The advantages of telenursing have been documented in recent research. The present project is dedicated to testing the effectiveness of telenursing in reducing readmission, depression, and anxiety, as well as improving general health outcomes. Specifically, the use of telephone calls for follow-ups is investigated. Here, the results of the study will be considered through a hypothetical analysis with a special note on the limitations that should be acknowledged while reviewing the findings.
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The study managed to recruit a sample of 188 patients from one hospital. One hundred fifty-six of them were cardiac patients, and 32 were admitted because of experiencing a traumatic injury to the emergency department of the hospital. One hundred two of the patients identified as male (27 in the emergency group) and more than 80% of them described themselves as non-Hispanic White people. 16% of the sample were African Americans, and the rest of the participants either did not specify their ethnicity or chose the option “Other.” The age of the participants ranged between 28 and 58; the mean age was 37 for the emergency group and 49 for the cardiac one.
The measured outcomes for this project were chosen based on the ones which are evidenced to be affected by telehealth interventions (Balenton and Chiappelli, 2017; Ramelet et al., 2017; Shahrokhi, Azimian, Amouzegar, & Oveisi, 2018). As a result, the study focused on readmission rates, levels of anxiety and depression, and the general quality of life and satisfaction. None of the participants from the emergency group were readmitted throughout the study, but since the sample is rather small, it is not reasonable to make conclusive statements based on these data.
For the cardiac group and the entire sample, the readmission rates were lower than those for the cardiology department and the hospital by 2% and 4% respectively. However, the statistical analysis did not show statistically significant differences for either of the groups (p>0.005). In other words, the study cannot claim that the employed telehealth intervention is effective in reducing readmission rates since the changes are not statistically significant.
The depression rates for both groups of the participants were relatively low as shown by the Beck Depression Inventory (Maruish, 2017). Less than 10% (n=17) of the participants demonstrated symptoms of mild depression at the beginning of the project with an average score of 4.9 (σ=3.8), and none of them exhibited moderate or severe depression. After the intervention, some improvement was seen, but it mostly occurred within the 10%, and the changes were not statistically significant for this group or the whole sample (μ=4.8; σ=3.7).
From the perspective of anxiety, which was measured using the Beck Anxiety Inventory (Maruish, 2017), most project participants (87%) exhibited mild or moderate symptoms of anxiety at the beginning of the project with a mean score of 25 (σ=9.5). After the intervention, there was a statistically significant drop in anxiety in both groups (μ=22; σ=8) with the emergency participants showing especially prominent improvement (μ=16; σ=4.5).
For the quality of life and satisfaction, both groups showed statistically significant changes as related to general health and emotional well-being; the score for them rose by 10 points on average. In addition to that, the pain was reduced for emergency patients in a statistically significant way. Various aspects of self-efficacy that are reflected in the Short Form Health Survey (SF-36) by RAND (n.d.) did not show substantial improvements. However, these findings should be considered while taking into account the limitations of the study.
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Limitations and Recommendations for Future Research
Several limitations are necessary to consider while reviewing the study’s results. First, it was carried out in one hospital, which limits the applicability of the findings. To test the results, it would be reasonable to choose another hospital or several different settings in the future; a larger sample could also help. Also, the participants of the study were overwhelmingly White; it may be reasonable to consider recruiting different ethnic groups in future investigations.
The findings also suggest that testing the effectiveness of telehealth for a particular group of patients may be helpful since the outcomes appeared to differ for cardiac and emergency participants. Future research may focus on a more specific sample to check if telehealth could be especially useful in certain cases. This approach can also benefit from introducing different outcome measures for various groups depending on their specific needs.
However, the major potential improvement for future research is the introduction of a control group. Control groups are necessary for randomized controlled trials and controlled trials, both of which yield high-level, reliable evidence (Polit & Beck, 2017). The present study was almost exploratory, but future research can focus on testing the described approach to telemedicine by introducing control groups. Thus, the presented methodology could be improved in the future.
The analysis of a hypothetical project dedicated to telehealth allowed making the following conclusions about its findings and future investigations on the topic. The studied sample showed statistically significant improvements in anxiety rates and certain aspects of general health as measured by SF-36. The depression rates did not improve, but they were low during the pre-intervention stage. The readmission rates were not calculated for the emergency group since it showed no readmissions; no statistically significant changes in readmissions were shown for the other group or the entire sample.
The present research also presents an opportunity for making conclusions about methodology improvements. Future studies may benefit from choosing a more specific sample (for example, patients with particular conditions and various demographics) and introducing a control group. The discussed study could contribute some data on the topic, but more research is required for any direct conclusions about the relatively new field of nursing that is telehealth.
Balenton, N., & Chiappelli, F. (2017). Telenursing: Bioinformation cornerstone in healthcare for the 21st century. Bioinformation, 13(12), 412-414.
Maruish, M. (2017). Handbook of psychological assessment in primary care settings. New York, NY: Routledge.
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Ramelet, A., S., Fonjallaz, B., Rio, L., Zoni, S., Ballabeni, P., Rapin, J., … Hofer, M. (2017). Impact of a nurse led telephone intervention on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: A crossover randomized clinical trial. BMC Pediatrics, 17(1), 1-10.
RAND. (n.d.). 36-Item Short Form Survey (SF-36). Web.
Shahrokhi, A., Azimian, J., Amouzegar, A., & Oveisi, S. (2018). Effect of telenursing on outcomes of provided care by caregivers of patients with head trauma after discharge. Journal of Trauma Nursing, 25(1), 21-25.