections. By the aims to protect children in the Kingdom of Saudi Arabia and all
community groups from diseases, the Ministry of Health (MOH) published the approved
version of the vaccination schedule on 01/01/2013 to remind parents of the dates of
vaccinations and follow-up. Telehealth and telenursing has become the new reality in
studying nursing. A quasi experimental study was done to evaluate the effectiveness of
telenursing programme on creating awareness and knowledge regarding immunization and
KSA vaccination schedule among B.Sc.nursing students at Applied Medical Science
College , Alnamas.

Aim/objectives of the study:

1) To assess the demographic variables of B.Sc. Nursing students

2) To assess the pretest awareness regarding immunization and KSA vaccination
schedule.
3) To assess the pretest knowledge regarding immunization and KSA vaccination
schedule.
4) To assess the post test awareness regarding immunization and KSA vaccination
schedule
5) To assess the post test knowledge regarding immunization and KSA vaccination
schedule
6) To evaluate the effectiveness of telenursing programme on immunization and KSA
vaccination schedule.
7) To associate the post test knowledge regarding immunization and KSA vaccination
schedule with selected demographic variables.

Hypothesis: Null Hypothesis

Methods: A Quasi Experimental approach is used in this study. 25 students were selected by
simple random sampling method. The tool used for the study includes demographic data ,
Awareness and Knowledge Assessment Questionnaire, Power point presentation on
immunization and KSA vaccination schedule. After collecting the data, data was analysed
using descriptive and inferential statistics. Frequency and percentage were calculated for the
demographic characteristics of B.Sc. Nursing students and percentage, mean, standard
deviation, mean percentage were calculated for awareness and knowledge level. To see the
effectiveness of telenursing programme, “z” test was used.
 Result: Regarding the effectiveness of telenursing programme on immunization and KSA
vaccination schedule is assessed by „z‟ test. The study findings reveals that the post-test
mean score was higher than the pre-test mean scores of both awareness and knowledge .The
„z‟ value for awareness is -24.29 and P value is< 0.00001 which was significant at 0.05
level. The „z‟ value for knowledge is -7.6963 and P value is < 0.00001 which was
significant at 0.05 level. Regarding the association there was association between post test
knowledge score and age, year of study, available apps for video conference and area of
residence. There was no association found between post test knowledge score when
compared to previous schooling.

Recommendation: Based on the study, nursing students can utilize telenursing programme to
give health education in the schools, hospitals, and community. Also they can utilize
telenursing in both service and academic. Conclusion: The study reveals that telenursing
programme is effective in creating awareness and knowledge regarding immunization and
KSA vaccination schedule among B.Sc. Nursing students at Applied Medical Science
College, Alnamas.