This edition of Standards in Focus highlights the Standards of Practice and Conduct that address appropriate, safe, competent, and ethical use of technology in nursing practice, such as the technology that is used in providing virtual care. This article will provide you with the opportunity to reflect on how to apply the applicable Standards in your practice. 1
Category two (II) of the Standards is focused on competent practice and states that licensed practical nurses are responsible for safe, compassionate, and ethical nursing practice. The Standard related to the use of technology states the following.
As an LPN, you must:
- Develop and maintain the knowledge, skill, and judgment required to use technology in the practice setting in an appropriate, safe, competent, and ethical manner. (Standard 19)
The entry-level and full competencies 2 for the profession also lay out the expectations for technology-related competencies. Examples of competency statements include:
- Selects the most appropriate technology in all forms of communication.
- Uses appropriate technology to perform safe and efficient nursing interventions.
- Demonstrates knowledge of the uses of virtual care and the related ethical considerations and professional requirements.
To read more on the competencies, please use the following link:
CLPNM Entry-Level Competencies
Technology in Nursing Practice
Technology in nursing practice refers to items such as healthcare information management systems, electronic medical records, mobile health services, patient monitoring systems, telehealth applications, and communication devices. 3
Evidence shows that technology can support quality nursing practice and improve patient care. For example, nurse telephone support has been found to improve the management of patients with chronic health failure. 4 Nurses practising in facilities that use electronic health records have been found to have more time to perform nursing interventions in patients’ rooms. 5 Nurses have also effectively used mobile devices to provide advice on pain management to clients with cancer. 6
Telehealth
Telehealth, a form of virtual care, is one example of how health care professionals use technology in practice. Telehealth refers to the delivery of health care when patient and provider are geographically separated — it can involve video conferencing, telephone calls, electronic data transmission, and other ways of communicating over the Internet. 7
The CLPNM, in collaboration with eight other Manitoba regulatory colleges, has developed a Telepractice Practice Direction, available here. This practice direction is intended to assist regulated health care providers in deciding when the use of telepractice is appropriate and to support the provision of effective healthcare using technology. Additionally, this practice direction outlines performance expectations for telepractice in the following areas:
- Informed consent
- Privacy
- Safety and adverse events
- Competence
- Documentation
Nursing Practice Scenario 8,9
Edgar, an LPN at a primary care centre, receives a message, via the centre’s receptionist, from one of the centre’s clients, Mr. Feldman. Mr. Feldman has a history of congestive heart failure. Mr. Feldman is concerned about recent rapid weight gain and an increase in his blood pressure and would like to speak to someone about the information he received about his diet during his last visit.
In this scenario, Edgar’s employer supports LPNs providing care via telehealth to known clients. There is also a nurse practitioner available for consultation if necessary, and Edgar is aware of the parameters for referral in his workplace. Edgar has received an orientation to providing telehealth services via the centre’s videoconferencing platform and has practised providing telehealth services with a colleague. He is also familiar with the requirements for providing telehealth services contained in the CLPNM Telehealth Practice Direction.
Edgar proceeds to contact Mr. Feldman via video link. Before initiating care, Edgar verifies Mr. Feldman’s identity and obtains Mr. Feldman’s consent to participate in a virtual session. He also verifies Mr. Feldman’s phone number and address should he need them if the video link fails or if emergency medical services need to be sent to Mr. Feldman’s home. Edgar then asks him about the signs and symptoms that he is experiencing. Edgar also takes notes of verbal and nonverbal cues communicated by Mr. Feldman. Mr. Feldman states that his wife is away, and he has been eating most of his meals in a restaurant, making it difficult for him to control his sodium intake.
Edgar knows the dietary requirements for an individual with congestive heart failure. Edgar reinforces the importance of maintaining a low sodium diet. Mr. Feldman decides to prepare his meals at home as often as possible to reduce his sodium intake.
In accordance with guidelines, Edgar provides Mr. Feldman with supportive health teaching and encourages him to call again if his symptoms do not improve. He also reinforces that Mr. Feldman should seek medical attention if his blood pressure and weight gain continue to increase. Finally, Edgar evaluates if Mr. Feldman understands the information by asking him to repeat the session’s main points.
Edgar documents the information in the centre’s electronic health record. The log is set up to guide nurses’ documentation. It includes areas to record the date and time of the call, the client’s contact information, the reason for the call, the assessment of signs and symptoms, the specific protocol used to manage the call, the support and education given, the disposition of the client, and required follow-up.
In this scenario, Edgar has upheld standard 27 – Develop and maintain the knowledge, skill, and judgment required to use technology in the practice setting in an appropriate, safe, competent, and ethical manner.
Edgar took steps to become familiar with the video conferencing platform and used it in a manner that was in keeping with the policies and protocols of his workplace. He also took steps to ensure his client’s safety by obtaining his client’s address and an alternate means to contact him. Finally, he provided direction on follow-up care and instructed his client on what to do if his condition worsened. Edgar also demonstrated several entry-level competencies related to technology by using appropriate technology for communication with his client, using the selected technology to perform safe and efficient nursing interventions, and demonstrating knowledge of the professional requirements for virtual care.
Reflection Exercise
Consider engaging in self-reflection about your nursing practice and technology, and ask yourself the following questions:
- What is your comfort level with the use of technology?
- How have you applied technology in your practice?
- What strategies have you used to overcome barriers to using technology in your practice?
- What are some of the positive aspects of using technology in nursing practice?
- What are some of the negative aspects of using technology in nursing practice?
Conclusion
The CLPNM Standards of Practice and Conduct expect that nurses will develop and maintain the knowledge, skill, and judgment required to use technology in the practice setting in an appropriate, safe, competent, and ethical manner (Standard 27). LPNs are expected to follow the practice guidance in the CLPNM Telehealth Practice Direction when using telehealth technology to provide virtual care. However, Standard 27 applies to any technology used in nursing practice. When using any form of technology in nursing practice, it is each LPN’s responsibility to ensure that they are knowledgeable about the technology being used and that the technology allows for the provision of safe, ethical, and competent care.
Next month‘s edition of Standards in Focus will be on the topic of Reporting and Documentation.
References
1. College of Licensed Practical Nurses of Manitoba. Standards of practice and conduct for Manitoba’s practical nurses. 2021.
2. College of Licensed Practical Nurses of Manitoba. Entry-level competencies for the licensed practical nurse in Manitoba. 2021.
3. IGI Global. What is healthcare technology. 2021; Available from: https://www.igi-global.com/dictionary/healthcare-technology-adoption-at-the-group-level/12912.
4. Grustam, A.S., et al., Cost-effectiveness analysis in telehealth: a comparison between home telemonitoring, nurse telephone support, and usual care in chronic heart failure management. Value in Health, 2018. 21(7): p. 772-782.
5. Schenk, E., et al., Impact of adoption of a comprehensive electronic health record on nursing work and caring efficacy. CIN: Computers, Informatics, Nursing, 2018. 36(7): p. 331-339.
6. Jibb, L., et al., Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial. BMJ Open, 2020. 10(3): p. e037251.
7. Canada’s Drug and Health Technology Agency (CADTH). Telehealth: Summary of Evidence. 2016; Available from: https://www.cadth.ca/sites/default/files/pdf/telehealth_bundle.pdf.
8. Rowan, M.M., et al., Planning, Developing, and Implementing Nursing Telehealth Simulation, in Innovative Learning and Teaching: Experiments Across the Disciplines, I.D. Alexander and R.K. Poch, Editors. 2017, https://open.lib.umn.edu/innovativeteaching/chapter/planning-developing-and-implementing-nursing-telehealth-simulation/.
9. College of Nurses of Ontario. Practice guideline: Telepractice. 2020; Available from: https://www.cno.org/globalassets/docs/prac/41041_telephone.pdf.
