SEMINAR ON

TELE-MEDICINE AND TELE- NURSING: ROLE OF NURSING ADMINISTRATION IN

HOSPITAL AND COMMUNITY
PRESENTED BY: GUIDED BY:
Kathing Lanluila Mrs. Divya Varghese
IInd YEAR M.Sc. Nursing. Assistant Professor
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INTRODUCTION
The state of health of a population is a direct determinant of development. Access to better health
reduces poverty and increases productivity. Developing countries face various problems in the provision of
medical services and health care, including funds, governments and private health care providers must make
use of existing resources and the benefits of modern technology.
❑ The term ‘Tele-medicine’ derives from the Greek “Tele” meaning “at a distance”.
❑ And the present word ‘Medicine’ which itself derives from the Latin “Mederi” meaning “Healing”.
❑ Telemecine is a phrase first coined in the 1970 by Thomas Bird, referring to health care delivery
where physicians examine distant patients through the use of telecommunication technologies.

DEFINITION.
The delivery of healthcare services, where distance is a critical factor, by all healthcare professional
using information and communication technologies for the exchange of valid information for diagnosis,
treatment and prevention of disease and injuries, research and evaluation, and for continuing education of
healthcare providers, all in the interest of individuals their communities.
-By world health organizations (WHO), 1997.
Telemedicine is any healthcare provided to patient via technology across a distance.

-(Remmes, Thompson and William,1996).

OBJECTIVES
• Move the information, not the patient.
• Information about the patient could be obtained locally and exchanged through a network to a
specialist.
• To replace transporting the patient or the specialist to a given localization.
• Exchange of information and expertise for medical diagnosing and treatment is a basic concept of
telemedicine.

LANDMARKS EVENTS IN THE HISTORY OF TELEMEDICINE:

TYPES OF TELEMEDICINE:

Telemedicine in the international scenario:

• It is not a new phenomenon and work in this field has been going on since last 30 years.
• Number of telemedicine project are being undertaken by NASA, the US universities, Australia,
Europe, International Space University (ISU) Strasbourg, France.

Various other organizations and countries:

• Telemedicine may infact have a more profound impact on developing countries than a developed
one.
• Satellite stations in Uzbekistan, wireless connections in Cambodia, and microwave transmission in
Kosova have shown that the low bandwidth internet can reached into remote areas, some of them
with troubled political situations and uncertain economic environments.

Projects in other countries:

• IMPHONE is a research program at the department of radiology, university of Pisa, looking at the
application of advanced informatics in medicine.
• TeleSCAN project on cancer is being carried out at the Netherlands' Cancer Institute.
• Yale telemedicine centre, Connecticut provides clinical consultation to various universities and
medical institutions.
• Israel has formed telemedicine and telecare development centre based at Ben Gurion University of
the Negev and at Soroka Medical Centre Beer Sheva.
• Japan is at the major edge push into telemedicine. The number of active programs in Japan jumped
from 49 in 1995 to 98 in 1996 and to 148 in 1997.
• Tripler Army Medical Centre’s internet Tumor and Board-a web-based telemedicine project has let
to better care for remote cancer patients and better communication among military medical
specialists throughout the pacific islands.

Telemedicine in Indian scenario:

• Apollo Hospital Group has set up a 50-bed telemedicine centre at Aragonda Village (Andra-
Pradesh, South India).
• It has also set up freestanding centres at Guwahati and Kolkata.
• These centres are equipped with facilities like CT-Scan, x-ray, ECG and integrated laboratory and
are linked to Apollo’s Specialized hospitals at Hyderabad, Chennai and Delhi for seeking referral
services, second opinion, post-acute care, interpretation services and health education.
• Hospital group has also a Web Portal, Apollo Life that allows patient to interact with doctors via
the web, upload all their diagnostics and reports on the net.
• Escorts Heart Institute and Research Centre (EHIRC), Delhi through its Escorts Heart Alert Service
(EHAS), utilizes telemedicine in establishing prompt contact with patient in distress.
 • Telemedicine project by Bharat Electronics Limited (BEL’s) links a General Hospital in Chennai
with a government rural hospital in Wallajah about 100km away.
• Telemedicine project by NIC (National Informatics Centre), Ministry of Information Technology
aims at providing health-related information resources, decision support tools and data at the time
and place of need by health care providers across the country.
• Cardiovascular Technology Institute (CVTI), Hyderabad in association with Defence
Organizations has successfully tested on indigenous telemedicine field unit capable of transmitting,
all the clinical data including MRI, CT-Scan and even X-Ray to a doctor of one’s choice through
computer and telephone

Practices of telemedicine:
1. Tele-cardiology
2. Trans-Telephone Electro-Cardio Graphic Monitoring (TTEM).
3. Tele-echocardiography.
4. Tele-pathology.
5. Tele-radiology.
6. Tele-psychiatry.
7. Tele-neurology.
8. Tele-dermatology.
9. Tele-medicine and Army.
10. Medical video-conferencing.

BENEFITS OF TELEMEDICINE.
Challenges faced by the practice of telemedicine:
1. Infrastructure.
• Telecommunications.
• Medical technologies.
2. Quality of transmission.
3. Hardware and software compatibility.
4. Costs.
5. Dispersion of liability.
6. Privacy and confidentiality.
7. Acceptance.
8. Reimbursement.

ROLES IN TELEMEDICINE.
• Telemedicine can be used when healthcare professionals and patient are unable to meet face-to-
face due to geographical distances, convenience or practically.
• Providing individualized health information.
• Enhancing decision making in clinical management.
• Facilitating communication between healthcare professionals.
• Offering support.
• Educating patient, carers and relatives on managing health problems by facilitating remote
monitoring and information delivery.

BARRIERS IN TELEPHONE.

oPHYSICIAN/PATIENT ACCEPTANCE.
Physician and patient have unique technology resources available to improve the
patient-physician relationship. I it has been found that patient have no difficulty in accepting telemedicine
program.

oAVAILABILITY OF TECHNOLOGY AT AREASONABLE COST.

It is a myth to establish a telemedicine platform is an expensive. The basic system
needs hardware, software and communication link.

oACCESSIBILITY.
Although informative technology has reached in all corners of the country by the accessibility
of people living in remote and rural area to the nearest health center(PHC,CHC OR district hospital) may
not be easy due to poor infrastructure of road and transport.

oRELIABILITY.
Some healthcare professionals have doubt about the quality of images transmitted for tele-
consultation and tele-diagnosis. In tele-radiology, tele-dermatology the quality of image (color, resolution,
field of view, etc.) should be of international standards to avoid any wrong misinterpretation and
misdiagnosis.

oFUNDING/REIMBURSEMENT ISSUES.
There should be a format to calculate the investment and recurring cost of the telemedicine
system.
oLACK OF TRAINED MANPOWER.
Telemedicine is a new emerging field, there is lack of training facilities with regards to
application of IT in the field of medicine.

oLEGAL AND ETHICAL.

Telemedicine technology has been proved and established and its advantages and benefits are
well-known but still many healthcare professionals are reluctant to engage in such practices due to
unresolved legal and ethical concerns.

oPRIVACY AND SECURITY CONCERNS.

There are many issues that should be considered regarding the security, privacy, and
confidentiality of patient data, in telemedicine consultation.

ADVANTAGES OF TELEMEDICINE.
• To eliminates distance barrier and improve access to quality health care.
• Facilitates patients and rural practitioners’ access to specialist health services and support.
• Lessens the inconvenience cost of the patient.
• Reduces unnecessary travel time for health professionals.
• Reduces isolation of rural practice by upgrading their knowledge through tele-education or tele-
communication

DISADVANTAGES OF TELEMEDICINE.
• A large number of people are difficult to manage in a single teleconference.
• Cost can be high.
• Community people are alienated if a meeting is poorly implemented or anticipated goal are not
meet.
• Teleconferencing reduces opportunities for face-to-face contact between participants and
proponents of plan or projects.
• Difficult for complex interpersonal communication, such as negotiation or bargaining.

TELE-NURSING.
INTRODUCTION.
Tele-nursing refers to the use of telecommunications and information technology for providing
nursing services in healthcare, whenever a large physical distance exists between patient and nurse, or
between any members of nurses. As a field it is a part of tele-health, and has many point of contacts with
others medical and non-medical applications such as tele-diagnosis, tele-consultation, tele-monitoring, tele-
care etc.

DEFINITIONS.
Tele-nursing is the delivery, management, and co-ordination of care and services provided via
telecommunication technology within the domain of nursing.
-American association of ambulatory care nursing (AAACN,2004).

Tele-nursing is the use of telemedicine/telehealth technology to deliver nursing care and conduct
nursing practice.
-Encyclopaedia of nursing research, Fitzpatrick J. ed., 1999.
Telenursing Definition from International Council of Nursing:
 Telenursing refers to the use of telecommunications technology in nursing to enhance patient
care.
 It is also defined as distance communications, using electrical or optimal transmission, between
humans and/or computers.

OBJECTIVES:
• To deliver care and expertise.
• For curative, preventive and rehabilitation.
• For training and information.

TYPES OF TELE-NURSING
1. In Synchronous (real time) or
2. Asynchronous (different time) mode.
3. Direct (nurse-person encounter).
4. Indirect (nurse-caregiver encounter).

In a real time (synchronous) videoconferencing link,

• Telehealth nursing.
• Telephone triage nursing.
• Teletraige.
• Telecare.
• Telepresence.
• Telephone nursing.
• Tele-home care

Telenursing technologies include activities such as-

• Videoconferencing.
• Medical imaging and
• Data transfer.

Factors promoting the requirement for telenursing-

• Increasing shortage of nurses.
• Costs of health care.
• Need to provide cost effective, timely and quality healthcare (remote, rural people).
• Rise in aging and chronically ill population.

Telenursing-scope of practice-
Assistance to physicians in the implementation of medical treatment protocols.
For example: immediate post-surgical situations (the care of wounds, atomies, handicapped individuals)

NURSES CAN-
• Actually, viewed healing wounds.
• Can access physiological monitoring equipment to measure physical indicators such as vitals.
• Providing online assessment and follow-up care without the client having to travel to the health
care agency for an appointment.
• Helps patients and families to be active participants in care (self-management of chronic illness).
• Home-care.
 • Immobile patient- patients with chronic or degenerative diseases are “visited” and assisted regularly
by a nurse via video-conferencing, internet, videophone, etc.
• Scope of practice.
• For educating the clients,
• Nursing teleconsultation.
• Examination of results of medical tests and exams.
• Also used by call centres.

USES OF TELE-NURSING.
• Tele-nursing has been used as a tool in home nursing. (For example: people who are immobilized
or faraway places, or living in difficult to reach of places.
• Citizens who have chronic ailments such as COPD, DM, CHD, etc.
• Still other application in home care is patients after surgeries with wound dressings, ostomies,
handicapped etc., can be assisted in care with help of telenursing.
• Telenursing helps to extend the nursing service to more patients. In home-care delivery, a nurse is
able to reach and care for 5-7patients but tele-nursing help to attend more in same amount of time.
• To perform patient triage in emergencies through call centres.
• Expert assessment and intervention by specialist clinical nurses.
• Discharge services.
• To do counselling and guidance services.

TELE-MEDICINE COMPETENCIES.
1. HARDWARE (PHYSICAL COMPUTER BODY)
➢Computer (laptop, desktops).
➢Palm computer.
➢Telephones.
➢Graphic’s chart.
➢Sound cards.
➢Internal memory (RAM).
➢External memory (flash drives).

2. SOFTWARE (PROGRAM TO OPERATE A COMPUTER

➢Monitor, keyboards, mouse, printer.
➢Web cameras, speaker, microphone.
➢Email, database, wors-processing, internet, browsing, conference calls.
Example: Digi scope-program to collect patient info related to diabetes.

IMPLICATIONS FOR TELE-NURSING.

1. FOR THE PATIENT.
➢ Monitoring vital signs on daily basis at home setting and informing the care specialist
provides opportunity for early intervention.
➢ Reduces the number of visits to the doctor or emergency department.
➢ Avoids unnecessary visits to or by providers.
➢ Provides patient education.
➢ Removes geographic barrier-nursing can be provided to remote locations.
 2. FOR THE PROVIDER.
➢ Increases the competencies and scope of practices.
➢ More venue for monitoring client safety in home-care.
➢ Facilitates easy client decision-making.
➢ Creates professional practice environment.
➢ Able to provide expert and specialized care from experienced staff and care managers.
➢ Able to take joint decisions regarding care by consultation with staff even at far of places.

3. FOR THE HEALTH CARE SETTING.

➢ Initial expense up front but as health improves the system will save money.
➢ Decreased number of in-hospital days for patient with chronic illness who have
access to supportive telehealth.
➢ Decreased number of in-hospital days reduces the required number of staff. (nursing
in particular).
➢ Remove barriers of time and distance.
➢ Proper training and administration support is a vital responsibility for the system.

ADVANTAGE OF TELE-NURSING.
➢Increase public access to health care.
➢Provide access in rural areas.
➢Decrease wait time.
➢Decrease unnecessary hospital visits.
➢Decrease healthcare cost.
➢Increase continuity of care.
➢Increase patient compliance with aftercare.

DISADVANTAGES OF TELE-NURSING.
➢Decreased face-to-face interaction.
➢Risk of decreasing quality care.
➢May increase liability.
➢Concerns with security.
➢Concerns with maintaining confidentiality.
➢False diagnosis.
➢Telemedicine infrastructure.

ROLE OF NURSING ADMINISTRATION IN HOSPITAL AND COMMUNITY:

(JOURNAL RELATED)

1. The impact of telemedicine on healthcare management: opportunities and challenges.

In recent years, telemedicine has emerged as a transformative force in the healthcare
industry, revolutionizing the way patient’s receive medical care and transforming healthcare management.

OPPORTUNITIES:
a) Improved access to healthcare.
b) Enhanced patient outcomes.
c) Cost savings and efficiency.
d) Remote monitoring and chronic diseases.
CHALLENGES:
a) Infrastructure and connectivity.
b) Regulatory and legal issues.
c) Patient acceptance and adoption.

2. Impact of using Telemedicine on knowledge management in healthcare organization: a case

study-
• Telemedicine is advocated for its potential to improve accessibility and availability of
healthcare with lower costs.
• The healthcare organizations are knowledge-oriented organizations and most of the
services provided by the organization, are operated by human knowledge.

Telemedicine essential-
a) Distance.
b) Information communication technology: -
• Communication (telephone line, ISDN, E1, etc.)
• Communications through mobile facilities.
• Internet connection.
• Fiber optic network.
• Satellite network, etc.

3. Telenursing Healthcare Administration-Nursing.

• Telehealth technology may help medical institutions sidesteps this nursing shortage
altogether.
• Technology arrived at a time when patients suffering from chronic illnesses require
augmented consultations and services.
• It allows Nurse Practitioners (NP’s) to deliver medical services via the internet and mobile
devices.
• Improved bed-allocation by improving follow-up care to high-risk clients- such as chronic
illness sufferers and recent surgical patients.
• Increased healthcare employment opportunities.
• Accessibility by patients in remote areas.

4. The impact of telenursing on Nursing Practice and education: A systemic literature review-
• Impact of telenursing intervention using telephone and/or videoconferencing on satisfaction
and health outcomes.
• Associations of the patient’s comorbidity characteristics with nursing utilization of
telenursing and/or withdrawal from telehealth service during a telenursing care episode.

CONCLUSION
Advances in telecommunication and technologies are revolutionizing education and health services
globally, including the provision of nursing services. Decreasing time distance, these advances increase
access to health and healthcare, especially underserved population and those living in rural and remote
areas. They help to manage the demand for services, ensure more effective use of human and health
resources and facilitate education and research activities.

Thank You