The tremendous growth in telehealth triggered by the COVID-19 pandemic has permanently established a new and convenient way for patients to receive health care. And patients who have tried telehealth are coming back for more. According to a 2022 J.D. Power survey, 94% of patients surveyed who had received services through telehealth said they would definitely or probably receive health care via telehealth in the future.

As telehealth continues to evolve, nurses are being called upon to play a significant role in ensuring the success of this new method of health care delivery. This means that nurses will need to enhance their knowledge about best practices in telehealth nursing. In particular, nurses need to know how to communicate effectively with their patients via telehealth so that patients can achieve positive health outcomes.

Nurses who are new to telehealth can benefit from developing a broad understanding of what telehealth is, its benefits, and specific telehealth nursing roles.

The U.S. Health Resources and Services Administration (HRSA) defines telehealth as the use of technologies in electronic information and telecommunication to support:

• Long-distance clinical health care
• Professional and patient education about health
• Public health
• Health administration

HRSA also offers a simplified definition of telehealth from a patient’s perspective: Telehealth takes place when a provider cares for a patient without an in-person visit.

Patients can use telehealth for a wide variety of health care services. Following are some examples of telehealth services:

• General health care, such as wellness visits
• Mental health counseling
• Nutrition counseling
• Prescription services
• Urgent care for health issues such as urinary tract infections or rashes

The COVID-19 pandemic and the accompanying need for social distancing precipitated a dramatic rise in the use of telehealth services. According to a report on telehealth use by consulting firm McKinsey and Company:

• The rate of telehealth use in April 2020 was 78 times the rate of telehealth use in February 2020.
• As of July 2021, the rate of telehealth use had stabilized to 38 times the rate of telehealth use prior to the COVID-19 pandemic.

Certain factors contributed to the steep increase in the use of telehealth during and after the peak of the pandemic. Among them were an increase in patients’ and providers’ willingness to try telehealth, and regulatory changes that made telehealth more accessible and eligible for insurance reimbursement.

Nurses should understand the various forms of telehealth and the many ways in which they can provide telehealth services. Types of telehealth include the following:

• Audio-only visits, which are patient visits using the telephone (but no video)
• Case-based teleconferencing, which helps to coordinate a patient’s services across multiple interdisciplinary providers
• E-visits, which are non-face-to-face communications that a patient initiates through an online portal
• Live video, which involves real-time, face-to-face interaction between a patient and a provider
• Mobile health, which enables a patient to review their personal health information on mobile devices and communicate changes in their health status to their provider
• Remote patient monitoring, which involves using digital technologies to collect a patient’s health information and transmit it to their provider
• Store and forward, which consists of remote evaluation of recorded video or images that a patient submits to their provider

The advantages of using telehealth are numerous. The use of telehealth can result in benefits such as:

• Improvements in patients’ ability to access health care
• Reductions in “no-shows” (occasions when patients do not show up for appointments)
• Easier processes for following up on patients
• Greater opportunities for collaboration among multiple providers who care for the same patient
• Improvements in patient outcomes, for example, by reducing the risk of infection and by improving patient education through telehealth sessions
• Reductions in costs, for example, by decreasing expenditures for large waiting rooms and associated administrative staff

Telehealth nursing encompasses several different roles. For example, nurses can be responsible for telehealth implementation and operations in roles such as:

• Telehealth manager or director. In this role, a nurse manages an organization’s telehealth program, creates telehealth protocols, helps in selecting telehealth technology, identifies telehealth patient populations, and refines and expands the telehealth program.
• Telehealth coordinator. In this role, a nurse coordinates an organization’s telehealth operations, educates other providers and patients about telehealth, manages the use of telehealth equipment, and evaluates the telehealth program.

Nurses who work directly with patients use telehealth in roles such as:

• Health educator or coach. In this role, a nurse uses telehealth to educate patients, manage patients’ medications, review patients’ test results, and coach patients on making changes to improve their health.
• Telehealth triage nurse. In this role, a nurse consults with patients who believe they may need to go to an emergency department; telehealth triage nurses also consult with other providers regarding appropriate transfers for patients.
• Discharge planning or follow-up nurse. In this role, a nurse manages the discharge matters related to chronically ill patients or patients who have had surgery.
• Nurse telepresenter. In this role, a nurse prepares patients for telehealth sessions, assists them in using telehealth technology, and verifies orders that providers make through telehealth.
• Bedside or intensive care unit (ICU) nurse. In this role, a nurse who cares for patients in acute care settings can use telehealth to facilitate making their rounds, set up communication channels between patients and their families, or enable other providers to make virtual visits.

Nurses also can use telehealth in roles that focus on collaboration, such as:

• Patient navigator or care coordinator. In this role, a nurse brings members of an interdisciplinary team together virtually to navigate patient care.
• Tele-ICU nurse. In this role, a nurse who is working remotely collaborates with and provides clinical expertise to other nurses who are working in critical care units.

Strengthening certain communication skills can help telehealth nurses be successful. Examples of these skills are outlined below.

Both verbal and nonverbal skills are important when nurses are providing care via telehealth. For example, telehealth nurses need to use their verbal skills to actively engage with their patients so that the patients feel connected and less distant. Nurses should avoid trying to follow a script during telehealth sessions and instead adapt the conversation to each patient’s needs. Nonverbal skills also are important. For example, nurses should try to reduce their use of distracting hand gestures that can take up the entire screen.

Using plain language during telehealth sessions can make it easier for patients to follow and understand the information that’s being provided and the questions being asked. For example, nurses should try to avoid using medical jargon that can diminish patients’ ability to understand. If a nurse needs to use complex medical terms, they should define what those terms mean.

The ability to express empathy is crucial to the successful delivery of telehealth care. Nurses who cultivate their ability to consistently express empathy can improve their patients’ chances for positive health outcomes. Expressing empathy also helps nurses build therapeutic alliances with their patients, which can lead to greater patient satisfaction.

When nurses practice active listening during telehealth sessions, their patients feel better understood. To employ active listening, nurses need to demonstrate that they are paying attention to their patients, show the patients that they are engaged and open to communication, offer feedback to the patients based on their comments, and summarize what the patients say.

Telehealth works best when nurses actively strive to build rapport with their patients. This is true even when a nurse has previously established rapport with a patient through in-person appointments.

Nurses can follow a number of telehealth best practices to help ensure successful telehealth nursing sessions. The information below highlights specific best practices for typical steps in a telehealth session, from preparing for a session to confirming a patient’s understanding of what has been discussed.

Nurses can increase their odds of having successful telehealth visits if they prepare in advance. Nurses can prepare for telehealth visits by doing things such as:

• Ensuring they know how to use the telehealth equipment
• Verifying that the telehealth equipment and technology are working
• Reviewing the patient’s history
• Ensuring that their location is private
• Eliminating any distractions

Telehealth sessions should begin with an appropriate greeting. Following are several suggestions for greeting telehealth patients:

• With new patients, nurses should introduce themselves and explain what their role will be.
• Chatting or speaking informally for a few minutes can help nurses working in telehealth begin to form a connection with their patients.
• Double-checking that patients’ cameras and microphones are working and stable can get telehealth sessions off to a good start.

Many patients could be experiencing telehealth for the first time, so nurses need to introduce them to the telehealth environment. Nurses can introduce patients to telehealth by doing things such as:

• Explaining specific features of the telehealth experience
• Informing patients about the telehealth tools they will be able to access, for example, health monitoring technology or medication reminders
• Instructing patients on how to use the telehealth tools
• Providing patients with materials such as “cheat sheets” that offer instructions for using different telehealth tools
• Encouraging patients to ask questions about telehealth

Actively striving to build rapport can help telehealth nurses better serve their patients. Strategies for building rapport include doing the following:

• Establishing a disconnect process at the outset by informing patients about what to do if they are disconnected, to reduce patients’ anxieties about using telehealth
• Making eye contact with patients by consistently looking at the camera
• Introducing patients to any other health care providers who are present
• Informing patients ahead of time about what they may be doing — such as consulting a medical history file or taking notes — that patients cannot completely see on their screens, to keep patients from being distracted
• Providing verbal affirmations as patients are speaking, and asking patients open-ended questions that can elicit more information from them

Respecting patients’ cultures and backgrounds is essential to achieving success in telehealth. Recommendations for practicing cultural competence include the following:

• Refraining from making assumptions about patients
• Withholding judgments about patients
• Striving to use concise wording, particularly with patients whose first language is not English, and obtaining the services of interpreters when appropriate
• Maintaining awareness of cultural differences in the use of facial expressions or gestures

Using visual aids during telehealth sessions can help patients better understand their conditions. Some examples of telehealth visual aids are:

• Charts with a pain scale of 1 to 10
• Visual aids showing the anatomy of the area where a surgery will be performed
• Photos of symptoms — for example, a rash — with which patients can compare their symptoms

Using an approach referred to as teach-back can help telehealth nurses ensure that patients understand the information being shared with them. Using the teach-back approach entails:

• Explaining health information as clearly and plainly as possible
• Assessing patients’ understanding by asking them to articulate their understanding in their own words, and avoiding simply asking, “Do you understand?”
• If necessary, repeating or clarifying the health information by explaining it in a different way
• Checking patients’ understanding a second time by asking them to explain it again in their own words

To ensure telehealth sessions are successful, nurses need to express empathy to their patients. Recommendations for expressing empathy include:

• Using a gentle tone of voice and speaking slowly
• Giving patients time to respond and react to information
• Openly recognizing when situations may be difficult
• Acknowledging what is happening, rather than immediately offering to fix what is happening
• Naming patients’ emotions, for example, by expressing that a patient may seem worried or upset, and asking the patient how they feel

Nurses can communicate a lot through their body language, so it’s important to be conscious of it when conducting a telehealth session. Exhibiting helpful body language during a telehealth session includes:

• Maintaining good posture and avoiding reclining in a chair
• Maintaining awareness of one’s facial expressions, and trying to avoid expressions that could appear confused or be interpreted as scolding
• Not fidgeting, and keeping one’s hands still
• Remembering to smile when appropriate

Nurses who provide telehealth nursing services can review these additional resources on telehealth communication best practices:

• American Academy of Pediatrics, General Tips in Telehealth Implementation. This resource offers telehealth tips specifically for pediatric visits, including communication tips.
• Current Allergy and Asthma Reports, “Conducting a Professional Telemedicine Visit Using High-Quality Webside Manner.” This journal article provides best practices for communication when conducting telehealth sessions.
• International Journal of Telerehabilitation, “Best Practices for Building Interprofessional Telehealth: Report of a Conference.” This journal article discusses communication best practices for teams of professionals conducting telehealth sessions.
• JMIR Medical Education, “Teaching Telemedicine: The Next Frontier for Medical Educators” This journal article discusses how to teach telehealth techniques, and includes tips for conducting virtual visits with patients.
• Perspectives in Health Information Management, “Building Best Practices for Telehealth Record Documentation in the COVID-19 Pandemic.” This resource offers suggestions for documenting discussions held during telehealth sessions, for example, by recording notes in a notes template.
• S. Department of Health and Human Services, Best Practice Guides. This resource offers telehealth best practice guides that providers can consult when communicating with specific populations, such as behavioral health patients or patients with chronic conditions.

Among the many factors to consider in telehealth nursing, ensuring patients’ privacy may be one of the most important. Recommendations for respecting patients’ privacy during telehealth sessions include the following:

• Comply with privacy requirements. Nurses should use telehealth applications that comply with HIPAA (Health Insurance Portability and Accountability Act) and other legal requirements.
• Offer patients suggestions for privacy. Nurses can make suggestions to patients about things they can do to maintain privacy on their side of the conversation. For example, nurses can suggest that patients move to more private rooms in their homes, to their cars, or to outdoor areas away from other people.
• Confirm provider and patient identities. Nurses should specify their names and credentials and complete a confirmation process to verify the patient’s identity — for example, by asking the patient to verify their demographic information — at the beginning of a telehealth session.
• Rely on encryption. Nurses should use telehealth platforms that feature end-to-end encryption.

Nurses who wish to learn more about privacy in telehealth can consult these additional resources:

• Association of State and Territorial Health Officials, “Addressing Privacy Concerns of Using Mental Healthcare via Telehealth.” This article provides information on telehealth privacy specifically for mental health care.
• BMC Medical Informatics and Decision Making, “Risk Management-Based Security Evaluation Model for Telemedicine Systems.” This journal article discusses risk evaluation methods for telehealth systems.
• Healthcare and Public Health Sector Coordinating Councils, “Health Industry Cybersecurity — Securing Telehealth and Telemedicine.” This resource provides best practices for cybersecurity in telehealth.
• HealthTech, “How to Keep Telehealth Secure.” This article offers tips for strengthening the security of telehealth systems.
• Maryland Health Care Commission, “Safeguarding Privacy and Security in Telehealth: Tips to Keep Your Practice Safe.” This resource outlines recommendations for ensuring privacy in telehealth.
• National Cybersecurity Center of Excellence, Telehealth Security and Privacy Tips for Providers. This resource offers health care providers tips for maintaining privacy in telehealth.

Telehealth represents a new and promising opportunity for nurses. Nurses can play a critical role in the long-term success and effectiveness of this method of health care delivery by knowing how to communicate with patients via telehealth. Nurses who can safely, professionally, and effectively engage with their patients through telehealth will help to ensure that patients receive optimal care.