Using Remote Technology in Patient Care

Q What is it like to care for patients using remote technology? Are there best practices and/or resources I should know about?A Lisa-Mae Williams, PhD, RN, CCRN-K, replies:Technological innovation in remote care has brought about a rapid increase in capabilities and enabled live interactions between patients and nurses. Remote technology has enhanced care delivery in part through innovative centralized work-flows that increase the capacity for safe and efficient nursing care.1 More nurses are turning to virtual nursing as an alternative work environment that allows them to remain in an active role within the profession while providing respite from the demands of on-site physical care.2,3 To understand what it is like to work in the remote environment, it is important to be aware of the characteristics of nurses who work in virtual care and the skills needed to practice in this setting.Virtual nursing, also referred to as telehealth nursing or telenursing, is defined as delivering nursing care remotely via audiovisual platforms, software applications, and telecommunication modalities.4 Virtual critical care nursing began in the early 2000s, when experienced critical care nurses used remote care workflows to provide clinical support and interventions for patients in the intensive care unit.5 Other settings have followed suit, primarily step-down and medical-surgical units.2,3Nurses are instrumental in the successful implementation of these telehealth initiatives. Virtual nursing models provide support to on-site staff at a time when nurses’ expertise is desperately needed as a result of a worsening nurse staffing crisis, a declining number of experienced nurses, and increasing nurse burnout. As remote work has gained popularity, health care organizations have had to quickly learn to navigate the new landscape and ensure high-quality and cost-efficient patient care.Professional nursing practice is not restricted or expanded by the use of remote technology. Telehealth technology is a portal for professional nursing practice consistent with the nurse practice act.4 The remote environment does not change the nursing process or obviate the need for sound clinical judgment. All nurses practice according to the code of ethical and professional practice standards during all patient encounters, regardless of whether they are on-site or virtual.Virtual nurses are uniquely positioned to foresee and prevent complications.5,6 For example, a virtual nurse can leverage technology to assess for and identify early signs of clinical deterioration and then use that information to prioritize patient needs, develop a plan of care, coordinate or facilitate interventions, evaluate the patient’s response to those interventions, and analyze subsequent outcomes. Technology allows the virtual nurse to perform these tasks seamlessly and efficiently for a relatively large patient population.As vital practitioners collaborating with the patient care team, virtual nurses facilitate coaching and mentoring of novice and experienced on-site nurses.7 Thus, virtual nurses must have strong communication and collaboration skills to overcome the barrier of the remote dynamic.5 Effective virtual nurses have developed strong situational awareness and self-efficacy and have a clear understanding of the importance of a supportive telepresence (including tone of voice and facial expressions, which are amplified when using audiovisual technology).6 The most common virtual nursing model in the acute care setting is continuous monitoring and surveillance of a large patient population from a central hub, with the virtual nurse conducting proactive evaluation across multiple patient locations. The virtual nurse is an agile resource with the ability to respond to urgent and emergent situations as they arise. Health care organizations and leaders are responsible for clearly defining roles and expectations of virtual nurses to ensure that their interventions align with those of the medical provider and the hospital.2 The 2022 American Association of Critical-Care Nurses tele–critical care nursing consensus statement provides several vignettes and examples of virtual nursing practice.7 Examples of virtual nursing care are shown in the Table.Virtual nurses employ a variety of technological modalities in their provision of care. The types of applications, video surveillance platforms, electronic health record systems, and adjunct equipment used depend on program requirements. The goals of telehealth-mediated patient care (virtual care) programs will determine the roles of nurses, how they use specific technology to deliver care, the number of assigned patients, and the acuity level of those patients. Virtual nurses perform continuous or episodic (on-demand) evaluations and interventions based on alerts or prompts generated by software applications. Virtual nurses are experts at quickly navigating through copious amounts of data using analytical and technical skills to filter for actionable information that will prompt intervention or supportive measures for patients and on-site staff.Evidence shows that nurses using remote technology contribute to improved patient safety, quality of care, and healthy work environments. Virtual nursing has helped improve workflows and enabled consistent application of best practices. Virtual nursing is on the forefront of technological innovation and can be used to provide services during routine care or during crisis, to detect precursors of instability, and to support the strained on-site team.8 As the nursing profession continues to evolve and adapt to changing patient needs, more research is needed to guide development of best practices for nursing care using remote technology.