Nursing Issues: Telehealth, Technology and Nursing Practice: Complementary Futures
As the provincial regulatory organization for registered nurses, the RNANS operates within a mandate that includes, among other services, programs that support the delivery of safe, competent, ethical nursing care. On the strength of this mandate and the organization's values of accountability and life-long learning, a proposal and a business plan were developed to obtain funding from the Department of Health. Knowledge development was at the core of the proposition to integrate telehealth technology for accessible, appropriate, cost-effective clinical education for registered nurses that would contribute to continuing competence and improved patient care. The Department of Health recognized the idea as one solution to immediately benefit the nursing workforce during a period of considerable government-driven health system change. The government also recognized the potential public service benefit of improved patient care and agreed to 100% funding for the first year of the project in the Eastern Health Region. Other RNANS partnerships working to make clinical education via telehealth a reality involved the Eastern Regional Health Board, which provided office space for the new staff coordinator. TecKnowledge also partnered to assist with staff recruitment and implementation logistics for program delivery.
Clinical education programs via telehealth were launched in the
Eastern region in May 1998 to
the 14 health facilities where 1,100 registered nurses practice. Six one-hour sessions are delivered by clinical nurse specialists and other clinical experts each month based on education priorities identified by nursing staff. Some of the priorities identified included specialized content areas such as oncology, palliative care (pain management, practice guidelines, program development), emergency care (assessment, triage, practice guidelines), mental health (critical incident debriefing, assessment, pharmacology), gerontology (functional assessment, family counselling) and communicable disease control including HIV management. Sessions may be repeated to extend access when scheduling or workloads are deterrents to participation.
After one year 1,449 participants accessed telehealth clinical education sessions. Of these, 1,082 were registered nurses and 367 represented other health professionals for whom the content was relevant, for an average of 20 participants per session. The telehealth interactive video conferencing technology was readily adopted by participants as an acceptable approach to delivering clinical education support. The appropriateness and relevance of the education content was highly rated by 98-100% of participating nurses, the majority of whom accessed the network from rural areas. Prior to the availability of telehealth, nurses would have had to travel considerable distance and pay a workshop fee. The evaluations frequently noted the need for continued clinical education on-site and appreciation for the effectiveness of telehealth in eliminating traditional access, cost and distance barriers.
As access to knowledge becomes increasingly critical to delivering quality health services, it is notable that many nursing practices are based on intangible knowledge such as experience, tradition, intuition, common sense, and untested theories. By contrast, tangible knowledge comes from captured data such as research reports, databases and best practices. Telehealth is helping nurses to learn best practices for enhancing clinical competence and improving patient care. Almost 90% of participating nurses noted the impact of the education sessions in terms of updating procedures, more comprehensive patient assessments, improved accuracy on test interpretations, and integration of new communicable disease and pharmacology information. Some unanticipated but positive comments from participants suggested a greater sense of loyalty to the RNANS for initiating the project, acknowledgement of a larger sense of "professional community" among nurses from the various participating sites and with the clinical expert delivering the content and recognition for education solutions that fit site specific contexts. Experience with the network has also engaged nurses in using the technology for direct patient services, for example, demonstrating nursing care procedures from the hospital to home care nurses in remote communities to support continuity of care for discharged patients.
Today the telehealth network links all health care facilities in the province by interactive video conferencing, related telehealth equipment and high speed telephone lines. This expansion means that every registered nurse (9,400) can access clinical nursing education through the network. The RNANS has moved forward with the delivery of education services to all sites and continued evaluation of the effectiveness of this strategy for enhancing continuing competence and improving patient care. The Department of Health has sustained funding support at 66% of the total operating costs. Overall, telehealth has proven to be a strategic initiative for the Association and a powerful stimulus for other technology applications that increase our capacity to deliver on our mission including improving connections with nurses and the public for better healthcare.
About the Author(s)
Carolyn Moore, RN, MScN (University of Toronto) is the Executive Director of the Registered Nurses' Association of Nova Scotia. She holds Adjunct Professor appointments in Nursing and in Health Services Administration, Faculty of Health Professions at Dalhousie University.
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