Transcript ptsandnursesexp

Patients’ and nurses’ experiences
with telehomecare: results of a
research study
Lynda Atack, R.N.,Ph.D Centennial College
Diane Duff, R.N., Ph.D York University
CST Conference, September 2005 Manitoba
Acknowledgements
CANARIE
Ontario Innovation Trust
East York Telehomecare Project
A video-based THC
program to improve
health outcomes for
patients with chronic
illness
Partners

Centennial College and York University: project
management, research

East York Access Centre: patient referral; funding for
nursing care

Comcare Health Services: nursing service provider

Toronto East General Hospital and Family Physicians:referral
and medical follow-up

American TeleCare Inc: technology provider
Research question and method
What are patients’ and providers’
experiences with telehomecare?
 Grounded theory design
 Patient interviews conducted until data
saturation reached (n = 25)

Demographic profile



Ages ranged from 64
to 87
67% women
Most >15 years with
multiple, chronic
illness
multiple
COPD
CH F
diabetes
angina/chestpain
arrhy thmia
other
Patients’ experiences
“ Living confidently with illness”
Making a connection
-health situation
-community care
-provider
-technology
Focusing on vitals
Understanding illness
-focused on norms
-exploring S+S
-understanding norms -connecting with
and variations
directives
-identifying potential
-integrating
for change
medications
Taking control
-stabilizing
-exploring capacity
+ limitations
-becoming proactive
- Fewer ER visits
Patient’s experience
I noticed my heart rate started to go up about five
weeks ago and was watching it warily…I wasn’t
that surprised when the defibrillator [defibrillator
implant] kicked in. I called my GP the week
before the defib went on…just because I was
concerned about my heart rate and trouble
breathing. I’d had heart failure before which was
like drowning on the inside… and I was concerned
I was sliding into that space… but with the THC
equipment I had enough ammunition to say I’ve
got to do something.”
“I had a serious problem last week and with this
defibrillator thing I got a shock at 1 a.m. And it
was very reassuring to go downstairs and do my
BP test, take my pulse and oxygen thing. To
know that in spite of the shock I was still alive…
Patients’ experiences


“It may have kept me from going crazy with not
having enough information. This gives you good
information.”
“I do this [vital signs ] first thing in the morning.
If it’s a bit high I can usually hit the nail on the
head about what’s come along and triggered
it…and I do adjust like my fluid intake or
activity…then I can take it the next day or later in
the day just to see if it’s up…it gives me a
comfort zone.”
Nurses’ experiences
N=5
 Two hospital clinic nurses
 Three community nurses

Nurses’ experiences with telehomecare

Clinical impact: more flexible and responsive

Impact on patient health: improved decisionmaking regarding daily activities, increased
confidence in self-managing health and improved
compliance and accountability with medications
Experiences with technology: easy to learn, easy
to use, reliable
Impact on practice: increased focus on patient
education, monitoring and support.


Nurses’ experiences
“This is the future and I’m glad to be doing it”
“I’ve seen a lot of people become empowered to
care for themselves more and make more
informed decisions for themselves about when to
go to the hospital, when to go to the doctor,
when to call and ask for advice. For those who
are ‘frequent flyers…those people, if they use the
equipment comfortably on their own, then there’s
a much greater chance of keeping them out of
the hospital or ER for little or no reason.”
Nurses’ problems

Community nurses: Insufficient numbers
of patients on THC =
mixed caseload of THC + community

Hospital nurses: limited to THC three days
per week
Conclusion


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Patients and nurses learned THC processes
quickly and were very satisfied with care delivery
THC enabled patients to live with increased
confidence, security, engage in disease
management, improve quality of life
THC enabled nurses to deliver more timely
patient care, provided patients with a decisionmaking tool regarding daily activities and disease
management
In the absence of providing physical care, nurses’
focus turned to patient education, monitoring and
support.
Next steps

Expand urban partners and include rural sites

Expand care to include interdisciplinary team

Measure satisfaction, health service utilization
and system costs and examine work processes to
support THC implementation
Contact information
Project website:
www.telehomecare.ca
Lynda Atack, R.N., Ph.D,
[email protected]
Diane Duff, R.N.,Ph.D
York University
[email protected]