Providing Virtual Health Education for Adolescents with Congenital Heart Disease
Summary
The unprecedented disruption to the Ontario healthcare system caused by the COVID-19 pandemic was the primary motivation for this fellowship. More specifically, I chose to examine the swift adoption of virtual care by healthcare providers, patients, and organizations in light of widespread cancellations of in-person, ambulatory clinic visits. Though a much-needed and practical solution, the rapid implementation of virtual care left a knowledge and skill gap for healthcare providers, including myself, in terms of understanding its use and effectiveness. As such, I chose to focus my fellowship on addressing this knowledge and skill gap in order to effectively provide patient care and education within my clinical role as a pediatric, cardiac transition nurse.
The role of the cardiac transition nurse is to facilitate the transition of adolescent patients as they move from a pediatric congenital heart disease (CHD) program to an adult CHD clinic. This primarily involves empowering adolescents to self-manage their CHD and recognize the importance of necessary life-long care and continuity of care across health systems through the provision of structured patient education sessions. Effective delivery of this patient education is vital to preventing lapses in care, which is why learning to provide it within a novel, virtual format was the focus of this fellowship.
This project took place at The Hospital for Sick Children in Toronto, which has identified the utilization of virtual care explicitly within its 2020-2025 strategic plan, in an effort to create a seamless child and family experience. At SickKids, the use of virtual care is recognized as an innovative means through which to connect with a geographically diverse patient population and in the context of COVID-19 it has also been recognized as a strategy to minimize health risks for patients and staff. The COVID-19 pandemic was a catalyst to the implementation of virtual care at SickKids, providing me the unique opportunity to address my knowledge and skill gap to become a virtual care leader within my clinical setting.
The overall learning goal for this fellowship was to gain leadership knowledge and skill in providing virtual health education to adolescents with congenital heart disease, aged 14 - 18 years old, as they prepared to move from pediatric to adult health care. To achieve this goal my objectives included, (1) exploring current evidence-based, virtual health education practices, (2) learning about existing local and national virtual, adolescent-focused education offerings, (3) understanding the adolescent patient perspective on using virtual care and, (4) becoming an departmental virtual care champion within my organization.
The RNAO Advanced Clinical Practice Fellowship afforded me the opportunity to gain invaluable knowledge and skills in providing virtual health education for adolescents. Despite a paucity of research examining virtual care best practices in the pediatric setting, key learnings included issues of (1) access to and use of technology, (2) computer literacy, (3) incorporating a multi-disciplinary team, (4) ensuring privacy/confidentiality, (5) effects on the patient-healthcare provider therapeutic relationship, and (6) provider workload management.
During my discussions with both local and national healthcare providers, I learned about existing virtual health education sessions/clinics and their practices, along with the barriers and facilitators they experience while utilizing virtual care with adolescent patients. I also gained an appreciation for the impact virtual care has had on the both the clinical workflow and the individual workload for some healthcare providers.
Contributing further to my understanding of virtual care provision, was being able to obtain feedback directly from adolescents. By completing a quality improvement project to obtain patient satisfaction with virtual care, I was able to learn more about what adolescents liked and/or disliked about their virtual care experiences and their preferences for virtual care versus in-person care. Their feedback was instrumental in understanding the impact virtual care was having on their care and how best to modify virtual education sessions to meet their needs.
Lastly, all of the knowledge gained has enhanced my nursing skills in providing adolescent patients with virtual health education. I am confident in delivering health education in a virtual setting, and will continue to champion virtual care within my clinical setting.
Outcomes
As a result of the knowledge and skills gained through this fellowship, I was able to provide continuity of care for those patients unable to attend the in-person cardiac ambulatory clinic for their virtual health education visits. I was able to confidently conduct virtual visits using strategies and practices based on research findings, and feedback from both clinicians and patients. This was especially vital for those adolescents for whom this was their last pediatric cardiac appointment prior to transfer to adult care. Being able to continue to provide transition education during the pandemic in a virtual format was a necessary step and will continue in support of the SickKids strategic plan.
Furthermore, the ability to confidently provide virtual visits for cardiac transition patients, greatly enhanced patient convenience. Patient feedback indicated that of the respondents, 72.7% either agreed, or strongly agreed that virtual appointments were convenient for them and saved them time. An additional 81.8% felt that the virtual appointments saved costs associated with transportation, parking, and time off work.
In addition to ensuring continuity of care for adolescent patients, the quality of their virtual care was enhanced . Using the findings from the fellowship, multiple strategies were employed to ensure a successful visit, including providing patients with detailed instructions prior to their appointments, ensuring patients had the appropriate hardware and software, providing patients with expectations for the visit, and ensuring privacy by encouraging patients to use headphones, using the chat function and placing their workstation in a private area. Patient feedback indicated, that of those surveyed, all patients were satisfied with their transition virtual health education visit.
Throughout the fellowship, I was able to share findings with those at SickKids who were also providing virtual care. This knowledge sharing lead to improved technical skills and efficiency amongst colleagues with regards to the use of virtual care and also improved knowledge regarding virtual care communication strategies. Patient feedback and virtual care recommendations arising from this fellowship have also served to augment virtual care data currently being collected hospital-wide.
Overall experience
The RNAO Advanced Clinical Practice Fellowship has been an invaluable experience. Perhaps the most insightful understanding has been how quickly patients, clinicians, and organizations adapted to provide and receive virtual care, under the extraordinary circumstances resulting from the COVID-19 pandemic. In a matter of months, many clinicians successfully changed their daily clinical practice, and implemented virtual care with relatively little to no previous experience. This spoke volumes of their dedication to ensuring continuity of care for patients.
The opportunity to discuss virtual care practices with local and national healthcare providers was another highlight of my fellowship experience. Despite our differences in clinical backgrounds, I learned that many of us faced similar experiences with providing virtual care in terms of its barriers and facilitators. It was a great networking opportunity during which I learned many virtual care strategies, many of which were instrumental in the development of my own virtual care recommendations.
Lastly, the fellowship provided me the opportunity to improve my own virtual care practice, and receiving positive feedback from patients, was very encouraging. When asked what they (adolescents patients) liked the most about their virtual visit, comments included,
“It was a 1 on 1 private conversation and I felt comfortable speaking to someone about my health conditions.”
"I liked being able to be in a safe space at home while receiving this information."
"I was less anxious because I did not need to go in person."
Overall, my experience with the RNAO advanced clinical practice fellowship has been instrumental in shaping my nursing knowledge and skill in providing virtual care. I look forward to sharing my virtual care knowledge with colleagues and continuing to provide quality care for patients.
