Telehomecare communication and self-care in chronic conditions: moving toward a shared understanding

Remote telemonitoring of patients' vital signs is a rapidly increasing practice. Although methods of communication in remote electronic monitoring differ from those in traditional home health care, the understanding shared by the nurse, patient, and family members remains the same: patients' self-care behaviors affect exacerbations of chronic health conditions. The purpose of this paper is to examine the relationship between communication and information integration into the daily lives of patients with chronic illnesses and offer best practice recommendations for telehomecare nurses (THN).

The original study used the Social Relations Model to examine relationships within 43 triads composed of patients with chronic conditions, home helpers, and their nurse involved in telehomecare at three Veterans Health Administration sites. This secondary descriptive and correlational analysis compared 43 patients' and nine THNs' ratings of themselves and each other on communication (frequency, timeliness, and understanding) and the use of patients' daily telemonitored information.

There was almost no correlation between patients' perception of THNs' communication (frequency [r=0.05], timeliness [r=0.09], and understandability [r=0.03]) and patients' integration of information into daily health practices. However, significant correlations were found between the THNs' perception of patients' communication frequency and timeliness, and integration, (p=0.02; p<0.001) respectively.

This study suggests that frequent phone communication may lead the remote THN to believe patients are integrating blood pressure, weight, and other information into daily self-care behaviors, when in fact the patient reports that they are not. The influence of a halo effect on the THN may cloud an accurate perception of what is actually occurring. Remote communication may require more attention to THNs educating patients about shared understandings when using telemonitoring. Best practices for THN should include explicit goals and intentions for telemonitored home care with individualized instructions about how to use the information for self-care.