Telehealth in Rural Nursing: Embracing Change for Better Patient Outcomes

rural road Photo by Bradyn Shock on Unsplash

When I first heard of telehealth services coming to our rural hospital, no one was a bigger skeptic than I was.

Perhaps the main reason was the way I was educated as a nurse and how I learned to practice as an APRN. Honestly, I am “old school” in every way possible. My first thought was, “This is not good practice; how could it be? Won’t there be shortcuts? How about the lack of a physical exam? How can you properly physically evaluate someone over telehealth? How can you take safe care of patients and avoid missing something that’s potentially life-threatening if you can’t touch them? How could someone a thousand miles away help me way up in the mountains of the Eastern Panhandle? What could they know about the community here and their needs?”

These were just a few of the questions and concerns I had regarding telehealth coming to our rural community access hospital. When we assess our patients, we not only to listen to their heart and lungs, look into their eyes, hear their voice, feel the temperature of their skin, but we connect. We are building trust and ensuring support with looking, listening, and […]

2023-10-03T10:04:41-04:00August 25th, 2023|digital health, Nursing, nursing roles, patient experience, Patients|5 Comments
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In the Nick of Time: Advance Care Planning in the ICU

Marian Grant, palliative care NP

I’m a health policy consultant for national palliative care organizations and often advocate for advance care planning, a process that helps people with serious illness prepare for future decision-making. I also work as a palliative care nurse practitioner (NP) in an academic medical center where I see the real-life aspects of advance care planning.

I recently saw a patient whose case typifies how advance care planning and policies to support it can work. A middle-aged woman with metastatic breast cancer at our cancer center had been seen the day before by the palliative care NP there. The NP was called to help assess the patient’s new-onset dizziness. While seeing the patient, she also spoke to her about her cancer status and suggested completing an advance directive. According to the NP’s note, the patient’s son, who was there with her, seemed surprised that things were not going as well for his mother as they had hoped.

The ‘Five Wishes’ advance directive.

Later in that same visit, the patient became profoundly hypotensive and was sent to the emergency department and then admitted to the medical ICU. The team there put in a request for a palliative care consult for metastatic cancer. I first saw the patient the next morning. […]

2022-09-22T10:08:13-04:00September 22nd, 2022|end of life, Nursing, Palliative care|1 Comment
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Becoming an NP: The Growing Issue of Finding Clinical Placements

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While weighing the decision to become an NP, I thought about the time and money it would take to get into and through the program. I was very interested in the subject of psychiatry and thought it was a good fit for my personality and skill set. I found a program that worked for my schedule and budget and was able to complete the program. I’ve now been in practice for two years. What I didn’t have to worry about when I weighed the pros and cons of becoming an NP was where I would do my practicum or clinical rotations. That’s because the school I attended arranged those for me. However, many NP students are not as fortunate.

The growing difficulty of finding a placement.

Like many colleagues, I have been contacted by students on multiple occasions who are trying to arrange their own clinical placement. There are also numerous posts on message boards and social media from students pleading for someone to take them on at their clinical site. Students have reported having to sit out multiple semesters or not being able to graduate because their schools have left them with the responsibility of securing these arrangements on their own. Others report driving several hours to attend sites far from home or even moving temporarily to get to a practicum site.

One would expect that, when paying thousands of dollars in tuition, the school collecting this money would include the responsibility […]

2022-06-23T10:36:29-04:00June 23rd, 2022|Nursing|1 Comment
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The ‘Clog Kick’: In Trying Times, Adapting to the Loss of a Palliative Care Team’s Essential Rituals

Palliative care, under optimal circumstances.

I work as a palliative care NP on an inpatient consult team at an academic medical center in Massachusetts. In the best of times, palliative care teams are exemplars of interdisciplinary functioning. According to nationally accepted consensus reports, since palliative care is holistic in nature, it must be administered by a team that can address the multidimensional elements of suffering for both patients and families in the setting of serious or life-limiting illness.

In my experiences on two interdisciplinary palliative care teams, we were damn strong together. We met each morning to divvy up the workload; around the crowded table were NPs, physicians, chaplains, social workers, sometimes a pharmacist or a librarian, and a bevy of rotating students of all disciplines. On the table was often food: from someone’s garden, our own kitchens, or the grocery store bakery.

A ‘thread of lightheartedness’ amidst the heaviness.

The work was seemingly endless (as many people as there were around the table, there were scores more patient consults), and the situations were heavy and complex. We took our work seriously because the situations we waded into day after day were often worst-case scenarios for our patients and their families.

But there was also a thread of lightheartedness that ran through the days and weeks. We prioritized team and clinician wellness, and often laughter was the centerpiece of the table. We strategized together, cried and fretted about our patients, roared or seared in frustration, and yes, we watched funny cat videos to keep the […]

2021-02-23T17:02:36-05:00February 18th, 2021|COVID-19, Nursing|0 Comments
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An Intimate Glimpse of Community Health Nursing During the Pandemic  

Photo courtesy of Monica M. Finifrock.

We hear a lot about frontline nurses and the trauma they’ve endured throughout the year fighting the world’s deadliest pandemic in 100 years. Their stories are harrowing and heroic and shine a much deserved spotlight on the importance of the profession. And yet COVID-19 has touched not only those working in ICUs and EDs—but in every area of health care. Our December In the Community article, “Keeping Calm in the Buffer Zone,” is just one example of a nurse touched by COVID-19 in her daily work.

Community health as a ‘buffer zone.’

When the article opens, author Monica M. Finifrock is on her way to work at a community health clinic in Seattle. It’s April and the pandemic is beginning to take a toll.

I don’t consider myself on the front lines of the pandemic . . . I’m not watching patients take their last gasps of air or making hard decisions about who gets a ventilator and who doesn’t. I’m a community health nurse, and my role during the COVID-19 pandemic is to do exactly what I always strive to do—serve the community.

Calling her clinic a “buffer zone,” Finifrock argues that community health clinics are […]

2020-12-10T08:42:36-05:00December 10th, 2020|COVID-19, narratives, nursing stories, Public health|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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