T JENNINGS1, E TAN2,
1Renal Service Bay Of Plenty District Health Board, Tauranga, New Zealand; 2 Renal Service, Waikato District Health Board, Hamilton, New Zealand.
Aim: To explore how telehealth revolutionised the role of Rural Renal Nurses (RRNS)
Background: The geographic isolation of Satellite Dialysis Units (SDU)s from the main unit increases the vulnerability of RRNs. RRNs also miss out on education and service development opportunities. Telehealth may bridge this professional inequality gap.
Methods: Telehealth, introduced in 2014, commenced with video clinics; the hub physician video linked with patients and nurses in the SDU. RRNs performed patient observations, medications reconciliations, document-filling, fluid assessments and examinations. Gradually, virtual consultations expanded to include blood result reviews, dialysis rounds, impromptu clinical assessments, patient-family-doctor meetings, dietetics, pre-dialysis counselling and transplant work-ups. Virtual links also facilitated meetings and education sessions with the hub and other SDUs. Implementation of these telehealth projects relied heavily on highly skilled senior RRNs with broad expertise in technology, physical assessments skills, disease management, pharmacology and biochemistry. Patient feedback on the video clinics was obtained.
Results: Telehealth provided nurses with a unique platform for professional development: up-skilling in both clinical and computer knowledge. Increased clinician interaction and attendance at education sessions provided invaluable training and research opportunities. Flexible clinician access through video consults reduced the vulnerability of isolation. Increased opportunities to attend virtual service development meetings meant better engagement with the central hub. Minimal work disruption and reduced travel need resulted in a more efficacious use of nursing time with significant cost time savings and carbon footprint reduction. Patient feedback obtained was excellent.
Conclusions: Telehealth expanded the role of RRNs, reducing their vulnerability to isolation and bridging the gap towards providing equal opportunities for educational, service and professional development; empowering RRNs to operate semi-autonomously, paving the path for extended practice roles.