Telehomecare Communication and Self-Care in Chronic Conditions: Moving Towards a Shared Understanding

Background—Remote telemonitoring of patients’ vital signs is a rapidly increasing practice. While 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. Methods—The original study utilized the Social Relations Model to examine relationships within 43 triads composed of patients with chronic conditions, home helpers and their nurse (THN) involved in telehomecare at three Veterans Health Administrations. This secondary descriptive and correlational analysis compared 43 patients’ and 9 THNs’ ratings of themselves and each other on communication (frequency, timeliness and understanding) and the use of patients’ daily telemonitored information. Results—There was almost no correlation between patients’ perception of THNs’ communication (frequency [r = .05], timeliness [r = .09] and understandability [r = .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 = .02), (p < .001) respectively. Conclusions—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. After patients experience an acute exacerbation of a chronic health condition, they frequently receive transitional care from home health nurses. Increasingly, home health agencies are using technology to facilitate communication between nurses and patients. Communication is the basis of a partnership based on teaching and information transfer. Nurses provide knowledge to patients and their families on how to manage living with a chronic condition, and detect signs and symptoms of an exacerbation. Patients, in turn, Copyright © 2012, Sigma Theta Tau International Address correspondence to Dr. Kimberly Shea, 1305 N. Martin Ave., Tucson, AZ 85721; kimberly.shea@asu.edu. NIH Public Access Author Manuscript Worldviews Evid Based Nurs. Author manuscript; available in PMC 2013 April 01. Published in final edited form as: Worldviews Evid Based Nurs. 2012 April ; 9(2): 109–116. doi:10.1111/j.1741-6787.2012. 00242.x. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript discuss challenges they encounter with managing their disease. Technology-based communication transfers information between patients and nurses so that knowledge can be integrated into self-care behaviors in the home environment. Understanding associations between communication and information integration into daily lifestyles is vital to successful management of chronic conditions at home. The Sociotechnical Theory predicts that optimal outcomes result when there is a balance between social and technical characteristics in a system that provides services (Pasmore, Francis & Haldeman 1982). Patients will be more involved in self-management when they accept and can easily use technology for health efforts (Or, Karsch, Severtson, et al. 2011). The purpose of this paper is to examine the relationship between communication (frequency, timeliness, and understandability) and information integration into the daily lives of patients with chronic illnesses and offer caveats and recommendations for eliminating misperceptions and strengthening the shared understanding between nurses and patients when technology mediates interactions. Examining processes used in communication is crucial to creating stronger partnerships between healthcare providers, patients, and their family members in an effort to better self-manage chronic illnesses. Background Communication and Home Health Care Communication is an interpersonal interaction that involves sending and receiving information in an effort to create a shared understanding between communicators. Communication requires that the sender select a mode of information delivery (e.g., face-toface, digital technology or telephony). The mode that is chosen is a primary factor in deciding the content medium (e.g., audio, graphics or text). Sometimes more than one mode of delivery is needed (i.e., redundancy) to assure that the message is correctly understood. In today’s communication-intensive environment, health information may be delivered in person or via telephone, books, or the Internet. A shared understanding among nurses, chronically ill patients and family members is that self-care behaviors can minimize life-altering exacerbations (Bodenheimer, Lorig, Holman & Grumbach 2002). Home health nurses work diligently toward the goal of having patients integrate this shared understanding into their daily lives. However, creating a shared understanding can be challenging. In the home healthcare situation, patients and nurses take on the communication roles of both sender and receiver throughout the interaction. Each must consider the perspective of the other if the message is to be conveyed accurately. The sender may have a different perception of the communication’s intent than the receiver understands. Experiences, desires and beliefs unique to each nurse or patient shape how information is sent and received. (Koppelman-White 2009) Information Integration and Self-Care Behaviors Information consists of raw data that are processed using the receiver’s knowledge (McGonicle & Mastrian 2009) Patients engaged in telemonitoring first gather relevant data by monitoring their own body’s signs and symptoms of disease. The data is processed by the patient using their knowledge that is derived from learning and experience. Once the patient has the information, they can choose to apply, note or ignore the implications for their health behaviors. Application of information for self-care behaviors requires patients to collect data, use knowledge and then act accordingly. (McGonicle & Mastrian 2009) Nurses can and should be sources of knowledge on the nature of the chronic disease as well as how to interpret the related signs and symptoms. Self-care behaviors are actions (or intentional lack of action) that result when the information is applied to the patient’s Shea and Chamoff Page 2 Worldviews Evid Based Nurs. Author manuscript; available in PMC 2013 April 01. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript environment (Henry, 1997). For example, patients with diabetes learn to measure their own blood sugars and adapt their diet to prevent severe hyperor hypoglycemic complications. The process of integrating information into behaviors is complex, yet with frequent practice, the process happens quickly and can become part of a daily lifestyle.