Purpose: The purpose of this evidence brief is to prove that the utilization of registered nurses as primary team members interacting with patients during telehealth visits in an outpatient setting will improve patient outcomes.
 1. PIO In the outpatient clinical setting, will the utilization of registered nurses as a primary team member to perform telehealth visits improve patient outcomes?
 2. Background: Due to the increasing demand to access care, there is increased demand for telehealth during the pandemic. The issue is to meet the demand. Registered Nurses need to become Primary Team Members to interact with Patients during Telehealth.
 3. Objective: The objective of this research is to discover information on how registered nurses can play a role as primary team members during telehealth visits through Evidence-Based Practice to improve patient outcomes.
 4. Search for evidence was done in databases CINAHL Plus, Pubmed, ***Search words used were “registered nurse and telehealth”, “ role of the nurse in telehealth,” and*** The selection criteria of articles were English language and peer-reviewed articles. was The specifics of articles used were within the last 10*** years, with a majority of them in the last 5*** years, incorporating all evidence levels, I to VII
 5. Summary of research-based evidence:
     1. Yliluoma, P., & Palonen, M. (2020). Telenurses’ experiences of interaction with patients and family members: nurse–caller interaction via telephone.
         1. Nurses’ capabilities and communication skills, including their ability to listen and be sensitive to their patients, nurses’ control of the interaction to keep it relevant improved telephone interactions with the patients. However, background noises when a caller calls, communication problems such as inadequate communication, callers’ inappropriate behavior, inability to conduct an assessment, callers’ inability to describe the symptoms, issues such as family members providing different information than information provided by callers, technical issues, lack of appointments to accommodate all the callers, and long queues all these make it difficult to have effective interactions (Yliluoma & Palonen 2020). Level V1
     2. Mataxen, P. A., & Webb, L. D. (2019). Telehealth nursing: More than just a phone call.
         1. The article discusses that Telehealth is not just a phone call, but it is a resource for patients and families and nurses play an important role in providing those services to patients via technology. Nurses are a good resources, and they can provide effective care by using good communication skills and competencies (Mataxen & Webb, 2019). Level V
     3. Robeznieks, A. (2021). How to implement telehealth in your practice with equity in mind.
         1. Many people are interested in utilizing Telehealth but there are several barriers on both patients’ and clinicians’ sides. Patients lack digital skills and literacy, have no access to the internet, or limited data plan which makes it difficult to have a quality telehealth visit. Similarly, many healthcare settings are unable to provide video-enabled devices to their clinicians, use difficult apps, or have security issues (Robeznieks, 2021). (Expert Reviewed)
     4. Javanparast, S., Roeger L., Kwok Y., Reed RL. (2021). The experience of Australian general practice patients at high risk of poor health outcomes with telehealth during the COVID-19 pandemic: a qualitative study.
         1. This study explored the experiences of telehealth for vulnerable patients in general practice during the pandemic. The significant findings of this study concluded that patients are satisfied with telehealth for its convenience and efficiency. However, patients expressed that this only works if the patient and provider have already developed a relationship prior to the transformation of care. Another finding is that the common use of telehealth is for medication refills, follow-ups and reviewing diagnostic results. (Javaboarast, Kwok, Reed & Roeger, 2021) Level VI
     5. Song, Y., Reifsnider, E., Zhao, S., Xie, X., & Chen, H. (2020) A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients.
         1. This study is to explore the results of medication adherence rate and disease process on patients with rheumatoid arthritis via customized telehealth education versus patients discharged home with standard care instructions. The telehealth education includes disease process, treatment goals, how to take medication properly and side effects. The results of this study concluded that customized telehealth education after discharge leads to a better medication adherence rate and, therefore, better symptom control and prohibits the progression of the disease. (Chen, Reifsnider, Song, Xie & Zhao, 2020) Level II
     6. Asiri, A., AlBishi, S., AlMadani, W., ElMetwally, A., & Househ, M. (2018). The use of telemedicine in surgical care: A systematic review. Acta Informatica Medica, 26 (3), 201.
         1. Although telehealth is typically associated with remote care in therapy and related procedures, the paper by Asiri et al. (2018) establishes that telehealth can also be used in a surgical context. Specifically, the authors of the study prove the importance of incorporating telehealth as the device for patient evaluation after the surgery, thus, assessing the efficacy of the surgery and the extent of its success. Moreover, the threat of nosocomial infections and the associated concerns can be avoided with the help of the proposed technique. The study proves the role of telehealth in modern nursing.
     7. Ramaswamy, A., Yu, M., Drangsholt, S., Ng, E., Culligan, P. J., Schlegel, P. N., & Hu, J. C. (2020). Patient satisfaction with telemedicine during the COVID-19 pandemic: Retrospective cohort study. Journal of Medical Internet Research, 22 (9), e20786.
         1. The study assesses the extent of telehealth efficacy in the environment of the COVID-19 pandemic. According to the results of the study, the range of telehealth applications by APNs has expanded to embrace a variety of patient-specific needs, which has led to a rise in patient satisfaction rates. Compared to in-person visits, the use of telehealth has proven to be much more popular with patients as the tool that allows APNs to establish a rapport with the target population quickly. Moreover, the accuracy of the diagnosis and the opportunity to minimize medical errors when performing the assessment of a patient and to administer the required treatment have been noted as important factors in improving the performance of APNs.
 6. Summary of expert evidence from professional organizations, experiences, or experts in the specialty
     1. The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine. (2011)
         1. In the section “Examples of Redesigned Roles for Nurses”, the Department of Veterans Affairs recreated and extended nurses’ roles in the health care system to collaborate with Advanced Practice Registered Nurses, and the result exceeded its expectation. RNs are assigned to coordinate care and chronic disease management, while APRNs are the primary care providers. The result of this collaboration showed VA patients are getting better care, as evidenced by many quality-of-care indicators in comparison to Medicare patients. (Institute of Medicine, 2011)
     2. Jnr, B. A. (2020). Use of telemedicine and virtual care for remote treatment in response to the COVID-19 pandemic.
         1. Representing an important voice in the community of experts on the subject matter, Jnr (2020) explains in his paper that the role of nurses in promoting the use of telehealth in the healthcare context is vital in fighting the coronavirus pandemic. The study outlines the challenges associated with providing virtual care and offers solutions based on the promotion of nurse-patient communication. In turn, Telehealth is seen as a central tool in assisting nurses in building connections with patients. According to the results of the study, telehealth and other tools for remote healthcare during the COVID-19 pandemic has a largely positive effect.
     3. Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care.
         1. The paper by Lowe et al. (2012) details the significance of support and professional performance by advanced practice nurses in the healthcare setting. Specifically, the research illustrates the role of APNs in the healthcare context has been debated quite profusely and shaped significantly over the past decade. However, the authors agree that the role of an APN in the nursing setting should expand to include of patient education and raising awareness. However, the authors also warn that, with the blurring of the lines between nurses’ roles, certain ambiguity about the functions of an APN emerges. Therefore, the study encourages examining the expansion in the range of APNs’ responsibilities and functions, implying that alleviation of the workload may be needed.
     4. Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on the quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review.
         1. The study shows that APNs have a critical function in the context of modern healthcare. Specifically, APNs contribute substantially to the extent of a patient’s access to critical care by improving the efficacy of communication and precision in service delivery. Furthermore, the study proves that the inclusion of APNs into the critical care context leads to reduced length of hospital stay, as well as an increased rate of patient satisfaction. Promoting innovation in the hospital setting and encouraging autonomy in nurses, APNs contribute to a significant rise in the efficacy of critical care. Thus, the research establishes an important shift in the perception of APNs and their function in the nursing context, transforming their role in critical care toward a more meaningful one.