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HISTORY:
During the last few decades, the world has become increasingly reliant on a variety of technologies to manage information needs. Application of telecommunications technology in health care has become common practice and the use of remote technology to enhance health care is becoming more accepted.
This growing use of technology in the delivery of health care enhances the practice of school nursing (Bergren, 1994). Currently, school nurses use telephones, computers, interactive video, and teleconferencing in their practices. More sophisticated electronic monitoring and assessment tools, which allow for even more innovative approaches to disease management and health monitoring, are also being used in the school setting.
The American Nurses Association (ANA) has participated in the national dialogue on telemedicine/telehealth since 1996. ANA’s position provides guidance for all professional nurses.
ANA strongly believes that the strength and promise of telehealth lie in providing increased access to health care services by augmenting existing services, not in replacing them. Telehealth technologies should not be used to replace needed access to in-person health care services. The potential for abuse of these technologies by providing "cheaper" substitutes for in-person care needed in homes, communities, schools, nursing homes, hospitals, and other settings requires the development and enforcement of standards that ensure these technologies will be used appropriately,
(ANA, 1997, p.2)
DESCRIPTION OF ISSUE:
Telehealth has been defined as "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health related education, public health and health administration" (Hutcherson, 2002, p.4). Technology that gathers and electronically transmits interactive consultation between the school nurse and health care provider can serve as an adjunct to health care, especially for students in rural areas with few health care providers. This technology clearly has the potential to enhance health care of all students. Fundamental to its effectiveness, however, is the presence of a licensed professional on both ends of the transmission - one to assure accurate input and subsequent directed intervention and the other to provide diagnosis and prescriptive interventions.
This technology encompasses a host of complex legal and regulatory issues of privacy, confidentiality, parental rights, quality of service, jurisdiction, and standards of practice. The need for well-established safeguards and monitoring mechanisms cannot be overemphasized.
RATIONALE:
A student’s health and education performance are interdependent. Clearly, the healthier the child, the more he or she is likely to participate in and benefit from learning (Hardy, 2002). Telehealth holds tremendous possibilities to augment existing school health services. By virtue of their relationship with the students, families, and school personnel, school nurses can provide significant leadership when considering the following issues surrounding the use of telehealth:
- Quality of service
- Confidentiality
- Standards
- Documentation
- Protocols
- Follow-up
- Parental rights
- Liability
- Jurisdiction
- Cost
- School policies
- Coordination of services
In spite of the need to work through the complexities of legal and regulatory challenges, it is important to consider what is in the best interest of children and their families (Hutcherson, 2001).
CONCLUSION:
It is the position of the National Association of School Nurses that school nurses have expertise in school health. School nursing is a nurse-directed practice that requires independent professional nursing assessments, judgments, and decision-making skills. Students deserve a school nurse who supports their educational successes by providing them with quality school health care.
Technology has the potential to greatly enhance the services provided by the school nurse, but not to replace in-person health care provided by the registered professional school nurse (NASN, 2002). Therefore, the issues of telehealth in the school setting must be thoroughly evaluated, and school nurses practicing in this new environment must partner with regulatory and professional agencies to develop and use standards for safe and effective practice (Hutcherson, 2001).
References/Resources:
American Academy of Ambulatory Care Nursing (AAACN) (2001). Telehealth nursing practice and administration of standards. Pitman, NJ: Author. Available at: http://www.aaacn.org/resource/telephon.htm.
American Nurses Association (ANA) (1997). ANA policy series: Telehealth-Issues for nursing. Washington, DC: Author.
American Nurses Association (ANA) (1998a). Competencies for telehealth technologies in nursing. Washington, DC: Author.
American Nurses Association (ANA) (1998b). Core principles on telehealth. Washington, DC: Author.
American Nurses Association (ANA) (2001). Developing telehealth protocols: A blueprint for success. Washington, DC: Author.
Bergren, M.D. (1994). Information management and the computer. Electronic communication. Part 1. Journal of School Nursing, 10(3), 6, 8-9.
Hardy, L. (2002). Healthy learners: The link between health and student achievement. American School Board Journal, 189(1).
Hutcherson, C.M. (2001). Legal considerations for nurses practicing in a telehealth setting. Online Journal of Issues in Nursing, 6(3), 1-10. Available at http://www.nursingworld.org/ojin/topic16/tpc16_3.htm
National Association of School Nurses (NASN) (2002). NASN Resolution. Telehealth technology. Scarborough, ME: Author.
Thede, L.Q. (2001). Overview and summary: Telehealth: Promise or peril? Online Journal of Issues in Nursing, 6(3), 1-4. Available at http://www.nursingworld.org/ojin/topic16/tpc16ntr.htm.
Adopted: October 2002 |