Tele-ICU Enhancements

Telenursing in the Intensive Care Unit: Transforming Nursing Practice Lisa-Mae Williams, RN, MSN Kenneth E. Hubbard, RN, AAS, CVRN-BC Olive Daye, RN, BSN, CVRN-BC Connie Barden, RN/CNS, MSN, CCRN-E, CCNS

In tele–intensive care units, informatics, telecommunication technology, telenursing, and telemedicine are merged to provide expert, evidence-based, and cutting-edge services to critically ill patients. Telenursing is an emerging subspecialty in critical care that is neither well documented in the extant literature nor well understood within the profession. Documentation and quantification of telenursing interventions help to clarify the impact of the telenurse’s role on nursing practice, enhancement of patient care, patient safety, and outcomes. Tele–intensive care unit nursing will continue to transform how critical care nursing is practiced by enhancing/leveraging available resources through the use of technology. (Critical Care Nurse. 2012;32[6]:62-69)

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ursing practice is constantly evolving along with the technology being used to enhance and deliver care. Tele–intensive care unit (teleICU) nursing, as an outgrowth of the rapidly exploding telemedicine approach to care, has the potential to influence the ongoing transformation of nursing practice and significantly contribute to care. It is a developing subspecialty of critical care nursing and requires highlevel critical thinking and analytical skills. ©2012 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2012525

Telenursing is the use of telecommunications technology to provide nursing care while using information and data remotely.1 Telemedicine is defined as “the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.”2 The tele-ICU is the arena where informatics and telecommunication technology coupled with telemedicine and telenursing are brought together to affect the care of critically ill patients. Tele-ICU provides expert-driven, evidencebased, cutting-edge services to the monitoring and treatment of critically ill patients. In addition, tele-ICU

62 CriticalCareNurse Vol 32, No. 6, DECEMBER 2012

delivers support to the bedside health care team through collaborations between the tele-ICU nurse and the bedside team.3 Having had an active tele-ICU in our health system for several years, we felt it important to begin to delineate the role and contributions to care of this developing nursing subspecialty in our health system. During the period of observation, themes emerged that helped to categorize tele-ICU nursing practice at Baptist Health South Florida in Miami. The purpose of this article is to describe these tele-ICU nursing interventions that contributed to patient care within our health system during the course of 1 year.

The Tele-ICU Environment Tele-ICU nurses have been an integral part of the tele-ICU since its inception. Examination of the usefulness of the tele-ICU in improving outcomes for critically ill patients has demonstrated reductions in ICU mortality,4-8 shorter stays in the ICU5-10 and the hospital,5-7,9,10

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Table 1

Color-coded acuity system used to categorize patients on the basis of physiological criteria, therapeutic measures currently in use, and safety concernsa Acuity status

Sample physiological criteria

Sample therapeutic measures

Sample safety concerns

Red

New admission