clinical practice
What if a patient has a particularly sensitive issue and may not feel comfortable speaking over the phone or on video chat ? How can we navigate those kind of communication gaps ? There was concern with that relational continuity and that rapport building , but I think it depends on context . In primary healthcare we have the ability to have that temporal and relational continuity with patients . So if there ’ s an existing relationship , that helps , but it ’ s also using communication strategies around openended questions and content reflections so people actually know that you ’ re listening to them , ensuring that they can ’ t hear your keyboard typing away whilst they ’ re talking . I know people often write notes in that way and that people are time-pressured , but it doesn ’ t necessarily mean that the person at the other end feels that you ’ re giving them their full attention .
I think if you are able to give people the space to ask those questions and have communication and ask ‘ What else would you like to talk about today ?’ To give them that space , I think , is helpful . It is very useful though , once you ’ ve got that communication between the provider and the patient to be able to have those follow up conversations .
It does have a place , particularly around issues that might come about because of chronic disease management or for lifestyle coaching and all those mediums . Provided that our practitioners have those communication skills and that they learn those through experience , it is a helpful thing .
In your interviews with nurses what was the general consensus about telehealth ? We had that many responses over a period of 11 days because nurses had something to say . The interviews were taken from participants who volunteered through the survey and they were taken from both community health settings – so Aboriginal medical health services , community mental health or women ’ s health – as well as general practice nurses .
Their challenges , while similar , were also unique . So things like the MBS really impacted general practice nurses ’ scope of practice . And the issues that we found for them were quite interesting in that between the end of April and May 2020 their hours were reduced or many lost their jobs . So that was quite hard for them .
Primary healthcare nurses , on the other hand , could do things like exercise classes , and they could ring up some of their vulnerable clients just to ask them how they were going . There wasn ’ t that funding restriction for them to provide that care .
Were there any differences in the experiences of nurses who lived in different geographical areas or worked in different types of clinics ? Nurses in rural and remote areas are used to accessing services in that way , whether it be through specialists or flying doctors . So they ’ re already set up to provide those video consultations through established platforms . Others did not necessarily have the hardware to support video or have their processes in place .
One nurse made the point , ‘ We ’ ve only got so many lines in and out of our practice . We can ’ t all be doing telehealth at once .’ There were concerns about security of some platforms as well . I think there are some lessons that can be learned from our rural and remote colleagues about how this can be done .
Did the nurses say how they would feel if telehealth becomes the norm after the pandemic ? I think there is a view that it can be done . But I think again , it needs to be fit for purpose , so a mix of services would probably be best . You ’ ve got people who absolutely love telehealth ; it ’ s a way of accessing care . It meant that you can still get your script . You can get your pathology results . You can talk to people easily about health concerns .
Nurses in the general practice sector wanted to be able to not just ring particular clients under a certain care plan arrangement , they wanted to check on all of their patients they thought might be vulnerable . They saw it as an opportunity to provide education about COVID and about vaccinations .
You mentioned that the initial exclusion of primary healthcare nurses from the MBS funding scheme for telehealth was problematic . How do you think that can be used in the future to consider crisis planning around telehealth services ? I think there needs to be a better utilisation of nurses . I think utilising nurses to the extent of their scope is overdue in some of these areas . Issues such as infection control for the practice and funding mechanisms to support those elements of care that don ’ t directly attribute an MBS item number need to be addressed .
“ I think utilising nurses to the extent of their scope is overdue .
While there is some block funding available for nurses , we know that it isn ’ t necessarily used to the extent that it could or should . The other issue too is that some nurses were moved elsewhere to deal with temperature checking or immunisations , which is all warranted and useful , but those other elements of preventive care still need to be done . How we resource that going forward will be interesting to see .
We know telehealth is here to stay . What are some of the problems we need to address now ? I think we need to support people or clinicians to provide care through hardware and being able to support their communication skills for assessment . We need to address how to deal with the backlog of preventive care that has not necessarily taken place .
We need to be able to utilise the workforce more broadly in immunisation . So for nurse practitioners we need to utilise not only the nurses themselves , but other students within their supervised capacity to provide this care . The other issue with a pandemic is opportunities around supervised clinical assessment and whether that ’ s occurring or not depending on our risk to the student .
What were some of the common concerns that people raised about the care they were receiving over the phone ? The nurses perceived that members of the public may not be able to use some video platforms . It ’ s one thing to be able to use a mobile device for conversations , it ’ s another to be able to interact and know how to use video technology for a medical consultation . However , some people felt that it was more a concern for the clinician than the patient .
The other issue was about the care experience : nurses felt their patients may not have believed they were getting the full care experience because it wasn ’ t face to face . It was very focused and probably a shorter consultation because of that . There was other concerns about people with language barriers or who do not have English as their first language – they really relied on that rapport or that nonverbal communication for those consultations . ■
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