How do you judge the bedside manner of a digital nurse?
Managing the expectations of patients receiving care from remote nurses is one of the biggest challenges of telenursing. Providing care from afar by digital means such as video conferencing is already a major part of our healthcare reality. The technology exists to perform even traditionally “hands-on” procedures–including measuring blood pressure and glucose levels–without having to be within touching distance.
But healthcare is more than just functional. We have become accustomed to receiving other types of support from our nurses, family doctors, and caregivers. The challenge for the digital delivery of healthcare, which has proven to be a valuable addition to medical services in rural and remote areas, is to convince us we’ll get the same comfort, reassurance, and trust over a Skype connection as we do in a more personal setting.
So, what does that mean for us as patients? Do we have to change our bedside expectations, or does the digital delivery of medicine have to become more personal?
Digital Doctors and Nurses
Telenursing, the delivery of nursing services by remote technology, is already common. More than 70 percent of healthcare providers currently use some form of remote digital medicine–a rise from 54 percent five years ago. These services are made up primarily of mental health and primary care engagements via:
- Patient apps
- Remote patient monitoring
- Remote monitoring of off-the-shelf consumer devices
The number of annual telemedicine visits in the U.S. rose from around 200 to more than 200,000 between 2005 and 2017.
The technology has been deployed by leading providers including the Mayo Clinic and the Department of Veterans Affairs–which spends $1 billion on research annually and has treated more than 700,000 patients remotely–and has been sponsored by state and federal governments. More importantly, the number of annual telemedicine visits in the U.S. rose from around 200 to more than 200,000 between 2005 and 2017.
Despite this rapid rise in patient engagements, a recent report into the future of telenursing published by the U.S. National Library of Medicine concluded that while digital delivery would become a cornerstone of 21st-century healthcare, it was “incontrovertible” that technological advancement would never replace the work of nurses at the bedside.
And we agree, to a point. Certainly, there’s no reason for all nurses to be remote. But, since digital devices will make it possible for nurses to complete all their core duties remotely, why shouldn’t their care match the quality of in-person care?
The Challenges of Telenursing
The Library of Medicine report’s conclusion is based on a view that a nurse’s physical presence near a patient is integral to delivering optimal, patient-centered, and evidence-based clinical services. It says nothing, however, about why those facets of the role cannot be replicated online.
For their part, the American Psychiatric Association has declared that video-based care provided outcomes equivalent to in-person care and the American Medical Association has endorsed expanding the use of telemedicine.
The University of San Diego has introduced advanced training programs that teach nurses how to build relationships with remote patients.
If the clinical aspects of the nurse’s role can match the standard set by in-person care, then the challenges of telenursing lie in overcoming the perception that something inherent to a person’s recovery is lost when a computer screen is placed between a caregiver and a patient.
Even that problem has a potential solution. The University of San Diego has introduced advanced training programs that teach nurses how to build relationships with remote patients while performing their medical roles. The courses focus on the importance of physical appearance and physical cues during video conference consultations, limiting visual distractions, and looking directly into the webcam.
This kind of training seems like the best way to improve the challenge of remote interaction. Ultimately, however, it seems likely that patients will simply accept the loss of a little human interaction as a necessary sacrifice in return for increased convenience, accessibility, and effectiveness of medical services.
A Positive Patient Experience Doesn’t Have to Be In-Person
While we believe that both the healthcare and social aspects of nursing can be replicated via video conferencing, telenursing is still best understood as an additional service rather than a replacement. In rural and remote areas, where a trip to the doctor involves lengthy travel, having instant access to a medical opinion over the internet is an obvious advantage. The same can be said for cases where the patient is socially isolated. We have seen a number of in-home devices reach the market that make it easier for nurses to monitor the recovery and ongoing treatment of elderly patients, for example. In such cases, the additional social interaction that would not occur without video conferencing is again a clear benefit.
It could be that we need to learn to think of the patient experience as something more like an online customer support service than a vibrant emotional exchange.
Understandably, there is more concern over the challenges of telemedicine in relation to bedside care in areas where in-person nursing is readily accessible. Patients who seek out convenient online nursing services may simply have to make do with polite conversation and maybe the exchange of digital photos of grandchildren rather than sharing a cup of coffee and a hug. Provided that the level of remote care matches that of in-person services, that seems like a small price to pay. It could be that we need to learn to think of the patient experience as something more like an online customer support service than a vibrant emotional exchange–at least in some cases.
Despite these challenges of telenursing–and perhaps the change in thinking that may need to accompany remote healthcare–there’s no reason why remote nursing can’t become the dominant form of first contact in a 21st-century healthcare system.