Towards a framework for telenurses’ decision making: the decision ladder




Tuden, Danica S.

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Telenursing is a highly specialized area of nursing practice that has evolved in response to the advent of new technologies within the delivery of health care. Telenursing has been defined as “the use of communications and information technology [ICT’s] to deliver health and health care services and information over large and small distances (CRNBC, 2016). Telenurses use health information systems (HIS) in the form of a Clinical Decision Support System (CDSS) to assist callers with their health related concerns on a 24/7 basis. As decision making is an integral part of telenurse practice, particularly because they are using a CDSS while assessing the caller over the phone, it was important to understand the factors that influence the decision making process so as to better support telenurse practice in terms of education as well as other supports. This thesis identified those factors and used Rasmussen’s Decision Ladder as a model in order to provide a framework for telenursing. It was found that there were several factors identified that influenced how telenurses made decisions while using a CDSS. Additionally, the decision ladder was validated as a framework to describe telenurse practice.



Telenursing, Clinical Decision Support Systems, Decision Making, Telehealth