Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Developing a protocol for the use of telenursing in community health in Australia

As the first step in developing a protocol for the use of video-phones in community health, we carried out a feasibility study among clients with a range of health needs. Clients were equipped with a commercially available video-phone connected using the client's home telephone line. A hands-free speaker-phone and a miniature video-camera (for close-up views) were connected to the video-phone. Ten clients participated: five required wound care, two palliative care, two long-term therapy monitoring and one was a rural client. All but two were aged 75 years or more. Each client had a video-phone for an average of two to three weeks. During the six months of the study, 43 client calls were made, of which 36 (84%) were converted to video-calls. The speaker-phone was used on 24 occasions (56%) and the close-up camera on 23 occasions (53%). Both clients and nurses rated the equipment as satisfactory or better in questionnaires. None of the nurses felt that the equipment was difficult to use, including unpacking it and setting it up; only one client found it difficult. Taking into account the clients' responses, including their free-text comments, a judgement was made as to whether the video-phone had been useful to their nursing care. In seven cases it was felt to be unhelpful and in three cases it was judged helpful. Although the study sample was small, the results suggest that home telenursing is likely to be useful for rural clients in Australia, unsurprisingly, because of the distances involved.

A review of guidelines and standards for telemedicine

We conducted a review to establish the range and scope of current telemedicine guidelines and standards. Published guidelines were identified by searching the Medline and Telemedicine Information Exchange (TIE) databases, and by performing a Google search using the term 'telemedicine guidelines'. Three types of guidelines were identified, namely clinical, operational and technical. Clinical guidelines included those for teleradiology, telepsychiatry, home telenursing, minor injuries telemedicine, surgical telemedicine, teledermatology and telepathology. Operational guidelines included those for email communication, Internet access and videoconferencing. Technical guidelines included those from the American Telemedicine Association and the US Office for the Advancement of Telehealth. The main standards relevant to telemedicine include those of the International Telecommunication Union and the DICOM standard. The scarcity of guidelines and standards suggests that telemedicine is not yet near to routine use. If an international telemedicine organization were to take responsibility for defining guidelines, under the direction of clinicians with appropriate telemedicine experience, this might speed up their development.

Effet d’un suivi infirmier téléphonique effectué auprès de parents, sur la gestion de la douleur et la prévention de complications postopératoires d’enfants ayant subi une amygdalectomie

Introduction : Il a été démontré que les enfants opérés pour une amygdalectomie éprouvaient des niveaux de douleur modérée à sévère, et ce pendant plusieurs jours suite à la chirurgie. Suite au retour à domicile, plusieurs parents ont tendance à administrer l’analgésie de façon non-optimale à leur enfant et ce pour diverses raisons, ce qui contribue au maintien de niveaux de douleur élevés et à l’incidence de complications postopératoires. But : Cette étude avait pour but d’évaluer l’effet d'un suivi infirmier téléphonique, effectué auprès de parents d'enfants opérés pour une amygdalectomie, sur la gestion de la douleur et la prévention de complications postopératoires. Méthode : Cette étude clinique randomisée a comparé un groupe expérimental (suivi infirmier téléphonique) à un groupe contrôle (traitement standard) (n = 52). Le suivi infirmier téléphonique fut effectué au 1er, 3e, 5e et 10e jour postopératoire et permettait d’évaluer l’évolution du client et d’offrir un enseignement personnalisé selon un cadre prédéfini. Les critères d’évaluation furent l’intensité de la douleur, la quantité d’analgésie administrée à l’enfant, les complications postopératoires et le recours à des services de santé non-planifiés. Résultats : Les enfants du groupe expérimental ont présenté une intensité de douleur plus faible au 3e jour postopératoire, le matin (P= 0.041) et le soir (P= 0.010). Les enfants de ce groupe ont reçu davantage de doses d’analgésiques au 1er jour postopératoire (P= 0.007) et au 5e jour postopératoire (P= 0.043). Ils ont eu moins de vomissements au congé de l’hôpital (P= 0.040) et au 3e jour postopératoire (P= 0.042), moins de somnolence au 1er jour postopératoire (P= 0.041), une meilleure hydratation au 1er (P= 0.014) et 3e jour postopératoire (P= 0.019), mais ont souffert davantage de constipation au 3e jour postopératoire (P< 0.001). Aucune différence significative n’a été observée quant au recours à des services de santé. Conclusion : Le suivi infirmier téléphonique, effectué auprès de parents d'enfants opérés pour une amygdalectomie, a certains effets bénéfiques sur la gestion de la douleur et la prévention de complications postopératoires, mais n’a pas eu d’effet significatif sur le recours à des services de santé.

Décrire quantitativement les interventions téléphoniques des infirmières au service Info-Santé selon le niveau de compétence novice - compétent - expert

Ce mémoire est un des segments d'une recherche de plus grande envergure sur le service Info-Santé, et qui se déroule au Centre de Santé et de Services sociaux de Laval.

Imaginative construction of care: the nursing professional experience in a remote care service

The direction of care delivery goes from the action to the being; a process built from professional experience, which gains special characteristics when the service is delivered by telephone. The goal of this research was to understand the interaction between professionals and users in a remote care service; to do so, a research is presented, using Grounded Theory and Symbolic Interactionism as theoretical references. Data were collected through eight interviews with professionals who deliver care by telephone. The theoretical understanding permitted the creation of the theoretical model of the Imaginative Construction of Care, which shows the interaction processes the professional experiences when delivering care by telephone. In this model, individual and social facts are added, showing the link between the concepts, with special emphasis on uncertainty, sensitivity and professional responsibility, as essential components of this experience.