Telenursing Future in Solving the Nursing Global Workforce Gap

*Zainab Attia Abdallah, Engy Abdel Rahman Khamis, Fatma M. Ibrahim and Ayiat Allah Wagdy Farag*

### **Abstract**

Although there are 28 million nurses worldwide, it is not enough to meet patient needs. So we face a future with too much work, with too few workers. Telenursing can help in solving this issue by utilizing the technology in providing distance healthcare and health education to patients/clients with lower costs, effective services and proper clients' satisfaction especially in rural areas through insufficient accessibility to local clinics or hospitals. Telenursing can use phone calls, video visits and remote monitoring devices in different nursing fields as family, pediatric, geriatric nursing and/or others. Telenursing can improve the quality of nursing care for patients by building relationships with them and improve the preferable outcomes. Telenursing also can decrease the work burden on nurses and direct contacts with patients with negative related health consequences specially after COVID 19 pandemic.

**Keywords:** telenursing, telehealth, telemedicine, distance healthcare, nursing practice, nursing education, nursing shortage, technology, COVID 19 pandemic

### **1. Introduction**

Telenursing means use of digital devices as phone calls, video visits and remote monitoring devices in different nursing fields as family, pediatric, geriatric nursing and/ or others. Telenursing means as the nursing services can be provided through electronic platforms, which includes phone calls, video conferences and remote patients' monitoring through different electronic devices. Applying of telenursing in healthcare systems with related health and safety benefits, can provide high quality of life and significant financial benefits to all of patients, family and health and welfare services. It creates the necessary for the development of electronic learning (e-learning) in nursing, telenursing simulation, evidence based nursing practice and nursing research. Telenursing also includes health education services, vital signs' regular remote monitoring, ECG or blood pressure and remote doctor or nurse-patient consultations as needed [1].

According to the American Telemedicine Association, 50% of health services could be provided by telehealth. To cover the needs of healthcare systems and to achieve the balance between the health team workforce and the quality of care, we need to 1.1 million new registered nurses at least. The Global Healthcare Expert, Dr. Mark Britnell, reported that by 2030, the global will face a future with too much work, with too few workers. He said: "We will reach 18 million health workers short by 2030 and this represents a gap to care." So, the need for solving the nursing and health team workforce become very necessary from now. Appearance of many global technological methods in health care delivery systems through COVID 19 pandemic, may make the problem solution slightly easy [2].

Telehealth offers flexibility and accessibility of patients to their documents and nurses and health care providers safely from home, with more control of their health care. Additionally, nurses can be accessed with telehealth equipment to host virtual meetings with their patients. Using telenursing in providing health care has several advantages as cost savings, convenience, and overcoming patients' care with mobility limitations especially rural areas' citizens who meet difficulties in accessibility to healthcare resources [3].

The integration of telenursing principles in academic programs becomes very necessary to expand the documentation bases for telenursing services and to develop such a new nursing theory involving the impact of telenursing on patient, family, community, health care delivery systems and research protocols. The future challenges in telenursing could be the technological advancement in health care systems and the training of future nurses and health care providers based on clinical simulation and online courses to apply distance-based nursing care [4].

## **2. Overview of telehealth and telenursing**

Telehealth or telemedicine is defined as where a health provider can provide care or health services without a direct face-to-face office visit, but from a distance and is done electronically, online with internet access with different devices as a computer, tablet or smartphone. Telemedicine also has many other definitions as Mobile Health or Health Mobile, Telehealth and E-Health. Telehealth Nursing is applying of different telehealth technologies as tools to provide health care in a variety of ways as addressing of social determinants of health such as [5]:


Telenursing refers to using of information technology in providing nursing care and services through mobile devices and computers whenever distance exists between patient-nurse, or between a number of nurses or health care providers. Based on accessibility of mobile devices, telehealth becomes more prevalent as one of healthcare options. Telenursing as a field, is a part of telemedicine, and has a direct and indirect contacts with other medical applications and others of non-medical, as tele-diagnosis, teleconsultation and tele-monitoring. Telenursing enables patients from connecting nurses through mobile devices/applications, video technology, computers and also remote patient monitoring. So healthcare does not be limited to in-patient clinical setting, patient can access nurse and/or primary care providers at any location [6].

### *Telenursing Future in Solving the Nursing Global Workforce Gap DOI: http://dx.doi.org/10.5772/intechopen.110745*

There is a variety of tools using in providing health care through telenursing. As well as, nurses can use telenursing for sending information to patients through websites or mobile applications. They can monitor patient condition regularly through remote monitoring. However, telehealth and telenursing are not comprehensive enough and still being developed, they become more utilized than ever as clients are preferring face to face interaction with nurses or other healthcare providers. Recently, telenursing is growing up in many countries. This growing in some countries may be because of the preoccupation in driving down the affordability of health care services, increasing of aging and chronically ill persons and the increase in desiring of coverage of health care to distant, rural areas, small/sparsely populated regions. There are many examples of applying telenursing technology as a tool of providing care as the following [7]:


### **3. Historical background of telehealth and telenursing**

In 1870s, Graham Bell the inventor of telephone carried out the first telephonic call aiming for management of battery acid burns. In 1912, Australian Inland Mission applied nursing care for nurses in remote areas. In 1929, The first telenursing service was through the Trager pedal radio processing services communication between outpost nurses and flying doctors. In 1960 National Aeronautics and Space Administration (NASA) invented and applied a telemedicine to monitor astronauts' health. During 1970s, some health organizations used nurses to give advices through telephone. In 1974, Mary Quinn documented the Logan airport care providing to patients from Boston through telemedicine [5]. In 1997, the Indian Apollo group of hospitals carried out telemedicine via the first outreach use of communication technology. Following that in 2003, a telehealth certificated course was started by Apollo group of hospitals with cooperation with Annamalai University by training of 30 students in each batch. In 2005, International Council for Nurses (ICN) conducted the international telenursing survey which revealed that nearly 719 tele-nurses responded positively. After 2005 and all over the world, telenursing became to be applied more, and nurses and patients' tele-interaction become more noticed and advanced gradually [8]. By spreading of COVID 19 pandemic in the end of 2019, different countries have directed to use innovative methods for fighting against COVID 19 virus. The main challenges for all healthcare systems all over the world were large number of patients, in addition to who could be cared at home, shortage of health team members especially doctors and nurses, lack of intensive care units' facilities and lack of

hospital capacities. Therefore, recent methods had been proposed, tele-nursing was one of the good ways to control COVID 19 pandemic [9].

### **4. Telenursing' legal, ethical and regulatory issues**

Telenursing is surrounded by legal, ethical and many regulatory issues, as what happens with telehealth. Those legal issues such as malpractice, negligence and accountability, etc. are also still repeated and difficult to address. Ethical issues also include maintaining autonomy, patient's integrity as well as harmless of clients. In many countries, practical telenursing is forbidden because, the tele-nurse must have a doubled license; one in state/country of residence and another in the location where patient receiving telecare and services. So, the *telenursing licensure* helps in resolving some of these issues [10].

Telenursing professionals store and chart patient data using an electronic medical record (EMR). Transmission of digital clinical data can increase the risk that outside sources may break the confidentiality of sensitive patient information by intercepting and exploiting them. Therefore, tele-nurses should strongly audit all of their current and available security measures and assess how to protect their patient privacy and protection through applying of policies. Most of tele-nurses are working for a hospital or organization which providing them by laptops with a recent and very high level of security and encryption, so that hackers and/or other outside sources cannot intercept patients' confidential sensitive and personal information [11].

Currently, the Health Insurance Portability and Accounting Act (HIPAA) summarize rules and regulations discussing how nurses and healthcare providers protect patients' personal data through storing and sharing. HIPAA declares that patients' identifiable information should to be encrypted so that only the nurses and other healthcare professionals involved in patients' care can access it. In addition to, many other considerations related to the patients' confidentiality and safety of their clinical data [10, 11].

### **5. Types of telenursing delivery models in nursing practice**

Mainly, there are three types of Telenursing delivery models. The *first model* is storing and forwarding technologies to enable transferring of diagnostic imaging and physiologic data starting with digitally generated, stored then transferred as needed, without necessary of patient's presence. For example, vital signs, lab results, diagnostic tests such as MRI, CT, ultrasound and x-rays. *Second model* is live videoconferencing which is carried out by using of advanced telecommunication technologies such as virtual two-way, real-time using computers, microphones, audio and video transfer. It can be used for live visits specially for mental health, urgent care, patient education and other care management. Remote monitoring is the *third model*, using remotely for monitoring patients through digital technology to collect medial information then transmitting it to other specified healthcare providers at another location which named as Center for Connected Health Practice (CCHP). *Fourth model* is mobile health (MHealth) which means using of smart phones or mobile devices in healthcare provision. It means that any nursing care or health services can be provided through a combination of all or some of the other telehealth types. For example, using of mobile

devices in patients' home which can transmit daily vitals, lab results for more frequent access to care, as diabetes and cardiac diseases [12].
