Christianne Fowler

Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations.

Abstract Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practices.

Influenza: Past, Present, and Future

Influenza is a viral infection of the respiratory tract spread by airborne transmission. Vaccination remains the best strategy for influenza prevention, and is especially recommended for high-risk groups, such as residents of nursing or residential homes, as well as those with diabetes, chronic renal failure, or chronic respiratory conditions. The clinician must realize the importance of active surveillance in addition to symptomatology interpretation and diagnostic testing to reliably and efficiently diagnose influenza. Active surveillance allows the clinician to monitor regional patterns of influenza movement to know when influenza is present in any given area. Surveillance data allows the practitioner to effectively time vaccination programs and implement prophylaxis protocols as indicated. An influenza management protocol ensuring the prompt recognition and management of influenza outbreaks should be devised and implemented for high-risk facilities. Managing clients with influenza requires prompt diagnosis and initiation of therapy, including use of antivirals available for the prevention or treatment of influenza. Because of the severity of morbidity and mortality caused by the influenza virus among older adults in particular, it is imperative that gerontological nurses have expert knowledge related to influenza. The clinician who participates in active influenza surveillance, promotes vaccination programs, implements influenza management protocols, and stays abreast of recent breakthroughs in the arena of influenza research--such as the development of neuraminidase inhibitors--will be able to contribute to diminishing the morbidity and mortality impact associated with influenza.

Telehealth and eHealth in Nurse Practitioner Training: Current Perspectives

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.

How to Prepare Interprofessional Teams in Two Weeks: An Innovative Education Program Nested in Telehealth

Abstract Problem: Preparing health professional students for interprofessional collaborative practice, especially at a distance where provider shortages prevail remains difficult. Approach: A two-week interprofessional education (IPE) immersion experience preparing students from 11 disciplines and four universities was implemented. Week-one, using online technology, students develop/present an interprofessional careplan for a complex patient. Students then meet face-to-face to conduct group interviews with two standardized patient dyads. Week-two, students develop a website for use of the patient dyads. Websites are presented to faculty and fellow students via an online virtual meeting space. Outcomes: To date, 594 students have participated demonstrating capacity to: 1.effectively engage in interprofessional care,  2. utilize Telehealth to impact care and break down barriers of isolation, and 3. implement skills to advance healthcare. Conclusion: IPE combined with Telehealth technology provides future providers with knowledge and skills for interprofessional care regardless of geographic barriers. Next Step: Integrate more technology using mobile devices and enhance the evaluation process.

Helping Dementia Caregivers Through Technology.

It is estimated there are between 43.5 and 65.7 million caregivers in the United States who provide unpaid care for older adults. Although the number of informal caregivers is expected to continue to increase, few programs have been established in home healthcare agencies to support these caregivers. This article describes a project that used a unique Web site to connect caregivers of people with dementia in a geographic region with an interprofessional group of healthcare providers and caregiver peers. Virtual Healthcare Neighborhood (VHN) was developed and maintained by an interprofessional group of healthcare providers from nursing, physical therapy, clinical counseling, and dental hygiene. The VHN provided weekly information on topics relevant to caring for a loved one with dementia at home as well as Question and Answer and Social Support Blogging sections for use by participants. This project was viewed as a positive and helpful method to provide support for caregivers of homebound older adults that could be easily replicated by home healthcare agencies.

Telehealth etiquette in home healthcare: the key to a successful visit.

The use of telehealth by home healthcare agencies is growing. It has been shown to reduce rehospitalizations by up to 62%, reduce costs, and increase efficiency. Due to the use of telehealth technology, new and unique rules of etiquette must be followed to make both the patient and clinician comfortable and satisfied with the process. Little literature exists regarding telehealth etiquette. This article explores the techniques and methods that home care clinicians should utilize to assure that the telehealth experience is positive and effective. After providing a less successful scenario, steps for success are outlined and a suggested successful conclusion is provided for the scenario. Home care agencies will benefit greatly from expanding their ability to visit patients in different ways. Simple steps need to be taken to assure successful visits that follow the rules for assuring patient comfort, autonomy, and protection.

Home visits by care providers – Influences on health outcomes for caregivers of homebound older adults with dementia

Homebound older adults benefit from provider home visits and there is an increasing need for these visits. A study was conducted to evaluate the effect of provider (MD, NP) visits on the caregivers of homebound older adults. Fifty-five caregivers were interviewed to determine any difference in health measures between those whose care recipients had access to a provider and those that did not. The participants completed the SF-36, questionnaires on demographics and access and one opened ended question. Analysis revealed statistically significant differences between the two groups of caregivers. The caregivers whose care recipients did not have access to a provider showed poorer health measures. Providers may have a positive impact on caregivers health as well as that of the homebound. Developing new and innovative ways to support caregivers while providing care for our patients will be even more important as the population ages and the numbers of available caregivers decrease.

The APN-PLACE Telehealth Education Network: Legal and Regulatory Considerations

Telehealth technology can enhance nursing clinical education by allowing for virtual site visits, preceptor support, preceptor education, and student oversight. The Advance Practice Nurse-Preceptor Link and Clinical Education (APN-PLACE) Telehealth Education Network is a new and innovative video communication system that connects schools of nursing to preceptors and clinical practice sites. Specific areas of focus include preceptor education and support, student assessment, and clinical experiences when implementing a telehealth education network. As with in-person, or traditional, clinical education, it is important to consider the legal and regulatory issues related to the use of telehealth programs in clinical education. This article presents a telehealth preceptor support network and provides an overview of the associated legal and regulatory issues surrounding its use in advanced practice registered nurse clinical education.