mHabitat lunchtime learning workshop on teleconsultation - June 2015
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Nurses and teleconsultation: Opportunities and challenges David Barrett mHealth Habitat learning event, June 2015
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Transcript of mHabitat lunchtime learning workshop on teleconsultation - June 2015
Nurses and teleconsultation: Opportunities and challengesDavid Barrett
mHealth Habitat learning event, June 2015
Background and context
• Teleconsultation is the use of real-time video to support the delivery of healthcare
• Used in a variety of clinical contexts – notably acute stroke assessment and prisons healthcare
• Used to overcome barriers related to;
– Geography– Logistics– Centralisation of specialist
services
A brief history of teleconsultation
A brief history of teleconsultation
The research question
The research question
How do nurses use teleconsultation?
Approaches to teleconsultation (1)
Nurse-Patient teleconsultation: The nurse is remote from the patient and interacts via video. The patient is often accompanied by a third party – in this case, a family member.
Approaches to teleconsultation (2)
Nurse/Patient-Practitioner teleconsultation: The nurse is proximal to the patient. The nurse and patient interact with a remote practitioner – in this case, a doctor– via video.
Factors that are most likely to impact on staff acceptance and adoption
Adaptations made to enhance the use of teleconsultation
Barriers to acceptance
• Technophobia -“I’m not very IT literate, so it has been a steep learning curve for me”
• Technical difficulties – “the smallest problems are enough to act as really powerful barriers”
• Lack of physical proximity – “there is nothing to replace a cuddle. You know, a reassuring hand around the back.”
• Additional workload – “...it does take longer to do...”
• Clinical pathways, processes and environment not designed to incorporate TC – “...one of the problems has been actually finding a place to do it”
• Role anxiety - “…some really don’t like to do it. They would much rather be out there ‘hands on’ with the patient…”
Drivers of acceptance
• Mainly focused on ‘value-add’ over the telephone;
– Increased richness of communication – “you feel properly involved”
– Ability to use two-way non-verbal communication – “you do pick up on the non-verbal cues”
– Ability to carry out visual assessment of patient and environment -“...we can see whether they are caring for themselves”
• Recognition of user, carer and organisational benefit – “we are able to offer a lot more clinic appointments”
Compensatory mechanisms
• The third party: “but you can get someone over there to press on it [a burn]. So, you can get the camera to focus in and say ‘right, press on that bit there, press on that bit here’.”
• Workforce development: “Before we even started, we had to make sure that all the staff had been given training on the actual use of equipment.”
• Temporal compensation: “I can keep going back and looking at a patient every half hour, which, out in the community, there’d be no chance I could do that at all.”
• Exclusion from teleconsultation:
– “You would never see a new patient, a completely new patient [via teleconsultation].”
– “I would be shocked if anyone was given bad news via something like that [teleconsultation].”
Conclusions
• When using teleconsultation to provide care, nurses’ role mimics those carried out during ‘traditional’ interactions
• Reliable and easy-to-use technology can support acceptance; sub-optimal or faulty equipment provides a powerful barrier
• Nurses will have concerns regarding the lack of physical proximity and ability to touch patients/clients
• Clear recognition of benefits will support acceptance and adoption
• Personal animosity towards (or fear of) technology should not be overlooked as a barrier to adoption
• Compensatory mechanisms – including exclusion from teleconsultation – should be used to overcome barriers
