Laying the Foundation for the National TeleNursing Center: Integration of the Quality-Caring Model Into TeleSANE Practice.

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.

Tele-enfermería en pacientes crónicos: revisión sistemática / Tele-nursing in patients with chronic illness: a systematic review

Para proporcionar un cuidado individualizado e integral a los pacientes que conviven con un proceso crónico se aboga en la actualidad por el uso de nuevas tecnologías, como la tele-enfermería. El objetivo es identificar las principales características de la tele-enfermería, así como las barreras y facilitadores para su implantación. Revisión sistemática de las bases de datos PubMed, Cochrane Library, Cinhal, Psycinfo, Cuiden, Dialnet y Scielo entre 2008 y 2019. Los 34 artículos seleccionados identificaron el soporte virtual, el seguimiento telefónico y los dispositivos electrónicos como principales características de la tele-enfermería, el perfil del paciente (no joven, con nivel socioeconómico y educativo bajo) y la resistencia de los profesionales de enfermería fueron las barreras identificadas, mientras que la nueva era tecnológica se identificó como un facilitador para su implementación. Proporcionar una mayor formación entre los profesionales de enfermería para dar a conocer las principales características de la tele-enfermería es fundamental para su aceptación e integración y, consecuentemente, su implantación en la práctica clínica diaria

At present there is a strong case for using new technologies, such as tele-nursing, to provide individualised and integral care to patients who live with a chronic process. The aim is to identify the main characteristics of tele-nursing and the factors that facilitate and hinder its implantation. Systematic review of the following databases: PubMed, Cochrane Library, Cinhal, Psycinfo, Cuiden, Dialnet and Scielo during the 2008-2019 period. The 34 articles selected identified virtual support, telephone monitoring and electronic devices as the main characteristics of tele-nursing; the patient's profile (not young, with a low socio-economic and educational level) and the resistance of the nursing professionals were the barriers identified; while the new technological age was identified as a factor facilitating its implementation. The provision of greater training for nursing professionals to make them aware of the main characteristics of tele-nursing is essential for its acceptance and integration and consequent implantation in daily clinical practice

[Tele-nursing in patients with chronic illness: a systematic review]. / Tele-enfermería en pacientes crónicos: revisión sistemática.

At present there is a strong case for using new technologies, such as tele-nursing, to provide individualised and integral care to patients who live with a chronic process. The aim is to identify the main characteristics of tele-nursing and the factors that facilitate and hinder its implantation. Systematic review of the following databases: PubMed, Cochrane Library, Cinhal, Psycinfo, Cuiden, Dialnet and Scielo during the 2008-2019 period. The 34 articles selected identified virtual support, telephone monitoring and electronic devices as the main characteristics of tele-nursing; the patient's profile (not young, with a low socio-economic and educational level) and the resistance of the nursing professionals were the barriers identified; while the new technological age was identified as a factor facilitating its implementation. The provision of greater training for nursing professionals to make them aware of the main characteristics of tele-nursing is essential for its acceptance and integration and consequent implantation in daily clinical practice.

Swedish Healthcare Direct managers' views on gender (in)equity: applying a conceptual model.

BACKGROUND: Although Swedish legislation prescribes equity in healthcare, inequitable healthcare is repeatedly reported in Sweden. Telephone nursing is suggested to promote equitable healthcare, making it just one call away for anyone, at any time, irrespective of distance. However, paediatric health calls reflect that male parents are referred to other health services twice as much as female parents are. Regarding equity in healthcare, telephone nurses have expressed a continuum from Denial and Defence to Openness and Awareness. To make a change, Action is also needed, within organizational frames. The aim here was thus to investigate Swedish Healthcare Direct managers' views on gender (in)equity in healthcare through the application of a conceptual model, developed based on empirical Swedish Healthcare Direct telephone RN data, as a baseline measure at the service's national implementation. METHODS: All Swedish Healthcare Direct managers were interviewed during the period March-May 2012. They were asked how they view equitable healthcare, and how they work to achieve it. A conceptual model for attaining equity in healthcare, including Denial, Defence, Openness, Awareness and Action, was used in a deductive thematic analysis of the interview data. RESULTS: The five model concepts - Denial; Defence; Openness; Awareness and Action - were found in a variety of combinations in the manager interviews. Denial and Defence were mentioned to a higher extent than Openness and Awareness. Several informants denied inequity, arguing that the decision support tool prevented this. However, those who primarily expressed Denial and Defence were also open to learning more on the subject. Action was only mentioned twice in the informants' answers, and then only implicitly. CONCLUSION: Although a majority of the interviewed managers expressed a lack of awareness of (in)equity in healthcare, they also expressed an openness to learning more. While this may reflect a desire to show political correctness, it also points to the need for educational training in order to increase the awareness of (in)equity in healthcare among healthcare managers. Future follow up measurements will reveal if this has happened.

Effect of remote nursing monitoring on overweight in women: clinical trial / Efeito do monitoramento remoto de enfermagem sobre o excesso de peso de mulheres: ensaio clínico / Efecto del monitoreo remoto de enfermería sobre el sobrepeso de mujeres: ensayo clínico

ABSTRACT Objective: to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. Method: controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. Results: in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. Conclusion: the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.

RESUMO Objetivo: avaliar o efeito do monitoramento remoto de enfermagem na melhora das medidas antropométricas de mulheres com excesso de peso. Método: ensaio clínico controlado, randomizado, realizado em ambulatório de referência em obesidade. Constituíram o baseline 101 mulheres, alocadas aleatoriamente em dois grupos, 51 no grupo de intervenção (GI) e 50 no grupo controle (GC). O GI recebeu o monitoramento remoto por telefone e acompanhamento convencional e o GC acompanhamento convencional. A avaliação das mulheres ocorreu no baseline e após três meses de intervenção. Para avaliar as diferenças das medidas antropométricas intragrupos, utilizou-se o teste t pareado e, intergrupos, a análise de covariância, adotando-se significância estatística de 5%. Completaram o estudo 81 mulheres. Resultados: na comparação intergrupos após a intervenção, verificou-se redução de 1,66 kg na média do peso (p = 0,017) e redução de 0,66 kg/m2 na média do IMC (p = 0,015) para o grupo intervenção. Houve redução de 2,5 cm na CC no grupo intervenção com diferença estatística boderline (p=0,055). Conclusão: o efeito do monitoramento remoto foi benéfico na redução das medidas antropométricas. RBR-3hzdgv.

RESUMEN Objetivo: evaluar el efecto del monitoreo remoto de enfermería en la mejora de las medidas antropométricas de mujeres con sobrepeso. Método: ensayo clínico controlado, aleatorio, realizado en ambulatorio de referencia en obesidad. Constituyeron el baseline 110 mujeres, colocadas aleatoriamente en dos grupos, 51 en el grupo de intervención (GI) y 50 en el grupo control (GC). El GI recibió el monitoreo remoto por teléfono y el seguimiento convencional y el GC tuvo seguimiento convencional. La evaluación de las mujeres ocurrió en el baseline y después de tres meses de intervención. Para evaluar las diferencias de las medidas antropométricas intragrupos se utilizó el test t pareado y, intergrupos, el análisis de covariancia, adoptando significancia estadística del 5%. Completaron el estudio 81 mujeres. Resultados: en la comparación intergrupos después de la intervención se verificó reducción de 1,66 Kg en la media del peso (p=0,017) y reducción de 0,66 Kg m2 en la media del IMC (p=0,015) para el grupo intervención. Hubo reducción de 2,5 cm en la CC en el grupo intervención con diferencia estadística boderline (p=0,055). Conclusión: el efecto del monitoreo remoto fue benéfico en la reducción de las medidas antropométricas. RBR-3hzdgv.

The Effect of Telenursing on Referral Rates of Patients With Head Trauma and Their Family's Satisfaction After Discharge.

We aimed to assess the effect of telenursing on referral rates of patients with head trauma and their family's satisfaction after discharge. Seventy-two patients with head trauma were randomly allocated to equal intervention and control groups. The caregivers in both groups were provided with 1-hr face-to-face training on patients' home care and educational booklets, 2 days before discharge. The cell phone numbers of the telenurse was given to the caregivers of the intervention group. Then, the patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks and the patient status checklists were completed. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data were analyzed using SPSS software, version 19. Ultimately, 33 patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years were studied in the intervention group (p = .098). The 2 groups differed significantly with respect to referral rates; 39.4% of the participants in the control group referred to physicians whereas only 25.7% of the patients in the intervention group needed to refer to physicians (p = .017). Also, the mean times of referring to a physician differed significantly in both groups. In general, 53.8% of the caregivers were satisfied with the telenursing program. Follow-up programs using telephone calls were effective and would lead to higher caregiver satisfaction.

Efecto del seguimiento telefónico en la adherencia al tratamiento en los pacientes con falla cardiaca / Effect of telephone monitoring on adherence to treatment in patients with heart failure

Objetivo: Determinar el efecto del seguimiento telefónico en los niveles de adherencia al tratamiento farmacológico y no farmacológico en los pacientes que asisten a un programa de falla cardiaca de una institución de cuarto nivel de atención. Método: Ensayo clínico controlado (n = 61) en el que los pacientes se aleatorizaron a seguimiento telefónico o a seguimiento usual. Para determinar el efecto de la intervención se realizaron tres mediciones de los niveles de adherencia: antes del seguimiento, a los 12 meses y 6 meses después de finalizar el seguimiento. Se utilizaron la prueba de tendencia de Cochrane-Armitage y un análisis multivariado con un modelo logístico mixto de cuantiles. Resultados: Los pacientes con seguimiento telefónico tuvieron tendencia a clasificarse en niveles de mayor adherencia que los del grupo control (p < 0.0001). En el modelo multivariado se encuentra una asociación entre los puntajes de adherencia y el seguimiento telefónico, que dependen del tiempo, en los percentiles estudiados en la distribución. Hubo mayor adherencia con la intervención de la segunda visita en los cuantiles bajos de la distribución (P10 y P25) y, en la tercera, en los cuantiles más altos (P50, P75 y P90). Variables como sexo masculino (P10 y P25), universitarios (P10 y P90) y presencia de cuidador (P90) estuvieron asociadas con mayores niveles de adherencia. Conclusiones: El seguimiento telefónico se convierte en una intervención efectiva que promueve la motivación, la autogestión y la comunicación asertiva con el paciente, siempre y cuando se realice de manera estandarizada y a lo largo del tiempo

Objective: This work sought to determine the effect of telephone monitoring on levels of adherence to pharmacological and non-pharmacological treatment in patients attending a heart failure program in a tier IV health care institution. Method: Controlled clinical trial (n = 61) in which patients were randomized to telephone monitoring or to usual monitoring. To determine the effect of the intervention, three measurements were made of the adherence levels: prior to monitoring, at 12 months, and 6 months after finishing the monitoring. The Cochran-Armitage trend test was used, along with a multivariate analysis with a quantile mixed logistic model. Results: Patients with telephone monitoring tended to classify in levels of greater adherence than those from the control group (p< 0.0001). The multivariate model shows an association between the adherence scores and the telephone monitoring, which depend on time, percentiles studied, and the distribution. There was greater adherence with the intervention of the second visit in the distribution’s low quantiles (P10 and P25) and, in the third, in the highest quantiles (P50, P75, and P90). Variables, like male gender (P10 and P25), university schooling (P10 and P90), and presence of a caregiver (P90) were associated with higher adherence levels. Conclusions: Telephone monitoring becomes an effective intervention that promot es motivation, self-management, and assertive communication with patients, whenever it is carried out in standardized manner

Effect of Telenursing on Outcomes of Provided Care by Caregivers of Patients With Head Trauma After Discharge.

Telenursing is a suitable tool for increasing health-related awareness of the caregivers for a better home care. But its efficacy may be affected by several factors. Considering the important complications of head trauma injury and high rate of readmission, we aimed to assess the effect of telenursing on care provided by the family members of patients with head trauma.This randomized controlled trial investigated 72 patients with head trauma, who were randomly allocated to intervention and control groups (36 patients in each group). The caregivers in both groups were provided with 1-hr face-to-face training session on patients' home care and educational booklets. The patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks, who recorded the patient's status, as well. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data on patients' readmission and pressure ulcer (based on Norton's scale) rate and time were compared between the groups and analyzed using SPSS software, version 19. Thirty-three patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years in the intervention group (p = .098). None of the patients in the intervention group were readmitted, whereas 2 patients in the control group were readmitted s(p = .139). Risk of pressure ulcer did not differ between the groups (p = .583). Telenursing had no significant effect in readmission and decubitus prevention for patients with head trauma. Considering the chronic nature of the illness, a longer follow-up period is deemed necessary for an accurate conclusion.

Enhanced Transitions of Care: Centralizing Discharge Phone Calls Improves Ability to Reach Patients and Reduces Hospital Readmissions.

BACKGROUND: The discharge phone call (DPC) is an important initiative aimed at improving transitions of care and reducing readmissions. It is of added importance as financial penalties will be imposed on hospitals with "excessive" Medicare readmissions. This study examines the impact of DPCs on percentages of patients reached through the DPCs and hospital readmission rates based on the centralized or noncentralized mode of DPCs. METHODS: The health system centralized the Studer Group Discharge Phone Call program into one central call center with the goals of reaching more discharged patients and to ultimately reduce hospital readmissions. The study analyzed hospital visits from 74,754 patient admissions that could result in an unplanned hospital readmission. Hospital discharge data were analyzed from August 2010 to January 2014. Primary outcomes included DPCs reaching discharged patients and effects on hospital readmission rates as a result of centralizing the DPC program. RESULTS: Centralized DPCs are significantly associated with increases in the percentage of patients reached by the DPC, which in turn reduces readmissions rates. Patients not reached were 1.32 times more likely to be readmitted than patients reached by centralized DPCs. CONCLUSIONS: Centralizing the DPC program within a call center helps reach more patients and reduce readmission rates further compared with noncentralized DPCs.

[Implementing Telemedicine, EHealth and Telephonic Nursing Assistance in Spain]. / Implantación de la telemedicina, eSalud y atención telefónica de enfermería en España.

Introduction: Tele-Health or eHealth are defined as diversified health services provided remotely by a team of professionals using ICT (Information and Communication Technology) to improve the health of a user or population. Development: The development of ICT during the 2000 and 2010 decades allowed for a wider applicability of these services. Techniques like teleradiology and telepathology appeared. Tele-nursing began to be practiced through teleconsultations. Tele-nursing emerged from consulting telephone nurses in the United Kingdom and Canada. In 2005, the WHO established the Global eHealth Observatory to review the benefits of ICT. Currently in Spain, 061 Cat Salut Respon, managed by nurses, gives coverage to Catalonia through its website, telephone, email or chat. In Andalusia, Salud Responde is a service and information center providing citizens with remote healthcare. Conclusions: Health systems offer services through multichannel schemes and specific applications (apps) improving accessibility anytime, anywhere, provided with internet connection. The involvement of nurses in eHealth programs, such as telenurses, is increasingly spreading in Spain, mirroring the trend at an international level.

The Impact of Telenursing on Nursing Practice and Education: A Systematic Literature Review.

This systematic review aims to answer the following question: What is the impact of telenursing on nursing practice and education? Any article that was written in English and published in PubMed and Computers Informatics Nursing (CIN) journal from January 2012 to February 2016 discussing the impact of telenursing on nursing practice and education were included, while any opinion and review literature was excluded. The results show that there are four themes covered by the literature: 1. Impact of telenursing intervention using telephone and/ or videoconferencing on satisfaction and health outcomes; 2. Association of the patients' comorbidity characteristics with nursing utilization of telenursing and/or withdrawal from telehealth service during a telenursing care episode; 3. Tele-intensive care unit (tele-ICU) nursing and developing its competencies; and finally 4. Training on telenursing. Articles on Intensive Care Unit telenursing were found to be the most covered specialty/area of nursing in using telenursing. More research is still needed to show the impact of telenursing on nursing education as well as other specialties of nursing practice.

[Telemedicine in Switzerland]. / Telemedizin in der Schweiz.

Telemedicine always was at the edge in adapting newest information and communication technologies. Since medicine occurred, telemedica/ activity was undertaken with the aim to overcome a distance. Telemedicine is defined as an interaction between one or several health professionals, within the context of a medical process, but at a distance, without direct physical contact. Classical fields of telemedicine or Teleradiology, Telepathology, are mainly related to medical specialties and hospital centres,in Switzerland as well. In parallel, Swiss Telemedicine did undertake a specific evolution, by developing sophisticated telemedical consultation centres focused on primary health and with highly trained multiprofessional staff They contribute to the development of decentralized and population based integrated health and care services. In turn, this enables development of new interprofessional health professionals' roles and activities. As progression of patient-citizens' mobility and spreading out of mobile devices take place simultaneously, this opens the opportunity to overcome structural change of the Swiss healthcare system by creating new and innovative healthcare services.

Training oncology nurses to use remote symptom support protocols: a retrospective pre-/post study.

PURPOSE/OBJECTIVES: To evaluate the impact of training on nurses' satisfaction and perceived confidence using symptom protocols for remotely supporting patients undergoing cancer treatment. DESIGN: Retrospective pre-/post-study guided by the Knowledge-to-Action Framework. SETTING: Interactive workshops at three ambulatory oncology programs in Canada. SAMPLE: 107 RNs who provide remote support to patients with cancer. METHODS: Workshops included didactic presentation, role play with protocols, and group discussion. Post-training, a survey measured satisfaction with training and retrospective pre-/post-perceived confidence in the ability to provide symptom support using protocols. One-tailed, paired t-tests measured change. MAIN RESEARCH VARIABLES: Satisfaction with the workshop and perceived confidence in the ability to provide symptom support and use protocols. FINDINGS: Twenty-two workshops, 30-60 minutes each, were conducted with 107 participants. Ninety completed the survey. Compared to preworkshop, postworkshop nurses had improved self-confidence to assess, triage, and guide patients in self-care for cancer treatment-related symptoms, and use protocols to facilitate symptom assessment, triage, and care. Workshops were rated as easy to understand, comprehensive, and provided new information on remote symptom management. Some specified that the workshop did not provide enough time for role play, but most said they would recommend it to others. CONCLUSIONS: The workshop increased nurses' perceived confidence with providing remote symptom support and was well received. IMPLICATIONS FOR NURSING: Subsequent workshops should ensure adequate time for role play to enhance nurses' skills in using protocols and documenting symptom support.

Assessing the impact of nurse post-discharge telephone calls on 30-day hospital readmission rates.

BACKGROUND: Several care transition interventions propose that post-discharge phone calls can reduce adverse events and decrease costly return visits to the hospital. However, given the multi-faceted nature of most care transitions interventions, the true relationship between post-discharge phone calls and readmissions in a real world setting is uncertain. OBJECTIVE: To determine the effect of receiving a post-discharge telephone call on all-cause 30-day readmission in a general medicine population. DESIGN: Retrospective observational study. PARTICIPANTS: Patients discharged home from the Medicine Service at a tertiary care academic medical center between November 2010 and May 2012. INTERVENTION: Patients received two telephone call attempts by a nurse within 72 h of discharge. Nurses followed a standard script to address issues associated with readmission. MAIN OUTCOME AND MEASURES: Billing data captured readmissions. We used logistic regression-adjusted patient and clinical covariates as well as a propensity score representing likelihood of being called to determine the association between call receipt and risk for readmission. KEY RESULTS: There were 5,507 eligible patients. In unadjusted analyses, patients who received a call and completed the intervention were significantly less likely to be readmitted compared to those who did not [155 (5.8 %) vs 123 (8.6 %), p < 0.01]. In multivariable models adjusting for socio-demographic and clinical covariates alone, completing a post-discharge telephone call intervention was associated with lower odds for readmission (AOR 0.71; 95 % CI: 0.55-0.91). However, when models adjusted for the likelihood of receiving the phone call using the propensity score, no association between call receipt and readmission was observed (AOR 0.91; 95%CI: 0.69-1.20). CONCLUSIONS: Effectiveness of post-discharge phone call programs may be more related to whether patients are able to answer a phone call than to the care delivered by the phone call. Programs would benefit from improving their ability to perform phone outreach while simultaneously improving on the care delivered during the calls.

Evaluation of a primary care-based post-discharge phone call program: keeping the primary care practice at the center of post-hospitalization care transition.

BACKGROUND: The post-hospitalization period is a precarious time for patients. Post-discharge nurse telephone call programs aiming to prevent unnecessary readmissions have had mixed results. OBJECTIVE: Describe a primary-care based program to identify and address problems arising after hospital discharge. DESIGN: A quality improvement program embedding registered nurses in a primary care practice to call patients within 72 h of hospital discharge and route problems within the practice for real-time resolution. PARTICIPANTS: Adult patients with a primary care provider in the general internal medicine practice at the University of California San Francisco who were discharged home from the Medicine service. MAIN MEASURES: Patients reached directly by phone had a 'full-scripted encounter;' those reached only by voice-mail had a 'message-scripted encounter;' those not reached despite multiple attempts had a 'missed encounter.' Among patients with full-scripted encounters, we identified and cataloged problems arising after hospital discharge and measured the proportion of calls in which a problem was uncovered. For the different encounter types, we compared follow-up appointment attendance and 30-day readmission rates. KEY RESULTS: Of 790 eligible discharges, 486 had a full-scripted, 229 a message-scripted and 75 a missed encounter. Among the 486 full-scripted encounters, nurses uncovered at least one problem in 371 (76 %) discharges, 25 % of which (n = 94) included new symptoms, and 47 % (n = 173) included medication issues. Discharges with full-scripted and message-scripted encounters were associated with higher follow-up appointment attendance rates compared with those with missed encounters (60.1 %, 58.5 %, 38.5 % respectively p = 0.004). There was no significant difference in 30-day readmission rates (12.8 %, 14.8 %, 14.7 %; p = 0.72). CONCLUSIONS: Our results suggest that centering a post-discharge phone call program within the primary care practice improves post-hospital care by identifying clinical and care-coordination problems early. With the new Medicare transitional care payment, such programs could become an important, self-sustaining part of the patient-centered medical home.

Influencing dressing choice and supporting wound management using remote 'tele-wound care'.

This article describes a local involvement in a project to evaluate a remote system of wound management, incorporating the use of digital and mobile technology. It outlines how this involvement influenced the current system of 'tele wound care' (remote wound management) in a large community organisation. The system allows remote wound assessment, management advice and ongoing monitoring of wounds to ensure that the dressing choice remains appropriate and that timely wound care support can be provided to community nurses, practice nurses and GPs.

Goals of telephone nursing work--the managers' perspectives: a qualitative study on Swedish Healthcare Direct.

BACKGROUND: Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD. METHODS: The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis. RESULTS: The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: 'create feelings of trust', 'achieve patient safety', 'assess, refer and give advice', and 'teach the caller'. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given. CONCLUSIONS: The interviewed managers mainly echoed the organisational goals of TN work. The managers' expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.

Feasibility study: home telemonitoring for patients with lung cancer in a mountainous rural area.

PURPOSE/OBJECTIVES: To explore the feasibility of rural home telemonitoring for patients with lung cancer. DESIGN: Exploratory, descriptive, observational. SETTING: Patient homes within a 75-mile radius of the study hospital in West Virginia. SAMPLE: 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis. METHODS: Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months. MAIN RESEARCH VARIABLES: Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction. FINDINGS: Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer. CONCLUSIONS: Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact. IMPLICATIONS FOR NURSING: Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.