Evidence Based Nursing Research

This report proposal focuses on the use of telehealth in the healthcare setting by conducting a literature review. It explores the significance of telehealth, theoretical framework, PICO question, and synthesis of literature. The report also provides practice recommendations for implementing telehealth in patient care.

Running Head: EVIDENCE BASED NURSING RESEARCH
Evidence Based Nursing Research
Name of the student:
Name of the university:
Author note:

1Evidence Based Nursing Research
Introduction:
According to WHO (2019), telehealth is defined as the type of telecommunication and
the virtual technology in order to provide healthcare facilities in more convenient way as
compared to the traditional way of providing care to the patient. It provide care to the patient
based on the principle of eHealth which involves use of broader range of communication and
information technologies (WHO, 2019).
Telehealth is used widely by the nurses to assess and treat the patient by interacting with
the patient over computer, video and audio accessories and monitoring their condition and then
suggesting the treatment (Ali, Carlton & Ali, 2015). The mortality rate of individual in rural
areas is more as compared to the other individual due to the less accessibility of the healthcare
facilities. In such cases, telehealth can be used to provide healthcare facilities to the rural
individuals (Steventon et al., 2016). It is considered as one of the challenges to take care of the
individual residing in rural areas. With the help of telehealth, healthcare accessibility of the
individual of the rural areas can be increased. Instead of having wider use, use of
telecommunication in the healthcare sector is limited as people do not have the accurate
knowledge about telehealth (Rubin, 2019). Hence in order to increase the awareness regarding
the use of telehealth, the proposal of the literature review is presented. This report focusses on
the use of telehealth in the healthcare setting by conducting the literature review. This is a report
proposal for to introduce telehealth in increasing the patient satisfaction and providing quality
care to the patient. This proposal includes, the significance of the current practice along with the
importance of telehealth. Theoretical framework which includes Salmon White’s construct for
public health nursing theory. Review of literature is conducted based on the formulated PICO
question. After conducting the literature review, practice recommendations are provided. The

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proposal also includes the project description where the healthcare setting is Miami Cancer
Institute at Baptist Hospital in Florida, USA. At last the project is evaluated and plans for the
dissemination is explained.
Significance of the Practice Problem:
Barriers in the healthcare services such as, absence of reliable transportation, distance
between the patient and the healthcare provider, disintegration in the care of the patient due to
appointment gaps and the lack of healthcare providers as compared to the number of patient.
Telehealth can be considered as a strategies that helps the healthcare organization to overcome
such barriers and provide advantage over the traditional methods. According to National Quality
Forum (2017, August), telehealth assist in enhancing the interaction among the healthcare
providers and the patient residing at far places in order to provide patient care with the help of
distant specialist such as consultation. Telehealth supports in providing provider-to-provider
training. It also helps in enabling direct interaction among the patient and the healthcare provider
which helps in better assessment, treatment and monitoring of the patient which includes follow-
up for hypertension and diabetes. Telehealth helps in managing multiple chronic illness in the
patient from a distance by enhancing quality and service capacity such as, providing small
emergency hospital in rural areas and the pharmacy service. Telehealth not only increases the
access of the health care service, but also improves the quality of the care delivery and increases
patient satisfaction (Polinski et al., 2016). Apart from the health care service, it also have
financial impact on the individual as it reduces the cost of travelling to the healthcare setting.
According to Lazare (2013), telemedicine care saves about 19 percent of the expenditure over
the inpatient healthcare cost. It provide better satisfaction to the patient by involving the patient
engagement as in case of the telehealth patient gets better convenience, real of time and the

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flexibility. There are certain ethical issue associated with the broader use of the telehealth.
Professional relationships and the conduct as it takes time for the patient to trust the clinical over
the phone. Privacy, human values and the patient safety is also considered as ethical issue due to
the fear of poor cyber security which can be managed by the help of improving the software.
Protecting the autonomy of the patient is also extremely necessary which can be achieved by
telehealth as communication between the patient and the providers is easy as compared to the
traditional method (Warner et al., 2019). Telehealth also helps in better patient care as it assist in
the involvement of the family of the patient. Hence it is important for the family member to
acknowledge the importance of telehealth in the quality care of the patient (Chaet et al., 2017).
Pico Question:
The implementation of telehealth to provide care to patients at Miami Cancer Institute
will increase the patient satisfaction resulting in effective patient care in 2020?
Populations: Population involved in this proposal is the patient at Miami Cancer Institute. The
patient at the Miami Cancer Institute is taken as respondents and their health is monitored.
Interventions: Intervention used to improve the patient care quality is the telehealth, which is a
type of telecommunication between the patient and the health care provider.
Comparison: patient treated with telehealth is compared with the patient where the telehealth is
not intervened.
Outcome: Outcome of this intervention is improved patient satisfaction which results in effective
patient care.

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Timing: The effectiveness of the implementation of telehealth is measured till 2020. It is to be
expected that the by the help of telecommunication, patient satisfaction and the patient care will
increase by year 2020.
Theoretical Framework:
Salmon White’s construct for public health nursing is a community health nursing
theories introduced by Mark salmon white in 1982. It focusses on the protecting, promoting and
restoring the public health by the help of community healthcare nursing. This nursing theories
have provided three practice priorities which is prevention of the chronic disease and the
improvisation of the poor health, protection from infectious disease and the external agents and
the promotion of the health (Krubiner et al., 2016). To maintain this three categories, nursing
intervention are formulated. Interventions are providing education towards the voluntary change
in the behavior and attitude of the individual, risk-related variables are managed, mandatory
regulations are directed in order to achieve better public health. The interventions are targeted
into 4 categories which includes, human/biological, environmental,
medical/technological/organizational and the social (Smith, 2017).
Telehealth helps in accessing the principle of Salmon White’s construct for public health
nursing among the community population as they have limited healthcare facilities. With the
help of telehealth, disease can be prevented and the poor health of the public can be improved
with the direct interaction between the patient and the provider (Wessels, Taylor & Coates,
2017). Distant specialist can create awareness among the people of rural areas about the disease
and hence it can be prevented, they can also talk about the protection strategies (Collier et al.,
2016). Telemedicine can help in achieving better public health.

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Synthesis of the Literature:
According to Polinski et al., (2016), increased patient satisfaction is observed in case of
telehealth experience. The patient stated that telehealth facilitate the access to healthcare by the
help of perceived and convenient health care. After surveying 3303 patient it is reported that, the
patient are more satisfied with the health care facilities provided by telehealth in the CVS minute
clinics. In the article written by Hsieh et al., (2015), it is mentioned that there is increase in the
chronic and severe disease in the developed countries. To reduce the death rate due to the severe
disease, telehealth is applied in the community based health system. 336 respondents were
observed and it is reported that telehealth helps in improving the intrinsic qualities which are,
information quality system quality, and service quality which leads to increased patient
satisfaction and quality care. In a qualitative interview conducted by Powell et al., (2017), among
32 patient (only 19 patient successfully interviewed), it is observed that patient has experienced
several benefits such as, efficiency, convenience, communication, comfort, privacy, and
decreased cost by applying telehealth facilities. According to a literature review conducted by
Ward, Jaana and Natafgi (2015), it is observed that, despite of frequent use of telehealth in the
healthcare setting, there were limited research which shows the impact of telehealth in patient
care. After reeving 340 articles from different database such as, CINAHL, PubMed, Cochrane
and EMBASE, it is concluded that only 11 articles were focused on the telehealth for the
diffused patient population. From the 11 articles, it can be stated that, telehealth is considered as
the effective tool in providing patient care and patient satisfaction. Telemedicine is also observed
to be useful in the case of oncology. According to Doyle-Lindrud (2016), telemedicine is found
to be effective in the case of patient suffering from oncology disease. Telemedicine has
improved the access to patient care and also helps in enhancing patient satisfaction in oncology

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field. With the help of telemedicine, patient are able to communicate with the multidisciplinary
team of the oncology which assist in better recovery of the patient as well as increase patient
satisfaction. McKissick (2017), conducted a secondary analysis to evaluate the impact of nurse–
delivered telehealth practice on the healthcare setting that is used by children suffering from
medical complexity. To evaluate the effectiveness, planned as well as unplanned clinical and the
therapy visit were conducted for about 30 months, it is observed that the advanced practice
registered nurse–delivered telehealth is effective in providing quality care to the patient. It also
supports a certain shift in the patient care to planned from unplanned patient care among the
CMC. J Pediatr Health Care. Nursing intervention such as, telehealth also helps in providing
improved quality care to the patient suffering from end-stage renal disease. To evaluate the
efficiency of telehealth in end-stage renal disease, Lunney et al. (2018), conducted a research,
where 10 main studies were included out of which 7 are randomized control trial and 3 are
cohort study. By going through the research it can be stated that, telehealth has potential benefits
for the patient suffering from end-stage renal disease. From the literature review it is observed
that telehealth helps in improving the patient care and also provides quick recovery. However
positive impact of telehealth is not only observed in the patient suffering from any chronic
illness, but is also observed in case of surgical patient. According to a research conducted by
Nandra et al. (2018), where 655 videos of the healthcare were encountered during the period of 9
months (February 2017 – November 2017). After that the patient were surveyed and it is found
that, telehealth aids in providing high satisfaction and also saves time and travelling costs among
the patient who previously had surgical patient in urban areas. It is observed that dietary behavior
is responsible for the change in behavior in patient suffering from Chronic Kidney Disease.
Warner et al. (2019), conducted interviews among the adults of 28 to 38 years old who has been

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suffering from stage 3 to 4 Chronic Kidney Disease. After interviewing the respondents, it is
observed that telehealth helps in improving the diet of the respondents and they felt supported
and empowered after communicating via telehealth. The higher patient satisfaction is also
observed in case of patient suffering from Chronic Kidney Disease. Telehealth is found to be
effective in the field of pediatrics. According to Olson and Thomas (2017), telehealth is proved
to be effective in the pediatrics condition in order to get quality patient care in the wide
population of children. Olson and Thomas (2017), conducted a literature review from where the
effectiveness is evaluated. There are barriers observed in the implementation of the telehealth in
the child healthcare. However strategies to overcome such barriers are also mentioned in the
article. In the research conducted by Schneider and Biglan (2017), it is observed that disparities
is observed among the world for the healthcare service, hence to minimize the disparity,
telehealth is introduced. In the article, several articles where primary research has been
conducted is taken and the participant were taken as respondents. From the article, it is
concluded that telemedicine is found to be effective in the treatment of the chronic neurological
disorders such as, Parkinson’s disease. According to a literature search conducted by Weinstein,
Krupinski and Doarn (2018), it is explained that telemedicine has wide use in the field of
healthcare in improving the patient satisfaction among the medical field. However there are
certain limitation observed such as such as executing a remote neurology investigation is
extremely difficult in case of medical health. According to a literature review conducted by
Gutierrez (2001), medical providers have unique opportunities to provide patient care to the
individuals suffering in rural areas with the help of telemedicine. For the implementation of the
telemedicine, reimbursement is required. If the reimbursement is not done, it can have negative
impact on the health care access of the individuals residing in rural areas. According to a survey

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conducted by Parmanto et al. (2016), where questionnaire is distributed which is based on the
literature review. The questionnaire consist 1) literature evaluation; (2) concept development; (3)
article development; and (4) investigation of consistency. After conducting the survey it is
concluded that, telehealth interaction and the services helps in providing better patient care.
Framework to support the development of telehealth in the healthcare has been formulated by
National Quality Forum (2017, August). In the article, it is stated that telehealth has potential to
provide better patient care. It helps in better communication among the patient and the
practitioner and also reduce the travelling costs which enhances patient satisfaction.
Practice Recommendations:
By using the evidence from the different literatures, it can be stated that telehealth is used
in providing better care to the patient who are residing in the rural areas. It helps in enhancing
the patient-practitioner communication which helps in building better therapeutic relationship
among the patient and the general practitioner. It is found to be helpful in patient suffering from
chronic disease and disability disease, but there are certain limitation such as misdiagnosis,
payment parity is observed which needs to be resolved for wider application of telehealth (Lin et
al., 2018) Strategies such as to avoid the limitation should be introduced such as proper diagnosis
is to be done. It is also observed that instead of having wider application, rural people are
unaware of it. Hence, awareness regarding the telehealth should be created among the
individuals.
Project Description:
This project is initiated to evaluate the efficiency of telehealth in the patient satisfaction.
Setting of the project is Miami Cancer Institute at Baptist Hospital (Florida USA). The patient

9Evidence Based Nursing Research
who has been suffering from severe disease are taken as respondents. The project is continued
for 6 months. During the six months, patient were provided with telehealth care service.
To implement the project in the Miami Cancer Institute at Baptist Hospital (Florida
USA), permission from the higher authorities should be taken. Ethical consideration such as
privacy, informed consent of the respondents who have participated in the project is to taken into
account.
There are certain barriers that can be observed such as, making the Individuals agree for
the participating. Taking consent from the higher authorities (Zhou et al., 2017). As a supervisor
of the project, it is my responsibility to look over the barriers and providing strategies such as
making the patient as well as the higher authorities aware about the importance of telehealth.
Project Evaluation Results:
After conducting the project, the results were analysed by the data obtained through
direct observation or questionnaire distribution.
Formative assessment: Direct observation of the respondents during the period of 6
months.
Summative assessment: Survey by distributing the questionnaire to the patient.
The criteria that has been used for the project is that, only the patient who has been
suffering from chronic illness or mobility complication are included. The scale used to collect
the data are ordinal data, as it provides relevant information about the satisfaction of the patient
(Christensen, 2015).

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After collecting the final data, rate of patient satisfaction and recovery has been
calculated and analysed (Sutton & Austin, 2015). The patient satisfaction before and after the
implementation of telehealth should be compared and it is expected that, the patient satisfaction
should be more after implementing telehealth as compared to before the implementation .
Discussion and Implications for Nursing and Healthcare (based on the literatures):
From the literature review, it is concluded that telehealth has potential benefits to
improve the patient care and patient satisfaction. For the implementation of telehealth, it is
important for the registered nurse to acknowledge the patient about the advantages of telehealth
(Haynie et al., 2017). The nurse should communicate properly with the patient in order to
remove any misdiagnosis and to for an effective therapeutic relationship in order to enhance
patient satisfaction.
Plans for Dissemination:
After the completion of the project, it is important to share the result with the other
individuals in order to aware the people about the efficiency of the telehealth. It is important to
implement the telehealth in other health organization which can be done by organizing meeting
with the higher authorities. By organizing conference meeting and awareness camps and
programs, national and local people will get acknowledged. The result should also be published
in the form of research article as an evidence for the future research.
The Summary and Conclusion:
From the above project, it is concluded that telehealth is one of the most promising tool
in providing better patient care and enhances patient satisfaction. To evaluate the efficiency of
the telehealth, a research has been conducted at the Miami Cancer Institute at Baptist Hospital

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(Florida USA). The participant who are suffering from chronic illness are taken for the duration of 6
months. After the research, the data has been analyzed on the ordinal scale by direct observation and
by surveying. After analysing the data, the plans for dissemination is evaluated. The role of nurse and
health care staff in the implementation of the telehealth in wider perspective is also mentioned in the
report.

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