Telenursing and Its Implications for Nursing Practice

1.0 Introduction

Telenursing, a subset of telehealth, integrates nursing care with telecommunication technology to

deliver healthcare services remotely (Ibitola et. al., 2022). It has emerged as a pivotal practice in
modern healthcare, addressing geographical barriers and enhancing accessibility to nursing
expertise. The context of this writing explores the historical evolution, applications, challenges,
and implications of telenursing for nursing practice, emphasizing its potential to redefine the nurse-
patient relationship and healthcare delivery dynamics.

To define Telenursing, Detwiler (2020), establishes it as the use of information technology in the
provision of nursing services whenever physical distance exists between patient and nurse, or
between any number of nurses. According Jotform (2020), Telenursing is defined as nursing
services provided through an electronic platform. This includes phone calls, video conferencing,
and remote monitoring through devices like Bluetooth-connected blood pressure monitors.
Telenursing is the delivery, management, and coordination of care and services provided via
telecommunications technology within the domain of nursing (AAACN, 2004). Hence from these
definitions, telenursing can be summarized as the dispensation of nursing services, between
healthcare providers and patients or other team of medical professionals, using telecommunication
technology regardless of the location or distance between the two parties.

As a field, it is part of telemedicine, and has many points of contacts with other medical and non-
medical applications, such as telediagnosis, teleconsultation, and telemonitoring.( Edmunds &
Marilyn, 2010) (Barbosa IdeA. Silva MJPda. IdA B. 2017)

The convergence of technology and healthcare has revolutionized medical practice, with
telenursing becoming a prominent player. Telenursing employs information and communication
technology (ICT) to provide nursing care, education, and support over a distance (Al Afik, Moses
Glorino Pandin, 2021). By reducing the need for physical presence, it caters to patients in remote
areas, individuals with limited mobility, and populations with restricted access to healthcare
facilities. However, its implications extend beyond logistical advantages, influencing professional
roles, ethical considerations, and the quality of care.

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1.1 Historical Context and Evolution of Telenursing

Telenursing can trace its roots to the broader telehealth initiatives of the 1960s (Abigail 2021)
when healthcare services began utilizing telecommunications for remote diagnosis. Early
applications included radio consultations for rural populations and emergency services during
disasters. It is thought that telemedicine was first used in the 1960s when the National
Aeronautics and Space Administration (NASA) built health monitoring sensors into the
astronauts’ spacesuits to monitor the health effects of space travel (Dawna, 2016). Dawna
(2016) further expressed that in the 1960s, telemedicine was used within the psychiatric mental
health care population, but in this case primarily for health care providers to communicate and
consult with each other. The first documented use of telemedicine to provide direct patient care
occurred in 1967 at Boston’s Logan International Airport. A medical station was created,
linking the airport with Massachusetts General Hospital, in order to provide care 24 hours a
day. During the decade that followed, NASA continued to play a role in telemedicine
technology by employing satellites that transmitted information from Alaska (1971) or
microwave technology to connect residents of an Arizona Indian Reservation with care
providers (1972)
Telehealth nursing is essentially what patients have known in the past as counselling over the
phone. (Wojciech, Glinkowski, Katarzyna Pawlwka, Kozlowska. 2013)
The advent of the internet and mobile technology in the late 20th century accelerated the
adoption of telenursing. Governments and healthcare providers embraced these innovations to
manage chronic diseases, conduct follow-ups, and enhance preventive care.

Figure 1: Remote on spot x-ray examination of a patient using telenursing tools

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 Figure 2: Health professionals remotely attending to a patient in isolation
Telenursing became widely used at the time of pandemic. It was a need for the community to
have access to accurate nursing care at distant. During Locked down when people had no way
to go at the time of medical issues due to restrictions, Telehealth really helped as an anchor in
sea to stabilize the people’s health. Telenursing improves the provision of health services and
care by
guiding people to take care in accurate manner though they are at their homes (Harshna, 2022).
The global pandemic underscored the necessity of remote healthcare, propelling telenursing to
the forefront. Nurses played a crucial role in providing virtual care, managing patient
monitoring systems, and supporting overwhelmed healthcare systems.

2.0 Applications of Telenursing

i. Remote Monitoring: Nurses utilize wearable devices and remote monitoring tools to
track patients’ vital signs, ensuring real-time assessment and early detection of
anomalies. Common applications include managing chronic conditions like diabetes,
hypertension, and heart failure.
ii. Tele-triage : Telephone triage refers to symptom or clinically based calls. Clinicians
perform symptom assessment by asking detailed questions about the patient's illness or
injury. The clinician's task is to estimate and/or rule out urgent symptoms. They may
use pattern recognition and other problem-solving process as well. Clinicians may

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 utilize guidelines, in paper or electronic format, to determine how urgent the symptoms
are. Telephone triage requires clinicians to evaluate symptoms and provide health
advice which guides patients to the appropriate level of care, (emergent, urgent, or
nonurgent) according to their condition and symptoms. Telephone triage staff also
provides advice for self‐care at home for nonurgent patients. Telenursing supports the
triage process by assessing symptoms, determining urgency, and guiding patients to
appropriate care facilities. This reduces unnecessary emergency room visits and
optimizes resource allocation (Jácome et.al., 2019).
iii. Patient Education and Counseling: Nurses deliver educational sessions and
psychological support to patients and families via video conferencing platforms. Topics
often include medication management, disease prevention, and post-operative care
instructions.
iv. Home Health Services: Virtual visits enable nurses to oversee home care, addressing
patients' needs while reducing exposure to infectious diseases. Home care
One of the most distinctive telenursing applications is home care. For example, patients
who are immobilized, or live in remote or difficult to reach places, citizens who have
chronic ailments, such as chronic obstructive pulmonary disease, diabetes, congestive
heart disease, or debilitating diseases, such as neural degenerative diseases (Parkinson's
disease, Alzheimer's disease or ALS), may stay at home and be "visited" and assisted
regularly by a nurse via videoconferencing, internet or videophone. Other applications
of home care are the care of patients in immediate post-surgical situations, the care of
wounds, ostomies or disabled individuals. In normal home health care, one nurse is
able to visit up to 5-7 patients per day. Using telenursing, one nurse can “visit” 12-16
patients in the same amount of time.
v. Case management: A common application of telenursing is also used by call
centers operated by managed care organizations, which are staffed by registered
nurses who act as case managers or perform patient triage, information and counseling
as a means of regulating patient access and flow and decrease the use of emergency
rooms.

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3.0 Framework in Telenursing

The framework in telenursing requires an infrastructure consisting of a telenursing session room

and a specialty center. While the telenursing session room is the place where consultants/specialist
speak with the peripheral centers. The telenursing specialty center is linked to peripheral center,
situated in the suburban and rural areas from the place the affected person or healthcare employee
can consult. Equipment and science required for telenursing are excessive decision video camera,
internet camera, report camera, microscope, private computer, microphone, telephone, fax
machine, faxes and modem to supply provider to the patients. In addition, technologies used in
telemedicine are internet, digital imagery, trans telephonic electrocardiogram monitoring (Dorothy
2022).

Figure 3: Framework of guidelines and standards applicable to telenursing (Dorothy 2022)

3.1 Essential Tools and Devices for Telenursing

i. Smartphones, tablets, and laptops, excessive decision video camera, internet

camera, report camera, microscope, private computer, microphone, telephone, fax
machine, faxes and modem to supply internet service provider to the patients, serve
as primary communication devices.

ii. Specialized software applications ensure secure data transmission and compliance
with healthcare regulations.

iii. In addition, technologies used in telemedicine are internet, digital imagery, trans
telephonic electrocardiogram monitoring (Dorothy 2022)

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 iv. Telehealth Platforms: Platforms like Zoom for Healthcare, Doxy.me, and
Microsoft Teams integrate video conferencing with electronic health record (EHR)
systems.

v. Wearables and IoT Devices (Internet of things devices): Devices such as blood
pressure monitors, glucose meters, and ECG patches provide nurses with
continuous data streams.

3.2 Telenursing Implementation

According to CRNSS (2008), Telenursing can be highlighted four phases in Figure 2 below

Figure 4: Telenursing implementing format as recommended by CRNSS (2008)

Figure 5: The technical model of telecommunication in telenursing (Zwiefka, 2011)

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4.0 Advantages/Benefit of Telenursing
Among many advantages of telenursing in nursing care are the improved accessibility to
health care, faster services development, an increase in the prestige of the profession, data
security, better information flow, convenience, facilitated communication between nursing
staff and hospitals, available for both personal and patients, and improvement of time and
resource allocation (Rehab, 2021).

4.1 General benefits of Telenursing

i. Improved Accessibility:

o Telenursing bridges gaps for rural and underserved populations.

o It offers timely interventions, reducing travel and wait times.

ii. Cost-Effectiveness

o Both patients and healthcare systems benefit from reduced expenses associated
with transportation, hospital stays, and infrastructure.

iii. Enhanced Chronic Disease Management

o Consistent monitoring and virtual support improve disease outcomes and patient
adherence to care plans.

iv. Workforce Optimization

o Nurses can manage larger patient populations without compromising quality,

addressing global nursing shortages.

v. Preventive Care:
Telemedicine may make it easier for people to access preventive care that improves
their long-term health especially for people with financial or geographic barriers to
quality care. For instance, a study done by Ajalli A. Fallahi-Khoshknan M. (2015)
found that preventive telemedicine improved health outcomes of people with
coronary artery disease.

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 vi. Convenience:
Telemedicine allows people to access care in the comfort and privacy of their own
home. This may mean that a person does not have to take time off of work or
arrange childcare as they can still receive care without been absent from work or
home. People have choices and control over the way their health care is planned
and delivered, as a shift in focus on the individual consumer.
vii. Slowing the spread of infection:
Telemedicine help keep immuno-compromised patient
safe and eliminates the risk of been infected. A visit to the hospital means being
around people who may be sick, often in close quarters. This is risky for people
with underlying
conditions or weak immune systems.

4.2 Benefits for Healthcare Providers

Health care providers who render telemedicine may have lot of benefits such as;

A. Reduced overhead expenses: Providers who render telemedicine services may incur
lesser overhead cost. For instance, they may spend less money for front desk support or
invest in a fewer exam room in an office space.

B. Additional revenue stream: Health providers may find out that telemedicine
supplements their income because it creates room to provide care to more patients.

C. Less exposure to illness and infections: There is lower exposure to patients when seen
remotely and lesser worry on exposure to any pathogens the patient may carry.

D. Patient satisfaction: When a patient does not have to travel to the office or wait for
care, they may be happier with their provider (Zawn, 2020).

4.3 Disadvantages of Telenursing

There are few disadvantages as telenurses may not be able to handle the emergency care
from a distance. Also, some patients may be unable to describe their situations on calls
and telenursing might not be able to see the scars and wounds properly when it’s not

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 through physical contact (Rehab, 2018). In as much telemedicine has lot of benefits, it also
come with some disadvantages such as;

A. Expensive to setup; It can be costly to set up and maintain though a great and worthy
service but may be too expensive for a smaller healthcare facility (Brian, 2016).

B. Inability to examine patients: Some illness needs a physical assessment and cannot
be diagnosed through telemedicine (Brian, 2016). During telemedicine sessions providers
rely on patient self-reports; to ensure a comprehensive health history it may require the
providers to ask more questions. Health care or treatment can be compromised if a vital
information such as symptoms is being left out whereas it could have been noticeable
during an in-person care (Zawn, 2020).

C. Protection of medical data: patient’s medical data may be accessible to hackers and
other cyber criminals especially if the site is being accessed on a on a public network or
via an unencrypted channel (Zawn, 2020).

D. Care delays: During emergency, accessing telemedicine first may delay treatment,
especially since a lifesaving care or laboratory tests digitally cannot be provided.

E. Technological concerns: It can be challenging in finding the right digital platform to

use. A strong internet connection is required to offer quality care. Providers must also
ensure that the telemedicine program they use is secure and fully compliant with privacy
laws.

5.0 Challenges in Telenursing

i. There are various challenges which include but not limited to ethical and legal issues,
technical barriers, professional challenges and Health Equity Concerns (Amudha R., Nalini
R. Alamelu R. 2017). highlighted challenges in the implementation of telenursing. They
are:

ii. Technical Barriers

o Lack of internet connectivity.

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 o Likelihood of technology failures, poor quality transmission or dysfunctional
communication

o inadequate digital literacy in certain regions hinder implementation.

o Financial investments (Startup costs, training, internet connectivity, equipment

maintenance)

o Erratic supply of electricity

iii. Ethical and Legal Issues

o Ensuring patient confidentiality and compliance with stipulated regulations is

paramount.

o Licensing disparities across jurisdictions complicate cross-border telenursing

practices.

o Inter professional conflicts

o Risk for problems related to confidentiality and security

o Inability to provide adequate information to the client to make an informed consent

o Lack of institutional framework policies and legislation to regulate the standards

and practice telemedicine

o Lack of continuity of policy when government changes hand pecuniary interest of

approving authorities

o Susceptible to Cyber attack

iv. Professional Challenges

o Nurses may experience reduced job satisfaction due to limited physical interaction.

o Virtual settings complicate non-verbal communication and rapport-building.

o Increase in liability risks.

o Absence of direct “hands on” assessment and face to face interaction

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 o Likelihood for misdiagnosis due to inability to physically examine patients

o Lack of license if the client is from another province which is beyond the scope of
practice for the registered nurse

o Lack of locally trained experts, training facilities and high cost of foreign trained
expert salaries, coupled with inadequate knowledge of billing for services rendered
by

o healthcare practitioners on telemedicine platform

o Lack of education and skills to understand telemedicine by rural inhabitants and

their low purchasing power

v. Health Equity Concerns

o Socioeconomic disparities may exacerbate inequities in accessing telenursing

services.

6.0 Implications for Nursing Practice

i. Transformation of Roles

o Nurses must adapt to hybrid roles involving technical expertise alongside

traditional care.

ii. Education and Training

o Nursing curricula need to incorporate telehealth competencies, including

technology usage, virtual communication, and remote clinical decision-making.

iii. Redefining Patient Relationships

o Building trust in virtual environments requires new communication strategies and

empathy techniques.

iv. Policy and Regulation Advocacy

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 o Nurses must engage in shaping policies that address licensing, reimbursement, and
ethical standards in telehealth.

v. Integration into Multidisciplinary Teams

o Telenursing fosters collaboration across healthcare disciplines, emphasizing

coordinated and holistic care.

7.0 Future Directions

i. Artificial Intelligence and Machine Learning

o AI tools can enhance telenursing by providing predictive analytics and decision

support systems.

ii. Expansion in Rural and Low-Income Areas

o Targeted investments in infrastructure and training can extend telenursing's reach

to marginalized populations.

iii. Personalized Care Models

o Data-driven insights enable tailored care plans, improving patient outcomes.

iv. Global Collaboration

o Harmonizing international licensing and regulatory frameworks could facilitate

global telenursing networks.

8.0 Conclusion

Telenursing represents a transformative evolution in nursing practice, offering immense potential

to enhance healthcare delivery. While challenges persist, proactive measures in education, policy,
and technology adoption can address these barriers. By embracing telenursing, nurses can continue
to lead in providing compassionate, accessible, and innovative care in the digital age.

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Although several factors have contributed to the growing nature of telenursing globally and in
Nigeria such as high demand for the easy access and convenience health treatment, high media
literacy, access to internet and other ICTs tools only possible with urban dweller and literate
patient. However, nurses engage in commercially available protocols in their own ambulatory care
organization to assess the client over the telephone and to recommend approved interventions.

Majority of Nigerian rural dweller are communicating on phone and minority via Smartphone with
the aid of various application and software such as social media (Youtube, WhatsApp, special
heath apps), email, blog, skype and other live streaming tools. Telenursing can be

done anywhere, provided the technology that will be used to conduct telehealth session is available
in the homes, clinics and hospitals. Due to poor internet access in Nigeria and inadequate ICTs
knowledge of advancement communication gadgets among the nurses and most people in the
society especially the rural dwellers, telenursing is poorly practiced. Therefore, emergence of
telenursing aids monitoring health status to identify and solve community health problems; in
diagnosing and investigating health problems and health hazards hence informing, educating and
empowering people about health issue through electronic media or modern technology. It will also
increase access to information such as online medical records which can improve self-monitoring
and patient convenience.

9.0 Recommendations

The following recommendations were made following this review;

1. Adoption of Nursing informatics to develop and improve on technology, development in bio-

information and advancements as enhanced nursing with cutting edge technology. Hence,
technology would positively impact patients care due to improvement in nurses ‘efficiency and
effective communication.

2. Research and application of clinical best practices: nursing services with telenursing could
prove long distance service, time efficiency and allocation of funds. Therefore, a solution to
answer the aforementioned challenges.

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3. Training of other nurses on telenursing and use of Electronic Medical Records. Electronic health
record serves as a standard form of documentation to be shared by health care team thereby
enhancing patient safety, evaluate care quality, maximize efficiency and measure the need of staff.

4. Maintenance of electronic patient records. Health information management is the practice of

acquiring, analyzing and protecting digital and traditional medical information, which is very vital
in providing quality patient care. By complying with medical, legal and ethical standards and
entering and maintenance of information in the electronic medical record.

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