TeleICU Continues to Evolve

Jun 05, 2018

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At the bedside, when teleICU came to my unit I was very skeptical. But after seeing for myself what those extra nurses brought to the table … it turned out to be the best tool to care for our patients.

Lisa-Mae Williams

Lisa-Mae Williams is a nurse leader at the forefront of teleICU practice and a member of the task force that crafted the recently published “AACN TeleICU Nursing Practice: An Expert Consensus Statement Supporting High Acuity, Progressive and Critical Care.” It offers a fresh perspective on this evolving area of healthcare and updates AACN’s benchmark teleICU nursing guidelines first published in 2013. Williams’ career has evolved with the subspecialty — from bedside to teleICU nurse to nurse leader — and she brings a front-line perspective to the statement’s real-life scenarios, recommendations and practice model framework.

Where do you work?

I’m operations director of telehealth and eICU at Baptist Health South Florida in Miami. I’ve been a nurse for 16 years, with 10 of those in telemedicine.

Why did you decide to become a nurse?

I don’t think I had a choice. Growing up in Jamaica, I was always the 4-year-old taking care of all the other children in nursery school. I think I was born to be a nurse. I’ve never wanted to do anything else. I’ve geared my entire life around healthcare, so it wasn’t a decision. It was more this is what I am, so this is what I’m doing.

What was your most meaningful nursing experience?

It was as a critical care nurse several years ago in the surgical ICU. A gentleman was nervous about having open-heart surgery. I had never prepped a patient before. I talked to him that first day, then picked up in the morning and even went with him to the OR. It was unusual for me to actually see a patient prior to open-heart surgery. His family was there and I told them, “I’m going to be here. We have a plan. We talked about everything.” The surgery went over by several hours. They had trouble restarting his heart. The family was there, and everybody was very nervous and anxious, so I waited. The gentleman was a thin man, and he came out very swollen, at least three times his weight. I didn’t recognize him. And I kept thinking to myself, how am I going to let the family see him like this? We weren’t able to save him, but the part that really impacted me was how to bring dignity to him in that state, that he didn’t look like himself and then bringing the family in to see him. That was the most difficult experience but also rewarding because the family was so thankful.

You’re defending your doctoral dissertation soon, right?

Yes! I actually defend in the next couple of weeks. [laughs] Now, I’m telling you, I’d better do well! I’m so excited to finally be almost done. Yay! I actually used the original AACN teleICU guidelines and model of success as the framework for my study. [NOTE: Williams successfully defended her doctoral dissertation, “TeleICU Nursing Practice to Prevent Failure to Rescue of Patients in Critical Care With a Diagnosed Hospital-Acquired Condition,” earning a PhD from the Medical University of South Carolina.]

What attracted you to teleICU?

The ability to impact patient care with the available technology. In the ICU and at the bedside, you’re running around, in procedures, dealing with family members. In the teleICU I’m able to step back and survey the situation. I have time to assess trends and provide a synopsis of what’s going on to my bedside counterparts. I like that investigative type of nursing — putting the picture together to relay pertinent information in real time.

How did you prepare for this newer form of practice?

When I began 10 years ago, there wasn’t much out there to prepare you for working in teleICU. There was nothing in the literature, no certification. Folks didn’t understand how a teleICU nurse practiced nursing. It’s been an emerging subspecialty of critical care for the past few years, but now it’s evolving. Today, there’s an opportunity to learn about teleICU and prepare for working in that environment. Certification also plays into the teleICU setting, because those nurses tend to be the most experienced resources of specialty knowledge for their bedside counterparts.

In your 10 years serving in teleICU practice, what has changed?

I have seen a lot change over the years but mostly in the level of understanding what teleICU is all about, and what it can contribute to the patient care environment. There’s still a lot of education needed. The biggest change I’ve seen among teleICU nurses is moving from that reactive “needing permission” mindset to becoming a more proactive part of the team, seeking to prevent clinical compromise or decline and trying to catch things earlier. [Bedside nurses] have become more accepting of their [teleICU nurses’] interventions and recommendations. The trend I’m most pleased with is the teleICU’s impact on patient outcomes, mortality, length of stay and compliance to best practices. Also, in many teleICU settings there’s a central hub, bringing different hospital critical care units together under one umbrella for a standardized approach to care. That’s what I see as people and institutions grow more comfortable with the technology.

What was your role in crafting the AACN teleICU nursing consensus statement?

I worked with the task force on writing the exemplars that accompany the consensus statement. We looked for exemplars that really showed how expanded the role of teleICU has become and scenarios where teleICU nurses are collaborating beyond the ICU — in transport, helping with telestroke patients or other types of health services. We looked at how teleICU nurses participate in disaster management, so there’s a hurricane exemplar. The whole idea was to show that the scope of practice really had moved beyond what we first thought and outlined in the original AACN guidelines.

How will the teleICU nursing consensus statement advance telemedicine?

It shows that AACN is invested in teleICU nursing. They not only took the lead by defining the first teleICU nursing practice guidelines but now have come back, revisiting it years later to ensure that it’s still in line with what we are practicing, and updated it to reflect what’s current. This is such a relatively new extended specialty within critical care, but the most exciting part is showing the value teleICU brings to critical care nursing and validating it. For teleICU nurses who have difficulty articulating their practice, here are experts who feel that this is important enough to produce a consensus statement that has evolved over time to reflect what teleICUs are actually doing.

What would you tell a nurse who will now have teleICU assistance?

I would tell that nurse it’s nothing to be afraid of; teleICU nurses are their best friend. They are experts in critical care. They are there for their benefit and for the patient, and they’re interested in the best outcome for the patients. They are not there as big brother watching. They are there as an extra set of eyes to surveil vitals and support them as they care for their most vulnerable patients. We’re partners. At the bedside, when teleICU came to my unit I was very skeptical. But after seeing for myself what those extra nurses brought to the table — the available technology and time they had to assess trends and really delve into what’s going on — it turned out to be the best tool to care for our patients.