Considerations for Providing Virtual Care

October 01, 2020

Your school has made the decision to start the school year in a virtual environment before returning to the classroom or has chosen to do a mix of virtual and in-person learning. There may already be a system in place for delivering care to students via audio-visual technology because the school or district was virtual in the spring, but it's important to review the essentials of providing virtual care.

Most importantly, many states have modified requirements for telehealth, and it's imperative that nurses stay up to date on current state laws and policies. It's also a smart idea to ensure that policies have been implemented for sending and receiving resources between school and home. Consider whether it's appropriate to create a pick-up site at the school, drop off resources at a student's home, or mail resources directly.  The school may also want to implement drop-off lanes and bins and schedule drop-off times for students and families who need to return materials back to the school.

 

Determine if Virtual Student Visits are Appropriate
Providing virtual healthcare services requires critical nursing judgement and the adherence to state laws and district policies. For example, tube feedings, catherization, and other procedures that require specific training may not be appropriate for a virtual visit. Check with state and local requirements before providing virtual healthcare services, as these are changing in response to the pandemic. Here are some other things school nurses should consider before deciding whether to provide virtual healthcare services:

  • Refer to the State Nurse Practice Act (NPA) and consider contacting the state school nurse consultant and the state board of nursing if the school nurse is proposing to delegate for a direct student service which is allowed in your state
  • Contact state Medicaid agencies for assistance with reimbursement of virtual nursing services
  • Ensure compliance with the Family Educational Rights and Privacy Act of 1974 (FERPA) guidelines
  • Follow school and district guidelines before accessing student records
  • Determine if a virtual visit is appropriate for a specific need
  • Seek approval from district administrators before providing virtual services
  • Develop policies and procedures for virtual care provided by school nurses

 

Preparing for Your First Virtual Visit
Once the scope of the virtual consultations has been determined, there are plenty of things for school nurses to consider, including:

  • Make sure the background is uncluttered with no activity/traffic in the background
  • Adjust the lighting to make sure they are clearly visible and not shadowed
  • Keep the camera at eye level and talk into the camera to make it feel more personal
  • Remove any distracting noises such as pets, fans or radios
  • Wear the same clothing typically worn to school
  • Maintain audio and visual privacy so that others in the household cannot see or hear the nurse or the student/family during the virtual visit
  • Practice with the equipment to avoid technical glitches
  • Become familiar with teleconferencing basics such as adjusting the volume or camera
  • Know how to guide the student/adult caregiver in troubleshooting from their side
  • Speak slowly and pause enough to give time for the student to speak and respond
  • If technology issues continually interrupt the conversation, consider finishing via phone
  • Keep lists of community resource available to address family needs that may be identified at the visit

Conducting Virtual Visits
This very well may be the first virtual health encounter that the student and their caregiver has experienced, so set expectations at the beginning can create a more meaningful encounter. Here are some tips for communicating effectively during a virtual consultation:

  • The nurse should introduce themselves and describe exactly what they will be doing during the visit
  • Ensure the student’s environment is conducive to visit, meaning limited background distractions and prioritizing confidentiality
  • Involve the primary caregiver when able
  • Engage the student and build a relationship of trust
  • Speak in a calm, reassuring voice, and explain what will be happening in age appropriate language
  • Make eye contact
  • Engage younger students with by showing them small stuffed animals, reading a book, or singing, and engage older students with things like jokes or riddles
  • Remember to assess the whole child, not just the complaint
  • Take note of any nonverbal cues related to home or social factors that may be impacting the student’s health and ask any appropriate follow-up questions
  • Use the assistance of a caregiver or the student themselves to help assess, such as asking them to point with one finger to where it hurts
  • Make sure the student and their caregiver have access to the appropriate information

 

Ending the Visit and Appropriate Follow Through
When the visit is over, be sure to summarize any instructions given, and ask the student and caregiver to repeat the instructions to make sure they understood. Following that:

  • Ask if there are any further questions
  • Schedule follow-up appointments as needed
  • Make sure the caregiver has a way to reach the nurse if they have other questions
  • Provide a list of any community resources discussed during the visit to the student and family
  • Document the visit following the same protocol in an in-school setting, and note that the visit was virtual




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