Digital literacy part 4: Resources for community nursing

Our six part series continues with a review of ways in which community nurses can use digital technology to enhance patient care – and keep themselves safe

Our six part series continues with a review of ways in which community nurses can use digital technology to enhance patient care – and keep themselves safe

Picture: Alamy

As a community nurse, how can digital technologies help me deliver a better service?

In lots of different ways. For example, mobile technologies, such as smart phones and tablets, can give you access to patient records and relevant health and social care information in real time. They can also help you to input patient information wherever you are, eliminating the need to travel back to base to use a desktop computer. Other benefits include being able to find and order any necessary equipment there and then.

Is there any evidence supporting the use of digital technologies?

The Department of Health’s Whole System Demonstrator programme, launched in 2008 to explore the potential of telehealth and telecare, involved more than 6,000 patients in England. Initial findings published in 2011 showed a 15% reduction in A&E visits, a 20% reduction in emergency admissions, and a 45% reduction in mortality rates.

Another study, published in 2014, looking at the use of handheld computers in clinical practice, found that healthcare professionals’ use of these devices may also improve their adherence to guidelines and clinical decision-making. This is particularly important for community teams, whose members are often working alone.

In addition, there may be substantial increases in productivity. In England, the National Mobile Health Worker Project found that using digital technology could free up more time to spend with patients.

For example, removing the need to transfer information from paper-based notes to electronic systems releases extra clinical time for nurses.

I keep hearing about telehealth, telecare and telemedicine. What’s the difference?

Telehealth, according to the Telecare Services Association (TSA), is the remote exchange of data between a patient at home and their clinician, which helps with diagnosis and monitoring. It is typically used to support patients with long-term conditions. Read about a telehealth service that has helped thousands of patients manage heart failure, diabetes and COPD in their own home here

Telecare is the continuous, automatic and remote monitoring of patients, enabling them to carry on living independently in their own home more safely, by minimising risks such as falls or other emergencies. One of its simplest forms is a personal alarm.

Related: A primary care clinician's perspective on supported self care through technology

Telemedicine enables remote video consultations between patients and healthcare professionals, which can take place in patients’ homes. It is also being used in other settings such as nursing and care homes, prisons and GP surgeries. Benefits include reduced hospital stays, avoiding unnecessary visits to A&E, and reduced admissions overall.

Can digital technologies save money?

In its 2013 report Smart New World, the Queen’s Nursing Institute (QNI) cites several examples where digital technologies in community care have cut costs and improved lives. These include a pilot in Kirklees, west Yorkshire, where staff used laptops rather than returning to base, with estimated savings of more than £500,000 a year in travel costs alone.

Another pilot programme in Kent involved 250 patients with chronic obstructive pulmonary disease (COPD), who were given home monitoring equipment. This led to a 50% decrease in expensive hospital admissions and reduced home visits by 80%.

Why aren’t more community nurses using mobile technologies? Are we lagging behind acute care?

While it is widely acknowledged that technologies can open up new and better ways of working for community healthcare teams, research shows that district nurses’ use of mobile technologies is still low.

In July 2017 the RCN in Scotland published the report Enhanced Care in the Palm of their Hand on developing mobile technologies for Scotland’s district nursing teams. This quotes QNI data published in 2014 that says only 26% of district nurses reported using mobile technology to record care while in the patient’s home. The RCN report called for ‘extensive and concerted investment’, saying it was essential ‘for future-proofing this key workforce’.

Other practical barriers include continued patchy access to Wi-Fi, poor internet speed and unreliable 4G and 3G coverage, especially in more rural areas. There can also be concerns about the mobile devices themselves, including their weight and battery life, data security and log-in procedures, and adequate staff training.

Can my patients benefit from technology at home?

Yes, in many ways. For example, telehealth is especially useful in helping patients monitor long-term conditions at home. Those with hypertension can measure their blood pressure and automatically send the results to their GP. There are similar options for those with asthma or COPD, diabetes or recurrent urinary tract infections.

Benefits for patients include fewer visits to the GP surgery, increased awareness of their own health leading to more confidence in managing their condition, reduced delays in getting clinical support including emergency care if there is a sudden deterioration, and reassurance for patients and their families.

Independent healthcare think tank the King’s Fund, in a report on the digital revolution, highlights portable or ‘at home’ diagnostics as one of the ways digital technologies will continue to transform healthcare. These include mobile X-ray machines and blood-testing kits. Smart assistive technology is also revolutionising how people manage long-term health conditions, helping them perform tasks or manage activities once made difficult by their disability or condition.

Are there any good case studies?

One telemedicine scheme, run by Airedale NHS Foundation Trust in West Yorkshire to help those with long-term conditions, featured in an article in Nursing Standard.

‘Patients would often feel frustrated that they had a long drive to hospital, where they had a verbal consultation with a consultant but no physical examination,’ says Rachel Binks, nurse consultant for digital and acute care. ‘Some would question why they’d had to travel all that way when they were managing their own condition well at home.’

Now consultation and assessment with clinical staff, via video link, means no one has to travel, saving time and money. ‘It works for the vast amount of consultations, unless you need to be hands-on. But even then, a prior assessment or follow-up appointment can be done remotely,’ says Ms Binks.

I often work alone. Can mobile technologies improve my personal safety?

Compared with other sectors, health and social care staff are at increased risk of violence wherever they work, but the possibility is greater for lone workers. Analysis by NHS Protect, published in 2015, showed a 9% higher risk of injury from physical assault for lone workers compared with those who did not work alone.

Phones, laptops and tablets can help. All can be enabled with specialist software, GPS and apps supporting lone workers at the touch of a button. The RCN has produced guidance which covers these options called Personal safety when working alone.

Can digital technologies help me overcome professional isolation?

Social media and online professional networks can be especially useful for nurses who predominantly work alone, offering ways of sharing knowledge and keeping up to date. Those new to social media should read guidance from the Nursing and Midwifery Council.

WeCommunities hosts regular Twitter chats, with many aimed at different groups of community nurses, including district, school and general practice nurses, and health visitors.

The RCN’s community nursing forums also have their own closed Facebook pages, which you can ask to join. The RCN district nursing forum has more than 4,000 group members, while the RCN general practice nursing forum has more than 3,800. Both encourage you to take part in discussions about your field of practice.

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More in this series

Digital literacy part 1: You can be an e-nurse

Digital literacy part 2: The perils and potential of social media

Digital literacy part 3: Online learning resources


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