Sometimes low-tech works best in rural areas
Sometimes low-tech works best in rural areas
Choose equipment your patients can use
One of the keys to a successful telehospice program is to make sure the equipment you select works in all types of situations. This was the challenge for the researchers for the Missouri Telehospice Project who rely upon videophone contact to improve communication between hospice patients and their providers.
"The agencies in our project serve largely rural areas, and many patients' homes do not provide access to the Internet," explains George Demiris, PhD, associate professor of behavioral nursing and health systems at the University of Washington School of Medicine in Seattle and researcher with the Missouri Telehospice Project. "We had to find a product that worked with plain old telephone service," he says.
Finding the right product has been a challenge even though there are a number of videophones on the market, Demiris points out. "Many videophone products rely upon broadband service, but the rural areas our partner agencies serve do not have the infrastructure to make the use of these products feasible," he explains. The first product used in the project was manufactured by a foreign vendor who no longer is in business, so the project managers switched to the Beamer Videophone manufactured by Vialta in Fremont, CA. "This is the only videophone that operates on an analog system that we have found," he says. "This videophone connects directly to the patient's phone, so there is no need for the patient to change phones." Being able to keep and use their existing phone is reassuring for older patients who don't like change, he adds. This service also adds no cost to the patient's personal telephone bill, he says.
The cost of the videophone is between $150 and $200 per phone, and hospices must have a videophone for each patient using the service and a videophone available for the nurses, points out Demiris. Because the telehospice project is supported by grants, the cost of the videophones is covered by the project rather than the hospices, he says. Although Demiris does not recommend using the videophone to replace regular visits, he does say the telehospice service can be used to reduce the number of unplanned visits or to reduce visits to the emergency department.
When videophones were first introduced into hospices as a way for nurses to help patients and their family caregivers with interventional strategies and to reinforce coping skills, there was resistance from nurses, admits Demiris. "We found that the hospices that set specific parameters for the use of the videophones by scheduling regular times to call the patient, as opposed to telling the patient to call any time they needed help or had a question, had the best success," he says.
Nurses were less reluctant to participate in the program if they knew that they would be able to schedule the calls. "One hospice does provide a videophone for the on-call nurse to use at home so telehospice patients with emergency calls can use their videophone," Demiris explains. "The videophone has proven to reduce the number of emergency visits needed because the ability for the nurse to see the patient has improved the ability to assess the patient's needs." For example, when a caregiver calls to say that the patient is having difficulty breathing, the nurse can see the patient and can determine if the breathing difficulty is significantly different from the last visit. The nurse can determine if the patient needs an immediate visit or whether he or she can suggest self-care techniques to help the patient. Visual assessment is the missing component of telephone-only monitoring, he adds.
If your hospice chooses to use videophones, tailor video-specific training for your staff, suggests Demiris. "The technology is easy to use, so it doesn't take long to learn how to operate the videophone, but there are differences between telemonitoring by computer or telephone, and videophone contact," he says. The videophone used in the telehospice project has a small screen in the corner of the display that enables the nurse to see how she or he appears to the patient. "Nurses can use this screen to make sure that they are looking at the patient via the camera in the phone and that they are not looking down or away from the screen," Demiris says.
Even though they are talking to a patient by telephone, nurses should treat videophone contact in the same manner they treat face-to-face contact, Demiris says. Nurses are told not to look down to take notes during the conversation but to make eye contact with the patient. "Nurses do need to document the call, but they should not be looking down at a table the entire time," he explains.
Videophone telehospice offers several benefits to hospices serving rural areas and those serving patients with a need for additional reassurance, says Demiris. "We don't however, recommend that telehospice be used to replace nursing visits or personal contact, but it should be used to enhance care," he says. "Personal contact is too important a part of hospice care."
One of the keys to a successful telehospice program is to make sure the equipment you select works in all types of situations.Subscribe Now for Access
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