The purpose of this project was to examine the impact of using standardized telehealth protocols and telehealth training on nursing self-efficacy as well as any associated decreases in patient use of emergency departments (ED) and urgent care (UC) centers. Telehealth is an expanding healthcare strategy to improve patient experiences and decrease costs while ensuring safe patient care. Telehealth practice allows patients to speak to a nurse over the telephone and receive an assessment followed by safe, healthcare advice. Telehealth is a generic term for remote delivery of healthcare by a range of options, including landline, mobile phones, video tele-conferencing and internet. This project centered on telephone triage nursing practice with a goal to connecting military health care recipients with the suitable level of care resulting in positive patient outcomes. Telehealth is a complex task that carries inherent risks compared to a face-to-face visit. Communication skills and training are very important for the telehealth nurse to be successful and gain confidence. A professional telehealth educational program can influence self-efficacy and promote nursing confidence and thereby improve patient outcomes. The Air Force Medical Home (AFMH) model is structured to improve patient safety and outcomes which encompasses coordination of patient care across multiple settings, and telehealth nurses serve in a pivotal role in patient management. This project examined the effects of an integrated telehealth training plan that utilized standardized telehealth protocols.
Methodology
Telehealth nurses received a six-week, standardized training program which included a self-assessment, preceptor-led tandem triage exercises, Schmitt-Thompson Clinical Content (STCC) protocol reviews, telehealth training videos, and training with six health specialties, to include referral management centers, exceptional family member programs, health care integrators, disease managers and group practice manager. This was an Air Force-wide training initiative with participants from Joint Base San Antonio-Randolph Air Force Base (JBSA-R) and Scott Air Force Base (SAFB) participating. The self-efficacy of the nurses at these two locations that received standardized training were measured before and after training completion using the Nursing Care Self Efficacy Scale (NCSES). This tool was developed by Dr. Darlene Welch of the University of Louisville. The NCSES was completed by 30 nurses pre-training and 26 post-training. ED and UC utilization rates were also assessed during the pre-training and post-training periods and compared for quantitative results.
Results
The NCSES survey demonstrated nursing confidence levels increases in 13 of 16 items at both locations post-training. JBSA-R and SAFB clinics consist of seasoned telehealth nurses that averaged 19.6 years of nursing experience. The survey participants had significant clinical confidence prior to completion of training. In addition, there was no statistical significance in the volume of patients utilizing the UC or ED after indoctrination of the telehealth training and protocol use. It was ascertained that telehealth is a necessary part of healthcare and not a money saving strategy but an essential cost of providing safe care.
Implications for Practice
Standardized telephone training and use of evidence-based telephone protocols for nurses appear to enhance self-efficacy levels in nurses. The use of a structured telehealth training plan and use of (STCC) standardized protocols may impact the nurse’s ability to appropriately coordinate patient care services and thereby improve patient outcomes. Applications of standardized training and protocols can translate to other military health care services to include Army and Navy facilities. The historic military healthcare transformation of unifying all military healthcare services into one health care system has commenced. The application of standardized telephone training and protocol use can translate and enhance joint medical service partnership.
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