**11. Telenursing development in worldwide nursing research**

Up to date major nursing researches in telenursing are still focusing publication on the developed countries mainly as the United States, Canada and the United Kingdom which mainly still leading the field. The main findings of those major telenursing researches appear a positive significant association between the telenursing development's level and the technological development levels of countries. Different telenursing trials in such developed countries have proven that integrating of telenursing into the mainstream of their healthcare delivery systems is feasible and very beneficial [40].

There are so many telenursing trials all over the world which approved that mixed levels of efficacy could be reached among different age group of populations and through different healthcare dimensions as older adults' self-care management of many chronic illnesses, prenatal, natal and postnatal services specially in family planning counseling, surgical recovery, pediatric health care and emergency services. The majority of telenursing researches have demonstrated their outcomes of supporting the effectiveness of nursing care and related competencies, for reducing inaccessibility and contributing to nursing education, training and development [1].

Also nursing research based on telenursing trials in developing countries are presenting the same outcomes of those developed ones. As examples, applying of telenursing programs, trials and styles in nursing researches in such poor income African countries as Ghana, Nigeria, Ethiopia, Kenia, Egypt are detecting the big benefits and effectiveness of telenursing applications, mobile-based data, devices and other types in healthcare delivery system. Although the weak level of technological developments of developing countries, their findings were as the same line of other developed with nearly recommendations as many future researches in different telenursing dimensions as well as adding of telenursing education in the undergraduate and postgraduate curriculums [41].

Most recommendations of the recent telenursing research papers are focusing on the need for further research efforts be directed to theory-driven researches about communication, which will lead to effective telenursing process. Policy-makers and telenursing managers need to improve the management design of telenursing operations for optimizing of related efficacy and quality. Using of different telenursing

models still in need to further research and developments to be adopted and integrated widely into the healthcare delivery system [19].
