As use of digital health or telehealth has grown, healthcare providers have had to address challenges and get buy-in on multiple levels. Will patients feel comfortable and heard during a phone call or video chat? Will staff still be able to provide optimal care? Advanced practice RNs (APRNs) can apply their skills and experience to create a supportive telehealth environment for patients and families as well as for professional staff.
Anne Skwira-Brown, APRN, AOCNP®, from Essentia Health in Duluth, MN, and Abigail Baldwin Medsker, MSN, RN, OCN®, from Memorial Sloan Kettering Cancer Center, emphasized the importance of the three A’s—anticipate, assess, and address barriers—in telehealth during her session presentation on April 20, 2021, for the 46th Annual ONS Congress™.
APRNs Are Ideal Telehealth Managers
Advanced practice also requires APRNs to use the three A’s in daily care, and transitioning that to telehealth comes naturally. “APRNs are flexible, adaptable, and offer grounded perspective on what it takes to provide care safely and effectively,” Skwira-Brown said.
Successful telehealth requires the proper infrastructure, has numerous insurance implications, is challenged by a changing therapeutic landscape, and necessitates advocacy for coverage, support, and continued investment. These are all areas in which APRNs can have an impact.
APRNs often use visuals to help educate and explain concepts, which is critical during telehealth visits, Skwira-Brown said. And their assessment skills can apply to performing telehealth visit follow-up by asking all parties how the visit went and what suggestions they may have for the next one.
How APRNs Run a Telehealth Program
Skwira-Brown’s institution incorporated telehealth across 37 clinics, 12 hospitals, and 3 long-term care facilities that span more than 160 miles in a cold-weather environment with a primary hospital that is currently under construction. Being able to visit a doctor in a specialty clinic or long-term care facility without long travel times and parking hassles, as well as simply the physical stress of traveling when experiencing side effects like nausea and pain, is a huge benefit to patients. With telehealth, not only can a provider link the patient from any location to a specialist, but family members in various other locations can participate as well.
Sharing advice based on her experience with the telehealth program, Skwira-Brown said that the first step is to make sure providers and healthcare team members are comfortable with the technology so they can help patients access the system and offer instructions to ensure a successful visit. Patients may be older, less fluent with technology, live alone, and have fears of or experience frustration with technology. “It is important to be patient,” she said.
Another critical consideration is access, Medsker said. Many patients may live in areas that don’t have broadband Internet and may not even be able to run a video call.
To prepare for a telehealth visit, Medsker offers a “pre-visit” to introduce herself to patients and allow both patients and providers to test the technology. She also recommended creating scripts for talking to patients about the benefits of telehealth so that both staff and patients feel comfortable and informed. Telehealth may require additional forms or privacy statements, so providers should prepare patients for the check-in period and the overall process.
Once comfortable with the technology, providers can get creative with its use. Refer to lab results or handouts during video visits by sharing your screen, and step back from the camera to demonstrate exercises, breathing techniques, and meditation on a full screen.
When conducting a virtual visit, observe patients’ verbal, nonverbal, and contextual cues. Maintain eye contact, lean in to focus on what the patient is saying, and make patients feel comfortable to express their concerns, hopes, and goals. Pay attention to not only what the patient is saying, but how they are saying it: is it hard for them to speak, who is doing the speaking, and what are some of the other clues about the patient’s family and home life?
Skwira-Brown suggested minimizing the screen and positioning it below the video camera to enable looking directly into the camera and focusing on the patient. “Think about the patient’s perspective – be creative,” she noted.