Tele-health & Tele-teaching
Outline:-
Tele-health:
• Definition of Tele-health.
• Component of Tele-health.
• Classification of Tele-health.
• Definition of Tele-medicine &Tele-nursing.
• Application of Tele-medicine &Tele-nursing.
• Factors are influenced in the development of Tele-health.
• Mechanism of Tele-health (methods).
• Uses of Tele-health.
• Benefits of Tele-health.
• Barrier of Tele-health.
Tele-teaching:
• Definition of Tele-teaching.
• Approaches of Tele-teaching.
• Component of Tele-teaching.
• Tele-teaching technology.
• Role of instructors.
• References.
Introduction
The existence of Tele-health can be dated back to the 1960s, but this niche has only recently become widely popular. Among the first applications of Tele-health, it has been the monitoring of the astronauts’ physiological parameters. Due to technological advancement, a number of communications and technological tools have been implemented over the years in order to enable an easy transfer of patient information, consultations and recommendations across the specialties and the medical environment.
Tele-health involves the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities and also Tele-teaching student or learner receives information outside traditional teaching strategies. Tele-health& Tele- teaching which requires access only to telecommunications is the most basic element of “Tele-health& Tele-teaching” which uses a wider range of information and communication technologies.
Tele-health
Definition of Tele-health:
Tele-health is defined as “the use of communications and information technology to deliver health and healthcare services and information over large and small distances. (Picot, M.1997).
Components of Tele-heath
The technologies and systems used for Tele-health vary greatly from one ap¬plication to another. However, each application, even the simplest, contains at least three components.
1. Input: A device or means to capture, process, and store content whether sound only, electronic or digital images, tracings, alpha-numeric data, or a combination
2. Throughput: Content and a means to transfer or exchange the content, communications, telecommunications, or network technologies of all kinds and their associated software
3. Output: A means for receiving, storing, and displaying the content, possibly a video monitor, a computer file server, or a recorder of some kind.
Classification of Tele-health
Definition of Telemedicine:
Is the remote diagnosis and treatment of patients by means of telecommunications technology. Telemedicine encompasses the use of technologies and telecommunication systems to administer healthcare to patients who are geographically separated from providers. (Catalyst, M.2018)
For example, a radiologist may read and interpret the imaging results for a patient in a different county whose hospital does not currently have a radiologist on staff. Or a physician may conduct an urgent-care consultation via video for a non-life-threatening condition.
Applications of Tele-medicine
Tele-cardiology
This system enabled wireless transmission of ECG from the moving ICU van or the patients' home to the central station in ICU of the department of Medicine. This system was also used to monitor patients with pacemakers in remote areas; the central control unit at the ICU was able to correctly interpret arrhythmia. Also electronic stethoscopes can be used as recording devices, which is helpful for purposes of Tele- cardiology.
Tele-radiology
Tele-radiology is the ability to send radiographic images (x-rays) from one location to another. For this process to be implemented, three essential components are required.
• An image sending station
• A transmission network
• A receiving/image review station.
Other applications:
• Capnography • Vital Signs
• Blood Pressure • Blood Glucose
• Ophthalmology • Otoscope
• Peak Flow Meter • EEG
• Spirometer • Pulse Oximetry
• Elec. Stethoscope • Lab investigation
Definition of Tele-nursing
Refers to the use of information technology and telecommunication in the provision of nursing services whenever physical distance exists between patient and nurse, or between any numbers of nurses. (U.S. National Library of Medicine)
Applications of Tele-nursing
1-Address book: which is an alphabetical list that has fields for name, address, phone number, organization, and e-mail……thus a nurse can make a list of attending physicians, patients, staff members, nursing units, clinics.
2- Calculator: This is able to apply medical mathematical operations like body mass index (BMI), creatinine clearance.
3-Date book: this allows the nurse to keep track of her/his schedule, from a daily, weekly, or monthly perspective. Reminder alarms can be set to alert the nurse to an upcoming event as downloading assigned patient schedule.
4-Notepad/memo pad: which allow the nurse to jot down quick notes or memos on the screen using digital link. It is useful for noting changes in patient conditions, changes in orders on rounds, and taking notes at continuing education offerings.
5-To do list: which allows the nurse to create multiple lists and keep track of tasks to be done.
6-Beaming: this is infrared sharing of information that enables transmission of information or files from a PDA (personal digital assistant) to another device without the use of cables.
7- Bedside medication verification system: This is bar code scanning of patients and his medications at the bedside that allowing nurse to assign patients to individually locking/unlocking drawers with a single button push. At the bedside, scanning a patient’s wristband unlocks that patient’s medication drawer. It is effective in reducing medication errors and improving patient safety and document medication administration electronically.
8-Remote Monitoring Systems: in which mobile device communicatively connects to sensors embedded in patient body (especially for elderly, chronically ill, and the impaired patients) or included in clothing, shoes, hats and jewelry then data are send for medical analysis.
9- Alarm Notification System: in which mobile device provides alerts and alarm messages based on the health sensor data. Patients can self-monitor and transmit information to their health care provider like relatives as part of an ongoing caregiver arrangement.
10-Bio-monitoring system: in which physiological information are monitored as heart rate, ECG waveform, EEG monitoring, blood pressure, blood Oximetry, glycemic data, a photograph of a wound, fall detection, and location tracking.
11-Alerting; which reduce the number of missed appointments and reminding patients to adhere to the medication regime to alerting in case of an epidemic or an emergency like hypertension, detect breathing abnormalities associated with bronchial asthma. Caregiver receives alarm data via their pager-size receiver.
12-Pen-based wireless emergency medical system: this is an application that covers the full series of activities from the time an emergency call to the arrival of the patient in the emergency room. Record important trauma information at the scene like demographics, condition, history, vital signs, treatment provided, trauma and scene details. Thus Data is entered only once.
13-Tele-diagnostics: in which data transmitted from ambulance to hospital or from a small hospital to a medical specialist at a larger hospital who can make immediate diagnosis and transmit advice back to the ambulance.
14-Electronic mail and network: in which professionals can stay in touch with their offices and customers. They can respond to urgent e-mails from the field directly.
15-Palmuniversal wireless keyboard: this add a full size, complete yet compact keyboard to your handheld without a single wire. Type effortlessly with this foldable, practical keyboard that connects to you.
Characteristics of Tele-nurse
o Personal characteristics (positive attitude, open-mindedness)
o Have knowledge and ability to navigate the technology system and environment
o Understand the limitations of the technology being used
o Have the ability to recognize when Tele-health not appropriate for a client’s needs.
o Have communication skills
o Have the ability to deliver competent nursing services.
Roles of nurses who using Tele-nursing
o Inform clients of their full name, qualifications and registration status.
o Never leave confidential information on a voice-message system.
o Inform clients of the Tele-health process, professionals who may be participating and obtain consent before proceeding.
o Collaborate with other members of the healthcare team.
o Participate in the development, implementation, evaluation and improvement of all aspects of Tele-health related to nursing practice, including policy development.
o Comply with existing organizational policies and guidelines.
Factors are influencing the development of Tele-health
• Aging population:
The needs of aging healthcare consumers have initiated efforts to develop and adopt better Tele-health systems outside institutional walls, systems that would be better geared for home –based applications.
• Cost containment:
Tele-health systems are facilitating redistribution of health care services, reducing duplication, reducing numbers of drug 7 interactions and inappropriate prescriptions, and reducing patient and professional travel.
• Access:
Demand is increasing for equitable access to health care services for inhabitants of isolated geographic areas.
• Technology:
Ever more powerful technologies and communications band widths are becoming available at decreasing costs.
• Demand:
The increasing consumer demand for wellness and health information of all kinds has increased access to the internet and World Wide Web.
Mechanism of Tele-health (methods or modes)
1-Store-and-forward
This technique involves collecting (store) patient data, images and other clinical information and then forwarding (forward) from one location to another location .this is typically used for non-emergent situations mostly for second opinion. This mode may be used for transferring information especially images between two building in the same city or from one location to another anywhere in the world Tele-radiology , the sending of X-Ray CT scan or MRI is the most common example of store-and-forward telemedicine technique.
2-Real-time
Real- time Tele-medicine could a simple as telephone call or as complex as Robotic surgery it requires the presence of both parties at the same time and communication link between them allows real-time interaction to take place the physiological data can be transmitted in real-time across a standard telephone or digital Network radio cellular. An example of real-time telemedicine is the transmission of ECG from the patient's home to a medical Centre for diagnosis of emergency condition and seeking support for delivery of pre Hospital care .Tele-diagnostics is usually a real time and live dialogue between the specialist and the doctor or a remote site with regard to diagnosis of the patient's illness this is an online system that enable a consultation between the patient, primary care provider and a specialist with a two way interactive televisions a technique primarily uses videoconferencing equipment at both locations this means that the patients and doesn't have to travel to see a specialist as live patient image are available for him. Almost all specialists of Medicine have been found to be practical for this kind of consultation. Preferable devices can also be attached to computer or the video conferencing equipment which can facilitate and assist in an interactive real time examination for
3- Remote patient monitoring:
Remote monitoring also known as self -monitoring or testing or Tele-care enables medical professionals to monitor patient remotely using various clinical and other technological devices this method is primarily used for managing chronic disease or a specific condition such as heart disease and diabetes mellitus or asthma such services can provide comparable results to traditional in person patient meetings give greater satisfaction to patient and could be eventually cost-effective.
Uses of Tele-health
Clinical uses
❖ Transmission of medical images for diagnosis (often referred to as store and forward Tele-health)
❖ Teleconference between patient and healthcare provider for assessments and history taking
❖ Groups or individuals exchanging health services or education live via videoconference (real-time Tele-health)
❖ Transmission of medical data for diagnosis or disease management (sometimes referred to as remote monitoring)
❖Advice on prevention of diseases and promotion of good health by patient monitoring and follow up.
Non-clinical uses
❖ distance education including continuing medical education, grand rounds, and patient education
❖ Administrative uses including meetings among Tele-health networks, supervision, and presentations.
❖ Research on Tele-health.
❖Use in online information and health data management.
The Benefits of Tele-health
There are a lot of advantages to using Tele-health. The following list discusses a few
Patients Benefit
1-Travel to distant specialists is not necessary when Tele-health is used. That means patients can save the cost of travel, the expense of staying in the ‘big city,’ if the distance is such that an overnight stay is necessary.
2-Hospitalized patients whose care is supervised by a specialist via Tele-health have the advantage of staying in their home community where family and friends can easily visit. Studies have shown that recovery is faster when patients are close to home.
3-The danger of traveling in winter weather is removed
4-Patients don’t need to take whole days off work to see a specialist or to take their children to the doctor
5-Children miss less school when they can be seen via Tele-health
6-Patients can receive care rather than foregoing treatment to save time and money Providers Benefit
7-“Circuit-riding” specialists who start providing care through Tele-health can save a lot of “windshield time,” converting the hours spent traveling to hours spent seeing patients.
8- Practices can become more efficient by seeing distal patients.
9- Providers can serve more patients, thus easing provider shortages.
10- Rural providers can receive continuing education with Tele-health. connections, avoiding travel time and out-of-practice time.
11-quicker access to specialty providers for consults.
Benefits for health care provider
1-Improve early diagnostic, administrative and communication capabilities.
2-Improve emergency triage.
3-Help in solving problem of increasing shortage in staff.
4-Allow nurses to take their services out into the community through mobile health teams.
5-Remove barrier to health care.
6-Improve the way healthcare providers deliver care, access information and learn.
Barriers of Tele-health
1. No real face to face interaction.
2. Fear from wrong decision
3. Highly cost computers and machines
4. Need for frequent maintenance
5. Computer literacy of some patients
6. Need for frequent up to date information and trained people.
Tele-teaching
Definition of Tele-teaching (distance learning)
Obtaining education and training from a remote teaching site via TV, the Internet or private education network. Distance learning actually dates back to the mid-1800s when the University of London offered courses via mail. See e-learning and videoconferencing. (Markus, S.2000)
Tele-teaching also known as:
1- Distance learning.
2- Virtual learning.
3- Online learning.
4- E-learning.
5- Online education.
6- Web-based training.
7- Distance education.
Tele-teaching approaches:
Tele-teaching teaching is an instructional approach from Unidirectionalism to multidirectionslism approach.
Unidirectionalism:
In unidirectionalism there is only one transfer of component i.e. knowledge. The focus component is on knowledge itself. The process of imparting education as a piece of knowledge is distributed to arbitrary number of students. The knowledge transfer occurs between the teacher and the student via skill transformation followed by feedback.
Multidirectionslism:
The transfer of knowledge skills is not among only teacher and student but amongst them also. Each and every student is being included in the classroom practices where every student engaged on a common problem through different aspects either communicating or by taking the help of teacher or other students. The teacher’s role is as a guide, supervisor or knowledge imparter through various skills, strategies and methods.
Components of Tele-teaching
1. Syllabus:
The online course syllabus is similar to an on-site syllabus.
It must specify Course goals, learning objectives, description of course structure, required course materials or textbooks.
2. Orientation of students:
The first online course students take requires more instructions and patience from the teacher. Orientation can include a range of activities to provide practice in using tools in the learning management system as providing hyperlinks in the syllabus to resources that are important to student success. Good links to provide may be the course website, instructor website, online library, and technical support personnel. Orientation includes also instructor's contact information including:
An e-mail address and Skype contact name in addition to cell phone and office phone numbers.
3. Teaching strategies and materials depend on the type of program and the learning needs:
• Group problem-solving tasks
• Problem-based learning & Discussion
• Case-based strategies
• Simulations or role play
• Exploratory or discovery
• Lecturing
4. Lecturing or teacher-directed activities:
Controlling Learning environment is teacher responsibility either psychological environment "welcoming students before the course begins, personal introduction, providing lots of encouragement and support” or physical environment "students' home or workplace" must be structured
• Feedback: Students should know when their assignments will be graded (typically within 5 days of submission) and how to find their grades and feedback.
• Discussions: If the course includes discussion questions, a review of instructions and grading criteria is helpful. A grading rubric is a preferred method to use for discussion questions. A grading rubric provides information about length, quality, references, and scholarly rigor for the discussion question responses.
• Evaluation: Ways for students to evaluate their knowledge and skills and provide feedback to the instructor should be built into online courses. Consider self-assessment tests, quizzes, and an end-of-course survey assessing student perception of their course achievements.
5-Policy to control the program.
Tele-teaching Technology:
Tele-teaching technologies are the technical support and methods necessary to teach students who physically may not be in the same location as the teacher.
These Technologies are divided into
1- Synchronous technologies.
2- Asynchronous technologies.
1- Synchronous technologies (real time):
• Is a mode of online delivery where all participants at the same time. So it requires a time table to be organized.
• The teacher and the student interact in the same time.
For example:
1. Web based VoIP (Voice-over-Internet-Protocol).
2. Telephone. 3. Videoconferencing.
4. Web Conferencing.
Synchronous Learning Advantages:
1. It is cost effective.
2. Provides immediate feedback.
3. It is highly motivating.
4. Improve social inter action between teachers and students and between students each other.
5. Eliminate distance of physical barriers.
6. Provide opportunity to the teachers to participate in online discussions from any location, as long as they have an internet connection.
Synchronous Learning Disadvantages
1.Demands a high speed internet connection.
2. Time barrier: Different time zones can create communication challenges, as a synchronous learning course requires from both teachers and learners to be online at the same time.
3. Requires careful planning for doing schedule suitable for all.
4. It is challenging for employees with poor social skills in computer and how to use technological device.
5. Need trained expertise: The lack of technical staff or trained teachers.
Asynchronous technologies:
• Is a mode of online delivery where participants access course material on their own schedule.
• Students are not required to be together at the same time.
For example:
1. Audiocassette.
2. E-mail.
3. Printed Materials.
4. Voice Mail/fax.
5. Videocassette.
Asynchronous Learning advantages
1-Offers employees' complete control over their learning: As a learner-centered method, this means that everyone is allowed to decide how, when, and where to learn
2- Respectful to one’s own learning pace: Asynchronous learning gives learners time to reflect on what they are learning before answering questions or joining online discussions. As not all learners absorb the online training material in the same way.
3-Convenient: Asynchronous learning is the ideal learning solution for adults with busy schedules, as it doesn’t require employees to be online at a specific day or time.
4-Less social obstacles: there are many learners out there who don’t enjoy socializing and feel uncomfortable about the idea of participating in online discussions, it is useful for them.
5- Increases interactive between learners regardless of location and time barriers.
Asynchronous Learning Disadvantages
1. Lacks instant feedback.
2. Lacks personal interaction.
3. No live collaboration and real time activities.
4. Can cause lack of motivation.
The role of the instructor in Tele-teaching:
a) Guide the students to know when they are on the right track.
b) Highlight important points made during discussion.
c) Ask the students about their understanding or ask them to clarify
Remarks they have made or expand on certain ideas.
d) Correct misconceptions/misunderstandings.
e) Provide feedback to students.
f) The instructor must be able to use all distance learning tools that are to be used by the students in the online course and be able to guide the student in the basic use of these tools as part of the instructional process.
g) Provides student encouragement, motivation, and support.
h) To grade tests and essays and assign projects if appropriate.
Reference
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Dochterman, M., & Grace, K.(2001) Current Issues in Nursing. 6th ed. Mosby Inc. St: Louis.
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Heidenreiter, T. (1995) Using video teleconferencing for continuing education and staff development programs. Continuing Education Nursing. 26(2)135-138.
Kathryn, j. (2006,introduction to nursing information and Tele-heath. 3ed Retrieved from http://www.who.int/sustainablesector/strategies/telehealth/en
Means, B., Toyama, Y., Murphy, R., Bakia, M., & Jones, K. (2009). Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies. Available from the U.S. Department of Education at http://www.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf%E2%80%93
Potempa, K.,& Clark, R.(2000) AACN White Paper: Distance Technology in Nursing Education. Retrieved from http://www.aacn.edu/publications/positions/whitepaper.htm
Rani,S.,& Surana, A.(2015) The International Journal of Indian Psychology, The Future of Tele-teaching in Teacher Education:3(1) ,p39-43.
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