Evaluation of Educational Intervention Involving Telemedicine

Evaluation of Educational Intervention Involving Telemedicine

SECTION 1

Introduction

            Telehealth or telemedicine is the employment of telecommunications in the diagnosis and treatment of illnesses, mainly for health promotion and surveillance functions (Wilson & Maeder, 2015; Zhang & Zhang, 2016). The US Health Resources and Services Administration (HRSA) defined telemedicine as “electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration” (Health Services Resource Administration, 2017, para. 1). According to Pardue (2015), telemedicine uses electronic communications to provide information and health care services to patients and clients through real-time audio and video technology. It has been promoted as a promising and cost-effective way to address healthcare challenges. Furthermore, the expansion of telemedicine is expected to continue to grow as technology use in clinical practice becomes more widely accepted (Shulver et al., 2017). In a review of 1,300 studies, Wootton (2012) found that telehealth interventions were equal or better than traditional face-to-face approaches. As a result, telehealth has become a useful tool to improve efficiency and patient access to health care.

According to Whitten et al. (2010), healthcare providers’ function, including nurses, has expanded into the use of telemedicine in healthcare delivery. These services include the ability to guide patients to ED visits, clarify treatment options, diagnose and treat acute illnesses, and manage chronic diseases. Besides, healthcare is currently driven by the advent of telemedicine, which ranges from mobile patient-centered applications to the most complex interactions in referral hospitals (Wilson & Maeder, 2015). According to Serper and Volk (2019), procedural and surgical management of diseases and remote patient monitoring, are greatly enhanced upon the involvement of telemedicine approaches. As a result, patient satisfaction is enhanced in clinical settings where telemedicine is incorporated (Kruse et al., 2017). Moreover, Patient satisfaction is enhanced in clinical settings where telemedicine is incorporated (Kruse et al., 2017).

A critical role of telemedicine is expanding access to and improving the quality of health delivery to rural areas. Telemedicine in rural areas to deliver high-quality and specialized care can reduce traditional challenges and burdens of patients, such as transportation or lack of specialty care. Pardue (2015) acknowledged telemedicine as the primary and plausible solution for a healthcare system to assist patients in remote and rural areas where the affordability and access to healthcare services are limited. In this way, telehealth can address and reduce health disparities in areas where limited physicians are enrolled for healthcare providers and have the potential to eliminate the costs of transportation of patients (Mechanic & Kimabll, 2019).

Boxer & Ellimonti (2019) posited that despite the broad applicability of telemedicine in current healthcare practice, economics remains a barrier to telemedicine’s successful use in nursing care. Nonetheless, telemedicine not only presents the future of medical practice but also serves as a primary route through which healthcare is expanded for patients with limited access to physicians. Healthcare quality is based on patient-centeredness; therefore, enhancing patient-centeredness in quality healthcare provision and access of physicians and nurses is essential. The latter forms a fertile ground for the affordability and accessibility to healthcare services owing to the overgrowing population and number of patients within the hospital settings (Boxer & Ellimonti, 2019).

The involvement of nurses in telemedicine practice remains essential, and this requires preparing nurses to utilize telehealth and telemedicine technology through educational programs. These education programs focus on telehealth and telemedicine understanding (Rutledge et al., 2017). The American Nursing Association has described telenursing as one of the subsets of telemedicine care that mainly focuses on specific nursing practice roles (Schlachta-Fairchild, Elfrink & Dieckman, 2008). On the same line, nurses who practice telemedicine mainly focus on self-management, health, and patients long term wellness (Shortliffe & Cimino, 2014). The nurses’ knowledge of telemedicine is more favorable to nurses who tend to be more comfortable with technology (McClellan et al., 2020).  As such, the presumptions of telemedicine practice potentiate the effective delivery of healthcare services by nurses in assisting patients with critical conditions.

The adoption of the standards set up by the American Academy of Ambulatory Care Nursing for the provision of telemedicine care by both practical and registered nurses highlighted the significance of these standards in the delivery of effective and safe patient-centered healthcare with convenient and accessible qualities (Bashir & Bastola, 2018). Given today’s population of nurses, most nurses were born before the emergence of technology within the healthcare systems, and this poses many challenges to their adoption and adaptation ability to the use of telemedicine in healthcare (Khemapech, Sansrimahachai & Toachoodee, 2019) as telemedicine knowledge favors nurses who tend to be more comfortable with competency in technology (McClellan et al., 2020).  Thus, nurses must be trained and educated in the use of telemedicine for healthcare organizations to reap the benefits of telemedicine.

Problem Statement

Healthcare provision and nursing practice are faced by various challenges, including the poor access of the patients to nursing services. The latter serves as a hindrance to quality healthcare. In a rural setting, my healthcare facility containing 174 licensed bed hospital which serves a population characterized by low income, high unemployment, and low education levels. The remoteness of the area is a barrier for patients to full access to specialty healthcare providers and facilities. For this community, telemedicine allows patients to minimize this barrier and engage with specialty providers. However, in many cases, the nursing staff lacks knowledge on the use of telemedicine for patient-centered care remotely. Also, the evaluation of the level of knowledge suggests that most nurses have limited education and training regarding the use of telemedicine, which presents a potential risk to healthcare provision. Bingman (2019) concluded that most nurses have limited education and training regarding the use of telemedicine, which presents a potential risk to healthcare provision. These challenges and barriers related to patients, staff, and programs prevent the improvement and thriving of telemedicine practice, dependent on the nurse’s education on telemedicine practice.

Purpose of the Study

The advent of telemedicine in the healthcare provision systems provides the need to embrace telemedicine technology to enhance patient satisfaction and patient-centered healthcare provision. According to Cui, Daffner, Crossley, Sedney, & France (2018), telemedicine cost savings for spine surgery candidates compared to ambulatory visits were able to save at least $800,000. Additionally, the surgeons had effective time management and were able to concentrate their time on necessary procedures and patients, which improved patient outcomes. The utilization of telemedicine is essential for vulnerable populations such as those within the stated area of study owing to the poor access to healthcare provision services. For the nurses’ adequate provision of telemedicine services to address the problem of poor access to quality healthcare services by the patients, nurses must have adequate knowledge of telemedicine and how they can effectively adopt this technology. Therefore, it is essential to evaluate the educational intervention involving telemedicine by the nurses to determine their proficiency and level of education for adequate healthcare provision. By conducting a hospital evaluation through participation in meetings, an observation of how the hospital leaders work to solve issues at the hospital daily is necessary. Thus, the purpose of this project is to determine if an educational intervention geared towards telemedicine technology increases the knowledge and confidence level of RNs and LPNs practicing in a rural acute care center?

Nature of Doctoral Project

According to Teaoli and Aeddula (2018), patient privacy, lack of patient-physician relationship, regulatory issues, reimbursement, diagnostic accuracy, lack of nurse education on telemedicine, and technology-related barriers were some of the barriers to effective telemedicine practice within the healthcare systems. Scott et al. (2018) added that barriers to telemedicine and its use were specific to the patients, organization, staff, programmers, and county. The authors further noted that resistance to change and technical staff challenges posed negative impacts to the advancement of telemedicine. According to Teoli & Aeddula (2018), several other barriers underpinned telemedicine’s effective adoption and telehealth within the healthcare settings. The authors identified security, patient privacy, liability, diagnostic accuracy, reimbursement, regularity issues, lack of patient-physician relationship, and technology-related issues as barriers to the effective delivery of telemedicine related health.

Moreover, patient satisfaction remains at the center of healthcare provision. As such, most patients present as a barrier to telemedicine intervention’s success due to the redundancy of the practice (Teoli & Aeddula, 2018). The pressure to ensure patient satisfaction in telemedicine-related care exerts much pressure on healthcare providers due to inadequate education and knowledge on this kind of care.

The perceptions of both registered nurses (RGs) and practice nurses (PNs) changed upon their engagement in a conducive environment that best adapts to the telemedicine kind of healthcare provision (Hope-Kollveit et al., 2017). On the same line, the ability to provide affordable, quality, and safe healthcare in rural areas would be enhanced by such nurses (Hope-Kollveit et al., 2017). Donohue, Hoffman & Marcin (2019) added that LPNs and RNs who were well educated on the use of telemedicine in nursing service provision depicted much competence in enhancing the patient outcomes for patients living within the rural areas (Donohue, Hoffman & Marcin, 2019). Also, interventions without telemedicine involvement do not provide positive patient outcomes based on the challenges related to accessibility and affordability to healthcare services by the patients. Van Houwelingen, Kort & Ten-Care (2019) ascertained that the maintenance of confidence related to telemedicine practice was primarily based on sufficient knowledge by the nurses on telemedicine practice. As such, the researchers highlighted that the gap-filling process would involve implementing adequate policy adoption and facilitation.

Bashir & Bastolla (2018) stated that information technology (IT) solutions empower the nurses to educate, monitor, collect data, and follow up patients for foreign interventions. The education intervention for this project is aimed to take place at an acute care facility. Being the sole healthcare provider within a radius of 50 miles, the hospital is surrounded by low-income and indigent populations. Owing to the high population that requires robust medical attention, the hospital contains a busy telemedicine center that sieves most of the patients for the provision of easy access to physicians and nurses.

The promotion and facilitation of the Doctor of Nursing Practice (DNP) project will be primarily based on participating in meetings with the hospital leaders daily to solve issues that face the hospital facility. The student will have universal access to the committees, directors, and other relevant hospital personnel for support provision. The researcher will also work closely with the hospital stakeholders, including the CEO, bedside practice and registered nurses, telemedicine registered nurses, the CNO, hospital board, health insurance, and patients.

Significance of the DNP project

The DNP project stakeholders encompass the CEO, practice, and registered nurses, telemedicine registered nurses, the CNO, hospital board, health insurance, and patients. The patients will be the primary beneficiaries of the project as much of the focus will be on enhancing patients’ accessibility to healthcare services and reducing the costs of medication treatment. To the nursing practice profession, the doctoral project will enable the nurses to gain adequate knowledge in telemedicine practice, which will boost their competence and understanding of the fields for adequate healthcare service provision. Similarly, practice areas such as the pharmacy, medical diagnostics, and physicians will also learn from the project by gaining adequate knowledge on telemedicine, which would enhance the smooth provision of healthcare services and relieve various duties that would entail utilization of more time. Owing to the low access to healthcare facilities and healthcare services, the telemedicine program will lighten the society’s ability to access healthcare services.  Because the DNP’s project is the translation of knowledge into practice, it meets Walden’s mission of social change. At an individual level, the RNs and LPNs involved in this project will improve their skills and confidence, which will hopefully improve acute care facility workflow and the quality of telemedicine care provided to the community, which will impact positive social change. Moreover, the DNP’s project will educate RNs and LPNs to increase their knowledge and confidence towards telemedicine will be aligned with the purpose of and role of the DNP.

Summary

Telemedicine is the employment of telecommunications in the diagnosis and treatment of illnesses due to its specific target to medical applications rather than the broader field of telehealth, whose primary focus in on health promotion and surveillance functions. Telemedicine does not only present the future of medical practice but also presents as a primary route through which healthcare is expanded for patients with limited access to physicians. The involvement of nurses in telemedicine practice remains essential, and this requires preparing nurses to utilize telehealth and telemedicine technology through educational programs. These education programs focus on telehealth and telemedicine understanding. For the adequate provision of telemedicine services by the nurses to address the problem of poor access to quality healthcare services by the patients, nurses must have adequate knowledge of telemedicine and how they can effectively adopt this technology. It is, therefore, essential to evaluate the educational intervention involving telemedicine by the nurses to determine their proficiency and level of education for adequate healthcare provision.

Lack of patient-physician relationships, regulatory issues, reimbursement, diagnostic accuracy, lack of nurse education of telemedicine, and technology-related barriers present some of the barriers to effective telemedicine practice within the healthcare systems. LPNs and RNs who are well educated on the use of telemedicine in nursing service provision depict much competence in enhancing the patient outcomes for the patients living within rural areas. With adequate knowledge among the nurses on telemedicine services provision, the patient outcomes come out more positively than nurses who lack knowledge of telemedicine practice. The promotion and facilitation of the DNP project will be primarily based on participating in meetings with the hospital leaders on a daily basis to solve issues that face the hospital facility. To the nursing practice profession, the doctoral project will enable the nurses to gain adequate knowledge in telemedicine practice, which will boost their competence and understanding of the fields for adequate healthcare service provision. Therefore, through these interventions and the proposed significance of the study, the study will focus on theories, concepts, and models of this project and their relevance to the nursing practice.

SECTION 2: Background and Context

Introduction

RNs and LPNs are faced with challenges related to the nurse’s education on the delivery of services related to telemedicine practice. With the targeted hospital having installed a telemedicine facility, most of the region’s inhabitants are faced with challenges of poor access to quality healthcare, perhaps due to the high cost of transportation and low income. Additionally, with the advent of telemedicine, most nurses were born in the era when telemedicine and technology embracement within the healthcare system had not taken root.

The DNP project aims to determine if an educational intervention geared towards telemedicine technology increases the knowledge and confidence level of RNs and LPNs practicing in a rural acute care center. This aim will be achieved primarily through the engagement of hospital stakeholders, including the leaders, committees, and directors. The concepts, models, and theories of the project and its background will be explored as well as the relevance of the DNP to the nursing practice. This exploration will be achieved by providing a detailed description of the rationale for the use of the theories and models in the DNP project. Also, the historical background and context of the project, the roles of the DNP student, and the project team’s role will be explicitly highlighted.

Practice Focused Questions

1). What level of education do nurses have on telemedicine and the education intervention involving telemedicine for the patients?

2). What benefits do the patients are accompanied by the nurse’s knowledge of the use of telemedicine to deliver healthcare services?

Concepts, Models, and Theories

Implementation science discipline is progressively adopting a set of theoretical concepts and models to understand and explain why and how implementation fails or succeeds. Nilsen (2015) ascertained that mixed results for problems are often a result of a limited theoretical basis. This implies that poor theoretical underpinnings make it most difficult to explain how implementation fails, thus restraining development strategies for a project. Through the adoption and understanding of models, theories, and concepts, it is easier to implement the underpinning research problems in a structured approach.

Stetler at al. (2010) described a model that originated from the nursing field. The first nurse to emphasize the holistic care theory was Florence Nightingale. This theory is based on a humanistic and unity view for the patient (Jasemi, Valizadeh, Zamanzadeh & Keogh, 2017). In this perspective, nurses have a crucial role in ensuring the provision of total care to the patients. Bullington and Fergeborg (2013) added that the holistic care theory was subjective and nebulous. The nursing practice is a field where empathy and care must be embraced, and this accords for the relevance of the theory.

According to MoHammadi, Abbasi & Saadati (2015), Orem’s theory, Orlando’s nursing process theory, and Roy’s adaptation model were the most commonly adopted theories and models in the nursing practice. Moreover, the authors noted that the client’s dignity, the king’s theory of goal attainment, and the humanistic approach provided a framework for the therapeutic relationship between the clients and the nurse. Based on these theories, the perception of the nurses and patients on care must be centered on the nurse-patient relationship for holistic care.

In this DNP project, several terms used to depict several meanings concerning the nursing field. Clients imply those patients seeking the services of the nurses as far as their medical conductions are concerned (Marzorati & Pravettobi, 2017). The educators in the DNP project refer to healthcare professionals with a vast knowledge of the use of telemedicine in the provision of healthcare services (WHO, 2009). Remote areas refer to the places where individuals within the areas are unable to access adequate healthcare services due to the high cost of transportation and low income, which calls for telemedicine related healthcare interventions (Goodridge & Marciniuk, 2016).

Definition of Terms

In the DNP project, several terms used to depict several meanings concerning the nursing field. Clients imply those patients seeking the services of the nurses as far as their medical conductions are concerned (Marzorati & Pravettobi, 2017). The educators in the DNP project refer to healthcare professionals with a vast knowledge of telemedicine’s use in healthcare services provision (WHO, 2009). Remote areas refer to the places where individuals within the regions cannot access adequate healthcare services due to the high cost of transportation and low income, which calls for telemedicine related healthcare interventions (Goodridge & Marciniuk, 2016).

Relevance to the Nursing Practice

Telemedicine potentially addresses the problem of the shortage of healthcare providers globally and improves the quality of healthcare staff through the easy diagnosis, evaluation, treatment, and provision of patient care (Mars, 2013). A study conducted by Glinkowski et al. (2013) highlighted that most of the nursing students within Poland universities had little understanding of telemedicine and telenursing practice. Schlachta-Fairchild, Elfrink & Dieckman (2008) further posited that most nurses were unable to deliver effective and safe patient care due to a poor understanding of telemedicine practice. Nurses are faced with the challenge of the inability to use technology (Zadvinskis, Smith & Yen, 2018). In this regard, the nurses were employed and born in an era when the advent of digital technology had not emerged. From these perspectives, nurses tend to exhibit little knowledge of telemedicine, which requires a precise evaluation of educational intervention involving telemedicine in the nursing practice.

In the current nursing practice, Bashir & Bastola (2018) ascertained that the perceptions of professional nurses towards telehealth quality were more positive, indicating their willingness to adopt telemedical care.  Rutledge et al. (2017) described the importance of integrating educational programs in nursing involving the area of telemedicine to train nurses in telecare and telenursing. Much of the nursing training has been centered on clinical care without the involvement of technology-based nursing care. This goes in line with poor education and knowledge on the use of technology-based nursing care, such as telemedicine. This implies that most of the nurses lack adequate knowledge on telemedicine-based nursing care owing to the limited training and lack of exposition to this kind of health care (Cassano, 2014) Similarly, most patients are faced with the inability to access healthcare facilities as a result of limited funds and a limited number of healthcare providers which calls for the adoption of telemedicine-based care.

To facilitate and improve the healthcare provided to people in remote areas due to limited funds and low healthcare staff, telemedicine care must be adopted. The adoption of this kind of healthcare requires adequate training of the nurses on telemedicine practice. According to Yob et al. (2016), the implementation of educational intervention involving telemedicine would increase the confidence and knowledge of the nurse’s practitioners and ultimately support patient care through social change.

Strategies such as compelling the nurses to adopt telemedicine and the provision of telemedicine education enhanced the nurse’s education on telemedicine use (Hope-Kolltveit et al., 2017). Also, Rutledge et al. (2017) described the incorporation of nursing education on telemedicine as a means of improving healthcare. Through the use of nursing informatics, most nurses can now be able to effectively adopt technology-related care, including telehealth and telemedicine, to offer healthcare provision services (Darvish, Bahramnezhad, Keyhanian & Navidhamidi, 2014). Very little has been done to understand the education intervention of nurses involving telemedicine despite the strategies to educate nurses on telemedicine. Therefore, the DNP project aims to determine whether the nurse professionals have adequate knowledge of educational intervention on the use of telemedicine following education provision on the area.

Local Background and Context

Telemedicine utilizes electronic communication systems to provide healthcare services and information to patients, thus acting as a cost-effective healthcare service provision strategy (Pardue, 2015). Remote areas where the affordability and access to healthcare are limited have the chance to access healthcare services through telemedicine practice. Telemedicine also allows nurses to deliver effective and safe nursing care, which bridges the barriers related to active and real-time nursing care. Nonetheless, most nurses face challenges in adopting telemedicine care, and this might be a result of inadequate education intervention involving telemedicine (Glinkowski et al., 2013; Schlachta-Fairchild et al., 2008). Therefore, it is essential to evaluate the educational intervention involving telemedicine practice to determine the competence and ability of the nurses to deliver quality healthcare through telemedicine for the benefit of the patients.

The educational intervention aims to take place at a rural healthcare facility, which forms part of the broader healthcare system to improve the health of the community. The hospital facility lies within a radius of 50 miles. The population surrounding the facility encompasses people with low income and high unemployment and education levels, making access to appropriate healthcare services a challenge. Therefore, telemedicine becomes a resource for quality healthcare provision due to the limited staffing in healthcare and the high cost of healthcare access by the population.

The DNP student will achieve these aims through participation in meetings by the researcher to observe how the hospital leaders go about issues to bring solutions to problems. On the same line, access will be made to all the directors, committees, CEO, nurses, patients, and the hospital board. The remoteness in this setting in the project’s context refers to the inability of the population to access healthcare services due to limited funds. The federal context highlights the need for healthcare facilities to adopt telemedicine in the delivery of quality healthcare services in areas where populations are unable to access healthcare services (Jilian et a.,2018).

Role of DNP Student

Within the context of a nursing profession and nursing studentship in a doctorate program, the quality of nursing care remains essential, and this can be linked to adequate and affordable access to healthcare by the patients. Nursing professionals must, therefore, be competent enough and skillful in the provision of healthcare services using technology-based healthcare, which entirely entails telemedicine care. Many efforts have been made on driving up a project to look into the issue of the knowledge of telemedicine by the nursing profession since most nursing practitioners have focused much on patient care in clinical settings. Similarly, nurses face the challenges of inadequate knowledge of telemedicine intervention and end up not raising these challenges for obtaining solutions. Therefore, the DNP project will bring to light such issues and determine the nurse’s knowledge on telemedicine use and provide future directions on how such education intervention would be provided to the nurses to facilitate their nursing practice.

The instigation of the DNP project does not only aim at changing the telemedicine healthcare provision approach. Still, it is also determined to look at the patient perspective as far as poor affordability and access to healthcare services are concerned.  Biases related to protecting the nursing professionals regarding access to knowledge and education on telemedicine practice may arise and, in turn, outlook the other problems in the clinical settings. As such, the minimization of such biases will be overcome by involving all the hospital stakeholders, patients, and workers to determine the problems they face and the possible solutions to the problems.

Role of the Project Team

The project team will encompass the hospital’s committees and leaders, stakeholders such as the CEO, CNO, bedside registered nursed and telemedicine nurses, hospital board, and the patients. These individuals will have a role to contribute to the DNP project by providing relevant information and data on the nature of telemedicine provision and the education intervention involving telemedicine practice at the hospital setting. The background information, evidence, and other pieces of information will be relayed to the hospital stakeholders through email.

This email will include a short notification to a meeting that will be conducted for the verbal briefing of the stakeholders on the background of the DNP project. The patients will be supplied with printed newsletters containing a summary of the information intended to be relayed. Following this information, the team members will have the opportunity to provide their views about the DNP project utilizing questionnaires and structured interviews. The team members will review the DNP student by determining the DNP project’s relevance, the problem the DNP student is addressing, and the possible approaches to how the DNP project will be conducted. This will also constitute an explicit provision of the possible solutions to the highlighted challenges.

Summary

The DNP nurse is essential to address the problem of the lack of affordability and access to healthcare by the population subject to low income and employment near the rural facility setting. Nurses take many responsibilities on patient care but have limited opportunities to raise their concerns about their competence and experience on the use of telemedicine practice and their education level on this aspect. It remains essential to highlight the education intervention by the nurses involving telemedicine practice to determine their effectiveness on telemedicine practice and provide future directions in the field of nursing practice and telemedicine use. These challenges are aimed to be addressed by the DNP project, which will involve contributions from stakeholders for the effectiveness of the project.

Section 3

Introduction

Telemedicine provides a more effective healthcare provision approach owing to the limited number of healthcare staff and the low access and affordability to healthcare services. Most nurses depict limited knowledge and understanding of the use of telemedicine. Based on the rural facility located in an area where a low-income population is situated, the DNP project intents to evaluate the education intervention involving telemedicine practice among the nurses. Therefore, the DNP student will provide future directions and recommendations on the interventions to be taken in nursing training and practice to enhance their competence in the use of telemedicine. Thus, evidence focused questions are essential to attain these milestones.

Practice Focused Questions

There are limited access and affordability of healthcare services by the patients living near the rural healthcare facility, which calls for telemedicine practice to enhance patient care quality by the nurses and physicians. Nonetheless, there is limited knowledge on the level of nurses’ education on telemedicine use. As such, practice-focused questions for the DNP project are centered on the level of an education intervention on telemedicine by the nurses and whether telemedicine impacts positively on the patients owing to the competence level of healthcare providers using telemedicine. In this regard, does an educational intervention geared towards telemedicine technology increase the knowledge and confidence level of RNs and LPNs practicing in a rural acute care center?

Sources of Evidence

Sources of evidence for addressing the DNP project are entailed within various literature sources. In a systematic review conducted by Scott et al., (2018), several barriers underpin telemedicine use and its frequency. These barriers were linked to resistance to change, staff challenges, and reimbursement. Moreover, the authors noted that the barriers were specific to the country, organizations, patients, medical staff, and programmers. These authors went further to suggest policy development as a possible improvement to fill these gaps. The nurses’ perceptions of telemedicine use can be changed if the environmental adaptation to telemedicine practice is adaptable enough (Hope-Kolltveit et al.,2017).

Similarly, Donohue, Hoffman, & Marcin (2019) posited that RNs and LPNs who are well educated in telemedicine could enhance patient outcomes in neonatal care resuscitation for postpartum and families living in rural areas. Nalder, Marziali, Dawson, & Murphy (2018) stated that the mere knowledge that expert in telemedicine is available anytime in the facility or elsewhere where they can be reached, the more confidence the RNs and LPNs can have in utilizing telemedicine given that, they are assured that at any time, they can request for help if need be. The nurses’ provisions and access to telemedical knowledge can also improve their confidence in telemedicine practice (Nalder et al., 2018). Last, van Houwelingen, Ettema, Kort, & Ten-Cate (2019) demonstrated that for RNs and LPNs to maintain knowledge and confidence surrounding telemedicine, continuous education is paramount. As such, interrogating the nurse’s knowledge of telemedicine and providing further solutions through the provision of adequate knowledge in the field will enhance their confidence and performance for the benefits of the patients.

Published Outcomes and Research

Databases and search engines, including CINAHL, PubMed, and Google scholar were utilized for searching the relevant literature sources related to the topic of study. The search terms encompassed telemedicine AND intervention, nurses AND telemedicine, Educational intervention, AND telemedicine. The search terms have been indicated in Appendix A.

The scope of the review encompassed studies conducted within the last ten years and those published in the English language. The types of literature included cohort studies, systematic reviews, random controlled trial studies, case-control studies, and case reports, and series studies ( Kapoor, 2016). The studies focused on education intervention involving telemedicine among nurses in various clinical settings. To enhance the search’s exhaustiveness, the key terms were utilized alongside the use of Boolean operators (Ecker & Skelly, 2010). Similarly, a PRISMA flow diagram was utilized. Eligible studies were obtained after excluding duplicates and the removal of non-eligible studies to enhance the study’s exhaustiveness and comprehensiveness (Appendix B).

Archival and Operational Data

The nature of data to be collected will involve qualitative primary data and secondary data for literature information obtained from published literature sources. Qualitative data will include gathering information from the study participants in interviews, questionnaires, and surveys. The nature of questionnaires will involve the use of open-ended questionnaires to allow the study participants to give their general views regarding the nurse’s educational intervention involving telemedicine. Data obtained from the systematic reviews will constitute information published in various literature sources, including journal articles published in the English language within the last ten years on the area of telemedicine and nurse’s intervention. The data will be searched using keywords such as telemedicine AND nurse intervention, education intervention, and telemedicine AND educational intervention. The searching will be achieved through navigating the various databases and search engines such as Google Scholar, PubMed, and CINAHIL. The primary data was initially contributed to by the study stakeholders and project team, while the authors provided secondary data from systematic reviews in the published articles.

The relevance of this data to the DNP project will be based on its ability to address the research-based questions to answer whether educational intervention involving the nurses in telemedicine practice was sufficient at the hospital. Since literature information is published related to the area of study, the information given by these sources will be relevant in understanding what has been done on education intervention on telemedicine practice by the nurses and relate it to the problem being addressed in the project.

The collection of the data was collected by way of interviews, questionnaires, and surveys. Similarly, secondary data was collected by searching various databases for literature information published on the topic of study. The data obtained will be relevant and valid to the survey since much of the focus is directed towards determining what has been done on the topic and gathering the primary information collected from the hospital setting to answer the study research-based questions. Gaining access to the information data will be achieved by acquiring ethical approval to conduct the study. Similarly, permission will be sought to gain access to the databases and obtain the relevant pieces of information related to the area of study. Historical and legal documents such as those displayed at the hospital will also play essential data sources given that their focus is on the real problem at the hospital. This evidence shows the lack of access to medical facilities and limited knowledge of education intervention involving telemedicine by the nurses. As such, these sources are the most reputable sources of evidence in the study.

Evidence Generated for the Doctoral Project

Study Participants

Evidence for the DNP project was collected from various study participants. The participants will contribute to the evidence of the DNP practice about the limited access to affordable healthcare services. The study participants will involve various stakeholders within the hospital setting. The participants’ selection will be based on a probability selection criterion where purposive sampling will be used.  A total of 50 patients will be involved in interviews.

Similarly, 20 nurses in various categories, including RNs, telemedicine nurses, and  LPNs, will contribute to the evidence. Furthermore, a team of 10 hospital leaders and committees will provide appropriate information required for the DNP project. This figure will form a total of 80 participants, an appropriate figure to serve as a representative sample for adequate provision of evidence needed for the DNP project. The participants’ selection will be based on the inability of the patients to gain access to affordable healthcare. Moreover, the healthcare practitioners and hospital committee will be selected based on their working experience at the hospital and their level of understanding towards telemedicine service provision at the hospital. The study participants will provide adequate information required for the understanding of education intervention involving telemedicine practice at the hospital.

Procedures

Following IRB approval, I will work with my preceptor to identify specific stakeholders to gain support and approval of the project and further insight into the stated barriers, among which the absence of an educational program within the project site. From the discussion, an educational intervention based on the current literature will be identified and/or modified to meet the needs of the organization. Along with the educational program, a pre-test and post-test will be created to match the educational intervention. Once completed, the stakeholders will review and establish the content validity of the educational program, pre-test, and post-test using the I-CVI and S-CVI (Polit and Beck, 2006). Once content validity has been determined, an educational intervention will be scheduled for the RNs and LPNs working weekends at the hospital. The pre-test will include 3 to 5 demographic questions in order to describe the sample, ten questions regarding telemedicine, and two questions asking the participants to rate their confidence level of telemedicine. The pre-test will be given prior to the intervention. Following the educational intervention, the post-test will be given. The post-test will contain the same ten questions regarding telemedicine and two questions asking the participants to rate their level of confidence in telemedicine.

Protection

Walden IRB approval will be obtained before starting the project. No identifying information regarding the participants will be asked, collected, or recorded from the participants. All participants will create and use his/her own unique identifier that will not be recorded to label the pre-test and post-test. All data reported from this project will be reported in the aggregate. Thus, this project will have minimal risk to the participants.  Additionally, IRB approval will be requested from the project site’s IRB as well.

Analysis and Synthesis

Recording of the interviews and surveys utilized sophisticated mobile phones and computers for video and audio acquisition and storage purposes. The qualitative data obtained encompassed transcripts and audio recordings of the meetings. Also, comments from the interviews, video recordings, and field notes formed part of the collected data. Audio recordings were transcribed to convert spoken words into written information. A transcription software was used for the transcription process. Transcription was followed by listening through the audio recordings and correcting any spelling mistakes and wrongly interpreted words. For the privacy of the participants’ information, the data and transcripts were analyzed so that the participants remained unidentified. Notations such as laughter, commas, and punctuations were added to enhance the data’s validity and accuracy. Following transcription of the audio and video recordings, coding was done in which filed notes were applied to facilitate the coding process. The similarities, topics, issues, and differences given by the participants were identified in this process. Coding was achieved by hand on a hard copy of the transcript. Side to hand-coding helped the researchers to understand the perspectives of each of the participants. Lastly, after coding, the theming was done, where the codes were drawn together from several transcripts for the presentation of the research findings in a meaningful and coherent manner (Sutton and Austin 2015). The management of the integrity of the data involved, including all the information in the transcripts to ensure none of the information given by the participants, is misinterpreted.

The educational intervention participants will use a unique identifier to match the pre-test to the post-test to determine if there is a difference in scores between the pre- and post-test, which will serve as a proxy for increased knowledge. The pre-test data will be matched with the data from the post-test and entered into an Excel spreadsheet and transferred into SPSS. Descriptive statistics will be used to describe the sample. Inferential statistics will be used to determine if there is a difference in pre-test and post-test scores regarding knowledge. Inferential statistics will be used to determine if there is an increase in confidence in telemedicine.

Summary

This staff education approach is in alignment with addressing the gap in practice of the limitation of the RNs and LPNs’ knowledge and confidence regarding using telemedicine (Walden University, 2020). My DNP’s project to educate RNs and LPNs to increase their knowledge and confidence towards telemedicine is aligned with the purpose of and role of the DNP. Moreover, this project includes the organization’s stakeholders committed to the continuous education of employees to promote patient and organizational outcomes. As demonstrated, each stage of the process will be evaluated to refine the plan or the objectives of the project.

Appendix A

APPENDIX B: PRISMA FLOW CHART

PRISMA 2009 Flow Diagram

Appendix C: The Literature Matrix for Archival and operational data

References

Bashir, A., & Bastola, D. R. (2018). Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study. JMIR medical informatics, 6(2), e35. https://doi.org/10.2196/medinform.9080

Bullington J, Fagerberg I. The fuzzy concept of ‘holistic care’: A critical examination. Scand J Caring Sci. 2013;27:493–4.

Boxer, R. J., & Ellimoottil, C. (2019). Advantages and utilization of telemedicine. mHealth, 5, 12. https://doi.org/10.21037/mhealth.2019.04.02

Carter B, Whittaker K, Sanders C. Evaluating a telehealth intervention for urinalysis monitoring in children with neurogenic bladder. J Child Health Care. 2019;23(1):45-62. doi:10.1177/1367493518777294

Cassano, C. (2014). The right balance – Technology and patient care. Online Journal of Nursing Informatics. 18.

Cui, S., Daffner, S. D., Crossley, L., Sedney, C., & France, J. C. (2018). Integrating technology

into practice:  Effects of telemedicine triage on efficiency and cost-effectiveness in spinal care. The Spine Journal, 18 (8), S30–S31. doi: 10.1016/j.spinee.2018.06.072

Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of nursing informatics in promoting the quality of health care and the need for appropriate education. Global journal of health science, 6(6), 11–18. https://doi.org/10.5539/gjhs.v6n6p11

Donohue, L. T., Hoffman, K. R., & Marcin, J. P. (2019). Use of telemedicine to improve

Neonatal Resuscitation. Children (Basel, Switzerland), 6 (4). Doi:10.3390/children604005

Glinkowski, W., Pawłowska, K., & Kozłowska, L. (2013). Telehealth and telenursing perception and knowledge among university students of nursing in Poland. Telemedicine journal and e-health: the official journal of the American Telemedicine Association, 19(7), 523–529. https://doi.org/10.1089/tmj.2012.0217

Ecker, E. D., & Skelly, A. C. (2010). Conducting a winning literature search. Evidence-based spine-care journal, 1(1), 9–14. https://doi.org/10.1055/s-0028-1100887

Hope-Kolltveit, B.C., Gjengedal, E., Graue, M., Iversen, M. M., Thorne, S., & Kirkevold, M. (2017). Conditions for success in introducing telemedicine in diabetes foot care: a qualitative inquiry. BMC Nursing, 16, 1–10. Doi:10.1186/s12912-017-0201-y

Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A Concept Analysis of Holistic Care by Hybrid Model. Indian journal of palliative care, 23(1), 71–80. https://doi.org/10.4103/0973-1075.197960

Jillian B. Harvey et al., Telemedicine Journal and e-Health (2018), http://doi.org/10.1089/tmj.2017.0265external icon.

Kapoor M. C. (2016). Types of studies and research design. Indian journal of anesthesia, 60(9), 626–630. https://doi.org/10.4103/0019-5049.190616

Koivunen, M., & Saranto, K. (n.d.). Nursing professionals’ experiences of the facilitators and

barriers to the use of telehealth applications: A systematic review of qualitative

studies. Scandinavian Journal of Caring Sciences, 32 (1), 24–44.

Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open, 7(8), e016242.

Mohammadi E, Abbasi K, Saadati M. Barriers to the implementation of nursing theories in clinical practice from the perspective of nurses. Iran J Nurs Res 2015;10:13-24.

Mars M. Telemedicine and advances in urban and rural healthcare delivery in Africa. Prog Cardiovasc Dis. 2013;56(3):326–35.

Marzorati, C., & Pravettoni, G. (2017). Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes. Journal of multidisciplinary healthcare, 10, 101–106. https://doi.org/10.2147/JMDH.S122383

Mohammadi E, Abbasi K, Saadati M. Barriers to the implementation of nursing theories in clinical practice from the perspective of nurses. Iran J Nurs Res 2015;10:13-24.

McClellan, M.J., Florell, D., Palmer, J., & Kidder, C. (2020). Clinician telehealth attitudes in a rural community mental health center setting. Journal of Rural Mental Health, 44 (1), 62 – 73.

Nalder, E., Marziali, E., Dawson, D. R., & Murphy, K. (2018). Delivering cognitive-behavioral

interventions in an internet-based healthcare delivery environment. British Journal of

Occupational Therapy, 81(10), 591. Retrieved from https://www.waldenulibrary.edu

Pardue, D. (2015). Time can mark the difference between life and death. Physician Leadership 

Journal, 14 (3). Retrieved from https://www.waldenulibrary.edu

Schlachta-Fairchild L, Elfrink V, Dieckman A. Patient Safety, Telenursing, and Telehealth. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 48. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2687/

Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating

barriers to adopting telemedicine worldwide: A systematic review. Journal of telemedicine and telecare, 24(1), 4–12. doi:10.1177/1357633X16674087

Serper, M., & Volk, M. L. (2018). Current and Future Applications of Telemedicine to Optimize the Delivery of Care in Chronic Liver Disease. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 16(2), 157–161.e8. https://doi.org/10.1016/j.cgh.2017.10.004

Shortliffe EH, Cimino JJ. Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Health Informatics) 4th ed. London, UK: Springer-Verlag London; 2014. pp. 541–60.

Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of telemedicine and telecare, 24(1), 4–12. doi:10.1177/1357633X16674087

Shulver, W., Killington, M., & Crotty, M. (2016). Massive potential or safety risk? Health workers’ views on telehealth in the care of older people and the implications for successful normalization. BMC Medical Informatics and Decision Making, 16 (131). DOI 10.1186/s12911-016-0373-5.

Rutledge, C. M., Kott, K., Schweickert, P. A., Poston, R., Fowler, C., & Haney, T. S. (2017). Telehealth and eHealth in nurse practitioner training: current perspectives. Advances in medical education and practice, 8, 399–409.

Stetler CB. Stetler model. In: Rycroft-Malone J, Bucknall T, editors. Models and Frameworks for Implementing Evidence-Based Practice: Linking Evidence to Action. Oxford: Wiley-Blackwell; 2010. pp. 51–82.

Stetler CB. Stetler model. In: Rycroft-Malone J, Bucknall T, editors. Models and Frameworks for Implementing Evidence-Based Practice: Linking Evidence to Action. Oxford: Wiley-Blackwell; 2010. pp. 51–82.

Taylor J, Coates E, Brewster L, Mountain G, Wessels B, Hawley MS. Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption. J Adv Nurs. 2015;71(2):326-337. doi:10.1111/jan.12480

Teoli D, Aeddula NR. Telemedicine. [Updated 2018 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535343/

Mechanic OJ, Kimball AB. Telehealth Systems. [Updated 2019 Dec 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459384

Nilsen, P. (2015). Making sense of implementation theories, models, and frameworks. Implementation science : IS, 10, 53. https://doi.org/10.1186/s13012-015-0242-0

Van Houwelingen, C. T. M., Ettema, R. G. A., Kort, H. S. M., & ten Cate, O. (2019). Hospital     nurses’ self-reported confidence in their telehealth competencies. The Journal of           Continuing Education in Nursing, 50 (1), 26–34. Doi:10.3928/00220124-20190102-07

Wakefield, B. J., Scherubel, M., Ray, A., & Holman, J. E. (2013). Nursing interventions in a telemonitoring program. Telemedicine journal and e-health: the official journal of the American Telemedicine Association, 19(3), 160–165. https://doi.org/10.1089/tmj.2012.0098

Whitten, P., Holtz, B., & Laplante, C. (2010). Telemedicine: What have we learned? Applied clinical informatics, 1(2), 132–141. https://doi.org/10.4338/ACI-2009-12-R-0020

WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. Appendix 1, Definitions of healthcare settings and other related terms. Available from: https://www.ncbi.nlm.nih.gov/books/NBK144006/

Wilson, L. S., & Maeder, A. J. (2015). Recent Directions in Telemedicine: Review of Trends in Research and Practice. Healthcare informatics research, 21(4), 213–222. https://doi.org/10.4258/hir.2015.21.4.213

Yob, I., Danver, S., Kristensen, S., Schulz, W., Simmons, K., Brashen, H., …, & Penland, D.

(2016). Curriculum Alignment with a Mission of Social Change in Higher Education. Innovative Higher Education, 41(3), 203–219. https://www.waldenu.edu

Zadvinskis, I. M., Garvey Smith, J., & Yen, P. Y. (2018). Nurses’ Experience with Health Information Technology: Longitudinal Qualitative Study. JMIR medical informatics, 6(2), e38. https://doi.org/10.2196/medinform.8734

Zhang, X. Y., & Zhang, P. (2016). Telemedicine in the clinical setting. Experimental and therapeutic medicine, 12(4), 2405–2407. https://doi.org/10.3892/etm.2016.3656