When the pandemic hit in spring 2020, people around the world needed to learn how to communicate effectively through technology. From Zoom birthdays to video conferences, even the most tech-savvy individuals were suddenly thrust into learning the nuances of social dynamics via virtual interaction.
In the past year, many healthcare clinics in the United States have moved all or part of their services to virtual patient care, also referred to as telehealth. Telehealth has been increasing in use over the last decade, but the overwhelming necessity of the practice during the pandemic means healthcare professionals need to know how to effectively engage and assess patients remotely. Last spring, many of St. Catherine University’s nurse practitioner students suddenly had to switch from in-person clinical experiences to virtual ones. Their preceptors guided them on best practices and how to provide comfortable bedside manner while on a patient’s screen.
When St. Kate’s Assistant Professor of Nursing Gretchen Moen, DNP, APRN, CPNP-PC, started precepting for nurse practitioner students last spring at her pediatrics clinic Dakota Child and Family Clinic, she was familiar with telehealth but wasn’t using it regularly. “Our clinic already had a telehealth platform, but only one provider was using telehealth as part of her practice,” says Moen. Once the pandemic made virtual health visits a necessity, Moen and her students moved their clinical experience to a virtual platform. With each visit, Moen would get permission to have students participate. Then she would turn off her camera and microphone, observe the student’s visit with the patient, and return at the end of the visit to review the information and plan of care with the patient to wrap up the visit. After the visit, Moen and her students would discuss telehealth etiquette, such as the clicking sound of a keyboard or background of a screenshot, and then continue on to the next virtual appointment.
“The most challenging task was engaging the patient in the visit,” reflects Moen. “Children are tired of screens after online school, therapy, and being stuck at home, and were not thrilled with their healthcare provider invading their space online as well.” Moen and her students worked hard to keep their visits interactive to engage their young patients, while also communicating as efficiently and quickly as possible. “The students had to develop their communication skills far beyond what they would need in clinic,” says Moen.
Additionally, Moen and her students had to learn to document a visit remotely. “Since there was no hands-on examination, students had to learn how to use their observational skills and direct parents to help position the child or use a flashlight to get a better assessment.” During one visit, Moen and her students performed a wellness exam on four-year-old twins. “The twins’ mother was a former nurse practitioner student herself, so it was a good experience since she could listen to the children’s heart, look in the ears, etc. I really enjoyed observing the students instruct the twins and their mother on what to do,” says Moen.
There were also some fun interactions due to telehealth as well. “Nearly all the students expressed their delight in seeing children in their ‘natural environment’ and that they get a more complete picture of what the child is experiencing at home through telehealth. We have met families, pets, neighbors, and even the UPS man on our telehealth visits,” shares Moen.
Becky Ahlstrom, NP, MSN, is a co-founder of Integrative Geriatrics — a Minnesota-based practice that provides primary care to elderly patients in home settings and assisted living communities. She is also an adjunct nursing department faculty member at St. Kate’s and precepts for nurse practitioner students who are working toward their adult-gerontology primary care specialty. Elderly people are a high-risk population during the pandemic, so Ahlstrom’s students could not attend to her patients in person due to risk of exposure. “For most of our experiences, I physically traveled to the facilities where my primary care patients live, and used video apps to connect with students so they could participate in the visits. We then reconnected later in the day to discuss cases and work through documentation for the patients we saw together,” says Ahlstrom. When Ahlstrom was not present with the patients, assisted living nursing staff or family members would help the patient with the technology to conduct the virtual visit. Even with help, these visits could prove to be challenging. “Since our patients are older, many have vision or hearing deficits. The cognitive and sensory deficits of the patients made our video work more challenging at times,” Ahlstrom recounts. Assessing patients’ well-being remotely was difficult as well, even with nursing staff present with the patient. Ahlstrom and her students had to learn to instruct both patients and their assistants on how to conduct an assessment.
As nurse practitioner doctoral student Chinwe Obi-Walker DNP’22 reflects, “Something that stood out to me was the generational gap between myself and patients. We live in a technology-driven society where technological advances happened so quickly. As much as my colleagues and I interact with others via video calls, our older patients may not.” Obi-Walker recalled a colleague’s story about one solution to a technological issue with a patient. “A patient felt timid with so many faces on his screen — something to which we are used to and take for granted. To resolve this, some of the students turned off their video, so the experience was not so intimidating for the patient,” says Obi-Walker.
The patients and students both learned a great deal from the virtual process. Even with all the obstacles, “we were able to see patients for urgent visits due to an acute change in their condition, management of chronic health concerns, and Medicare annual wellness visits,” says Ahlstrom. These virtual appointments are an important way to stay connected and keep our elderly population healthy. As nurse practitioner doctoral student Maggie Lage DNP’21 says, “During the pandemic, we as a society feel very isolated. It was incredible to see how — just via video chat — we aren't really that far removed from those who are most isolated. I think it is just a matter of being creative and innovative with how we care for these patients moving forward.”
Telehealth and the Future of Patient Care
Moen recognizes that telehealth is here to stay. “In my own practice, we are now doing in-person and telehealth visits every week. Many providers have a dedicated telehealth day.” In addition to clinical experiences with telehealth, the Henrietta Schmoll School of Health’s Simulation Director, Krista Anderson, MSN, RN, CHSE, has integrated virtual simulated telehealth experiences in which students can learn, practice, and receive feedback on technical, patient-centered communication and cognitive skills in controlled environments. Simulation can be used to better prepare and educate students on best practices in telehealth to build patient rapport and manage challenges. “Our students will have the skills and tools to be leaders in this arena as they are with in-person patient care. This opportunity has presented a silver lining in an otherwise very dark cloud of COVID,” says Moen.