Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012)

Reducing Workplace Injuries Among Advice Registered Nurses

An area of concern for clinical nurse leaders (CNLs) is the increasing incidence of workplace injuries in integrated healthcare systems with call centers where repetitive stress injury (RSI) is among the leading causes of workplace injuries. Recurring pain and discomfort that call center Advice Registered Nurses (ARNs) experience hurts them and their teams, influences the operation of the call center, and decreases the quality of care provided to the healthcare system members. Due to high call volumes ARNs do not adequately use breaks or other measures to reduce physical strain. There is an opportunity to reduce RSIs through deployment of management support and existing resources utilizing small interventions that don’t interrupt workflow. To determine interventions for this evidence-based change of practice project an initial microsystem assessment was conducted using ARN safety report data to reveal the number and types of injuries. A subsequent microsystem assessment followed at six months, to identify any changes in the data. The assessments and safety report data suggested possible interventions, from which hotkeys, ForgetMeNot reminders, and microbreaks were chosen. The family of measures were completing ergonomic assessments, decreasing repetitive movements, and stretch break education. The ARNs benefited from the use of hotkeys and microbreaks and in contrast to the teams that do not use ForgetMeNot reminders, the project ARN team did not sustained any RSIs. This change of practice project showed that RSIs could be reduced through interventions specific to call center ARN work practices without interrupting workflow or decreasing productivity. Sustainability of the change of practice depends on leadership and manager support, safety pair engagement, and buy-in from the ARNs who benefit from a reduction in RSIs

Telehealth Nursing Research: Adding to the Evidence-base for Healthcare

This paper reviews recent, nurse-led telehealth research with the goal of describing research findings that provide evidence for practice. Methods: Using an iterative search method, of eight electronic databases, 84 nurse-led research papers were separated into intervention research, systematic reviews and meta-analyses, and descriptive research. The main emphasis was on full text analysis of the intervention research. Results: Fifteen intervention research papers reported findings related to cardiovascular disease, diabetes mellitus, older age, young adults, early adolescents, children with special health care needs, people with a stoma, post-partum mothers and nurses. Also reviewed for useable evidence for practice were 10 systematic reviews, two meta-analyses and two papers that described reviews plus meta-analyses. Resuts: Fifty-five papers with descriptive designs are briefly described. Nurse-led intervention research is increasing knowledge about the use of telehealth technology and applications in care delivery. People with healthcare needs do better with individual attention and increased follow-up. People have a tolerance for technology used with them to advance their quality of life and healing but there is a point at which too much technology is overwhelming. Clinical research is a challenge due to the number of extraneous variables that are difficult to control and that can affect a person’s response to the research intervention. Conclusion: Continuation of nurse-led telehealth intervention research will help to ensure that technology used to support and advance care delivery will be evidence-based

Australia’s Alcohol and Other Drug Telephone Information, Referral, and Counselling Services: A Guide to Quality Service Provision.

Ann Roche, Keith Evans, Tania Steenson, Ken Pidd, Nicole Lee, Lynette Cusack

Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

The effectiveness and cost-effectiveness of telephone triage of patients requesting same day consultations in general practice: study protocol for a cluster randomised controlled trial comparing nurse-led and GP-led management systems (ESTEEM)

notes: PMCID: PMC3574027This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Recent years have seen an increase in primary care workload, especially following the introduction of a new General Medical Services contract in 2004. Telephone triage and telephone consultation with patients seeking health care represent initiatives aimed at improving access to care. Some evidence suggests that such approaches may be feasible but conclusions regarding GP workload, cost, and patients' experience of care, safety, and health status are equivocal. The ESTEEM trial aims to assess the clinical- and cost-effectiveness of nurse-led computer-supported telephone triage and GP-led telephone triage, compared to usual care, for patients requesting same-day consultations in general practice.UK National Institute of Health Research Health Technology Assessment programmeDepartment of Healt

Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients

Telenursing is a way of caring for and educating oncology patients to promote self-care management at home. The objective of the study was to analyze the scientific evidence on telenursing in the care of oncology patients. This was a systematic and descriptive review in Spanish, Portuguese and English which was available in 3 databases: BMC, Pubmed and Scielo. The articles were selected in English, Spanish and Portuguese with data from 2010-2020. It was found that tele-nursing, a new form of access to the care service provided by nursing professionals to patients with oncology treatment, including technological tools allow a direct and timely relationship to respond to the detection of adverse events after chemotherapy, promote self-care and control and monitor the patient's health status at home. Conclusions: There is a need to use tele-nursing as an opportunity to care for the patient at home through virtual means by providing relevant information to promote self-care and quality of life

Palliative home-based technology from a practitioner's perspective: benefits and disadvantages

This critical review paper explores the concept of palliative home-based technology from a practitioner's perspective. The aim of the critical review was to scope information available from published and unpublished research on the current state of palliative home-based technology, practitioner-focused perspectives, patient-focused perspectives, quality of life, and the implications for clinical practice. Published and unpublished studies were included. An example of one UK patient-centered home-based technology is explored as an exemplar. The evidence suggests that despite the challenges, there are numerous examples of good practice in relation to palliative home-based technology. Improvements in technology mean that telehealth has much to offer people being cared for at home with palliative needs. However, some of the evaluative evidence is limited, and further rigor is needed when evaluating future technology-based solutions innovations

Synthesis of Data to Develop Cultural Competency Training for Telehealth Nurses Providing Outbound Disease Management Programs to Hispanic Patients.

Telehealth nurses deliver disease management programs to culturally diverse populations, including Hispanic patients. Disease management programs focus on chronic conditions such as diabetes, which are increasing in prevalence. The CDC predicts that the number of Hispanic people with diabetes will rise nearly six-fold by 2050. The nurses who deliver these programs via the telephone need training focused on culturally competent care. The purpose of this project is to review and synthesize information in order to develop cultural competence training for telehealth nurses providing disease management programs to Hispanic patients