DOES TELEHEALTH NURSING IMPROVE COMMUNITY HEALTH PATIENTS’ HEALTH OUTCOMES?
CHAPTER 1
Definition of the Problem
Nursing is an important field in healthcare as it is the process of caring for, or nurturing, for an individual known as the ‘patient’. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing (Gubrium, 1993). To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences (Gubrium, 1993).
Traditionally, nurses perform their services ‘on field’. Meaning - patients can acquire the services of nurses personally when they are confined or having transactions in hospitals or clinics. Nurses can also be hired for personal care at home. In other words, nurses can either be home-based or hospital-based. However, the recent surge in Information Technology added another alternative on how nursing services can be acquired. IT has spurred the recent escalation of various telehealth applications (Lehoux et al, 2000). Telehealth means acquiring the services of nurses through technology-based delivery methods, such as videophone skill training, and one- and two-way interactive computer networks (Coen et al, 2002). These new methods of giving access to people to health service is seen as the panacea to reach rural areas that do not have access to urban healthcare services (Coen et al, 2002).
However, despite the boasting of technology integration on healthcare services, some questions are still left unanswered. For instance, there still lack of consensus on whether telehealth nursing services are as effectives as traditional methods of nursing. Furthermore, there is also the lack of evidence that telehealth is really an effective healthcare service tool for citizens to embrace.
Introduction to the Study
This study investigates the effectiveness of telehealth in improving the community health patients’ outcome. As a new method of nursing, telehealth must first be tested in order to validate its contributions to healthcare. Proponents of new technologies might emphasize the speed and efficiency of the Internet in reaching out remote areas. However, one must also take into consideration the importance of human contact when it comes to healthcare.
Healthcare service is like teaching the patients how to address the health problems they face. It also means giving the proper care for them to recover from whatever illness they have. The problem with telehealth is its long-distance nature, whereas interaction between the patients and the service providers are miles away. This problem is analogous with the problems seen in distance learning. The advantages of distance learning include the conservation of time, space, and effort for students (McDonald, 2002). Furthermore, it provides students more flexibility in balancing their academic lives with their personal lives (McDonald, 2002). However, theories of human development emphasize the importance of personal human contact and interaction (Lerner, 1997). Theoretically, the absence of personal contact in distance interaction blocks some dimensions of learning that is important to any educational experience. Furthermore, experienced teachers deliver many subtle messages and important lessons in such classrooms, which might be diminished in online learning, which will decrease social and emotional learning (Donlevy, 2003). In addition, students with low reading abilities and problems with motivation may find it difficult to sustain interest in accomplishing all the learning activities associated with distance learning (Donlevy, 2003).
How can those situations analogous with telehealth? The simple explanation is that the patients are learners as they are ignorant about the nature of their illnesses, how it is treated and the likes. On the other hand, the healthcare providers can be considered as the teachers, educating the patients about what they should do or how they should treat their illness, or what type of care should be effective. Relating the situation to distance education, those who subscribes with telehealth services may have problems on several factors. First, there can be a problem with how they comprehend the information being given to them. Information might be too technical for the layman to understand. Another problem is that not all rural citizens know how to use the Internet. Furthermore, the lack of human contact in online interaction may affect the patients in a sense that they will not take advises seriously. Of course, all of these are just assumptions as it is still unclear which among distance and close interactions are effective. However, the effectiveness of telehealth nursing services can be quickly determined by surveying patients who prefer such service. Patients who prefer telehealth nursing service may have experienced something new about it that they like, unique to traditional nursing services. Gaining insights from their perspective may lead to the discovery of the effectiveness of telehealth nursing services or how it affects their health outcomes.
Purpose of the Study
Nurses acknowledge that the nursing profession is an essential part of the society from which it has grown. The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. The American Nurses' Association has defined nursing as "the diagnosis and treatment of human responses to actual or potential health problems." Just as medical diagnoses help in the planning, implementing, and evaluation of medical care, Nursing diagnoses help in the planning, implementing, and evaluation of nursing care (Mitchell, 1997).
Nurses practice in a wide range of settings from hospital to visiting people in their homes. Nursing is the most diverse of all healthcare professions. It is a universal phenomenon appearing in some form in every culture (Haller, 1979). Through this study, a new discovery about one of the recent trends of nursing can be discovered. The purpose of this study is basically to help alleviate the practice of nursing by identifying several key issues on telehealth nursing. As a new means of practicing nursing, telehealth should be evaluated in terms of effectives so that actions for improvement can be implemented.
Problem Statement
Because telehealth nursing is utilized through the internet, it may have a number of disadvantages that may stunt effective health outcomes of its proponent patients. Generally, the study will explore the effectiveness of telehealth nursing in promoting health outcomes.
Research Questions
Specifically, the study will answer the following questions:
1. How do patients of telehealth compare their experience in such service with traditional nursing services?
2. For telehealth users, what advantages do they get from using telehealth?
3. What are the perceived and experienced disadvantages of telehealth for users?
4. Do users receive effective health outcomes from the telehealth services they use?
Definition of Terms
The following are important terms that will be usually used in the study:
Health Outcome – for this study, it refers to the effect of the health service strategy to the person, whether the strategy is traditional nursing or telehealth nursing.
Nursing - refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences (Gubrium, 1993).
Patient – for this study, it refers to the person receiving telehealth services.
Telehealth – incorporates the wide array of systems available to transmit data from remote locations; refers to a technique of delivering health care where communication with the client is achieved at a distance, rather than in person (Marineau, 2005). Using personal computers and telecommunications systems, healthcare providers are now able to assess, diagnose, and monitor patients at a much lower cost than for face-to-face encounters (Allejo, 2005).
Telemedicine - the transfer of electronic medical data (i.e. high resolution images, sounds, live video and patient records) from one location to another. This transfer of medical data may utilize a variety of telecommunications technology, including, but not limited to: ordinary telephone lines (POTS), ISDN, ATM, the Internet and satellites.
Assumptions
The study will explore the following assumptions:
1. That because of the lack of human contact, telehealth is not an effective alternative to traditional nursing.
2. Telehealth has many other issues such as costs and the IT literacy of the user that may hamper the effectiveness of the service.
Limitations and Delimitations
One of the perceived limitations of the study is that an unexpected occurrence might take place during the study that may affect the dependent variable. The maturation of the study can also be a problem, as respondents may grow weary of finishing the questionnaire for some reason. Furthermore, respondents may also be grouped in classes, whereas the first class are true proponents of telehealth, while the others are just using telehealth because it was recommended to them. The instrumentation can also be a problem as a 5-point Likert Scale will be used. Uninterested respondents may just answer the questionnaires haphazardly for some reasons.
On the other hand, a delimitation problem may arise from the interaction effects of pretesting as those who are not pretested may have difficulty understanding the questionnaire. Another external validity problem is the accessibility of the respondent’s home. Furthermore, perhaps the most difficult problem is to identify or to look for respondents that actually subscribing the services of a telehealth.
CHAPTER 2
Literature Review
The following shows the annotated bibliographies of some of the related literatures cited for the study.
Holdereger, J., Fortune, J. and Barbara, F. (2000). Bridging the Gap: Telehealth in Profoundly Rural America. Presented at the Annual World Congress of the International Association for Scientific Studies of Intellectual Disabilities. Cheyene, WY. USA.
Holdereger et al (2000) describes the activities and outcomes of a telehealth project in Wyoming in which clinical psychologists use state of the art satellite technology to consult with paraprofessionals who live and provide treatment settings to persons with the dual diagnosis of developmental disabilities and mental illnesses. Individuals who were subjected to consultations were asked to fill a one-page evaluation form that asks about the helpfulness of online consultation. Results show that consultees think of the service as between ‘definitely helpful’ and ‘probably helpful’. Their rationales for such response are: receiving factual information; receiving specific recommendations; interacting with the consultants and their own team mates; interpersonal qualities of the consultants; receiving an alternative viewpoint; getting feedback on their current practices or case conceptualization; the structuring of consultation services; the specific benefits provided by teleconferencing medium i.e. visual contact, effective transfer of information, and cost effectiveness.
Ajello, J. and Dansky, K.H. (2005). Marketing telehealth to align with strategy. Journal of Healthcare Management. Vol.50, No.1; pp.19-30
Ajello and Dansky (2005) investigated management practices used to promote telehealth services, focusing on strategic goals for adopting telehealth. Interviews with senior managers from 19 home health agencies identified three strategic goals for adopting telehealth; clinical excellence; technological preeminence, and; cost containment. The study found through the analysis of organizational documents that organizations with the highest marketing scores emphasize clinical excellence as a major reason for using telehealth, whereas those with the lowest marketing scores tend to focus on cost containment.
Sirigindi, S.R. (2001). Integrated health care and telemedicine. Work Study, Vol. 50 No.6; pp. 222-229
Sirigindi (2002) discusses the impact of information technology on medicine and health care, and introduces the concept of an integrated health information system, and details its functions and its benefits, especially for developing countries. Accordingly, the advantages of telehealth or telemedicine include: the chance for teaching hospitals to expand and export their skills to the remote primary centres; lowers the cost of fetal ultrasound; provide advantages to teleendoscopy because of the capability of image transfer; and the convenience it can provide to patients as it avoids unnecessary or even harmful travel – and expense for the patient and family.
Marineau, M. (2005). Health/illness transition and telehealth: a concept analysis using the evolutionary method. Nursing Forum, Vol. 40, No.3; p.96.
Marineau (2005) explored the health/illness transition that occurs when an acutely ill client may be discharged into the home with telehealth in place of hospitalization or in an effort to promote an earlier discharge from the hospital. The analysis is a part of a longitudinal study and it involves twenty-nine HHAs in a mid-Atlantic state participated in this study during its first year. The respondents were divided into two: early adopters (prior to July 2002) and new users (after October 2002). Semi-structured questionnaires were used for instrumentation and data were analyzed through content analysis. Marineau (2005) found that the concept of the health/illness transition using telehealth has not been researched. Marineau (2005) suggested that qualitative methods of research using interviews could enhance the knowledge in selecting appropriate individuals and nursing interventions to enhance the clients" transition from the hospital to the home with telehealth.
Gagnon, M.P., Lamothe, L., Fortin, J., Cloutier, A., Godin, G., Gagne, C., and Reinhars, D. (2005). Telehealth adoption in hospitals:an organisational perspective. Journal of Health Organization and Management, Vol.19, No.1; pp. 32-56
Gagnon et al (2005) explored the influence of hospitals’ organisational characteristics on telehealth adoption by health-care centres involved in the extended telehealth network of Quebec. A review of literature and a questionnaire was administered via telephone interviews to the 32 hospitals involved in the Extended Telehealth Network of Quebec. Also, multiple case studies was conducted among nine hospitals representative of different categories of telehealth adopters, and in-depth interviews with various actors involved in telehealth activities were also conducted. The study found that telehealth programs are not isolated, but located within larger health organisations. Moreover, health-care organisations are also positioned in a larger geographical, economical and socio-political environment. Therefore, it is important to investigate the context in which telehealth projects are taking place prior to experimentation.
Research Methodology
The research will be exploratory and will deduce a particular hypothesis. Furthermore, the research will be based on positivism.
Hypothesis
The research will test the hypothesis: “Telehealth nursing is inferior to personal settings because it lacks human contact, but it is less expensive than the latter”.
Population/Sample
The study will survey and interview 50 telehealth nursing customers. Convenience sampling will be used because of the difficulty to find such group of persons. The focus of the study will be elderly people who use telehealth as targeting a specific group of respondents will help increase the validity of the results. The respondents will be divided into two groups: new users and old users.
Data Collection
Surveys and interviews will be used for data collection. This will be incorporated with the use of semi-structured questionnaires. Questionnaires will be sent to the respondents through email.
Instrumentation
A self-administered questionnaire, or the type of questionnaire that is usually completed by respondents (Saunders et al, 2003), will be constructed by the researcher to gather the needed data. This questionnaire will have two sections: the first part intended to acquire the demographic profile of the respondents, and the other section comprised of a set of attitude statements that intends to determine the level of agreement or disagreement using a five-point Likert scale. In the Likert technique, the degree of agreement or disagreement) is given a numerical value ranging from one to five, thus a total numerical value can be calculated from all the responses. (Underwood, 2004) The equivalent weights for the answers were:
Range Interpretation
4.50 – 5.00 Strongly Agree
3.50 – 4.00 Agree
2.50 – 3.49 Uncertain
1.50 – 2.49 Disagree
0.00 – 1.49 Strongly Disagree
Data Analysis
The latest SPSS software will be used for data analysis. The weighted mean and percentage of the results will be presented through tables in the study.
Summary
The study explores the health outcomes of telehealth nursing services to patients. Although many claims that telehealth has many advantages, the rationale of the study is that its lack of human contact makes it less effective to traditional method. Thus, the hypothesis: “Telehealth nursing is inferior to personal settings because it lacks human contact, but it is less expensive than the latter” will be tested. Surveys and interviews using semi-structured questionnaires will be sent to 50 elderly telehealth nursing customers to acquire their perceptions on the matter. Data will be analyzed with the use of the latest SPSS.
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