Telehealth in rural nursing: Leveraging change to attain higher patient outcomes

After I first heard concerning the telehealth services available at our rural hospital, nobody was more skeptical than me.

Perhaps the important reason was the way in which I used to be trained as a nurse and the way I learned to practice as an APRN. Truthfully, I’m “old style” in every way. My first thought was, “This is not good practice; how could this occur? Will there be no shortcuts? What concerning the lack of a physical examination? How will you properly evaluate someone physically versus telehealth? How will you look after patients safely and avoid missing something that’s potentially life-threatening if you happen to cannot touch them? How could someone 1000’s of miles away help me climb the mountains of the eastern Panhandle? What do they know concerning the community here and its needs?”

These are only a number of of the questions and concerns I had about telehealth coming to our rural access hospital. When assessing our patients, we not only take heed to their heart and lungs, look into their eyes, hear their voice, and feel the temperature of their skin, but additionally to mix. We construct trust and supply support by looking, listening and feeling.

The APRN in me desired to learn more concerning the evidence supporting these services; The literature review gave me hope and helped me higher understand the advantages of getting an additional set of “eyes” on my patients.

Filling the gap in care, saving lives.

Rural counties have fewer health care staff and specialists, intensive care units, emergency rooms and the power to move patients to appointments. AND recent research on videoconferencing to attach specialists in stroke centers with providers in smaller hospitals found that “telestroke” services helped deliver life-saving therapies, comparable to clot-busting drugs, more steadily to smaller hospitals in a median of 60 minutes across the country.

It can be crucial to contemplate that the number of doubtless excess deaths (deaths of individuals under 80 in excess of what could be expected) varies amongst public health regions and U.S. states. In light of this, the statistic that basically struck me was: a a much higher percentage trauma patients in rural and concrete areas die inside 24 hours: 89.6% vs. 64%. As you may imagine, trauma and critically sick patients who come to many rural emergency rooms are transferred if there’s a bed at one other facility and in the event that they can survive an hour (or longer) ambulance transfer.

The agricultural hospital where I served had few specialists. The closest specialists were an hour away in each direction. There was no neurologist, pulmonologist, hematologist/oncologist, trauma surgeon, psychiatrist or mental health specialist, infectious disease specialist, nephrologist, urologist, or gastroenterologist. We had a cardiologist who got here once per week for office visits, but he had no hospital consultations. Persistently I needed to be just a little little bit of each of those specialists to look after admitted patients.

Furthermore, we didn’t have an intensive care unit, only an emergency department and a medical-surgical department. When the Covid-19 pandemic hit and we housed patients in intensive care units, telehealth turned out to be my savior. Attributable to the dearth of hospital beds in other facilities, we had no selection but to confess these patients with a purpose to relieve the overloaded Emergency Department. At any time of the day or night, I could call a specialist (pulmonologist or intensivist) to remotely help treat seriously sick patients. These suppliers have helped us save countless lives.

Back to the time pressure of family practice.

After the pandemic, I made a decision to go away hospital medicine and return to family practice. I quickly remembered why I had left family medicine all those years earlier. Efficiency. Lack of time with patients and feeling rushed through the day worsened burnout. Attributable to EMR and documentation requirements, too many hours were spent on computers as a substitute of with patients.

Employers require providers comparable to APRNs to see a certain variety of patients per hour. Some APRNs are lucky enough to supply half-hour per patient, however the norm for follow-ups is often 10 minutes. In rural areas, our demographic generally requires more time to completely educate and prepare patients to look after themselves and their chronic conditions. Add to this financial constraints, illiteracy, lack of resources and consultants, and you could have a recipe for frequent hospital readmissions, non-adherence to medication/nutrition/exercise recommendations, and increased morbidity and mortality.

Telehealth and first care: a very good fit.

In response to those pressures, I made a decision to open my very own telehealth practice and see patients alone terms. (I practice in Virginia, which allows APRNs to practice full time, and in West Virginia, which is partial, but with my years of experience allowed me to use for full practice privileges). This meant I could spend as much time as I needed with patients, educating, encouraging and supporting them. Because I even have patients who work six or seven days per week, most of my visits are on Sundays. Ninety percent of the U.S. population has cell phones, so talking to them is not an issue in the event that they haven’t got video conferencing capabilities. With gas and food prices so high, many patients prefer this approach to communication; they feel supported and usually tend to miss meetings.

I’ve found two things to be true about running my very own practice: I even have on a regular basis I want with my patients, they usually like it, and I have no “no-shows” on practice days.

After two years of using intensive video telemedicine during a worldwide pandemic, I quickly modified my mind concerning the need for physical touch during all patient examinations. Nobody will deny that a physical examination is just not helpful. But this is just not at all times needed. Lots of the patients in my current practice come for specific services comparable to weight reduction, hormone substitute therapy, and chronic disease management and counseling. Some are also seen in person by primary care providers, some I see once in person before telehealth visits begin, and others are asked to have their blood pressure checked at home due to their medications. Each patient’s needs are different.

As a healthcare team or individual, we are able to do that connection whether in person, by phone or video. The space in between is just not at all times as vital as we expect.

Martha Vesterlund, DNP, APRN, ANP-C, FNP-C, is an assistant professor at Shenandoah University Eleanor Wade Custer School of Nursing in Virginia and a family nurse practitioner with Compassionate Care Telehealth Services.