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.americantelemed.org/about/telehealth-faqs-

2. Cigliuti, M., June 3, 2015; The Role of Nursing in Telemedicine; TeleNurse Network Blog, retrieved March 2, 2018; http://telenurse.co/the-role-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...