Nurse telepresenters” provide efficient care with a human touch

Kathleen Daman Optimized

It feels as if there are daily changes occur­ring in the health care world. With the onslaught of medical insur­ance challenges, soaring health care costs and subse­quent belt tight­ening, health care is charged with finding ways to save while providing the same high-level of care.

Despite these shifts, nurses are tasked with providing the same high level of care with fewer resources and are often the human touch point for our patients, which is why the intro­duc­tion of technology into health care is seen as both a blessing and a curse. Technology allows us to provide better monitoring and oversight, but poten­tially decreases the human touch and personal care that patients desire and need. As health care evolves, Telemed­i­cine relies on nursing to deliver safe, quick and efficient care while ensuring that the patients know they are the No. 1 priority. 

One partic­u­larly successful program devel­oped at the facility in which I work, is the TeleLung Cancer Screening program. This program was devel­oped to provide access to a nation­ally and inter­na­tion­ally renowned Lung Cancer screening program to a geograph­i­cally remote area in Washington state, Port Angeles on the Olympic Penin­sula. The program follows the rigorous U.S. Preven­ta­tive Services Task Force (USPSTF) guide­lines for lung cancer screen­ings and through Telehealth provides excel­lent service to this remote locale. Both sides of the camera are supported by nurses, both the DNP in Seattle and the BSN in Port Angeles. A collab­o­ra­tive approach to providing high-quality and person­al­ized care to this popula­tion has been well received by the patients and is a source of pride for all involved. 

On the patient side, nurses present” the patient to the provider, utilizing the Telep­re­senter” term. The role of Telep­re­senter was initially devel­oped over 20 years ago as a mecha­nism to assist the provider in evalu­ating or presenting” the patient in those areas of the country where physi­cian resources were stretched or nonex­is­tent and the patient popula­tion was spread across a large geograph­ical area. Coupling technology with this role allowed the patient to stay locally (partic­u­larly impor­tant when travel condi­tions were impacted by weather, etc.) while receiving the care that they needed from their provider. 

Training nurses to the role of Telep­re­senting includes clinical and technical workflows along with specifics about exami­na­tion needs. Where the nurse Telep­re­senter is involved is on the patient side, the Telep­re­senter educates the patient to the technology, HIPAA compli­ance and encryp­tion mecha­nism. During the consult, the Telep­re­senter ensures the provider is intro­duced and aware of all in the patient’s room and then assists the provider in any requested assess­ments, using any periph­eral technology as indicated.

Official Photo Jpgx2 Optimized

Kathleen Cuff Daman

Feedback from staff in facil­i­ties that have adopted telemed­i­cine and the role of Telep­re­senter has been overwhelming positive as they readily see benefit to their commu­nity and their practice. Staff appre­ciate working with providers who are well versed in the technology and collab­o­ra­tive in working with the nurses, assuring an efficient process for patient evalu­a­tions and/​or admissions.

The role of nursing within Telemed­i­cine is compat­ible and completely supports our patient-centered care model. Deliv­ering high-quality health care where it is not currently avail­able, whether due to geograph­ical obsta­cles, finances, lack of special­ized providers or trans­porta­tion barriers, via Telemed­i­cine enables health care providers to improve patient outcomes. With the support of the American Academy of Ambula­tory Care Nursing (AAACN) and the American Nurses Associ­a­tion (ANA), nursing has the capability to change the landscape through supporting varying modes of care delivery with technology assis­tance. I would challenge the nursing practice to be open to new modes of delivery, with our continued focus of patient-centered care and advocacy. 

Comments below from Telep­re­sen­ters working with hospi­tal­ists in a south­west Washington hospital provide examples of how Telemed­i­cine is perceived and accepted. 

When you wake up an on-call doctor in the middle of the night you may get some backlash. But the [tele] hospitalists are great… you know they are there and awake.
— Janiece Zauner, MSN, NP
The TeleHospitalist vs. at night home doc has been great since starting it here at MGH. I am able to reach the doctor in a timelier manner. The doctor can beam in and re-evaluate a situation at any given notice. I feel like I have more back up. It has been great.
— Laura B.-RN MSP
I love Dr. C. I had a patient that was not doing so well overnight. I spoke with Dr. C., she listened to me. Orders changed to fit the situation, and when results were back she listened. Dr. C. had the patient transferred to a higher level of care quickly in the middle of the night. Before the TeleHospitalist this situation would have taken three to four times longer waiting for the hospitalist to come in from home. I feel our patients have definitely benefited from this service.
— Barb P.-RN ICU
When describing how the TeleHospitalist system works to our patients prior to the admission exam, I sometimes get the odd look from the elderly patients. ‘What do you mean the doctor is not here?’ After demonstrating the equipment that will be used, they now seem more intrigued about what is going to happen. Many times during the exam with the doctor or at least after the exam many have said ‘this is so cool, I can’t wait to tell the grandkids I actually talked to a doctor over the computer and they were so nice.
— Nathan P-RN House Supervisor

1. Retrieved February 28, 2018, from American Telemed­i­cine Associ­a­tion: FAQs https://​www​.ameri​can​telemed​.org/​a​b​o​u​t​/​t​e​l​e​h​e​alth-faqs-

2. Cigliuti, M., June 3, 2015; The Role of Nursing in Telemed­i­cine; TeleNurse Network Blog, retrieved March 2, 2018;‑o…

3. Retrieved February 26, 2018, from American Telemed­i­cine Associ­a­tion: Video­con­fer­encing-based Telep­re­senting Expert Consensus Recom­men­da­tions, 2017. http://learn.americantelemed.o…

4. Haynes, T. October 17, 2016; American Academy of Ambula­tory Nursing Care website, retrieved March 2, 2018; Telehealth Nursing Practice; https://​www​.aaacn​.org/professi…