HLST259 Mental Health Nursing

Introduction

Tele-rehabilitation is the process of giving rehabilitation services to patients through communication and information technologies (Jackson et al. 2012, p.1088). In the clinical field the term tele-rehabilitation comprises of many variety of rehabilitation services that include intervention, monitoring, assessment, education, supervision, counselling and consultation (Laver et al. 2013). The tele-rehabilitation services are usually done to children and adults who have acquired injuries, developmental disorders or delays, and diseases by a wide range of healthcare practitioners in the healthcare field (Piqueras et al. 2013, pp.392-396). The professionals consists of the following  of but are not limited to speech language pathologist, physical therapist, rehabilitation physicians, nurses, occupational therapist, rehabilitation engineers, audiologists, assistive technologists, dieticians, psychologists, and teachers.  The tele-rehabilitation has power to delivers rehabilitation services across all the medical or healthcare areas and across all the lifespan. Tele-rehabilitation has a brad and wide range of professionals, similarly, it has many types of services it can offer to all people despite their ages (Koh et al. 2015, p. 151). 

The services of tele-rehabilitation falls under two class according to Cook et al. (2013) and Ambrosino et a. (2016) which include the clinical therapy and clinical assessment which asses the ability of the patient to function in his or her own ecosystem (pp.1038-1047). Tele-rehabilitation can provide rehabilitation services to patients who cannot go to the centres due to factors like physical or mental disability, or because the time of travel is long and to patients who have been already discharged from the hospitals. The discipline of tele-rehabilitation services is rare and not many scholars have done research about it (Ambrosino et al. 2016). There are two important areas to note in tele-rehabilitation which include coming up with the system which has new data that can help the professional deliver rehabilitation services online (Avila et al. 2014, pp. 1-5). Second, giving rehabilitation services which are in line with the code of conducts of rehabilitation field (Avila et al. 2014, pp. 1-5).

Implementation of Tele-Rehabilitation for Patients after being discharged from Hospital

The technological innovations in the healthcare field have allowed the medical practitioners to come up with new ways of administering health services to patients both at home and in the hospital (van den Berg et al. 2016, pp.1885-1892. The discharged patients can also get medical attention and rehabilitation services through new technologies. The tele-rehabilitation services are one of the many healthcare technological innovations. As Siemonsma et al. (2014) reported, many patients who were placed in the intensive care units due to the chronic diseases, disorders, or fatal accidents recover and go home (pp.2019-2030).

However, these patients do not recover completely, they always require rehabilitation to enable them pass the emotional stress of what they suffered. Some of the patients may not be able to go back for rehabilitation in the hospital facility because of reasons like insufficient money and time (Kairy et al. 2016, pp.201-206). Therefore, tele-rehabilitation can come to the aid of these kinds of patients. In the hospital I am working as an occupational therapist we use tele-rehabilitation platform which comprise fine-grained and mature services which support the online/real-time and off the internet connections between the hospital healthcare workers and the patient.  When there is an online or real-time interaction, a large hall is used where a group of up to ten patients are rehabilitated with one medical professional that is either me or my colleagues. For those that are online a high definition webcam is used to connect the healthcare worker and the patient. The offline platform is where one of the medical professional records a rehabilitation processes with a camera and the hospital posts the information in the internet either YouTube or Facebook for patients to view later especially those who missed the online session (Artz et al. 2015, p. 15). 

Tele-rehabilitation service can be implemented by many healthcare workers in the hospital are at home (Gregersen et al. 2016, p. 809). Personally I administer tele-rehabilitation services at my house through my YouTube channel. For example, when I am showing my patient who needs rehabilitation to walk properly, I record the details of what the patients need to do by showing example using my assistant show all the steps to be followed and then post the recording in my YouTube channel where my patients will get and watch the video. At the hospital in my work place, the exercise is done online where the practitioners show the patients what they need to do in the live feeds. The advantage of using live tele-rehabilitation, there is immediate feedback from the patient. In other words patients and the medical professional interact in real-time.

The tele-rehabilitation service can be implemented through many channels for example, blogs and websites (Agostini et al. 2015, pp.202-213; Gregersen et al. 2016, p. 809). I use blog to write to my patients on what they need to do to overcome certain problem. My hospital also has an official website where they post any information that can help patients recover from emotional and physical stress; the data also help in the rehabilitation process. The gadgets that can be used to implement the tele-rehabilitation services include the smartphones, tablets, laptops and desktops and using the internet connection (Bernocchi et al. 2016, pp.106-115). Artz et al. (2015, p. 15) suggest that the new technological advancements have improved the healthcare services.

Roles of some of the Tele-rehabilitation Staff

Implementation of the tele-rehabilitation programs for patients require work force from different levels in the healthcare which include the medical professionals, information technology personnel, and the marketing department (Bernocchi et al. 2016, pp.106-115). The marketing department advertises the services offered by the tele-rehabilitation facility to the discharged patients and give them links on how to join the program. In term of medical services there is the doctor, nurse, ergophysiologist, physiotherapist, and psychologist (Jin et al. 2015, p. 61; Vloothuis et al. 2015, p. 193; Kairy et al. 2016, pp.201-206).

The doctor has numerous roles in tele-rehabilitation which include one, preserving the patients’ medical records and hi/her history (Kairy et al. 2016, pp.201-206). Second, the doctor is also responsible for performing the clinical evaluation of the patient after and before the tele-rehabilitation services. The doctor is also obligated to prescribe the medicine the patient will use during rehabilitation program. Third, evaluation and assessment of the capacity and which the patient can exercise and prescribe the tele-rehabilitation program and exercise each patient can do in a day until they recover.  Fourth, the doctor educates the patients on what to do during rehabilitating and managing any emerging emergencies in the hospital. Fifth, communicate with the patients frequently through phone to monitor how the patient is doing and lastly the doctor is the one to recommend if the patient need rehabilitation program or if the patient has recorded. 

Nurses have also important roles in the tele-rehabilitation centre which include one, , preserving the patients’ medical records and hi/her history and providing patients with education about the disease or disorder they are suffering from (Morales-Vidal & Ruland 2013, pp. 101-107; Miller et al. 2014, pp. 1-5). Second, the nurse do follow up and contact patients either through telephones or any other means of communication to see and assess how the patients are reacting to medication and solve any problem about the tele-rehabilitation that may arise. Similar to doctors, nurses also have the obligation to attend to emergencies. Third, nurses ensure that the patients are qualified for the tele-rehabilitation program by checking all necessary forms provided by the service users. Fourth, the nurses are in charge of the technological fitness equipment. They monitor the equipment to make sure that they are functional and record any arising problem. Lastly, the nurses conduct and take anthropometric measurements after the rehabilitation program is over and before the program starts.

Ergophysiologists are important in that they evaluate and do assessment of the physical ability of the patient to determine if they are qualified for tele-rehabilitation (Sarfo et al. 2017, p. 203; Kizony et al. 2013; Miller et al. 2014, p. 1; Adinolfi et al 2016, p. 40). The ergophysiologists also prescribe the quantity of exercise the patient will undergo and also educate the patients on how to go about the prescribed training program. Lastly, the ergophysiologists monitor how the patients are training and record and recommend the next step for the patients. The psychologist in tele-rehabilitation service gives the patient psychological support and advice. They also recommend if the patient can enrol in rehabilitation program. The psychologists also assess and evaluate the psychological behaviour of the patient and prescribe drugs for him or her.

The psychotherapist synchronises the therapy programs the patients are undergoing and maintain the medical records of the patients (Chen, Xiao & De Bellis 2016, p. 74). The psychotherapist reads the patients’ medical report and selects appropriate therapy for them and then adds the therapy exercises in his YouTube account or that of the hospital. The psychotherapist also has the obligation of evaluating and analysing the electrocardiogram (ECG) and give report after consulting the doctor. The psychotherapist gives psychotherapy advice to the patients through phone calls or any other communication mediums. The psychotherapist also monitors how the patients are conducting their rehabilitation online and provide recommendations on where to improve the exercise. The medical records of patients are confidential therefore, the other role of psychotherapist is to keep the records safe and away from public eye.

There is another category of staff in the tele-rehabilitation centre that must be there for the successful implementation of the rehabilitation programs of the discharged patients (Chen, Xiao & De Bellis 2016, p. 77; Dalal, Doherty & Taylor 2015). The employees are the information technology personnel. The information technology workers must be there to ensure the digital part of tele-rehabilitation is running smoothly. The information technology personnel’s role is to maintain the digital system of the hospital which includes the website, the YouTube accounts and the blogs of the facility. The digital systems are the ones to ensure that tele-rehabilitation program that has been recorded reach the intended patients. The equipment at the hospital I am working at is technological in nature and need the information technology personnel to monitor and maintain them to prevent malfunction. 

Evidence for and against Tele-Rehabilitation and Determining Best Practice in Rehabilitation Services

Evidence for Tele-Rehabilitation

A good number of researches have shown that tele-rehabilitation has proven to be a success in many healthcare fields. The evidences have been seen in the field of cardiology where success was seen when cardiac tele-rehabilitation of discharged patient was completely healed in one of the Saudi Arabian Hospital (Zanaboni et al. 2016, p. 126).  The patient’s cardiac risk factors were reduced and the patient shown tremendous improvement without visiting the hospital. Another study by (Dobkin & Dorsch 2013, p. 331; Stylianides et al. 2013) shows that the doctors who used tele-rehabilitation method to treat discharged fellows in Saudi Arabia who were suffering from chronic pain were successful. The study shows that the use of tele-rehabilitation on the patient had a prolonged impact on the labour capability which is essential for an individual suffering from problems which are complex and pronging.  Ivanova et al. (2015) did their research on another patient and the results were the same. However, studies should be done to determine if at all the method is effective and reliable.

Table 1: The study for tele-rehabilitation program on chronic pain (Ivanova et al. 2015)

Another study done on discharged patient who suffered a fatal accident and have mobility problem was also successful (Veras et al. 2016, p. 79). The study gives evidence that TRH methods provide equal results as FTF and can be comfortably used in delivery services.  The table below shows the results of TRH on discharged patient who had mobility problems.

Table 2: The study for THR for mobility (Veras et al. 2016, p. 79)

 The other evidence was concerned with joint management. The study shows that patients who suffered joint complications at a certain health facility in Saudi Arabia were rehabilitated through THR and the outcome was astonishing (Fazio et al. 2016).  The service was done through the phone and was proven better and cost effective than FTF and UC by the Saudi Arabia health department (Hoda et al. 2014). The table below shows the orthopedic TRH service of discharged patients. 

Table 3: The table shows tele-rehabilitation in orthopaedic rehabilitation program (Fazio et al. 2016; Hoda et al. 2014)

Evidence against Tele-Rehabilitation

TRH is a cost-effective service and has been proven to be a success in many medical fields. However, there are some evidences that the practice is not that effective compared to one on one treatment of patient. Marzano, Lubkina and Rizakova (2015) argue that some patients may ignore the prescription given by the doctors online and take the medicine wrongly (Vol. 4, pp. 457-467). They say that most patients prefer to be treated and rehabilitated by doctors on sight.   Some of the fake doctors can take advantage of the online platform which is not monitored by the government of Saudi Arabia to mislead patients. Howard-Wilsher et al. (2016, p. 11) have concluded that some of the evidences supporting the TRH practice are not yet complete. The scholar says that the cost-effectiveness of the program is somehow costly.

Determining Best Practice in Rehabilitation Services

Rehabilitation services should be done in the best practices therein. There are some of the criteria to be followed to determine the best practice for tele-rehabilitation. The first determination is the qualification of the professional performing the practice. If I can reflect on my profession, a person must be qualified and registered with the department of health of government of Saudi Arabia for him/she to conduct rehabilitation activities. Unqualified persons cannot provide the best rehabilitation services. The second determinant is the equipment used for rehabilitation. They must be certified equipment and recognised by the government of Saudi Arabia. Gao et al. (2015) reported that the facility providing both tele-rehabilitation and normal rehabilitation must be registered to produce such services (pp.95-102).

The role of a leader and how to manage/lead change in the clinical setting

The role of a leader in clinical setting

Leaders are important figure in the clinical setting and they are the overseers of every activity taking place in the clinics. Many scholars have done studies and the results are that leadership is a vital body in any institutional setting. Ivanova et al. (2015) reported that leaders who are hardworking, disciplined and highly motivational are responsible from changing organizations from good to excellent. According to Gao et al. (2015, p.95) such great leaders in an organisation help in employing staff who are also capable of changing the firms.

The leaders come up with great developmental strategies which see the success of the organisation to the next level. Artz et al. (2015, p. 15) did study on the roles of the healthcare leaders and come up with some great results. In the study Artz et al state that healthcare facilities also see the leadership as important factor. Ivanova et al. (2015) also did some studies about healthcare leaders and suggested that successful leaders in medical field have the passion to improve the quality of health services, and work tirelessly to ensure that the healthcare facilities they are running are up to speed with current trends and technology. Howard-Wilsher et al. (2016, p. 11) argues that leadership in healthcare is responsible for setting the objectives of the firms, creating and executing action plans and strategies and coming up with rooms for change in the facilities. Artz et al. (2015, p. 15) and Ivanova et al. (2015) argue that leaders in the healthcare setting ensure that the safety of patients is protected by making the healthcare environment safe for them.

In tele-rehabilitation centres, the services of leaders are highly required in that they are responsible for checking if every activity is moving as planned (Mayo 2016). Leaders in TRH are responsible for recruiting new qualified staffs and help improve the production of TRH services. Another role of leaders in the clinics is to supervise every activity in the organisation. Leaders also keep the patients records safe and away from public eye.  Another role of leaders in healthcare is integrating care laterally with various disciplines. In healthcare there are many departments which need each other so that it can be easy to provide quality healthcare services to the patients (Oatis et al. 2014). A leader’s role in this scenario is to coordinate the two different departments who need each other to work together for example psychologist and psychotherapist. Leaders also solve problems whenever they arise in healthcare that is between the employees and patients or among the employees, or even among the patients. The last and important role of a leader in the clinical setting is to protect his/her employees and patients from external harm.

How to lead change in the clinical setting

Tousignant et al. (2014) states that leaders must use the leadership models also known as leadership theory to bring change in organisations. The model developed by James Scouller has three designs which strengthen the weakness of other leadership theories (Tousignant et al. 2014). It has three Ps that is Public, Private and Personal leadership (Dalal, Doherty & Taylor 2015).

The image shows the leadership model (Tousignant et al. 2014)

(Bernocchi et al. 2016, pp.106-115) said in their report that in the coming years healthcare practitioners will be forced to change how they conduct their activities due to many factors like new deceases and technology. Adinolfi et al. (2016, p. 40) suggest that most of the hospitals in the future with be fighting to survive therefore, they will be forced to look for change agents who can adapt to change quickly. The following ways are show how leaders can lead change in any healthcare facility including tele-rehabilitation.

First, a leader must show an example and he/she is ready to accept change in the organisation. Lange et al. (2012) reported that when the workers see their leader doing something then they will be force to follow the leader (pp.1863-1870).  The leader should lead by example so that he/she get education in new communication strategies and skills so that he/she can share the knowledge with the employees. Secondly, a leader should share with any person who is ready to change so that they draft ways in which they can influence the other groups. Zanaboni et al. (2016, p. 126) suggested that it is vital to include every key member of the organisation who is touched and inspired with the new idea. Lange et al. (2012) also say that these people will help you come up with other different ways of implementing the change. For example in the case of tele-rehabilitation, this is healthcare change that not only one person thought of and implemented. A lot of people were involved in ensuring that the change was successful. The people included almost all medical professionals, the government of Saudi Arabia, and the information technology professionals to design and maintain the websites.

Another way to lead change in clinical setting according to Tousignant et al. (2014) is to adopting the healthcare programs that other hospitals and used and proven that the programs are healthy and working (p. 31). Leaders can do this by taking a tour to developed hospitals that theirs and conduct a study on how the hospitals are implementing the new change. The leaders can then come back of their facilities and discus with every stakeholder to get their response on the change (Kizony et al. 2013). Change is inevitable and the world is developing fast thus leaders should also adapt to the transformations and train their staffs to learn to change.

The leadership in my hospital loves changes that improve the healthcare services. My leaders always love new inventions that can increase the production of our hospital. According to Zanaboni et al. (2016, p. 126) leaders should always have supplementary budget in the hospital which can be used to fund any idea which can bring positive change in the organisation. Mayo (2016) says that leaders should always leave their doors open for any employee who has an innovation that can change lives.

Change Management Process in Tele-Rehabilitation

My greatest role as a leader in the tele-rehabilitation is to manage the changes that come up in the sector because the service is technological oriented and technology change every day. Hoda, Dong and El Saddik (2014) stated that leaders in the healthcare services should use the SWOT analysis to evaluate and manage change in the organisations.  The below SWOT analysis for my work place was conducted based on the self-evaluation report on for year 2017.

Strengths

There are action plans in place to improve the services of the firm. The tele-rehabilitation has fewer competitors thus, it has many customers. The services offered are affordable therefore, the Saudi Arabia citizen prefer the tele-rehab. The organisation has some link with other health departments including Nursing, Pharmacy, and Applied Medical Sciences.

Weaknesses

The organisation has not established patient safety regulations. The academic level of the staff is not up to standard. There is communication challenge between the staff in the firm.  The firm has financial problem to run the IT systems.

Opportunities

The commission formed by the government of Saudi Arabia to help the health sectors in research will increase the research knowledge of the firm. Technological innovations in health sector occurring in Saudi Arabia. Lastly, the community around the firm and government support the program.

Threats

The competition from the government rehab centres. Poor academic qualifications of the staffs. The tele-rehabilitation training programs are limited. Lastly, there are fewer professionals in the field of tele-rehabilitation centres.

Wang, Blazer and Hoenig 2016 state that Kurt Lewin’ model explain how change can be managed in an organisation. The processes in Kurt Lewin’ model are unfreeze, change and refreeze (pp.1403-1406). The figure below shows Kurt Lewin’ model change management model.

(Wang, Blazer and Hoenig 2016, pp.1403-1406)

According to Adinolfi et al. (2016, p. 40)change is never a choice of choosing between the welfare of human being and the technology but to combine all of them together and study how they can co-exist. Chen, Xiao & De Bellis (2016, p. 77) suggested that change is about abandoning the old practices and employing the new practices to better the welfare of humans. But (Fazio et al. 2016) disagree and say that a person cannot abandon the old ways rather, the old ways should be improved. For example, tete-rehabilitation was a new way of treating patients away from the hospitals but, we cannot abandon rehabilitation facilities because of TRH (Fazio et al. 2016). Implementing change in an organisation especially in tele-rehabilitation centres is very hard because the ideal must pass through many agencies for authentication therefore, manages should not the people who give up easily. They should always fight to ensure that the change has been implemented. Furthermore, the managers should always supervise the change to see if the employees are catching up well (Miller et al. 2014, p. 3).

(Fazio et al. 2016; Hoda et al. 2014) agree that leaders should give a clear vision on how the change process will take place because the vision show if the change will transform the organisation. According to Chen, Xiao & De Bellis (2016, p. 77) managers should always monitor the change process and measure it results to see whether it has brought the transformation that was intended for it. Hoda et al. (2014) suggested that since change will not stop happening, the managers in charge of change process should develop strategies to counter any problems that may result due to change. 

As the manager of change in my firm I have contingency plans can help me if the change we have implemented fails. Globally there are changes that have been happening and have brought a lot of problems to healthcare institutions therefore, the healthcare firms should be ready for any change and counter it appropriately so that they can improve their productions. Solutions are needed to help healthcare organisations to survive the problems brought and changes that are happening continuously every day. Therefore, as the change manager my role is to upgrade my training and skills which can help me come up with solutions. Thus I have strategies to enrol my employees to get current raining on change adaption and management. It the changes upgrade the quality of healthcare services and help in generating more money for the firms, it is highly welcomed (Sarfo et al. 2017, p. 204). However the change is bringing catastrophe to the firms the managers should be ready to bring solutions (Kizony et al. 2013).

Action Plan to be used in Tele-rehabilitation in Rehabilitation Services

Any tele-rehabilitation centres should create their action plans on how they are going to operate the system. Tele-rehabilitation is a new invention that needs good advertising so that people can know that it exists (Kizony et al. 2013). Thus the first action plan after invention of the tele-rehab is to advertise the service through a known media channel in Saudi Arabia. The information in the advert will include the benefits of tele-rehab especially to the patients that have already been discharged but they still need medical attention at an affordable price (Sarfo et al. 2017, p. 204). The main purpose of the program is to ensure that the needs of the patients are met using the current technological advancements. The action plans for tele-rehab should consider the key clinical principles, administrative principles, ethical principles, and technical principles (Sarfo et al. 2017, p. 204). The mentioned principles are the base and the guidelines of any healthcare services to the people of Saudi Arabia.  The chart below shows the action plan for tele-rehabilitation of the discharged patients.

The chart shows tele-rehabilitation action plan (Miller et al. 2014, p. 2)

First and foremost the diagnosis is done to the patient after the patient has been discharged. Diagnosis according to (Adinolfi et a.l 2016, p. 41) is the examination of the patient to determine the possible cause of the disease or the disorder.  Diagnosis also shows the doctor the current state of the patient. After diagnosis the next step is the prognosis process where the medical practitioner goes deeper and research on the cause of the illness or the disorder after getting the diagnosis results (Miller et al. 2014, p. 2).  After prognosis there are two stages that take place concurrently that is the treatment plan and prediction of the desired outcomes. The healthcare practitioner who is conducting the tele-rehabilitation process predicts the possible outcomes of the treatment as a way of giving the patient hope.  The medical personnel then draft the treatment plan for the patient and prescribe drugs for him or her. In case the treatment involves exercises then the doctor will put aside sessions where he/she will be overseeing the exercise program (Kizony et al. 2013).

After the desired outcomes step, the tele-rehab goes to evaluation of the patient to see how he/she is progressing (Adinolfi et al 2016, p. 41). Evaluation processes include examining the activities of the patient frequently to see whether the patient is responding to treatment or another treatment should be recommended.  Another step after the treatment plan is the therapeutic interventions where the medical professional examines the patient to determine if the patient need to undergo therapy either psychological or physical depending on the problem the patient was suffering from (Miller et al. 2014, p. 2). Tele-rehab is a practice that requires a good action plan for the process to be complete. Other that the action plans the practice needs the people who are in charge of the service to uphold the medical principles and never to break them. The principles have been created by the government of Saudi Arabia to protect the rights of the patients and as well those of the medical practitioners (Miller et al. 2014, p. 2).

Critical Reflection

Tele-rehabilitation is an essential technological innovation in the healthcare sector. I have helped many patients who do not have enough money to join the rehabilitation centres and have been discharged from the hospitals and they have not yet recovered. Tele-rehabilitation is not that expensive because patients can go to YouTube and download the videos recorded by tele-rehab professionals and use the for their recovery processes.  The government should come up with laws which can protect patients from fake doctors who open YouTube channels to extort money from the patients. In my hospital many patients have reported cases of fake doctors who take money yet they do not deliver medical services. Thus, governments should put security monitor and curb such persons. The government should also support the tele-rehabilitation services by providing free Wi-Fi which patience can use to download the videos. The installation of Wi-Fi will reduce the cost of buying internet bundles for watching or downloading the tele-rehab programs and services.

Conclusion

Tele-rehab has proven to be very important innovation in the medical industry. Many people who have been discharged from the hospitals have been using the service to get help recover fast either mentally or psychologically. Tele-rehab has been also proven to be slightly affordable that getting rehabilitation services from rehabilitation centres.  Most people who done want to be associated with rehabilitation centres have been acquiring tele-rehab services either online and offline. During the study I discovered that the government of Saudi Arabia has made good amendments to protect the patients from fake doctors online since monitoring the internet is so hard. The efficiency of tele-rehab services have also yet been proved hence further research should be done to look into the matter. From the research I have discovered that the future of tele-rehab in Saudi Arabia is bright because health organisations in the country are venturing into the new healthcare innovation thus calling the attention of the government.  To conclude the government of Saudi Arabia should invest in tele-rehab medical change and support the institutions that are providing the services for example the firm am working in.

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