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Application of telenursing in nursing practice: an integrative literature review

Valtuir Duarte de Souza Junior RN, Ms, Isabel Amélia Costa Mendes RN, PhD, Alessandra Mazzo RN, PhD, Simone de Godoy RN, PhD

PII: S0897-1897(15)00103-2 DOI: doi: 10.1016/j.apnr.2015.05.005 Reference: YAPNR 50672

To appear in: Applied Nursing Research

Received date: 25 August 2014 Revised date: 18 April 2015 Accepted date: 9 May 2015

Please cite this article as: Duarte de Souza, V. Junior, Costa Mendes, I.A., Mazzo, A. & de Godoy, S., Application of telenursing in nursing practice: an integrative literature review, Applied Nursing Research (2015), doi: 10.1016/j.apnr.2015.05.005

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Application of telenursing in nursing practice: an integrative literature review

Valtuir Duarte de Souza-Junior, RN, Ms a , Isabel Amélia Costa Mendes, RN, PhD

a* ,

Alessandra Mazzo RN, PhD a , Simone de Godoy RN, PhD

a

a University of São Paulo at Ribeirão Preto College of Nursing - WHO Collaborating

Centre for Nursing Research Development, Brazil.

Av. Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre Ribeirão Preto -

SP – Brazil CEP: 14040-902. Telephone: +55 (16) 36023469 Fax: +55 (16) 3602-0518.

* Corresponding author.

E-mails

Souza-Junior: [email protected]; Mendes: [email protected];

Mazzo: [email protected]; Godoy: [email protected]

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Application of telenursing in nursing practice: an integrative literature review

Abstract

Aims and background: Telenursing is the use of technological resources and

communication systems to encourage the development of nursing. Its efficiency has

been demonstrated to help countries overcome barriers to healthcare. This study

investigates the current telenursing strategies utilized in nursing practice, as found in the

literature.

Method: Integrative literature review of the application of telenursing, using the

descriptors: telenursing, nursing care and communication means, in Portuguese, English

and Spanish, between 2003 and 2013.

Results: Telenursing is found particularly in care through telephone use for health

services and orientations. The country with the largest number of research publications

was the United States with 14 (37.8%), followed by Canada and the United Kingdom.

Final Considerations: It could be verified that telenursing is growing, in view of its

presence in different countries, with strong evidence and benefits of its use. It proves to

be an efficient tool to help countries overcome geographical barriers and provide health

care information to the population.

Keywords: Telenursing; Telephone; Internet; Nursing Care; Communications Media

Introduction

The expansion of communication media creates different possibilities for the use

of new tools in various knowledge areas in an attempt to enhance the effectiveness of

their processes and competencies, contributing to scientific development. In health,

these resources are used choosing the terminology according to the scientific area’s

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focus, such as in the case of telehealth, telemedicine and telenursing. Telehealth

technologies permit nurses to expand care to anyone who needs it, wherever they are.

Telenursing is a strategy that enhances nursing activities, allowing the professionals to

use it to guide and monitor patients and populations in light of their needs. It facilitates

access, saving time, resources and promoting greater self-care possibilities (ICN, 2007).

Through telenursing, the development of nursing and health in general can be

accelerated, using these technologies and communication systems in the field of

teaching, research and care. In teaching, in a study undertaken in the United States

concerning the implementation of the Virtual Clinical Practicum, teleconferencing

technology was used to permit nursing students’ real-time interaction with patients and

preceptors at kilometers of distance. The study showed satisfactory results through the

expansion of clinical experiences and the opportunity for critical reflection and

dialogue. The patients who participated in the research project were satisfied with their

virtual experiences, mainly seeing them as a complement to the information gained

from traditional health services (Grady, 2011). The use of telenursing in research was

evidenced in a Canadian study about the perceptions of families who received telehealth

care. To overcome the geographical distance between the participants and the research

team, the video system of the telehealth network was used to hold interviews (Sevean,

Dampier, Spadoni, Strickland, & Pilatzke, 2009).

A comprehensive national helpline system for healthcare has existed in Sweden

since 2003, where nursing staff attends to approximately four million telephone calls

from the population each year. International studies show satisfactory results of

telenursing in screening access. Telenursing has served as the entry door to other health

services, accomplished with safety, effectiveness and acceptance from the population

(St George, Cullen, Gardiner, & Karabatsos, 2008).

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Research has revealed that, as a result of the increase in the elderly population

and the number of bedridden people suffering from chronic conditions, telenursing

should be used in care as a tool to support care delivery. Telenursing makes it possible

to address excessive demand and mitigate difficulties posed by geographical distances

and transportation issues (Kawaguchi, Azuma, & Ohta, 2004). To expand the

development of this resource and extend its benefits to different populations as needed,

considering professionals as well as patients and community groups, the scientific

production profile of the use of telenursing needs to be verified.

This research project focuses on how telenursing is applied, observing the

technological tools used to develop intervention strategies. The use of telenursing is

examined in professional and student education, in patient teaching and in care delivery

to patients. In addition, the countries that publish most of the research on telenursing are

noted, as well as the evidence levels attained in that research, so as to better assess the

impact of these studies in nursing. Thus, the aim in this study was to investigate, in the

literature, the current telenursing strategies utilized in nursing practice.

Method

Research developed through an integrative literature review of the Medical

Literature Analysis and Retrieval System online (MEDLINE), Latin American and

Caribbean Health Sciences Literature (LILACS) and Web of Science databases. The

integrative literature review is a resource that seeks a detailed understanding of a

phenomenon based on existing studies. Data obtained through different research designs

are grouped to enhance the conclusions that research provides. For the appropriate use

of this method, the methodological phases need to be carefully established:

identification of the research problem; inclusion and exclusion criteria; definition of the

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information under analysis; assessment of the selected studies; and interpretation and

synthesis of the data (Torraco, 2005; Mendes, Silveira, & Galvão, 2008).

The guiding question used was: “Where and how has telenursing been applied?"

The following descriptors, derived from LILACS, were defined for the search:

telenursing, nursing care and communication media. The languages searched were

Portuguese, English and Spanish. The search identified 187 publications, whose titles

and abstracts were read. As a result, 56 publications were selected and the full versions

of these were read. From the articles reviewed, 37 met the following inclusion criteria:

studies published in the last ten years (2003 to 2013); written in English, Spanish or

Portuguese; having a focus on telenursing as a strategy for nursing care. To analyze the

articles, a tool was used based on Ursi and Galvão (2006). The following data were

identified: year of publication; journal; place of study; method; evidence level according

to Stetler et al. (1998); technology used; target population; theories used to support

telecare; and main outcomes.

The strategies were classified according to four main characteristics: Educational

Strategy (ELS)- use of telenursing as a teaching resource for students and/or

professionals; Educative strategy (EES) – the nursing intervention contains educative

material for patient consultation; Monitoring system (MS) – the intervention contains

components to monitor and transfer patients’ vital data to professionals; Care

management (CM)- the intervention involves telecare by trained professionals as a

support strategy in healthcare management for patients and/or family members.

As far as quality of evidence is concerned, the studies can be divided into four

levels of quality. Those quality levels are: level 1 – meta-analysis of controlled studies;

level 2 – studies with experimental design; level 3 – quasi-experimental studies; level 4

– non-experimental research; level 5 – case reports, program assessment; level 6 –

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opinions of authorities or expert committees (Stetler et al., 1998). The presentation and

analysis of the data is accomplished descriptively (Polit, Beck, & Hungler, 2004).

Results

The publications analyzed included one thesis and scientific papers. Among the

publications, one was a meta-analysis and eight were randomized clinical trials. In

regard to the language used, one was available in Portuguese, one in all three languages,

one in Spanish and the remainder in English. The data concerning year, publication

vehicle, place of study, tool, target population, theories used in telecare in the studies,

strategies and the quality levels of the studies’ evidence are displayed in Table 1.

Table 1- Year, publication vehicle, place of study, tool, target population, theories used

in telecare in the studies and the quality levels of the studies’ evidence

The strategies and main outcomes are displayed in Table 2. In seven of the

publications analyzed, telenursing strategies were present in the studies in the form of

care delivery to the population. This care delivery is part of the country’s national health

services.

Table 2 – Strategies and main study outcomes

Discussion

Telenursing is a booming area, as shown by the increase in the number of studies

performed and the presence of research developed in different countries, with strong

evidence regarding the benefits of its use. Among the publications analyzed, one was a

N* número da publicação

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thesis and the rest were scientific papers. It is clear that English is the main language for

much of the published research. English also affords greater international visibility to

those countries where English is not the primary language.

Concerning the locations of the studies, the majority were concentrated in

developed countries (86.5%), particularly the United States with 14 (37.8%), followed

by Canada and the United Kingdom with five (13.5%) each (Table 1). The countries’

level of technological development impacts the use of these technologies in science to

expand healthcare professionals’ competencies. If we take into consideration that

telenursing is a strategy to direct and monitor patients and populations, facilitating their

access, saving time, resources and promoting self-care (ICN, 2007), the countries that

would most benefit from its use would be exactly those with fewer resources.

As regards the tools used in the telenursing strategies, the tool present in most of

the studies was the telephone for patient care, aiming to support healthcare management

(Table 1). This greater use of the telephone may be associated with the greater mastery

of its use as a technology, as the telephone attained popularity before other resources.

Several countries include telephone care as a strategy to maximize their care

systemization and the search for health services as carried out by their populations

(Price, & Mckay, 2000; Rodriguez-Gazquez, Arredondo-Holguin, & Herrera-Cortes,

2012).

Care delivery through audio calls requires greater competency from nurses to

hold interviews, as they lose the possibility of using visual assessment for decision-

making (Fincher, Ward, Dawkins, Magee, & Willson, 2009). Mobile phone use also

permits information exchange through text messaging. Internet connections offer the

possibility of accessing different resources. These possibilities are further expanded

with the availability of mobile phones (McCann, Maguire, Miller, & Kearney, 2009).

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Various evidences exist for the use of telephone care to guide healthcare. In the

United States, a study by Hannan (2013) showed that telecare to help postpartum

patients proved to be an easy, safe, low-cost and effective intervention that improved the

health outcomes of mothers and children and reduced spending on healthcare. In

another study in the United States by Battaglia (2013), telephone care provided to

psychiatric patients to lead them to quit smoking was a feasible strategy. In Malaysia, in

a study by Tahir and Al-Sadat (2013), telephone calls to support breastfeeding were

shown to be an effective resource, increasing exclusive breastfeeding rates in the first

month postpartum.

The association of multiple technological resources can also present good

results, like the study undertaken in Norway by Jelin, Granum and Eide (2012) in which

telephone care with educative support through the web was used for care delivery to

fibromyalgia patients, helping with counseling and support for these patients’ chronic

pain. The dissemination of computers and access to the Internet permits the use of

technologies, through computers and other devices with Internet access. For example,

websites, video calls, videoconferencing, audio calls and text messages can be used in

combination with one another. Until a short time ago, this required a specific tool for

each system. Technological evolution, however, entails unlimited possibilities for

telenursing usage every single day. (Dale, Caramlau, Sturt, Friede, & Walker, 2009).

A study that, in part, verified which Facebook groups on diabetes were the

largest identified that patients and family members use these spaces to search for

information on the disease, in addition to experience-exchange among the subjects for

care and emotional support (Greene, Choudhry, Kilabuk, & Shrank, 2011). Regarding

the use of Skype as an assessment tool in orthopedics in patients after surgical

correction of a collarbone fracture, outpatient assessments followed by the same

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procedure performed via distance instruction through Skype showed no difference,

suggesting that this resource can be used for clinical assessments. The patients found

assessment via Skype to be more convenient due to the time and resources saved (Good,

Lui, Leonard, Morris, & McElwain, 2012).

In regard to the target population (Table 1), it was observed that telenursing is

fundamentally important to attending to situations or conditions where patients

experience greater self-care management difficulties. This is mainly the case for patients

with chronic illnesses like diabetes or heart failure, where there are difficulties

maintaining treatment.

Among the publications studies, some presented details of the theoretical

background used to support telenursing strategies (Table 1), including the studies by

Amoako, Skelly and Rossen (2008), Dale et al. (2009), and Lange et al. (2010), who

presented the use of cognitive-behavioral and motivational theories and techniques to

assess patients’ perceptions of their health conditions. The theories and techniques were

further intended to support patients in coping with their conditions, in order not to

restrict their actions and information exchange, making the dialogue therapeutic. A

theory can help reach a better interpretation of the reality in question and is fundamental

to elaborating strategies designed to achieve the objectives the professionals proposed.

The evidence levels that the studies attained were as follows (Table 1): level 4

(43.2%), level 3 (32.4%), level 2 (21.6%) and level 1 (2.7%). The use of these

classification systems is important to helping nurses make decisions based on scientific

evidence. The more research with strong scientific evidence is developed using

telenursing, the further it will be consolidated as a part of nursing practice.

The telenursing strategies found in the studies were classified as follows:

Educational strategy (ELS); Educative strategy (ES); Monitoring system (MS); Care

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management (CM). In 35 (94.6%) of the publications (Table 2), the strategies were fully

or partially focused on Care Management, in which the nurses delivered telecare to

patients to support their healthcare. In seven (18.9%) of these CM strategies, the care

was provided as part of the nation’s health service. In the remainder, the researchers

developed them for the sake of research interventions. To give an example, in Chile in

2005, a telecare service was implemented for the population; the service, called Health

Answers, provides information in health and education, functions 24 hours a day and for

the entire country, involving medical and nursing professionals (Ministerio de Salud,

2011; Romero, Angelo, & Munoz Gonzalez, 2012).

In some studies, the strategies can be classified in more than one category (Table

2). According to a study developed in Japan that associated an Educative Strategy with

a Monitoring System and Care Management, in home care for a type 2 diabetes patient,

a laptop connected to the Internet was used with e-mail, texts and videos. The patients’

data were included in a database, accessed by nurses or physicians. The patient was

offered a website to access the material available on type 2 diabetes control. The

patients measured their own blood pressure and pulse with the help of a device and the

data were transmitted to a server at the health center. The results were positive for the

control of patients’ capillary glucose, glycated hemoglobin and blood pressure

(Kawaguchi, Azuma, & Ohta, 2004).

In another study by Jönsson and Willman (2008), which associated an Educative

Strategy with Care Management for care delivery to patients being treated for lower

limb wounds, two intervention components were associated in the telenursing strategy.

One was educative, using a web application with information on health treatment to be

accessed by patients and caregivers, and another part used resources through an internet

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connection for communication between patients and nurses, supporting health care

management. The nurses and patients were very receptive of the system.

A telenursing strategy was developed in the United Kingdom, associating a

Monitoring System with Care Management, involving the construction of a mobile

telephone system to monitor chemotherapy toxicity symptoms in cancer patients. The

system helped the patients to communicate with the nurse about the effects of

chemotherapy in real time, when they received help for care management. The patients

reported increased safety and reduced severity of adverse treatment effects (McCann,

Maguire, Miller, & Kearney, 2009).

Among the strategies verified in the studies, 35 (94.6%) used telenursing as a

form of patient care (Educative Strategy, Monitoring System and Care Management).

Two studies (5.4%) concerned professional education (Educational Strategy) and one

involved nursing students and other professionals. In view of the increasing number of

publications that appear as the years progress in this review, this result can be perceived

as a trend toward research development in care.

As an example of an educational strategy, telenursing used in continuing

education is shown in a Brazilian study that covers the use of technological resources to

train nursing professionals, in which 30 auxiliary nurses received training for

intramuscular injection at a hospital. The training was supplied through a lecture taught

by means of videoconferencing, followed by in-class theoretical and practical training

(Godoy, Mendes, Hayashida, Nogueira, & Marchi Alves, 2004). The use of

technological resources for continuing education in healthcare is an important

professional qualification strategy, contributing to the development of the Unified

Health System (Mendes et al., 2007; Mendes, et al., 2011).

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The study results show the effective use of telenursing, but some measures need

to be improved, such as knowledge, mastery and familiarity with the technologies used

in the strategies, mainly by the users. When they start a telenursing strategy, patients can

initially experience difficulties. After adaptation to the system, though, adherence and

the search for this type of care increase. The same is the case for patient participation in

a telenursing intervention: at first, patients may not have much to say and may

experience difficulties using the system. After adaptation occurs, acceptance may be

good, offering excellent health management outcomes (Hodgins, Ouellet, Pond, Knorr,

& Geldart, 2008; Kawaguchi, Azuma, & Ohta, 2004).

The selection of the patient groups that need this type of care is fundamental to

the success of the intended objectives. Health professionals made telephone calls to

promote blood pressure control in hypertensive patients in a study in the United States,

based on the blood pressure levels transmitted to the health professionals from a

telemonitoring device inside the patient’s home. The individuals with poor blood

pressure control showed better intervention outcomes, indicating the importance of

identifying individuals who will benefit further from these telecare strategies (Bosworth

et al., 2011). The professionals responsible for the interventions presented should be

knowledgeable and have the skills needed to conduct telecare, showing their

receptiveness and valuation of respect and ethical conduct. The patients’ compliance

with telephone recommendations is related to nurses’ interactive roles, showing the

latter’s need to develop communication skills in order to hold the telephone

consultations, in addition to skills and knowledge concerning healthcare related to the

diseases in question (Purc-Stephenson, & Thrasher, 2012).

Telenursing is expanding, showing positive results especially as a strategy to

guide and monitor patients and populations. Its application facilitates health care access

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and saves time and resources, particularly in situations or diseases where the patients

experience greater care management difficulties, as is often the case for chronic

illnesses. For telenursing in patient care to be efficient, a solid legal background needs

to be constructed in each country, so that it can be structured as a nursing specialty and

be included among the health services offered.

Final Considerations

Telenursing is a promising field for the incorporation of possibilities and

strategies for nursing activities in research, teaching and care. It is an efficient strategy

to help countries overcome healthcare barriers and bring information about healthcare to

populations. Telenursing helps to promote primary care and enhance rehabilitation and

health maintenance processes. This contributes to complement, further and intensify the

integration of healthcare systems, emphasizing patients with chronic conditions who

experience greater treatment difficulties. The studies analyzed in this review, involving

research developed in 13 countries and a target population mainly suffering from

chronic conditions, demonstrate the importance of telenursing to complement the access

to and universal coverage of health systems.

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Table 1- Year, publication vehicle, place of study, tool, target public, theories used in

telecare in the studies and the quality levels of the studies’ evidence

N* Year Vehicle Place Tool Target

Public

Use of

theoretical

support

LE #

1 2013 Journal of Clinical Nursing USA Telephone Postpar

tum

-

2

2 2013 International Journal of

Nursing Studies

Taiwan Monitoring

system/Tele

phone

Heart

failure

Meleis’

Theory of

Transition

s (Meleis

et al.,

2000). 3

3 2013 Journal of the American

Psychiatric Nurses

Association

USA Telephone Mental

disorde

r due to

post-

traumat

ic

stress

Transtheor

etical

Model by

Prochaska

and

DiClement

e (1982).

Motivatio

nal

Interview

(Miller, &

Rollnick,

2002;

Parker,

Pederson,

&

Bergmark,

2007;

Resnicow

et al.,

2002). 3

4 2013 International Journal of

Nursing Studies

Malaysia Telephone Breastf

eeding

-

2

5 2012 Patient Education and

Counseling

Canada Telephone General

and

pediatri

c

patients

-

1

6 2012 Pain Management Nursing Norway Telephone Women

with

fibrom

yalgia

Cognitive-

Behavioral

Therapy

based on

Mindfulne

ss

(McCrack 4

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en,

Vowles,

Gregg, &

Almada,

2010).

7 2012 Journal of Advanced

Nursing

United

Kingdom

Telephone Pregna

ncy

-

4

8 2012 Revista Latino-Americana

de Enfermagem

Colombia Telephone Heart

failure

-

2

9 2011 Telemedicine and E-Health USA Videophone Family

caregiv

er of

palliati

ve care

patients

-

4

10 2011 Nursing Education

Perspectives

USA Videoconfer

encing

equipment

Nursin

g

student

s

-

3

11 2011 Archives of Internal

Medicine

USA Monitoring

system/Tele

phone

Hypert

ension

-

2

12 2010 Biblioteca Digital de Teses

e Dissertações da UERJ

Brazil Website Health

team

-

4

13 2010 Revista Médica de Chile Chile Telephone Type 2

diabete

s

Motivatio

nal

interview

(Barr

Taylor et

al., 2003;

Stacey et

al., 2003). 3

14 2010 Journal of Telemedicine

and Telecare

Sweden Telephone Pediatri

c

patients

-

4

15 2010 Patient Education and

Counseling

USA Telephone Ulcerat

ive

colitis

Approach

of

cognitive

and

emotional

reactions

according

to the

study by

Leventhal

(1992).

Motivatio

nal

interview

(Rollnick, 3

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Miller, &

Butler,

2007).

Cognitive-

behavioral

techniques

(Beck,

2000).

16 2009 Scandinavian Journal of

Caring Sciences

Sweden Telephone General

populat

ion

-

4

17 2009 Journal of Clinical Nursing Canada Website Rural

commu

nity

-

4

18 2009 Journal of Clinical Nursing Norway Telephone Post-

stroke

patients

-

2

19 2009 Oncology Nursing United

Kingdom

Mobile

telephone

Young

cancer

patients

in

chemot

herapy

Medical

Research

Council

(MRC)

complex

interventio

n-

evaluation

framework

(Campbell

et al.,

2000). 4

20 2009 Association of Operating

Room Nurses journal

USA Telephone Postop

erative

patients

after

arthros

copy

Meleis’

Theory of

Transition

s (Meleis

et al.,

2000). 4

21 2009 The Journal of the

Association of Nurses in

AIDS Care: JANAC

USA Telephone HIV

patients

Transtheor

etical

Model by

Prochaska

and

DiClement

e (1982).

Motivatio

nal

interview

strategies.

Cognitive-

behavioral

strategies. 4

22 2009 Patient Education and United Telephone Type 2 Bandura’s 2

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Counseling Kingdom diabete

s

Theory of

Self-

Efficacy

(1977).

Motivatio

nal

interview

(Anderson

, &

Funnell,

2000; Dale

et al.,

2007).

23 2009 European Journal of

Cancer Care

United

Kingdom

Mobile

telephone

Cancer

patients

in

chemot

herapy

-

2

24 2009 Journal of Gerontological

Nursing

USA Telephone

/Videophon

e

Parkins

on

Orem’s

Self-Care

Theory

(2001). 2

25 2008 Telemedicine Journal and

E-Health

Sweden Website/Vid

eophone

Patients

with

wounds

-

3

26 2008 Australian Family

Physician

Australia

and New

Zealand

Telephone General

populat

ion

-

4

27 2008 Canadian Journal of

Cardiovascular Nursing

Canada Telephone Heart

failure

patients

-

4

28 2008 The American Journal of

Managed Care

USA Telephone Psychia

tric

patients

Cognitive-

behavioral

counseling

(Azrin, &

Teichner,

1998).

Motivatio

nal

interview

(Kempet

al., 1996;

Kemp et

al., 1998). 3

29 2008 Western Journal of Nursing

Research

USA Telephone Type 2

diabete

s

Counselin

g and

behavioral

change

theories

(Cormier, 3

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&

Cormier,

1991;

Eagan,

1998).

30 2008 The Canadian Journal of

Nursing Research

USA Website Rural

women

with

chronic

illnesse

s

-

3

31 2008 European Journal of

Oncology Nursing

United

Kingdom

Mobile

telephone

Nurses

-

3

32 2008 Patient Education and

Counseling

The

Netherlan

ds

Website Patients

with

cardiov

ascular

disease

s

Self-

regulation

theory

(Johnson,

1999).

4

33 2007 Journal for Specialists in

Pediatric Nursing

USA Telephone Pediatri

c

postope

rative

patients

-

4

34 2005 Journal of Advanced

Nursing

Canada Telephone Postop

erative

patients

after

heart

surgery

-

4

35 2004 Oncology Nursing Forum USA Videophone Cancer

patient

with

new

stoma

-

3

36 2004 Journal of Telemedicine

and Telecare

Japan Website Type 2

diabete

s

-

3

37 2003 Health Services Research Canada Telephone General

populat

ion

-

4

N* publication number

LE # the quality levels of the studies’ evidence

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Table 2 – Strategies and main study outcomes

Strategies N* Main Outcomes

ELS 10 Effective clinical nursing teaching method, permitting the students’ interaction with

clinical situations through videoconferencing.

12 The strategy permitted overcoming geographical and time barriers, granting conditions

for the individuals to develop knowledge according to their own needs and conditions.

ES/MS/CM 36 The telenursing system showed to be an effective strategy and demonstrated significant

results regarding patients’ glucose, glycated hemoglobin and blood pressure levels.

ES/CM

3 Care management through telehealth to quit smoking was a feasible and high-fidelity

strategy. The participants were motivated to change their smoking behaviors.

8 The intervention studied positively affects the self-care of heart failure patients.

25 The virtual communication between patients and nurses represents a fundamental

resource for health care at home. The nurses and patients were very receptive of the

system, with good results for real-time communication, even in patients of advanced

age.

30 The intervention showed improvement in the participants’ social support and self-

efficacy, besides reducing solitude and improving the ability to manage the chronic

disease.

32 The program showed to be feasible, reducing the levels of the risk factors associated

with the development of cardiovascular diseases.

MS/CM

2 Traditional nursing care combined with telehealth care significantly reduced the family

caregiver’s burden, mainly in the stress domain related to their caregiver role, and

improved family functioning.

11 The interventions showed global moderating effects but the effects were stronger

among individuals with bad blood pressure control. The study indicates the importance

of identifying individuals who will more probably benefit from this care.

19 The system shows the chemotherapy patients’ symptoms in real time. Various potential

benefits of the system were identified, including the potential to promote self-care and

improve the communication between young people and health professionals.

23 The patients showed positive experiences in the use of the symptom monitoring system

related to chemotherapy toxicity. It permits the identification of early effects to

accomplish the necessary interventions, enhancing the safety and reducing the gravity

of the effects.

31 The nurses demonstrated positive perceptions in the use of the toxicity-monitoring

system related to chemotherapy in cancer patients. Real-time monitoring permits the

rapid identification of symptoms, with the possibility of early and more appropriate

interventions.

CM

1 Telephone call monitoring as nursing practice to support low-income mothers in care

for their first child showed to be an easily-applicable, safe, low-cost and effective

intervention that improved the health outcomes of mothers and children and reduced

the spending on health.

4 Telephone counseling for breastfeeding, offered by trained nurses, showed to be

effective to increase the breastfeeding rate in the first month postpartum.

5 The patient’s adherence to telephone screening recommendations was influenced by the

interactive role of the patients’ perceptions and the quality of the provider’s

communication. The need for communication skills training is highlighted in the

context of patient-centered telephone consultations.

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6 The patients experienced the monitoring program as motivating support, with relations

of trust and detachment with the therapist. The program can help with counseling and

support for patients in chronic pain.

7 Telephone care to pregnant women demands clear, friendly and respectful orientations,

showing the professionals’ confidence and receptiveness.

9 Potential value was perceived in video contact to provide access to non-verbal

communication and visual emotion, which can be used for care delivery.

13 The results show that the care model used, combined with habitual care, shows to be

effective for the control of glycated hemoglobin, reducing the emergency consultations

and enhancing the self-efficacy in individuals’ control of their disease.

14 The mothers were more prone to accepting self-care counseling by telephone, while

different father who received the counseling did not accept the orientations and visited

another health service.

15 Compliance levels with telephone counseling to cope with emotional and cognitive

reactions of a chronic disease were high in comparison with traditional health

treatment.

16 The patients identified the professional helpline as reliable and easy to access in daily

life, promoting self-care and permitting reflections and manifestations of feelings.

Presents effective outcomes when the nurse is calm, friendly and transmits respect and

confidence.

17 Telehealth video technology as a health care mode was well received among patients

and family members in rural / remote communities. The benefits of telehealth extend

not only to patients and family members, but also to care providers and the health

system.

18 The intervention group showed significant results after six months with regard to

quality of life and exercise frequency in comparison with the control group. Telephone

monitoring after discharge is an easy intervention that permits individual information

provision and support at a moment of stress for the patient.

20 The continuing contact between patients and nurses helped the patients to cope with the

recovery experience between 12 and 24h after knee arthroscopy.

21 Telephone counseling furthered a high compliance rate with antiretroviral therapy and

can be an effective care strategy in different contexts.

22 The telehealth intervention is feasible to help patients with treatment in general, but no

change was found in the physiological and psychological data verified. It is important

to identify the patients who will benefit more from this type of care.

24 The intervention showed to be easy to access by the nurses and offering greater patient

satisfaction. Through the videophone, further information can be verified for self-

management counseling and identification of physical capacity and mood changes.

26 The telephone care service, established as health care screening for the population,

already represents an important component with good acceptance of the population.

27 Telephone care by trained nurses for heart failure patients represents a fundamental role

to support medication therapy management.

28 The psychiatric patients who participated in the research attended emergency services

less frequently than the control group and presented lower rates of hospitalizations and

visits to the emergency service in comparison with the previous year.

29 The intervention group showed improvement in the self-care and social adjustment

components, reducing treatment-related uncertainties.

33 Telephone monitoring of pediatric patients in the postoperative phase of spinal surgery

permitted closer contact between nurse and patient, building an important relationship

that permits the identification of factors that may be related to pain coping, supporting

its management.

34 Telephone intervention can support health promotion for patients after discharge from

coronary artery bypass graft surgery, stimulating the patients towards self-care.

35 The patients who participated in the intervention group after the hospital discharge

showed a better nurse-patient relation and less cases of colostomy bag change. The

strategy reduces costs and enhances patient satisfaction.

37 Telephone counseling in health service delivery should be done carefully and involve

trained professionals. Many patients seem to interpret the orientations mistakenly.

N* publication number