Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.
The didactic portion of TeamSTEPPS®, which focuses on teaching teamwork and communication, coupled with interactive simulation methods provides a unique interprofessional education (IPE) learning environment. Across the literature there are a wide variety of such programs described, but there is not a consensus on the most effective methodology. A systematic review was therefore undertaken to synthesize, critically appraise, and evaluate existing literature on IPE programs that utilize didactic TeamSTEPPS in conjunction with interactive healthcare simulation. EBSCO and PubMed databases were searched from inception through March 2017 using predetermined inclusion and exclusion criteria. The initial search yielded 66 articles which was reduced to 42 peer-reviewed publications after duplicates were removed. An additional 2 articles were identified via hand search. Therefore, 44 articles were identified and reviewed and 11 studies met all inclusion criteria. Critical appraisal was performed using The Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. The outcome measures associated with each program as well as specifics of the didactic portion and interactive healthcare simulation are further explored in this review. It is anticipated that the findings from this systematic review will aid in the development of future evidence-based interprofessional programs.
IPE combined with Telehealth technology provides future providers with knowledge and skills for interprofessional care regardless of geographic barriers. Next Step: Integrate more technology using mobile devices and enhance the evaluation process.
Medical technology has rapidly decreased the time and cost required to sequence, visualize, and analyze an individual's genome since the Human Genome Project (HGP) ended in April of 2003. The resulting real-time implementation and expanded use of genetic testing in clinical practice, especially in the NICU, has often left ethicists playing catch-up and providing reactive guidance rather than proactive guidance, and nurses struggling to understand their role in resolving associated legal, ethical, and social concerns. This article provides proactive guidance concerning some of the common ethical issues that are manifest in the application of genomics in the NICU as well as practical resources for navigating these conversations with parents and families. Clinical scenarios illustrate key points of consideration for NICU nurses engaged with challenging issues related to genomics in the NICU.
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