Small Group Activity 2: Telehealth Role Play & Reflection

Scenario 1

A 75-year-old woman has recently been discharged from a Washington, DC hospital after an Acute Myocardial Infarction. The patient lives two hours from the hospital in a rural area of Maryland. Due to her distance from the hospital, the patient has opted to take advantage of a new telehealth service that includes remote monitoring of weight and blood pressure and weekly videoconference visits with a nurse. This is the first telehealth follow-up visit.

The nurse has the following remote monitoring data for the past week:

• Nurse: It is 8 days post-discharge and this is your first telehealth visit with this patient. Your goal for the call is to find out how the patient is feeling; to coach the patient about her diet, exercise and self-care; to verify medication compliance, and to address any problems or questions the patient may have. This is the third telehealth visit you have conducted and you are starting to get the hang of it. You have a notepad and pen ready to take notes throughout the call that you will transfer to the EHR after the call.
• Patient: You use your computer for email and Facetime for weekly calls with your grandchildren, but this is the first time you are using the videoconferencing system. You are anxious about it, but glad you do not need to bother your daughter to take you to the hospital for this follow-up. You click the link that was sent to you by email and successfully join the session. You can see and hear the nurse but she cannot hear you because your microphone has not been turned on. Wait for the nurse to coach you on how to turn on the microphone before clicking the button to enable it. When asked, you tell the nurse that you are feeling pretty good but feel light headed and have mild nausea from time to time. You cannot remember if you took your medication today. You think your blood pressure has been stable at about 124/60, but you are having trouble with the electric cuff squeezing your arm too tight.

Scenario 2

Joe Smith is a new father whose wife is out of town on a business trip. His 12-month-old daughter was well until yesterday when she began vomiting and then started having diarrhea today. Mr. Smith is calling the clinic’s new videoconferencing triage service to determine whether or not he needs to bring his daughter in to be seen.

• Smith: You are in a bit of a panic because your wife is away and this is the first time you have been alone caring for the baby. If asked, you tell the nurse that the vomiting began about 12 hours ago in the middle of the night after a nighttime bottle.  Your daughter has vomited twice, once in the middle of the night and the second time after drinking juice around 7 am. The last meal with solid food was dinner.  You cannot find a thermometer to take her temperature, but her skin feels warm.
• Nurse: After listening to Mr. Smith explain the situation, your first goal is to calm him down. You can then gather more information to learn about the baby’s symptoms. During the call, ask the father to hold while you try to reach the doctor on call. You are not able to reach her, so you err on the side of caution and instruct the father to bring the patient in. You would like to transfer him to the scheduling desk, but since you are on a videoconference, he will need to call in.

After completing the two role plays, respond to each of the following questions:

1. What are your overall perceptions of the value and benefits of telehealth in these two scenarios?
2. What technology problems did you experience during the telehealth visits, if any? How did you resolve them?
3. What observations did you make about the differences between interacting with patients virtually compared to an in-person visit?
4. What challenges, if any, did you encounter when building an interpersonal connection with the patient?
5. What challenges, if any, did you experience that may have been easier to resolve in a face-to-face clinical setting?
6. What types of training would be useful for the nurses in these scenarios? For the patients?

Reflect on your collaborative learning process:

1. Briefly describe your collaborative process:
2. Briefly describe the role of each team member.
3. Did all team members participate equally to the assignment? Why or why not?
4. Was this an effective learning experience? Why or why not?