This paper is a discussion of the global trends related to telemedicine, the numerous impacts of telemedicine on the practice of nursing, both now and in the

The most serious concerns are centered on the potential for nurses to lose sight of the caring and enabling side of their work (Nolan, 2000). There is concern that the dehumanizing affects of increasing technology will endanger the nurse/patient relationship, and that the quality of nursing care will deteriorate (Greenberg, 2000). Kelley (1999) emphasizes the importance of the nurse-person process according to Parse’s theory and stresses that individuals experience a true presence and are invited to explore and clarify issues, concerns, hopes, and desires through the nurse-patient relationship. Many in nursing fear that the nurse “presence” will be lost as the emphasis on technology increases. Benner (2000) emphasizes that “many qualitative distinctions can only be made by observing differences through touch, sound, or sight, as in skin turgor, color, and capillary refill.”

One of the most recent global technological advancements has occurred with telesurgery. In 2001, doctors in New York City removed the gallbladder of a 68 year old woman in Strasbourg, France. This was accomplished through a unique system with a control console that sent high-speed signals to robotic surgical instruments over a fiber optic network that transmitted signals so quickly that doctors could see the movements of the instruments on a video screen 155 milliseconds after making them (Alpert, 2001). Through advancements such as this, telemedicine has the potential to make a difference in the health care of not only Americans, but people all over the world. It is likely to be a valued option for those with rare medical disorders and those seeking advice from leading experts who may be geographically far away (Miller & Derse, 2002) Telemedicine may in fact have a more profound impact on developing countries than on developed ones (Edworthy, 2001). The World Health Organization is pursuing strategies that will help to build international cooperation and affiliations, and increase the proliferation of telemedicine in developing countries (Miller & Derse, 2002 & WHO 56th World Health Assembly, 2003).

Procedures and treatments that have traditionally required direct physical contact by a practitioner can now be performed via telemedicine. For example, blood glucose can be monitored, and visual observation of insulin syringes prior to injection can be conducted from a remote location (Klonoff, 2003). The Kaiser Permanente organization demonstrated that patients with newly diagnosed chronic conditions could be equipped with home videophones, electronic stethoscopes, and digital blood pressure monitors, and assessments could be performed and data transmitted to evaluate cardiac and respiratory function (Wooten, 2001). Biofeedback can now be conducted using telemedicine (Earles, Folen & James, 2001). Inmates now receive health care services through telemedicine (Strode, Gutske & Allen, 1999). Tele-home-health, population based telemedicine, interactive video conferencing and store and forward image and record transmission have made it possible to deliver health care services across distances (Petersen, & LaMarche, 2000 & Strode et al., 1999).

The provision of nursing care through a mediating source such as a telephone, computer, video link, or the Internet has the potential to create a dramatic shift in the relationships of patients and their providers (Miller & Derse, 2002). When one looks at the subject from this perspective, it appears that telemedicine technology is relatively simple compared to the telemedicine provider/client relationship. It follows then, that the provider community is often perceived as reluctant to accommodate telemedicine in routine practice. Thede (2001) notes the provider/client relationship encompasses all of the aspects of direct care plus the varied information that is made available electronically to both patients and providers.

Some topics in this essay:
Miller Derse, Petersen LaMarche, Profession Telemedicine, Gutske Allen, Reardon Shannon, Nurses AAACN, Definition Currently, Theory Advanced, Ohinmaa Hailey, Indeed Nolan, health care, nursing practice, miller derse 2002, practice nursing, derse 2002, miller derse, greenberg 2000, maddox 2002, care services, nursing care, benner 2000, health care providers, petersen lamarche 2000, health care services, health care information,