Sally and Rebecca, I appreciate your thoughtful discussion on PHRs. Sally, I was particularly interested in your questions regarding telehealth in psychiatry and how patient emails should be managed in the case of a potential suicidal crisis (Sally Rothacker-Peyton, personal communication, April 8, 2018). I struggled to find guidance in the literature on how to advise a clinician to manage emails which from potentially suicidal patients as you mentioned. I believe email is similar to voicemail in terms of its efficacy in managing emergent issues. However, unlike with a voicemail message, email does not allow you to provide instructions for an emergency or give a timeline for response up front. While it is possible, to have an automatic reply to …show more content…
emails with that information, there is less certainty that a patient will receive it than with voicemail. I believe that the voicemails of all my medical providers includes initial instructions to call 911 if this is an emergency. It is fairly standard, however, there is some controversy as to whether this is appropriate for patients seeking psychiatric treatment and if psychiatric providers should be available to their patients 24/7 for potential suicidal crises (Simon, 2008).
Personally, the idea that a provider must be available to all of their patients on a 24/7 basis is unrealistic. However, a backup call schedule, safety planning and emergency response planning should be considered in all practices. Shore, Hilty, & Yellowlees recommends detailed, individualized safety plans for those patients with chronic safety concerns which are developed and reviewed with the patient (2007). Guidelines for use of email with patients include: (1) not using email for urgent matters; (2) patient instructions for how email is used in the practice; (3) standard turnaround time for messages; (4) automatic reply for acknowledgement of email receipt; and (5) saving all emails to and from patients in their record, either through printing and placing or record or automatic storage in the EMR (Kane & Sands, 1998). By combining recommendations of literature reviewed in how to manage psychiatric emergencies such as suicidal crisis including the use of email through PHRs, such as MyChart, up front patient education with clear delineation of how to utilize the functionality of MyChart as well as safety planning are key. Documentation of that education along with that of the safety planning will be
very important. PHRs and the ability to electronically will obviously change how we work and communicate with our patients. Some patients and providers will be more or less comfortable with the advent of telepsychiatry, but with clear communication of and safety planning it has the potential to increase access to high quality specialty care (Adams et al., 2018).
Telemedicine can also include the use of e-mail, smart phones, wireless tools, and other forms of telecommunications technologies (Wager, Lee, & Glaser, 2013, p. 156.)
Rothwell, E., Ellington, L., Planalp, S., & Crouch, B. (2011, August 25). Exploring challenges to telehealth communication by specialist in poison information. Qualitative Health Research, 22(1), 67-75. doi:10.1177/1049732311420446
Friedman, L. N., Halpern, N. A. & Fackler, J.C. (2007). Implementing an Electronic Medical Record. Critical Care Clinics 23: 347-381.
One new way in which technology has been used to extend the services of the counseling field is through online counseling. According to Corey (2011), online counseling can be beneficial because some consumers want brief and anonymous therapy, some clients who are unwilling to participate in traditional therapy may be willing to accept help online, it’s easier for persons with physical disabilities, may be easier for clients who experience anxiety, allows for access to clients in rural places, enhances record keeping, expands pool of referrals, increases flexibility in scheduling, increases options for supervision, and enhances collection of research data. Despite that, Corey (2011), also discusses the disadvantages of online counseling which are as follows: high possibility of inaccurate diagnosis/treatment, confidentiality and privacy cannot be guaranteed, therapists’ duty to warn and protect others is hampered, suicidal clients cannot receive immediate help, enables minors to pretend to be adult to access treatment, and it can be difficult to build and maintain a therapeutic alliance.
Telemedicine is a new comer to the field of medicine and it is the treatment of patients by means of telecommunications technology. Telemedicine is carried out in a variety of ways whether it is by smart phone, wireless tools or other forms of telecommunications. Examples of telemedicine include: 1) transmission of medical images 2) care services at the home of the patient 3) Diagnosis at distance 4) education and training of patients. The diversity of practices in what is known as telemedicine raises many questions and one of those questions, which is extremely important, relate to the safety of the practice and the risks involved.
We as nurses rely on technology, but we also have been taught to beware technology from making judgments for our nursing car. We know that technology can be wrong or mess up just like a human; therefore, we must always be knowledgeable and question our practice, to ensure safe nursing. Technology has pros and cons just like the human person does. “Storing clinical data, translating clinical data into information, linking clinical data and domain knowledge, and aggregating clinical data” is a helpful and time saving use of technology (Yoder-Wise, 2015). However, technology sometimes take precious time away; for example, a study found that “nurses spend up to 40% of their workday meeting ever-increasing demands from the systems in which they work” (Yoder-Wise, 2015). Technology also brings up an “ethical dilemma” as to when and how to use “extraordinary means to prolong life for patients with limited or no decision making capabilities” (Yoder-Wise, 2015). When is technology prolonging pain and hindering a peaceful natural death. Other issues like, “safeguarding patient’s welfare, privacy, and confidentiality” have been called into question with use of patient information in the computer systems (Yoder-Wise, 2015). There has to be safety parameter to protect patients according to HIPPA law, for example firewalls (Yoder-Wise, 2015). However, computerized patient information has also been a live saver and time saver because “provider order entry” is more clearly written,
Talseth, A., & Gilje, F. (2011). Nurses' responses to suicide and suicidal patients: a critical interpretive synthesis. Journal of Clinical Nursing, 20 (11-12), 1651-1667. doi:10.1111/j.1365-2702.2010.03490.x
The thought of life coming to an end is a scary thought for anyone, but for someone who is depressed and suicidal it may seem to them as a release of some kind. In reality is suicide going to solve these patient’s problems? The patient may think so, but it will not solve any issues or problems. Suicide is a pertinent solution that no one can return from. My experience with depressed and suicidal people or patients is small. This is why I chose to write about patients who are depressed and suicidal. Even though my experience is small. I want to learn what can be done for these patients, and how I can be a better advocate for them.
In emergency situations, the first step in developing a telepsychiatry service is to assess availability of resources to deal with psychiatric emergencies at the patient sites, including health services (outpatient, inpatient, police, other), and the parties’ expertise in handling such emergency psychiatric situation (Shore, Hilty, & Yellowlees, 2007).
There are extremely large gaps in our entire aspect of understanding the role of communication services in health care delivery. The care of patients is interesting topic that needs to be addressed, it involves different individuals at all aspects of life, all needing to share patient care information and discuss the management perspective. The special services are increasing with interest in, the use of, information and communication technologies to support health services. Yet, while there is significant discussion of, and investment in, information technologies, communication systems receive much less attention and the clinical adoption of even simpler services like email, voice-calls, and any other electronic interactions is still not commonplace in many health services. Laboratory medicine is perhaps even more poorly studied than many other areas, such as the defining what primary care and hospital services are. Given this lack of specific information about laboratory communication services, this paper will help identify the financial structure of our healthcare system, particularly as it relates to health disparities, the uninsured, and functional communication challenges that America has been faced with, analyze the key components of a communication system, including the basic concepts of a communication channel, service, device and interaction mode. The review will then try and summarize some of what is known about specific communication problems that arise across health services in the main, including the community and hospital service delivery, and how it will we be able to improve the quality of care.
Those who are covering for medical professional and keeping a watch over suicidal tendency patient need to be properly educated and should be provided with proper guidelines. Slight neglect on their part can have grave outcomes.
I would not force my client into talking if they aren't ready but discuss when their comfortable whenever they are ready in disclosing. Since I am aware of my background of suicidal and know what could be done to help those with suicidal tendencies I would do everything I can to help my client feel protected and safe. I would ask my client more about them and find out if their situation because I would not want them at risk of harm. Therefore, my awareness and reflection will not influence my work with a client that is suicidal. I will strive to assist helping the client to make sure they are not harming themselves, when did the suicidal thoughts begin, do they have a safety plan created, who they have in their support system, and what they can describe to me they like to do as their interests. All of this would be beneficial to me when assisting the client when finding out that they are suicidal since they are the one at risk of harm. I would try not put my influences of my past assist working with the client. Since I truly believe that each one person that comes in that seeks help deserves a chance turn their life around. Also, I wouldn't want them to feel that their personal experiences of religion and culture will intervene with our relationship when they disclose to me that they feel this
Telehealth nurses use the nursing process to provide care for individual patients or defined patient populations over a telecommunication device” (Stokowski, 2008).
Considerations--Email was designed to enhance communications by making it faster and more to the point. But printing email messages on the company printer defeats this purpose. The "paperless" office is a long way off if too many employees insist on keeping paper files of all the email messages they send or receive.
Communication is one of the most important factors in our lives. It dictates the relationships formed with the individuals in personal and professional lives. Effective communication provides a foundation for trust and respect to grow. It also helps better understand a person and the context of the conversation. Individuals often believe that their communication skills are much better than what they actually are. Communication appears effortless; however, much of what two people discuss gets misunderstood, thus leading to conflicts and distress. To communicate effectively, one must understand the emotion behind the information being said. Knowing how to communicate effectively can improve relationships one has at home, work and in social affairs. Understanding communication skills such as; listening, non-verbal communication and managing stress can help better the relationships one has with others.