Are nurse practitioners and telemental health compatible?

By Rebecca Schroeder DNP, MPH, PMHNP

Never in my wildest imagination did I believe the COVID-19 pandemic would still be in our midst while continuing to grind away at our sense of normalcy.  At no other time in our collective memory has the world witnessed such a scourge. It caught the U.S. off guard and has left a wide swath of destruction in its wake.  As a psychiatric mental health nurse practitioner (PMHNP) working in a community setting and as a professor at the University of Southern Maine (USM) School of Nursing, it has become crystal clear to me that we are on the verge of a revolution in how we see and treat patients. Not only are we beginning to understand how to treat the virus, we are also figuring out how to best engage with patients who we can no longer see face to face.

I have witnessed first hand the rapid changes and devastation that the virus has brought to bear on my patients. They are more anxious, depressed and fearful that they too will succumb to the disease. They worry about the health of their family, how they will manage their children’s schooling, where their next meal might come from and how they will secure housing in an economy that is upside down.

As a whole, PMHNPs tend to manage the care of patients who live in non-urban settings and who are at greater risk for poor outcomes. Limited access and lack of psychiatric providers is a well-documented problem that has dogged this country for decades. PMHNPs are a savvy group of professionals that have been instrumental in filling gaps in areas of highest need and have become increasingly recognized as valuable members of the mental health team, especially now, when  “all hands on deck” is needed. As one of these clinicians, not only am I traversing the tricky business of patient care during COVID-19, but as nursing faculty all my efforts to teach a subject grounded in human interaction have been blocked. Students no longer meet in the classroom since everything is now online, and it has become almost impossible to find clinical sites for them because no one wants to put students in harm’s way or add risk by adding another person in the office. 

Despite all this disruption there have been dramatic changes to “care as usual”. Practically overnight, organizations have worked furiously to find ways to get telemental health (TMH) platforms up and running so that care could continue in virtual spaces. It’s hard enough to get people who need or want treatment to come to the office, but when there are more reasons not to show up for appointments (like COVID) it becomes almost impossible to intervene. For the time being TMH has become a partial answer to all that ails mental healthcare. Patients who can access the technology are now able to meet with their providers digitally and they no longer need to travel great distances to get to an office setting. And for providers, there are now opportunities to “visit” with patients in natural settings such as in their home or outside while taking a walk.

Although there is a growing body of research that suggests a virtual visit is similar to a live meeting, I suspect there are both patients and clinical providers who would take offense to that supposition. Despite the positive virtues of technology and accessibility options, virtual interactions are very different than the real thing and challenge our brains in ways that face-to-face exchanges do not. For the provider, reading social cues, assessing symptoms and managing silences are far more difficult to navigate in this virtual world. And for the patient, technology is useless if there is no broadband service where they live or they can’t afford a smart phone or computer.

As TMH increases its role in healthcare delivery it will be increasingly important for PMHNPs to develop adaptive practices to meet the demands of their patients. Part of preparing these advanced practice nurses for 21st century realities is to incorporate knowledge and skill development in the use and application of TMH into graduate education. This is something we have begun to do at USM and are working with clinical partners to help our students access virtual opportunities with patients as part of their field experiences.

It is unclear how long COVID-19 will be in our midst but the heartbreaking consequences are clear. PMHNPs have a unique opportunity to influence practice, now and in the future. Linking individuals with community resources and services, providing strategies to reduce stress and anxiety, initiating therapies and educating patients on best practices for remaining safe are key elements of care we can and must deliver, now more than ever.

Article Details

Adaptation or Revolution: Telemental Health and Advanced Practice Psychiatric Nursing During COVID-19
Rebecca A. Schroeder
First Published November 9, 2020 Research Article
DOI: 10.1177/1078390320970638
Journal of the American Psychiatric Nurses Association

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