New Zealand Nurses' Experience of Tele-Consultation within Secondary and Tertiary Services to Provide Care at a Distance

IntroductionHealthcare providers recognise, but continue to be challenged by the demands of providing quality services in a dispersed environment. This issue is compounded by rapid technological advances, increasing public expectations and an aging healthcare workforce (National Health Board, 2010). Information and communication technology (ICT) is recognized as a key component in meeting future healthcare needs (National Health Board, 2010). One of the technology-based approaches gaining recognition as being able to provide more accessible healthcare is telemedicine. Telemedicine is defined as using "communications networks for delivery of healthcare services and medical education from one geographical location to another, primarily to address challenges like uneven distribution and shortage of infrastructural and human resources" (Sood et al., 2007, p. 576). Tele-consultation, which is a subset of telemedicine, is described as "seeking medical advice or information from someone at a distance" (Kerr & Norris, 2004, p.2). For example, a nurse working in a tertiary service may tele-consult with another nurse or staff in an area where staff do not have specialised knowledge, and this can be with or without the patient being present. How the communication takes place is dependent on the type of interaction needed, but common mediums include telephone, texting, email and videoconferencing. Nurses, as the largest health professional group, are ideally placed to provide healthcare at a distance mediated by ICT. Currently little is known about New Zealand (NZ) nurses experience of using tele-consultation. This study examines the experiences of nine NZ Registered Nurses (RNs) who provide secondary and tertiary services to patients and healthcare teams using tele-consultation as part of their nursing practice. These nurses use tele-consultation in a variety of ways. Some use tele-consultation due to geographic isolation from a tertiary centre and others use tele-consultation because they provide a specialty service to an area that is rural or remote.Telemedicine and tele-consultationTelemedicine has arisen from the advancement of ICT and the application of these technologies to healthcare. The term telemedicine was first mooted in the 1970s (World Health Organisation (WHO), 2010). The last two decades have heralded growth of telemedicine in most countries because of the widespread availability and improved speed of the internet (Bashshur, Shannon, Krupinski, & Grigsby, 2013). Telemedicine services that focus on diagnosis and clinical management are now offered routinely in the United Kingdom, Scandinavia, North America and Australia (WHO, 2010). Telemedicine offers a different mode of healthcare delivery, that is of particular interest to health professionals who work in rural settings, as a tool to address health accessibility and equity issues (Di Cerbo, Morales-Medina, Palmieri, & Iannitti, 2015). Teleconsultation is a subset of telemedicine, and when teleconsultation is undertaken by nurses it may be considered a type of tele-nursing, which Canadian nurses define as the "delivery, management and co-ordination of care and services provided via information and telecommunication technology" (College of Nurses of Ontario, 2009, p.3).Nurses and tele-consultationInternationally nurses have been using tele-consultation as part of their practice for some time. For example, in Scotland an 11 year study that started in 1998 found nurses were enthusiastic about using tele-consultation and they had higher levels of job satisfaction (Harvey, Peterkin, & Wootton, 2010). Similarly in Canada more than 15 years ago, nurses were considering the potential benefits and risks of telemedicine (Canadian Nurses Association, 2000). Some of these benefits and risks will now be identified.It has been suggested that tele-consultation may facilitate and support nurses practicing at more autonomous and advanced levels (Harvey et al. …