Nurse and patient communication via low- and high-bandwidth home telecare systems

The nurse-patient communication: voices from nursing students

BACKGROUND

Effective communication skills have been found to be one of the pivotal factors in building positive interpersonal relationships. Little is known about nursing undergraduates' perspectives on communicating with patients.

OBJECTIVE

This study aimed to explore nursing students' perspectives and experiences of nurse-patient communication in their clinical placement.

METHODS

The participants included 21 second-year undergraduates and 21 first-year master's students. Interviews were conducted in Cantonese and then transcribed in Chinese and translated into English. A content analysis approach was adopted to analyze the data.

RESULTS

Five themes emerged from the interview data. 'The necessity of nurse-patient communication' reveals why the students valued nurse-patient communication. 'The conversation contents' describes the content of the conversations that students typically had with patients. The third theme is 'self-reflection on the nurse-patient communication'. The last two themes, 'the communication pattern in different hospital settings' and 'the obstacles impeding nurse-patient communication', are about the students' communication styles in different hospitals and the barriers they encounter.

DISCUSSION

To improve students' communication skills, educators and clinical staff should listen to students, enhance students' reflective skills and strengthen their confidence.

CONCLUSION

Through understanding students' difficulties in the nurse-patient communication experience and the skills that they lack, educators can provide them with helpful recommendations to improve their communication skills in clinical practice.

PRACTICE IMPLICATIONS

The results of this study reveal that students' nurse-patient communication skills need to be improved.

Promoting access through complementary eHealth technologies: recommendations for VA's Home Telehealth and personal health record programs

BACKGROUND

Many healthcare organizations have embraced eHealth technologies in their efforts to promote patient-centered care, increase access to services, and improve outcomes.

OBJECTIVE

Using the Department of Veterans Affairs (VA) as a case study, this paper presents two specific eHealth technologies, the Care Coordination Home Telehealth (CCHT) Program and the My HealtheVet (MHV) personal health record (PHR) portal with integrated secure messaging, and articulates a vision of how they might be implemented as part of a patient-centric healthcare model and used in a complementary manner to enhance access to care and to support patient-centered care.

METHODS

Based on our experience and ongoing work with both programs, we offer a series of recommendations for pursuing and ultimately achieving this vision.

CONCLUSION

VA's CCHT and MHV programs are examples of an expanding repertoire of eHealth applications available to patients and healthcare teams. VA's new patient-centric healthcare model represents a significant shift in the way that services are delivered and a profound opportunity to incorporate eHealth technologies like the CCHT and MHV programs into clinical practice to increase access to care, and to ensure the responsiveness of such technologies to the preferences and circumstances of patients.

Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study

The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

Telehealth in Speech-Language Pathology and Hearing: science and technology

BACKGROUND

distance learning (DL) is becoming a higher education modality with a meaningful impact. It offers students flexibility, mobility and choices. Also it can reach a greater number of professionals and students in a more effective way, when compared to other learning modalities, without losing quality. Brazil needs to develop direct actions to DL in the fields of Speech-Language Pathology and Hearing, due to its great continental territory (8,514,215.3Km(2)) and irregular distribution of professionals who work in these specific fields (i.e. this situation emphasizes the differences in quality and availability of services offered throughout the country). Heterogeneity in the quality and availability of services is also aggravated by the absence of a national strategy for continued education in order to recycle health professionals. This situation causes important differences in the knowledge and abilities of specialists from one region to the next.

AIM

to present Telehealth studies in the field of Speech-Language Pathology and Hearing that were developed in the last five years.

CONCLUSION

the analyzed data indicate that more studies are needed in this specific field. These studies should aim at improving the quality and access to services which in turn would improve prevention, diagnosis and treatment of communication disorders.

Evaluation of home telehealth following hospitalization for heart failure: a randomized trial

Previous studies have found that home-based intervention programs reduce readmission rates for patients with heart failure. Only one previous trial has compared telephone and videophone to traditional care to deliver a home-based heart failure intervention program. The objective of this study was to evaluate the efficacy of a telehealth-facilitated postdischarge support program in reducing resource use in patients with heart failure. Patients at a Midwestern Department of Veterans Affairs Medical Center were randomized to telephone, videophone, or usual care for follow-up care after hospitalization for heart failure exacerbation. Outcome measures included readmission rates; time to first readmission; urgent care clinic visits; survival; and quality of life. The intervention resulted in a significantly longer time to readmission but had no effect on readmission rates or mortality. There were no differences in hospital days or urgent care clinic use. All subjects reported higher disease-specific quality of life scores at 1 year. There was evidence of the value of telephone follow-up, but there was no evidence to support the benefit of videophone care over telephone care. Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost-effective.

Nurse and patient communication profiles in a home-based telehealth intervention for heart failure management

OBJECTIVE

This study compared differences in nurse and patient communication profiles between two telehealth modes: telephone and videophone, and evaluated longitudinal changes in communication, nurse perceptions, and patient satisfaction.

METHODS

Subjects were enrolled in a randomized controlled clinical trial evaluating a 90-day home-based intervention for heart failure. Telephone (n=14) and videophone (n=14) interactions were audio taped and analyzed using the Roter Interaction Analysis System.

RESULTS

Nurses were more likely to use open-ended questions, back-channel responses, friendly jokes, and checks for understanding on the telephone compared to videophone. Compliments given and partnership were more common on the videophone. Patients were more likely to give lifestyle information and approval comments on the telephone, and used more closed-ended questions on the videophone. Nurses perceptions of the interactions were not different between the telephone and videophone, nor did their perceptions change significantly over the course of the intervention. There were no significant differences in patient satisfaction between the telephone and videophone.

CONCLUSIONS

The results of this study did not support use of a videophone over the telephone.

PRACTICE IMPLICATIONS

It is critical to match technologies to patient needs and use the least complex technology possible. When considering use a videophone, health care providers should critically examine the trade-offs between additional complexities with the added value of the visual interaction.

Attitudes Toward Videotelephones: An Exploratory Study of Older Adults with Depression

Although technology holds promising benefits to support older adults at home, attitudes can be a hindrance to the acceptance and use of new technologies. The aim of this study was to explore attitudes of older adults with depressive symptoms using videotelephones (VTs) in their homes. A descriptive design involving 4 participants who received problem solving interventions from a clinical psychologist via VTs was used. Data analysis revealed that the participants' preattitudes were dependent on their active or passive role in the learning process of the new technology. Their postattitudes were classified as ambivalent and positive. Two participants who had a positive attitude toward the VT expressed a positive behavior use.

Technical Feasibility of Teleassessments for Rehabilitation

BACKGROUND

technical feasibility was evaluated for conducting standard motor assessment instruments in a remote setting. Remote assessment was compared to co-located assessment for five clinical evaluation instruments: joint range-of-motion (ROM), manual muscle test (MMT), Berg sit-to-stand, Berg forward reach, and timed up and go (TUG).

METHODS

co-located and remote rooms were in the same building connected by broadband video and audio. Ten subjects without impairments participated, but were given simulated impairments to mimic the patient population commonly seen in rehabilitation clinics. One therapist performed all co-located testing while another performed all remote assessments. Measurements followed standard clinical methods. Data were analyzed using repeated measures ANOVA and paired t-tests.

RESULTS

no differences were found between co-located and remote assessments except for some cases using screen-based ROM measures. Remote ROM tests using snapshots and a virtual goniometer were preferred. A digital dynamometer added no additional information to a visually-based remote MMT assessment.