Telenursing

In an era of increasingly restrictive heath care reimbursement patterns coupled with rapidly changing patient demographics, Telenursing is an important text for readers considering taking part in the development and expansion of this evolving, technology-based model of care delivery. The editors have presented more than a mere compilation of structured, scholarly overviews of the current status of telenursing from global nursing and informatics experts. The consistency of the themes identified across 14 countries, ranging from the emerging economies of Africa to the highly industrialized marketplaces of contemporary Western societies, suggests a beginning strategy for implementing this collaborative interdisciplinary approach to managing the care of patients with lifestyle-related chronic illnesses or with limited access to care, while offering solutions to the dwindling availability of primary care clinicians and the increasing costs of managing care for an aging population.

The majority of identified telenursing delivery models are either telephone triage systems using a structured symptom-based algorithm approach to care or systems using static collection of patient data that are then uploaded to a central source for later evaluation. However, all of the contributors to the book forecast the expansion of these models to include educating patients in the use and value of in-home teletechnology for care consultations or remote monitoring of patients to assess adherence to care. To achieve this end, all of the contributors identify the need for major shifts in nursing school curricula to include courses in telenursing technology, virtual learning platforms, patient education techniques, and an increased focus on learning comprehensive verbal and nonverbal communication skills. The contributors also reinforce the paramount importance of developing user-friendly technology infrastructures to support the successful streaming of patient information across the continuum of care while also addressing legal and ethical concerns regarding security of system and patient information as well as issues related to jurisdictional nursing licensure in the context of remote nursing care.

The strength of this book is the clarity provided by the concise systematic structure the editors have established for the contributors' chapter submissions. Tables, figures, and photographs support the concepts, and the URLs and comprehensive reference lists enable the reader to easily locate additional information on given issues. A summary at the end of each chapter reinforces the commonality of the challenges to be surmounted in the development of this delivery system.

Although research on the current effectiveness of telenursing is generally lacking, a recent article¹ reinforces the results of telenursing research conducted in other countries concluding that telephone triage or telephone management alone have not achieved the goals of enhanced quality and decreased costs. These results underscore the importance of further research designed to clearly define telenursing roles, assess the utility of existing technology infrastructures, and evaluate the effectiveness of the recommended expansion of nursing school curricula.

Information technology is the linchpin of a rapidly transforming health care delivery system. Clinicians from all disciplines are well advised to understand and participate in the development of both telenursing and telehealth. Although Telenursing can be a bit dense, the repetition of experience across the globe and the consistency of the recommendations and vision offset this aspect and reinforce the importance of well-developed implementation strategies to ensure that the goals of cost containment, timely access to care, and efficient in-home management of lifestyle-related chronic illnesses are addressed.