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Sight and Sound: The New Broadcast Media

Monday May 19, 2008
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Before there were “collaborative initiatives” or “interdisciplinary teams” in health care, there were nurses helping one another, and this aspect of nursing has never changed.

When nurses find it difficult to differentiate a patient’s signs and symptoms, they ask one another for support — “Can you come down the hall and listen to his lungs? They sound a little off to me, but I can’t put my finger on why.”

With the technological advances of recent years, we are able to cooperate with and educate one another in an entirely new and different way. When there is no one around to “come down the hall,” this technology can send the sounds of the patient’s lungs to wherever a colleague is available — across the county or across the country.

Telemedicine has been around for more than 30 years. It has evolved from simple telephone and video feeds for patients in remote locations to a way for nurses and other healthcare providers to share information and observations through high-definition videography.

Teleconnection challenge

John Manke, RN, BSN, PCCN, manager, Telemedicine Program, St. Joseph’s Regional Medical Center, Paterson, New Jersey, has been involved in the development of a comprehensive telemedicine program for more than two years.

“One of our initial challenges was to integrate the clinical viewpoint with the technical aspects of the program,” he says. “Telemedicine is a loosely used terminology; this program is based on video conferencing.”

Although the technology is based on video conferencing, it has reached a whole new level. With special equipment, the clinicians transmit images from a camera assessment device. The equipment allows Manke to share the images seen through an otoscope with clinicians who might be right in the building or elsewhere in the world.

“We have a relationship with St. Jude’s Children’s Hospital in Tennessee, and we use the equipment for remote assessments and educational staff programs in both facilities.”

The “wow factor”

As high-definition transmissions become more readily available, the images are ever sharper and the sensation of “being there” is more immediate.

The practitioner uses a stethoscope to transmit the breath or heart sounds being auscultated and the camera to share images and observations.

The amazing clarity of the images can give remote participants the feeling they are in the room, and the “real time” ability to review pathology slides and MRI and CT images makes for informative and worthwhile discussions.

“There is certainly a ‘wow factor’ for professionals who first participate in these conferences,” says Manke. With the help of the camera, they can see into the patient’s ear, hear the lung sounds through the stethoscope, and observe a patient’s behavior.

Behavioral observation is especially helpful in cases of psychiatric diagnoses. St. Joseph’s Wayne Hospital, Wayne, N.J., can transmit these observations to the psychiatric department at the Paterson campus via the telemedicine equipment.

This “telepsychology” provides the most comprehensive care for patients who need such specialized services. Nurses who are triaging in the ED can broadcast the patient behavior, relate the medication regimen, and have a real-time discussion with a psychopharmacologist or psychiatrist, with the patient participating or undergoing direct observation.

The Center for Pediatric Feeding and Swallowing at the St. Joseph’s Children’s Hospital, located at the Paterson Campus, offers treatment for feeding and swallowing problems often associated with a variety of complex medical diagnoses.

The multidisciplinary staff provides a medical, motor, and educational approach for treatment. Manke notes that the center can treat a child from a distant area and send the family home with a laptop and camera to follow-up by “e-feed.” This service extends the ability of the clinician to perform follow-up assessments and offer treatment.

The E-generation

Manke notes that professionals who are familiar with electronic and digital technology are most comfortable when making the transition to telemedicine; the new technology is simple and easy for them.

Practitioners who are not as technologically astute are often reluctant to make the transition, says Manke.

Typically, this changes as clinicians who are less familiar with the possibilities are exposed to the images and the available information streams. He says that once they realize the implications and possibilities, they quickly get on board with the new techniques.

The “E-generation” is a state of mind, not an age group.

Endless opportunities

What is next? Manke envisions a future full of teaching and treatment possibilities.

“We will be able to broadcast images to another campus as interventionists use new cardiac catheterization wires or approaches, and the clinicians will love it,” says Manke. “They will be able to focus on the techniques.”

Nurses teach the techniques to other nurses, patients, and families. Including remote family members in discussions about discharge plans or treatment options allows both family and patient to make good healthcare decisions.

When the primary healthcare provider cannot meet with family members in person, this technology offers the primary nurse a seamless link to the patient, family, and clinicians, resulting in discussions that help everyone to make the best possible decisions about the patient’s post-acute care.

For students and less experienced nurses, the benefits of seeing unusual or rare conditions are clear. Instead of nebulous verbal descriptions of a particular skin condition or wound status, high-definition images can be broadcast for teaching purposes. Wound care procedures can be demonstrated in real time, with opportunities to ask questions.

When nurses share information and observations, the ultimate winners are always the patients. This technology has moved nursing interactions from the local unit or facility-based level to the interfacility level.

The next step is not far away, and we may soon be asking a nurse on the other side of the world to “Please listen to my patient’s lungs — they sound a little off, but I can’t put my finger on why.”


Marylisa Kinsley, RN, BSN, is a contributing writer for Nursing Spectrum. To comment on this story, e-mail editorNJ@nursingspectrum.com.