Nursing Review Issue 6 November-December 2021 | Page 24

clinical practice
clinical practice

Fit for purpose

What nurses thought of telehealth during COVID-19 .
Sharon James interviewed by Eleanor Campbell

With ongoing social distancing and lockdowns , the use of telemedicine has skyrocketed across the globe , with more patients than ever reaching for the phone to meet their healthcare needs .

A new survey has delved into how primary care nurses have experienced the digital change , offering insight into how telehealth can be improved post-pandemic .
Dr Sharon James from Monash University ’ s Department of General Practice surveyed 637 nurses and spoke to 25 of them in-depth about their experiences .
James joined Nursing Review to weigh up the pros and cons of telehealth , its impact on nurses , and what we need to consider shifting into an increasingly virtual future in healthcare .
NR : What do you think about this huge shift we ’ ve seen in how care has been provided and how do you think it ’ s changed the role of the nurse ? SJ : I think care has changed in that some care was left undone , such as preventive health checks , or it was deferred in that people waiting to get a blood test or a cervical screening test would wait until it was perhaps perceived safe to do so .
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Even though some face to face care was still being undertaken , care was being done in a different way . Patients were being empowered to perhaps do some of their care themselves . They might have been taught how to do their dressings , or perhaps paperwork was being done over the phone to reduce the amount of face to face consultation time .
I think that ’ s where telehealth really came in . In previous years , telehealth was reserved for initiatives such as mental health and supporting services for rural and remote settings . Even before the pandemic it was known as an efficient , cost-effective or high quality option for healthcare services .
However , during the pandemic , there was a suite of those temporary item numbers that were introduced by the government . They were designed to keep people safe , but at the same time provide care in a controlled way to reduce the risk of transmission where people are likely to congregate , such as waiting rooms , and also to help keep healthcare workers safe .
Telehealth also meant that small businesses such as general practices could still have some functionality with some restrictions in place . Care in those settings initially included telephone and video , but recent changes to item numbers have meant that video is the preferred method . We know from literature as well that most consultations occurred by phone .
While for some consultations telehealth works really well , there are others that require face to face – things like physical assessment of wounds , but also those opportunistic things , when you go in for a consultation and you say , ‘ Oh , can you just check this out ? Or would you mind taking my blood pressure please ?’ That isn ’ t really occurring .
Does using telehealth produce any communication barriers you might not get face to face ? There was one nurse who pointed out that it ’ s fit for purpose . And I think that encapsulates it really . You ’ ve got challenges in that you may not get that rapport or be able to read the nonverbal communication that you can face to face over Zoom . You can get that to an extent , but there ’ s the assumption that services and consumers have that technology and that it is clear enough to provide those consultations .
You might want to look at a wound over a video platform , but sometimes it just isn ’ t clear or it doesn ’ t give you the full picture . It may not give you other sensory input like odour , which is often required in some kinds of physical assessments .
There were some nurses in the study I recently did that commented on issues of rapport or people with language barriers , or perhaps people were confused with the need to wear masks such as those who have dementia , or who really rely on lip reading to be able to have that communication . So there ’ s those things around communication , but also having enough bandwidth or data to be able to provide that care was an issue .