Nursing and Midwifery Participation in Virtual Care

Whilst it is clear that virtual models of care will be a predominant feature in future health infrastructure, there are varying interpretations of what constitutes virtual care (VC). There is no supported standard definition, and VC is often used synonymously with telehealth, telemedicine, autonomous health, and remote monitoring. For the purpose of this editorial, VC is a broad term that incorporates healthcare providers remotely interacting with their healthcare users and/or significant others using digital tools to communicate in real-time. VC safely connects healthcare users and/or significant others with healthcare professionals when and where required, complementing in-person care.

Digital technologies that support VC include:

• synchronous tools, such as live two-way audiovisual interaction between the healthcare provider and healthcare users and/or significant others. For example, a telehealth consultation via videoconferencing.
• asynchronous applications, such as secure messaging, SMS, telephone call, email, teletriage, and store and forward transmission. For example, a patient sharing photos of a skin rash for review and diagnosis or image sharing between healthcare providers for diagnostic reporting.
• digital self-care tools, such as applications that collect and store biometric data
• remote home monitoring, such as devices measuring vital signs, cardiac rhythm, oxygen saturation, blood glucose, and body weight.

According to NSW Health [1], VC offers benefits to:

• healthcare users:
  • Receiving care closer to home, their family and community
  • Enhanced convenience and choice
  • Diminished travel time and cost
  • Improved continuity of care through increased equity and timely access to services
  • Access to specialist services otherwise not available in their area
  • Ability to connect with their loved ones through technology.’
• healthcare professionals
  • Improving access to specialist services and professional support
  • Enhancing clinical networks and professional collaboration
  • Encouraging flexible service delivery models and multidisciplinary care
  • Supporting clinical education and professional development.

A decade ago, VC was predicted to be a game changer [2], however adoption in Australia has been slow, that is until the current pandemic. The COVID-19 landscape has required health services to be agile, diminish exposure to sick patients, conserve personal protection equipment, and abate the effects of patient throughput escalating in healthcare facilities [3]. VC has assisted the delivery of health services greatly during these unprecedented times by addressing all three demands. The need for social distancing led to swift federal policy changes around the use of VC, however these allowances may be short-lived, leaving clinicians uncertain about their ability to offer VC post-pandemic.

Perceived barriers to the uptake of VC solutions [4] include:

• suitable reimbursement models
• limited access/reduced connection to reliable Internet services
• behavioural and change management challenges across health and social care
• security and privacy of personal information concerns.

Telehealth in nursing and midwifery (also known as telenursing and telematernity) have increased during the current pandemic, with services provided through electronic platforms, such as teaching, triaging, consulting, coordinating, and providing direct services to healthcare users and their significant others, particularly advantageous during widespread nursing and midwifery shortages.

Various studies [5-8] have found that nurses and midwives view virtual care as

• benefitting many but not all healthcare user groups
• ideal for assisting individuals with chronic conditions
• helpful for those from high-risk populations, living in rural and remote areas, and limited travel ability
• promoting immediate access to care
• an effective model to deliver high quality care in a fiscally responsible manner
• useful when sufficient resources and effective management strategies are provided
• easing the burden felt by time-poor nurses and midwives
• facilitating meaningful contact with healthcare users due to the lack of intrusions, interruptions, and distractions often occurring in a traditional visit
• reducing hospitalisation, hospital readmission, and hospital length of stay
• requiring clear policies to support working remotely
• burdensome if the nurse or midwife has to function in a hybrid environment (in-person and virtual).

Examples of virtual care include:

• Healthdirect – healthdirect health app, symptom checker, risk checker, question builder, 24-hour health advice.
• RPA Virtual Hospital in Sydney Local Health District, which grew from six nurses to over 50 medical, nursing and allied health teams within seven months.
• NSW Health Virtual Care Accelerator – designed to identify and learn from ‘best virtual care innovations across the health systems’.
• Silver Chain Australia’s Enhanced Medical Mixed Reality (EMMR) designed to empower nursing staff while on home visits with hands-free data and to ease access to specialist advice and assessment from remote specialist doctors
• Goondir Health Service virtual health monitoring to Aboriginal and Torres Strait Islander communities in South East and South West Queensland
• Bendigo Health’s telemonitoring service for suspected COVID-19 patients at home, which alerts clinicians that the patient is deteriorating (Pulse+IT, 30 April 2020)
• Monash Health’s proof of concept trial for a virtual hospital service (Pulse+IT, 24 August 2021)
• Waitemata District Health Board in New Zealand launched a remote monitoring service to reduce the need for patients with serious health disorders to visit hospital during the pandemic (Pulse+IT, 2 April 2020)

In 2013, the Australian Nursing Federation launched telehealth standards and guidelines for nurses and midwives to guide and support nursing and midwifery practice for the future [9-10]. Additionally, the Australian Health Practitioner Regulation Agency and National Boards have published telehealth guidance for practitioners in 2020 [11].

The RPA Virtual Hospital was the subject of a webinar in June 2021. Go HERE to view the webinar on Digital Health TV.

Dr Jen Bichel-Findlay, August 2021

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