By Michelle Clarke
As telehealth becomes increasingly more common in healthcare, the need to train providers in this technology and care delivery is also rising. So how can nursing school educators train their APRN students about telehealth in an effective way?
Last November, the University of Texas at Austin did just that. It introduced a new project to the School of Nursing’s Simulation & Skills Center—RoboAPRN: Telepresence Robots in Healthcare Education.
RoboAPRN is a robot with a screen for the head, a long pole for a body, and it sits on wheels. The robot is moved around, or "driven" via computer or app by nurse practitioner students. Nurses can control the robot from any location, and navigate the robot around the hospital to see patients. This allows nurses to address patients' needs without being physically present in the same room.
The goal of using the robot is twofold: to familiarize students with telehealth and to improve patient access to mental healthcare, especially for patients who live in remote areas and may not have access to a mental healthcare provider.
Achieving this goal is particularly important for states such as Texas where there is a significant shortage of mental health professionals. According to the Hogg Foundation’s Mental Health Guide: Understanding Systems and Services in Texas, 206 out of 254 counties in Texas were designated as full or partial mental health professional shortage areas. Of those 206 counties, 185 counties did not have a single psychiatrist or mental health provider in the area.
Providing better patient access through telehealth services could help with this issue.
"In a rural state like this, where there is such a lack of mental health providers, I think we have to be innovative and creative and figure out what we can do without being face-to-face,” says Donna Rolin, PhD, APRN, PMHCNS-BC, PMHNP-BC, director of the psychiatric nurse practitioner program at UT Austin.
The project trains both undergraduate nursing students and psychiatric nurse practitioner students on the use of telehealth with a strong emphasis on mental health services.
“Once our NP graduates become licensed, many of them are hired into telehealth positions and this [program] helps train them before they are out in the real world,” explains Rolin.
Introducing new technology
Rolin's department received nearly $10,000 in grant money for the project. The UT Austin team, including Valerie Danesh, PhD, RN, CCRP, assistant professor; Scott Hudson, director of simulation and skills labs; and Sean White, instructional technology specialist, researched robots to figure out which one to use while Rolin tweaked the existing curriculum to include telehealth content and determine which simulation to use for the pilot.
Rolin chose the substance abuse disorder and detox assessment and treatment, with the alcohol detox simulation as the starting point using the robot.
The testing period of the technology itself was relatively brief; it took the staff and student testers less than a week to feel comfortable with the RoboAPRN before they used it into the simulation lab. As part of the pilot, Rolin test drove the robot remotely via her computer and iPhone app both from her home office and a different building on campus.
How It Works
The RoboAPRN allows the patient to see and communicate with the nurse who appears on the robot's screen, creating an environment as though the nurse and patient were in the same room.
The NP psychiatric students act as on-call remote providers for a simulated hospital with the UT Austin Simulations Lab. They must respond to a nurse role-playing as a patient going through detox, handle undergraduate RN-level students calling them for orders, as well as respond and direct other issues that might arise from patients undergoing alcohol detox.
In this simulation, the robot is the facilitator of communication between the NP psych students, the undergraduate students, as well as the “patients” in the simulation lab.
During the simulation, the psych NP students drive the RoboAPRN into the examination room. Via live video conferencing through the robot's screen, the NPs interact with the patient. The nurses can see what the patient is experiencing, speak with him or her to complete the assessment, and make healthcare decisions as if they were in the same room with the patient.
The students used the robot three times a month for a six-and-a-half-month period, and were required to provide qualitative feedback to the team throughout the semester. This enabled them to make immediate adjustments to the simulation when necessary.
The undergraduate RN-level student response has been positive with 27 of 36 students saying there has been strong value in adding telehealth to the simulation, Rolin says.
The psych NP students were required to provide qualitative reflections and said they felt more confident because of the hands-on training they received in the simulation lab before graduation, Rolin says.
The team at UT Austin is exploring a variety of other possible uses for RoboAPRN. There is consideration to bring other disciplines in remotely, but those are still in the early stages, Rolin says.
“We’re thinking about using the robot in a more physical assessment context as well, but we’re not sure how soon it’s going to happen,” Rolin says. “We’re going to try different things to see what works best.”