Jemma Black is a Urgent Care Nurse who uses telehealth to look after patients in their own homes. By working closely with social workers and other healthcare professionals, her team is able to craft tailored support for patients.
Jenny Chou: What does your role encompass?
Jemma Black: There are two main aspects to my role. These are pathways and telehealth. In addition to this is ongoing training to develop my skills within the urgent care centre.
Telehealth is a system that allows us to look after community patients (as they could have CHF, COPD, learning disabilities and diabetes) in their own homes by monitoring their vital signs from a computer based at the Urgent Care Centre.
As a telehealth nurse I review people’s readings against parameters which are tailored for each patient. If the reading is outside of those parameters I give the patient a telephone call to check on them and decide which intervention is most appropriate. This may be things like organising a visit from a community matron or giving them advice on how manage the condition.
Another aspect of my role is pathways. Patients are referred by their GP or community health care practitioner for assessment or treatment of deep vein thrombosis (DVT), Male Acute Urinary Retention or lower limb Cellulitis. Treatment and assessment is carried out in the urgent care centre.
I am also currently actively involved on the band 5 development programme, learning how to extend my role and develop skills in assessing and managing patients attending as walk in patients and out of hours GP services. This involves working alongside the nurse practitioners, attending training days and external courses.
JC: What inspired you to become a nurse?
JB: I have always wanted to be a nurse since I was a small child. I had grown up watching medical dramas like Casualty. My parents were both medical technicians in the Royal Air Force, so there was always an interest in the subject of health and wellbeing. At the age of 18, I applied to university to study nursing, but then backed out of my application. Instead I went in to customer services. But the desire to be a nurse never went away and finally in 2009, after working in customer services for 15 years, I started my degree in nursing at Oxford Brookes University. I haven’t looked back since.
JC: What telehealth devices do you use?
JB: All patients are provided with a blood pressure monitor, scales, oximeter and some have a glucometer. The patient also has a “My Medic” box in the house that uses Bluetooth technology to receive the readings from the equipment, which is then transmitted to our dashboard for review. The My Medic box talks the patient through taking their measurements and asks them questions at the end. (E.g. Are you more short of breath? Do you have chest pains?)
Taking their own regular readings helps the individual to understand their condition and know when to seek help if their readings are not within parameters.
The equipment is easy to use and easy to read for the patients. They are shown how to use the equipment when it is installed most of them learn how to use it within a few days. But we’re always there to help if they have any problems.
JC: What do you enjoy most about your job? What do you find most challenging?
JB: What I most enjoy is the interaction with the patients. That may sound odd because this is a computer based system, but I speak with most of my patients every day. After a while you start to feel like part of their family and build up some therapeutic relationships. I know from speaking with them, that something as simple as a phone call can really make a difference to how people feel.
One challenge is that some people can feel a bit overwhelmed when they first get the equipment installed in their houses. They think it might be too technical for them, but it is not long before they become more confident and use with ease.
JC: What benefits does telehealth care have over more traditional medical care?
JB: We work closely with other healthcare professionals and social workers, so we are able to provide a multi-disciplinary approach to care and give the right kind of support for our patients. Because we are monitoring most people on a daily basis, we are able to see quickly if someone’s condition is deteriorating and then the team can take steps to stop the condition getting worse.
Using telehealth allows patients to lead a more independent life, because they gain an understanding of their condition and are able to manage it better without the need to come into hospital. The feedback that patients have given us is that their confidence about being independent, is increased by knowing that we are just a phone call away if they need us.
By reducing hospital admissions we are not only allowing patients to lead a more independent life, we are saving money for the NHS as well.
JC: You mentioned that part of your role involves improving the mood of patients, can you talk a bit about your relationship with patients?
JB: I speak with most of the patients every day. Some of the patients live alone and appreciate the call and just having a chat with them can improve their mood and make them feel better. A lot of people with chronic conditions suffer with depression as well, so it’s important that we treat the whole person not just the condition.
JC: You said you speak to 156 patients a day, on top of the other duties of your role, how do you manage to fit them all in?
JB: Our team may speak to up to 156 patients a day depending on their readings. We have a team of nurses trained in telehealth who rotate between telehealth and other duties each day. It is a fairly busy role, but we prioritise our work load and deal with the most poorly patients first. Having the Telehealth dashboard on our computer enables us to identify the patients who are most likely to unwell. It uses an alert system, so patients who have readings outside their set parameters are red alerts. The patient with the most readings outside of their parameters will be on the top of the list and will be called first.
JC: Can you give me an example of some service improvements you have helped implement?
JB: Before I became a nurse I worked in customer services. I have been able to use some of the skills I learnt there, to help develop guides for telehealth about different conditions and signs and symptoms of deteriorating conditions. I have been involved in contingency planning – ensuring we have a plan in case of system failures so we can operate as usual, if there was a power cut for example. I have been involved in implementing procedures for teleheath and sending out a regular newsletter to colleagues to help improved the service and provide a consistent
Jenny Chou is the Research and Features Editor for primary care at Campden Health media, working on Nursing in Practice, Management in Practice and The Commissioning Review
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