Whether carrying a personal digital assistant into a patients home, monitoring vital signs remotely with wireless devices or offering elderly patients Wii video games for rehabilitation, todays home care nurses are expected to understand and apply the latest technology.
A home care nurse probably will not have to repair a broken modem, but a nurse might be the first one to respond when a patient cant figure out how to input information on an in-home monitoring device. A nurse also may have to troubleshoot common technology-related problems or help elderly patients who might not be tech-savvy integrate new devices into their care plans and homes.
By and large, the nurses who are on the front lines of the healthcare technology revolution say they are more than willing to invest the additional time and effort required to get up to speed on the latest gadgets in return for the increased efficiency and quality improvements they say technology can bring to home care.
The attitude is getting to be much more positive toward technology, says Catherine Wallin, RN, BSN, a staff nurse and preceptor who helps train new nurses for the Visiting Nurse Association of Central Jersey. Were seeing its so much easier for us to take care of the patient than it was when it was all on paper because weve got all of the information right there, so much more information than we ever had before.
VNACJ recently replaced the laptops its nurses carried into homes with handheld PDAs, and its home care nurses use them to access calendars for patients doctors appointments, social workers notes, medication interaction warnings, care protocols for local physicians and medication teaching guides for patients and their caregivers.
VNACJ also launched a telehealth program in 2006 that now has 106 patients with heart failure, diabetes and chronic obstructive pulmonary disease. The program relies on a bluetooth system the size of a small calculator installed in patients homes, says Christine Feuker, RN, BSN, manager of VNACJs telehealth program.
Handheld Teaching ToolsCatherine Wallin, RN
All each patient needs is a landline and electricity to run the telehealth system a bluetooth-connected scale. It also can incorporate readings taken with glucometers equipped with infrared technology. Patients are asked to input blood pressure and pulse oximeter readings, and the device asks questions such as whether patients have taken their medications. It scans for new information every 6 minutes and forwards new information to the telehealth center in real time.
It really keeps an eye on the patient, Feuker says. The information transmitted to the telehealth center is color-coded: green for readings within normal limits, yellow for information outside the normal range and red to alert nurses when readings are at potentially dangerous levels.
Telehealth is really a perfect example of patients taking responsibility to manage their care in their own homes, Feuker says. Its a teaching tool. And if theres a problem, we can get that out to the field nurses.
As a super-user of VNACJs technology, Wallin says new graduates receive more classroom guidance in this area and are more comfortable incorporating it into their routine.
For older nurses, it takes a little more training, but we do have the support, she says. Each new nurse receives two weeks of classroom training and follows a preceptor on home care visits for about four weeks. During that time, the trainee can observe how the PDA is used and incorporated into patient assessments. When VNACJ started using laptops, the organization provided extensive technology training, Wallin says. There is ongoing training when new features are added, and a 24-hour help desk to handle nurses technical questions.
Feuker says nurses and patients are not expected to be able to fix broken equipment, although nurses may occasionally have to troubleshoot if a patient has a problem understanding how something works or if there is simple user error. If a machine is broken, it is replaced by the vendor, usually within 24 hours, she says.
Instructions on how to use the telehealth equipment are written for a fifth- to sixth-grade reading level, and setup and training in the patients home takes about an hour, she says. Telehealth nurses train patients and provide them with phone numbers so they can contact a live person if they have problems operating the devices. A durable medical equipment company installs and replaces or fixes devices if they break, she says.
Some 23% of home health agencies nationwide are using telehealth, says Richard Brennan, director of the Home Care Technology Association of America, an affiliate of the National Association for Homecare and Hospice. About 40% of home health agencies use point-of-care systems in the field meaning tablets, handheld wireless devices or laptops. And 65% have adopted electronic health records with varying levels of functionality.
What the Future HoldsKeith Crownover
Remote monitoring systems have the potential to advance the home care industry by capturing vital patient information daily, giving the patient immediate access to that information and submitting it to the physician in real time, Brennan says. You can intervene at appropriate times and also use your available resources in a more efficient manner.
In this evolving industry, nurses play a crucial role in instructing patients how to use the remote monitoring systems, he says. Ive been part of home health visits where they sit down and use the monitors to report the vitals taken by the nurse directly to the home base by the monitoring unit, he says. It engages the patient more in their own care. They become interested in tracking their reports more. They become invested more in their own well-being.
The challenge in healthcare is no longer whether it is possible to acquire the data but how to make sense of it, says Keith Crownover, president of Delta Health Technologies, a company based in Altoona, Pa., that specializes in home care software. Some of the newer systems being tested use weight sensors under a patients bed to estimate how restless the patient was during the night, or passive monitoring systems that can gauge how active a patient is without requiring the patient to press a button to call for help.
Electronic and Human Connections
Marisol Vega-Beecham, RN, BSN, MA, is the telehealth manager in nursing informatics for Metropolitan Jewish Health System, which provides home care, hospice, palliative care, skilled nursing and other healthcare services in the Greater New York City area. Although some patients initially can be apprehensive about working with the telehealth equipment in their homes, they soon realize it increases their connection to their caregivers, she says.
If you are one of my clients and youve got blood pressure thats very high, glucose thats very high, Ill be calling you sometime today, Vega-Beecham says. It gives me an opportunity to discuss things with you.
Metropolitan Jewish provides its telehealth patients with a modem connected with monitoring equipment that attaches to a landline. The patient has to learn how to wrap the blood pressure cuff and press a button, Vega-Beecham says. Its a very easy technology, she explains. We have an older patient population, and theyre very capable of doing it.
At the Visiting Nurse Service of New York, nurses carry pen-based tablets that help them access VNSNYs patient care record system remotely. Nurses are trained on the technology as part of their orientation, and technology is integrated into the clinical training nurses receive, says Stuart Myer, VNSNYs vice president of applications design and development. Nurses also carry camera phones that can take photographs of wounds that can be transmitted to wound-care specialists for analysis.
Although VNSNY is just beginning to roll out a small telehealth pilot within its Long Term Home Health Care Program, nurses say the program is expected to expand to a larger patient base in the near future. For Denise Simmonds, RN, BSN, a public health nurse who works for VNSNYs Long Term Home Health Care Program, that day cant come too soon. Were all looking forward to it coming down the pike, she says.