A starter guide to telehealth for nurses
2021; Lippincott Williams & Wilkins; Volume: 19; Issue: 3 Linguagem: Inglês
10.1097/01.nme.0000741824.79852.8b
ISSN1552-2032
Autores Tópico(s)Patient Satisfaction in Healthcare
ResumoFigureThe COVID-19 pandemic is rapidly transforming the US healthcare system, with telehealth, or virtual health, being a key driver of change. The pandemic has pushed telehealth into the forefront, creating more opportunities than ever before for nurses to monitor and care for patients remotely. Experts believe now that patients and providers have seen its benefits, teleheath will continue to be widely used, even post pandemic. What do you do if you're a nurse who's being asked to use telehealth for the first time? In this article, we give you some background on telehealth and tips to get you started. Pandemic regulatory changes Important regulatory changes have helped make it easier for patients and healthcare providers to use telehealth during the pandemic. The US Department of Health and Human Services and the Office for Civil Rights temporarily relaxed enforcement of some Health Insurance Portability and Accountability Act (HIPAA) rules. During the pandemic, providers can use applications such as FaceTime, Facebook Messenger video chat, Google Hangouts, Zoom, or Skype, to provide consultations. The Centers for Medicare and Medicaid Services (CMS) temporarily lifted some restrictive regulations around telehealth, including a requirement that the patient and the physician have an established relationship before telehealth is used. During the public health emergency, Medicare will reimburse providers for telehealth services at the same rate as in-person visits. The CMS has also indicated that healthcare providers could reduce cost sharing, such as out-of-pocket deductibles, for telehealth visits during the pandemic. In some cases, practitioners licensed in one state may provide services to Medicare beneficiaries in another state. Benefits of telehealth Telehealth connects remote patients to clinicians and eliminates travel time for care. This means that older or chronically ill patients don't need to find drivers or assistants to bring them to an appointment. Now, with COVID-19, the idea that telehealth protects patients from needless exposure to pathogens is being reinforced. Telehealth can also mean earlier intervention, which keeps patients at home and out of the ED. Telehealth has been used extensively in rural areas where patients live miles from hospitals and the number of healthcare providers is limited. Behavioral health has been another early adopter of telehealth, perhaps because patient assessment relies more on history than a physical exam. Telehealth has been used successfully with congestive heart failure (CHF) patients, for diabetes care, in hepatitis C treatment, and even to direct home dialysis. Limitations of telehealth Telehealth is a wonderful tool for facilitating patient care. However, it has its limitations. Telehealth isn't suited for situations that involve direct patient contact. For example, a dermatology clinic might use a video-facilitated telehealth meeting to visualize a patient's skin to check for skin cancer. The clinician may even ask the patient to upload pictures of areas of concern. But an in-person visit would be required to determine whether a biopsy is required and, of course, to perform a procedure. For some patients and providers, it's important psychologically to have a face-to-face meeting. As most of us have learned during the COVID-19 pandemic, telehealth isn't a complete substitute for an in-person conversation. Nuances of body language can be lost. Another limitation of telehealth is accessibility. Most Americans now own smartphones and many kinds of telehealth visits can be conducted via smartphone apps. But it's important to remember that the digital divide is real and not all patients have the technology for a virtual visit. Factors such as internet access and the ability to navigate a telehealth platform must be considered. And people with disabilities, such as visual or hearing impairment, may not have the correct equipment or resources to set up a telehealth visit. Finally, older patients may find the technical aspects of telehealth to be challenging or they may feel uncomfortable communicating with a "telenurse" or "teledoc." Many nursing roles There are many different roles in telehealth for both RNs and advanced practice nurses. Here are just a few examples. Sindhu works for a large health maintenance organization that offers case management for CHF patients. Her patients' daily weight measurements and BP readings are sent via Wi-Fi to her desktop database where she tracks the data and is alerted to patient issues. She facilitates a telehealth interview with patients whose medical conditions worsen. Martha is a family NP who treats patients with opioid use disorder through telehealth. She's able to visit regularly with patients via a HIPAA-compliant smartphone app. These appointments allow for maximum flexibility to bring service to patients who live in remote regions of her state. Robert is a home health nurse who provides wound and ostomy care in a suburban community. During the COVID-19 pandemic, his clinic has opted for telehealth visits to stay in touch with patients. Patients with smartphones are instructed on how to set up a teleconference for real-time wound and ostomy consults. Family members are encouraged to assist so they can collaboratively review the patient's care plan to optimize outcomes. Telehealth etiquette Nurses new to telehealth will find that although many of the professional behaviors and communication styles you've learned for traditional face-to-face encounters are still important, there are a few new considerations when caring for patients remotely. These tips for telehealth etiquette and professional behavior will increase the effectiveness of your patient appointments. Telepresence Think about your on-screen presence. Remember, to some extent you're on stage when communicating with patients via telehealth. We know that body language is key to in-person nurse-patient interactions; in a telehealth interaction where the patient usually sees only your face and torso, your tone of voice, facial expressions, and choice of words become even more important. Some clinicians practice in front of a mirror or role play with a colleague before a live patient encounter. A good rule is to act in the same way that's considered to be professional in a face-to-face visit, but remember that small things such as shuffling papers, looking downward, or glancing away from the camera are distracting to the patient and could signal disinterest or a lack of concern. Eye contact helps develop rapport and express empathy. However, it's often hard to maintain eye contact with patients due to camera positioning. Train yourself to look into your computer's camera, not the patient's image on the screen. Otherwise, it may appear as if you're looking down or off to the side. Nonverbal cues, such as nodding, smiling, and projecting an interest in what the patient is saying, are important. You can lean into the camera to show you're listening. Use facial expressions to demonstrate that you're an attentive listener. Projecting a professional appearance is also important. Some NPs wear their white coat even if they're conducting interviews from their home office. Some nurses wear scrubs to convey the message that this a medical visit. Solid neutral colors are less distracting to patients than bright patterns. Avoid low-cut blouses or tank tops. Keep jewelry small and nonintrusive. You want the patient to be focused on what you're saying, not what you're wearing. You can use your computer's camera to do a quick self-check and make sure you look ready for a visit. Environmental readiness Be sure that the background the patient sees is free of clutter and not distracting. Some video apps enable the user to choose a photo background, such as a bookshelf or office image. The patient shouldn't be able to see too much of your personal surroundings. You can also consider buying an inexpensive screen to set up behind your chair if you're working from home and don't want patients to see your household décor as a backdrop. Ask the patient if he or she is in a private setting before you begin discussing healthcare issues. If there's anyone else in the room with the patient, confirm that the patient is okay with that person being present. Ensure that your own environment is free from noise, such as barking dogs, ringing phones, and other office or home distractions. Make sure that the lighting, including from windows or skylights, isn't creating glare or shadows. Don't conduct telehealth visits in public areas using public Wi-Fi that could be compromised. Communication tips Introduce yourself and your role. Make sure that the patient understands the purpose of the visit. Start every meeting with a friendly greeting by asking the patient how he or she is doing, how the week has been, or some other conversation starter. Speak in your normal voice. You don't need to shout. One advantage with telehealth is that the patient with hearing problems can adjust his or her own computer or phone microphone volume. Be aware that sounds can be amplified; for example, chewing gum or eating while interviewing a patient can be very distracting. Be as descriptive as possible when you explain a process or care tip. Be as clear as possible and avoid long, rambling sentences. Listening is as important as how you speak during a telehealth session. Focus your mind on what the patient is saying. It can be helpful to jot down notes during the conversation. Telehealth provides an excellent opportunity to practice reflective listening, which can be used to clarify what the patient is saying. Repeat or paraphrase what you've heard the patient say. This kind of reflective listening can show empathy, as well as ensure that you understand the patient's meaning. Summing it up Many patients appreciate the ease of a telehealth visit. Some patients say that they feel more relaxed in the comfort and privacy of their own home and can be more open with their clinician than they normally would in a medical office. By following the tips outlined here and taking the time to be prepared, you'll be able to provide optimum support and care for your patients, wherever they may be. cheat sheet Telehealth definedFigureTelehealth is a broad term that describes a range of electronic and telecommunication technologies used to provide health services to patients at a distance. Examples of telehealth include real-time audio-visual communication that connects healthcare personnel and patients; remote patient monitoring tools that a patient uses at home to track vital signs and other data, which are sent to clinicians for analysis; and electronic messaging through text or purpose-built web 2.0 portals. on the webFigureAmerican Academy of Ambulatory Care Nursing:www.aaacn.org/practice-resources/telehealth California Telehealth Resource Center:www.caltrc.org CDC:www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html Institute for Healthcare Improvement:www.ihi.org/Topics/Telehealth/Pages/default.aspx
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