**10. Global using of telenursing during COVID 19 pandemic**

Although telehealth and telenursing are not new concepts, their use became widely necessary and popular with the appearance of COVID-19 pandemic. So many societal changes are globally occurring science the rise of COVID-19 pandemic. All of these global changes lead the health field to create new ways for providing care with promoting of social distancing as possible, quarantining as needed and preservation of some limited hospital services [32].

Using of telehealth and telenursing as a response to cover the patients' needs during COVID-19 pandemic in not only inside the strong financial countries' healthcare systems, but also through the developed countries systems according to their available resources. In the United States, definitely on March 27, 2020, some legislations were passed in order to protect both patients and healthcare providers through the growth of telenursing capabilities in the country. Also the CDC reported that possibility of telehealth use is very recommended to eliminate the spread of COVID-19. Applying of telenursing enables the country from keeping the high-risk patients' safety in their homes and receiving their routine care at the same time. Telenursing also allows Corona Virus positive nurses with mild symptoms to continue caring patients online from home [33].

Telenursing has significantly raised during the COVID-19 pandemic, because it can increase the social distancing by eliminating the patients' need for traveling and going to crowded areas. Decreasing the cost of personal protective equipment (PPE) as vital needs for health team is another benefit of telenursing. The benefits of telenursing during this pandemic can promote infection control, connect health team from different regions and allow rapid triage [34].

Before the COVID 19 pandemic, a limited sector of the general workforce was working occasionally from home. In the European Union (EU), the incidence of home-based teleworking and the combined mobile telework especially in providing of healthcare services was varied around 30% in Denmark, Netherlands and Sweden and nearby 10% in Czech Republic, Greece, Italy and Poland [35]. According to important findings of a study, the United States workforce that are working distance from home or through another alternative location reached about 20%, 16% in Japan and just only 1.6% in Argentina [36].

Based on applying of the global social distancing strategies, almost 4 between 10 employees in Europe used teleworking. Also health team members starting to use telehealth and telenursing in order to face the shortage of workforce especially in nurses. Other ways of teleworking started to be appeared as mobile health and monitoring [37]. The most noticed increase in teleworking was in the most affected countries by Corona virus, and based on where well developed teleworking was before the pandemic as in Finland, Luxembourg, the Netherlands, Belgium, Denmark, Ireland, Italy, Austria and Sweden by 40–60%. Also telehealth and telenursing were applied in Japan using the most recent robotic system and very advanced artificial intelligence technological devices [34].

Using of telehealth and telenursing during COVID-19 pandemic also appeared through the Middle East and inside the Arab countries with their different healthcare systems according to their available resources. In Egypt, telehealth and telenursing were applied using new technological devices which affected positively on the health care system in decreasing the patients' waiting list, increasing the health team members' efficacy and limiting the work burden on them. It reflected on the number of patients' visits to different outpatient clinics which decreased to 50% specifically in family medicine clinics [38].

In Saudi Arabia, the Ministry of Health applied "Seha," the e-health application which is free of charge, to enhance the healthcare system. This App support the visual medical consultations and apply face to face medical consultations for all citizens with their doctors anywhere across KSA. The "Seha" application was providing audiovideo communication any time even through the weekends. In United Arab Emirates, the health care delivery system established telematics and telemedicine applications among 50% of hospitals for the long term provision of healthcare services. Through those hospitals, 90% of doctors and nurses providing healthcare by using smartphones and medical applications. Several UAE companies already provide telehealth services through different applications such as Health at Hand, TruDoc 24×7 and InstaPract. Also health insurance companies discovered that telehealth services can reduce healthcare costs [38] .

**Figure 1** clarifies the Data Bridge Market Research report and related expectation belonging the huge growing in telehealth market of Middle East and Africa from 2022 and forecast to 2029, by type as software, hardware, systems and telecommunication. This growing also will be appeared in delivery modes as cloud-based delivery mode, on premise delivery mode and web-based delivery mode. The market of applications on smart phones or other electronic devices also in continuing growing involving general consultation, Gynecology, Cardiology Pathology, radiology, dermatology and others. So the end user of all the previous types and examples of telehealth and telenursing technologies will be reflected on growing the international market of hospital telehealth, home telehealth & telenursing and/or physician telehealth [39].

**Figure 1.**

*Data Bridge, Market Research, Market Analysis Study: 2022. Published Report, Middle East and Africa Telehealth Market. https://www.databridgemarketresearch.com/reports/middle-east-and-africa-telehealth-market.*
