The purpose of this assignment is to explore the specialty of telenursing as one example of
the use of technology in various practice settings. Advantages and disadvantages for the
patient and legal and ethical principles for the nurse of this technology will be explored.


Technology advancement has largely contributed improved quality of service deliver in
healthcare, which has rapidly driven its adoption. Many countries such as the United States and
Sweden have embraced technology in their healthcare, and many others are following suit with
an aim of enhancing quality and reducing the cost of accessing healthcare (Peeters et al., 2012).
Telenursing has become popular in rendering healthcare to patients in various settings to
improve patient outcomes, lower costs and streamline operations. Telenursing involves use of
technology in provision of professional care. Telenurses who have multiple clinical experience
are expected to work independently, make decisions about need for further care, and give self
care advice or refer patients to another caregiver (Madoc-Jones et al., 2007). The paper
deliberates on specialty of telenursing incorporating case study involving Manuel. It further
deliberates on advantages and disadvantages and legal, ethical principles for telenurses.
Case Scenario
Manuel plans to leave his medical surgical position for a telenurse specialist position to
work for an agency that monitors the elderly and people with chronic illnesses, so as to help
them from being readmitted. However, he has no knowledge and experience as a telenurse.
Therefore, the discussion explores on the various aspects in telenursing as well as benefits and
drawbacks to help Manuel become familiar with the role awaiting him. Manuel works as a Care

Manager in the city hospital and providing education to the patients with chronic diseases like
COPD, CHF, Diabetes to prevent re-admissions and patients with CHF disease. He will use
TeleHealth program to monitor and help to prevent re-admissions within 30 days. In addition, if
the patient referred to home care agency after discharge this agency will provide TeleHealth
Call System Software
One of the technologies that telenurses employ in executing their mandate is the
telephone. Telephone calls allow the telenurse to provide support and advice to patients at their
remote locations. It is important therefore for telenurse to understand how to use this software to
impact on their healthcare (Ernesäter, Holmström & Engström, 2009). There are different
communication gadgets that are essential in facilitating communication. Telenurse understand
the functionality of these systems, understand, the etiquette when communicating with clients.
Some of the technologies that relates to telephone call system include central scheduling that
permits certain patients to call and schedule their appointments and simplify tests.
Others such as speech-assisted automated attendant systems recognize voices and reduce
staff overtime and other problems such as dropping of calls or negative patient interactions
(Boye, 2006). Other types of telephone technologies in health setting include self-registered
kiosks, wireless connectivity, master patient index computer terminals and online bill pay. Other
useful technologies that a telenurse must understand how to use include, electronic health
records, social media, tablets, Smartphone and computerized physician/provider order entry and
clinical decision support among many others.
Advantages of Telenursing

Since inception and introduction of the concept of telenursing, various benefits have
become evident in healthcare delivery. Researchers indicate that telenursing technologies have
proved efficient in promoting quality healthcare especially in management of chronic conditions
such as diabetes and chronic heart failure among others (Joseph, 2006). The rate of mortality and
re-admission has also improved through telenursing services. Patients are able to access vital
information and advice that helps them to manage their health conditions. Computerized decision
support system is one of the valuable sources of information as it allows users to search and
gather relevant information that impacts on the quality of health care (Ernesäter, Holmström &
Engström, 2009). Through the decision support systems, accurate information is accessed and
important tips on management of different patient situations is addressed helping in assessing the
condition of patients in the best way.
Telenursing has become one of the most cost efficient approaches to rendering quality
patient care. A patient will not have to travel to a health facility to receive care as this is done
through the telephone calls. The patients, therefore, save money that otherwise they could have
used to move from one point to another. Another advantage of telenursing from the perspective
of the patient is that it is one way of saving time (Ernesäter, Holmström & Engström, 2009). A
patient will just be required to receive a phone at their remote locations. This therefore, saves
them time that they could have spent moving to and from a health facility. The other advantage
of telenursing is that it improves or rather increases patients self-care ability (Hebda & Czar,
2013). The patient is given an opportunity to take care of themselves through the advices they
are given through the call. A medical practitioner does not necessarily have to encounter the
patient and this makes the patients to take initiative to manage their health conditions.

Use of home telecare is instrumental in improving patient independence and safety as
well as provides support for those with chronic illness. Patients need not to worry about the
shortage of nurses, as through the technology, many patients can be accessed (Ernesäter,
Holmström & Engström, 2009). Patients as well have an opportunity to call and inquire about
various issues such as medication to enhance their healthcare.
Disadvantages of Telenursing
Even though telenursing has a number of advantages, it as well has some disadvantages
that nurses must look out for when delivering healthcare assistance to their patients. One of the
disadvantages is that there is a risk of miscommunication between the caller and the receiver,
which is likely to impact on the patient outcome. This is experienced especially when there are
some barriers in the communication processes. For instance, when the patient is in a noisy
environment, this is likely to affect the communication process leading to inappropriate medical
advice (Ström, Marklund & Hildingh, 2009). This requires that the caller and the receiver/
patient communicate in a noise-free environment. Other forms of barriers such as semiotic,
language can be avoided by ensuring that telenurses improve on their listening and
communication skills to enhance the process of their patient assessment.
Another problem is that telenurses cannot see the patient to whom they are providing care
(Pettinari & Jessop, 2001). This may have negative implication on their assessments and
formation of opinion about the credibility of the caller as well as on the health condition of the
patient. A patient may not be able to ascertain whether the caller is specialized and experienced
in rendering the health care services or not. Therefore, these perceptions are likely to impact on
the quality of care as sometimes the patient may develop negative attitude that may affect their

recovery process. The caller as well may not be in a position to understand the exact health
condition of the patient trough cellphone conversation.
Further disadvantage is the likelihood of conflicts ensuing between what is best for the
patient and limited healthcare resources available. Nurses fear making wrong decisions, but if the
resources available are not adequate, it may lead to ethical dilemma as some of the health
providers may be referred to the healthcare system compromising on the patient care quality
(Holmstrom & Hoglund, 2007).
Telenursing technologies are prone to security threats and other communication problems
such as network problems that are likely to interfere with the communication process. During
such instances, patients are likely to experience problems especially when they require
assessment and advice from their telenurses and this may jeopardize the patient health outcome.
Telenursing is one of the professions that have taken healthcare to another level. With
telenursing, various benefits have become evident. Patients save time, costs, and it promotes
quality healthcare. Some disadvantages that nurses must look into include security threats and
communication barriers among many others.
It is important for telenurses to understand legal and ethical practices in their duties.
Even though technology is beneficial, it requires adherence to ethical practices such as respect,
independence, autonomy, honesty, and integrity. When communicating, it is important for
telenurses to be respectful to enhance communication. They are as well required to providw
appropriate assessment based on evidence research to impact on the healthcare of the patient.
There are a number of legal aspects that are important that telenurses need to consider in

rendering their care, such as confidentiality and privacy. They must protect the privacy of their
patients when communicating (Bohnenkamp, McDonald, Lopez, Krupinski, Blackett, 2004).
They must not disclose information about their patients to third parties without the consent of the
patient. Telenurses must also consider legal implications that relate to in appropriate use of
telephone and communication gadgets. They are required to use the systems in an appropriate
manner to provide accurate and sincere information to avoid any legal
The opportunity before Manuel, even though is complex and challenging, it is
recommended that he accepts it. Having experience in clinical settings serving as a medical
surgeon for 12 years indicates that he has requisite skills and competence to provide care to
patients suffering from COPD (chronic obstructive pulmonary disease) and CHF (congestive
heart failure). Furthermore, he has a passion and if he is determined, he is going to learn how to
use technology to render care. As a nurse, he should as well be ready to face challenging
scenarios and yearn to grow in his career. I, therefore, support that he goes ahead and takes the
job to help promote quality of healthcare and impact on patient outcome among his target

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