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Telenursing: the future of

telehealth

Transforming care at the bedside and


beyond – McGill Nursing Explorations 2009
October 23rd, 2009 - J.Desrochers

Nursing and Telehealth:


the perfect fit

Transforming care at the bedside and


beyond – McGill Nursing Explorations 2009
October 23rd, 2009 - J.Desrochers

Objectives
1. Define Telehealth, e-health,
Telenursing
2. Begin the reflection on the place of
Telenursing: why, what competencies,
accreditation, roles?
3. Look at different potential or current
roles for Telenursing, across the McGill
RUIS territory

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Telehealth
Syn: Telemedicine, Telehealth, E-health,
Connected health, Online health, etc.

 No generally accepted definition of


Telehealth

Telehealth
Health care delivered at a distance
Often used interchangeably
Telemedicine used more in the USA
One aspect of use of ICT

Quebec:
Telemedicine: physician-mediated interaction with
patient
Telehealth: telemedicine, telenursing,
telereadaptation, support to professional
practice…

E-health
Syn: Healthcare informatics, Health informatics
Includes:
EHR,
Telemedicine, Telehealth
Consumer health informatics, e-learning
Healthcare information systems (HIS), etc.
…healthcare practice supported by electronic
processes and communication technologies

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Telehealth
* is the use of information and
communication technology (ICT), over
large and small distances:
to deliver healthcare, social services , and
expertise,
for curative, preventive and rehabilitation
For training and information
In synchronous or asynchronous mode

*adapted from Canadian Society Telehealth

Telenursing
A) the use of ICT to deliver nursing care and conduct
nursing practice (Schlachta and Sparks 1998).
Encompasses a continuum of nursing to include
telephone triage through sophisticated interactive voice
and video systems whereby patients and providers can see
each other as well as hear each other *
B) the use of ICT enhances patient care… involves the
use of electromagnetic channels (e.g. wire, radio and
optical) to transmit voice, data and video communications
signals. It is also defined as distance communications,
using electrical or optical transmissions, between humans
and/or computers **.
*=ICN comptetencies for telenursing
** = http://www.icn.ch/matters_telenursing.htm

Telenursing
* Refers to the use of information and
communication technology (ICT), in
nursing, over large and small distances:
to deliver care and expertise,
for curative, preventive and rehabilitation
For training and information
In sychronous (real time) or Asynchronous
(differred time) mode
Direct (nurse-person encounter) and
indirect (nurse-caregiver encounter)
*adapted from Canadian Society Telehealth

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Telenursing
Examples of…
Nursing Informatics
Telehealth nursing
Telephone triage nursing
Teletriage
Telecare
Telepresence
Telephone nursing
Telehomecare, home telecare

All terms encompassed in this presentation


* = http://www.icn.ch/matters_telenursing.htm

What do Nursing and Telehealth


have in common?

Collaborative partnership
approach to care

Essential ingredients of collaborative


partnership
1. Sharing power
2. Being open and respectful
3. Being nonjudgmental and accepting
4. Living with ambiguity
5. Being self-aware and reflective

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1. Sharing the power
Believe in the importance & value of
sharing the power
Each partner has something to
contribute

Example:
New service delivery MUST be a joint
venture - for instance, the implementation
of a teledialyse service

2. Be open and respectful


Openness
Willing to develop, engage in relationship
See situation through other person’s eye

Example:
Implementing a D.R screening programme
among a first nation commmunity, where
partners are multiple: FN council, Quebec
Commission of First Nations, Health Canada’s
CNS, Tertiary centre experts

3. Be non-judgmental & accepting


Show tolerance for other person’s
belief, values, behaviours or
perspectives

Example:
Working to build a program in support of the
professional practice of nurses working in remote
settings – working across cultures – ex: Fishing
season …goose hunting, etc.

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4. Living with ambiguity
There are at least 2 drivers, to define
issues, direction, goals, etc.

Example:
We were already to go, when H1N1
happened in the remote community...
The nurse was just about to address a
sensitive issue during the encounter when
the connection broke down, momentum
was lost ...

5. Being self-aware & reflective


Foster individualized, flexible approach
to care

Example:

Indicators of Collaborative partnerhsip


in a telenursing intervention
1. Power sharing
 The nurse does not feel solely responsible
Openneness
 Both sites feel comfortable to disagree
Non-judgmental
 Move from « safe » topics to sensitive ones

Tolerance to ambiguity:
 Neither jumps to premature conclusions
Self awareness and reflection
 « good dancer » attuned to subtle changes in
other

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Telenursing
Person: patient, peer, community, etc,
The use of ICT in the relationship, transforms
the partnership…
Example:
Presence of non-professional: IT technician, present
during the session to manipulate technology;
IT quality: Image quality distorsion during a crucial
moment in the interaction
Remote site homecare nurse attends session

Telenursing vs Nursing
Scope of practice: unchanged
Competencies, as per ICN
Professional, ethical and legal practice
Care provision and management
Professional development

The virtual Health and Social


services Centre (CvSSS)
The project that will structure the
delivery of telehealth and telenursing
Implementation of 4 specialised clinical
integrated « networks »:
Cancer care: teleoncology
Women’s health: teleobstetrics
Mental health: telepsychiatry
Cardiac care: telecardiology

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Faculté de médecine, Université McGill

McGill RUIS
Centre universitaire de santé McGill
CH St. Mary
Sir Mortimer B. Davis Hôpital général juif

28 organisations:
Institut Douglas
CSSS de la Montagne
CSSS Cavendish CSSS du

23 CSSS
Sud-Ouest-Verdun
CSSS de Dorval-Lachine-Lasalle
CSSS de l’Ouest-de-l’Ile

1CHU
CSSS du Pontiac
CSSS de la Vallée-de-la-Gatineau
CSSS des Collines

3 CUA/Institut
CSSS de Gatineau
CSSS de Papineau
CSSS du Lac-Témiscamingue

1 Faculty of Medicine
CSSS des Aurores-Boréales
CSSS Les Eskers de l’Abitibi
CSSS de Rouyn-Noranda
CSSS de la Vallée-de-l’Or
CSSS de Témiscaming-et-de-Kipawa
CSSS du Suroît
CSSS Jardins-Roussillon
CSSS Vaudreuil-Soulanges
CSSS du Haut-Saint-Laurent
Centre régional de santé et de services
sociaux de la Baie-James
Centre de santé Inuulitsivik
Centre de santé Tulattavik de l’ungava
Conseil Cri de la santé et des services
sociaux de la Baie-James

10,000
Inuit in 14
villages
&
20,000
Cree in 9
communities

Northern
Quebec
910,000 km2
of the
953,900 km 2

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Teledialysis

(2000km
)
(1000km
)

CvSSS: structuring the future


Providers
Requesting partners 1 MUHC
Telehealth JGH
Isolated Regions Coordination Centre Douglas Institute
Patients/Communities
Specialists Fax CRCL
Family Physicians Telephone HSM
3 CvSSS
Other professionals E-mail
Delivery Web Val D’Or
Care/services Pierre Janet
Access to Virtual Health and social services Centre

Virtual visit initiated by host site

3 Access to CIS
Event Planning for all TH Access to provincial EHR
for all network partners
2 3

Documentation and archiving


of clinical notes/documents

1. Professional, ethical, legal


Accountability
Acquire IT training on ones used in
organisation
Assist remote site when needed to provide
safe care
Ethical practice
Instruct patient about alternatives/options

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2. Care provision and management
Assessment
Adapts assessment, processes and procedures to
technologies in use
Care management
Assess person/environment for appropriateness
for use of Telehealth
Ensures patient safety
Cultural appropriateness (organisational & ethnic)
Delegation and supervision
Maintains accountability of delegated acts
regardless of physical location

3. Professional development
Professional enhancement
Acquires familiarity/capacity to use ICT
Refines protocols impacting pt and practice
Continuing education
Acquires general knowledge technical
operations of ICT

What role do you see for Telenurse?


Certification?
Competencies?
Telenursing workshop Nov.1, 2009
McGill RUIS 1st Telehealth Symposium

Thank you!

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