In 2008, there were 44 million informal family caregivers and the number is expected to rise in the next decade. Hospice clinicians need to explore ways to decrease the burden of care for these informal caregivers. The use of electronic technology and social media may be a key component in improving support at end of life in the home setting.
Decreasing Informal Caregiver Burden With
SOCIAL MEDIA T
he inclusion of electronic technology in hospice services started in the 1990s with the use of videophones; however, a major obstacle for expansion of telehospice is clinicians’ perceptions that it is an inconvenience for patients (Whitten et al., 2009). Hospice agencies are using more technology but the inclusion of diverse types of technology has not been widely explored or used. With the increased usage of social media and readily available electronic
technology in most homes in the United States, the option exists for the hospice industry to provide enhanced support at end of life (EOL).
Growth of the Informal Caregiver One of the challenges of EOL care in the home is providing constant support to the informal caregiver. The informal caregiver is usually an unskilled family member, who contributes to and is involved in the caretaking responsibilities
Tammi Watkins, MSN, APRN, CHPN 304
Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
of someone in need (US Legal, 2013). Informal caregiving grew by 10% between 2010 and 2013 (Abutaleb, 2013). In 2008, it was estimated there were 44 million informal caregivers in the United States; 4 million of them were caring for someone with cancer (van Ryn et al., 2010). The age of most caregivers is estimated to be between 30 and 64 years (Abutaleb, 2013). The demand for informal caregivers is expected to rise by 85% over the next several decades (Collins & Swartz, 2011). It is estimated that family caregivers provide approximately $375 billion in healthcare savings nationwide. The projected increase in family caregivers is a result of shorter hospital stays, changes in insurance reimbursement, limited hospital discharge planning, and the aging of the U.S. population (Collins & Swartz, 2011). In 2011, the National Hospice and Palliative Care Organization (NHPCO) estimated 44.6% of all deaths in the Unites States received hospice care (National Hospice and Palliative Care Organization [NHPCO], 2012). In that same year, the median length of hospice care received was 19.1 days and 35.8% of the patients received hospice care for less than 7 days (NHPCO, 2012). The trend of short-term usage of hospice services impacts the caregiver and the patient. The stress for informal caregivers has been compounded by other issues as well: the caregivers and care recipients may be older and have a higher level of disability, and the duration, intensity, and the burden of care has increased (Collins & Swartz, 2011). Also the financial cost of providing care has risen and the use of paid formal caregivers has declined (Collins & Swartz, 2011). The growing need for informal caregivers validates looking at new and different options in providing caregiver support.
Caregiver’s Burdens Benjamin Franklin once stated “the only things certain in life are death and taxes” (QuoteGarden .com, n.d.) but the question for many is where they will die and with whom they will die? In a study by Agar et al., the majority of patients expressed wanting to die at home and one of their concerns was how their wish to die at home would impact their informal caregivers. In the same study, the importance of place of death was asked of patients and the caregivers at the beginning of the illness and again near the EOL.
vol. 32 • no. 5 • May 2014
At the beginning, more than 85% of both patients and caregivers wanted the patient to die at home; at the end the numbers dropped to 71% for the patient and to 66% for the caregiver. Another important finding was that the caregiver’s preference for providing home care decreased from 92% at the beginning of illness to 42% when death approached (Agar et al., 2008). A study in the Netherlands explored the experiences of caregivers and the continuous balance of care burden with the capacity to cope (Proot et al., 2003). The authors describe nine factors caregivers needed to balance, and if the balance was not achieved it placed the caregiver at risk for fatigue and burnout. The nine factors were accepting restricted activities, the burden of care, fear, insecurity, loneliness, facing death, lack of emotional support, and the need for practical and information-related support (Proot et al., 2003). These studies support the need to decrease caregiver burden. The field of psychology defines caregiver burden as the “fatigue, stress, and all other psychological symptoms experienced first-hand by parents, siblings, and other family members” (Psychology Dictionary, 2013). The hospice field needs to improve hospice patient and family satisfaction by reducing the stress of caring for someone at EOL. One solution is social media and electronic technology in the home.
Current Social Media and Electronic Technology Usage Personal Domain Usage
An article by Fox and Jones (2009) determined most caregivers get their healthcare information from the Internet. The article discussed key findings in studies concerning caregivers and their online usage: • 44% used the Web to research another’s personal health history; • 26% tried to find someone with similar health concerns; • 28% use social networking sites to get health updates; • 38% consulted review of drugs or medical treatments; • 75% researched a specific disease or medical problem; • 67% of caregivers who have Internet access look online for health information (Fox & Jones, 2009).
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
305
The growing need for informal caregivers validates looking at new and different options in providing caregiver support. According to a 2012 study by the Pew Research Center, 58% of U.S. adults own a cell phone and half of those are smartphones (Pew Internet and American Life Project, 2012). The study also reported the following information concerning smartphones: • In 2010, although the same percentage of U.S. adults owned cell phones only 17% reported using it to access health information; the number in 2012 has increased to 31% of adults accessing health information. • Usage appeals to certain groups of health consumers: caregivers, people with recent medical crisis, and those who have experienced a recent, significant change in their physical health (Pew Internet and American Life Project, 2012). The Internet is used by caregivers not only to search healthcare issues, but also as a way to find support and decrease the feeling of isolation. A survey performed by AgingCare.com found 65% of people caring for elderly parents used the Internet as their primary source of support and encouragement and most of the activity occurred late at night and/or early morning (Sollitto, 2013). Medical Domain Usage
The growth of social media is extending into the healthcare world and the literature suggests it could be beneficial in EOL. It is not uncommon for hospitals, clinics, or private practices to have Facebook pages. With the changing paradigm of healthcare and shorter time frames in which to provide care, there is a need to have other options available. Medical professionals are seeing more patients in less time. The use of social media may allow clinicians to stretch their contact with patients and caregivers, as well as offer a means of providing education and support.
306
Home Healthcare Nurse
Researchers from Johns Hopkins University and the University of Michigan were recently awarded a $1.7 million grant to create an online tool to help dementia caregivers track, treat, and understand the challenging behavioral symptoms of dementia (University of Michigan Health System, 2013). Another online tool is being developed by the insurance company United Healthcare along with Northwestern University and AARP to develop a Web and mobile application to help patients manage their daily medication regiments based on research by the Pew Research Center (Brown, 2012). The Hospice Foundation of America, a notfor-profit foundation, has an open forum on their Web site called “Ask a Question” where individuals may ask pertinent questions answered by a physician (Lamers, 2005). A Web site in Canada, the Canadian Virtual Hospice, has been answering online questions since 2004; in 2009 they answered 1,000 questions and received 25,000 visits a month (Grant & Wiegand, 2011).
How Will Social Media and Electronic Technology Improve Hospice Services? The use of social media will allow hospices to provide more and varied caregiver support 24/7 by alternative avenues other than faceto-face home visits. The expansion of social media and technology could increase the contact time clinicians such as the social workers, dieticians, and spiritual counselors have with the caregivers. Increasing the support from all clinicians may be an important factor in greatly decreasing the risk of caregiver fatigue and burnout. The incorporation of smartphones, Skype, or social media opens the door for clinicians to have face-to-face or instant communication with caregivers. Hospice care is available to patients 24/7, but there is a lag between the call after hours and when the clinician arrives at the home. Being able to provide instant visual connection through FaceTime or Skype can strengthen the support the caregiver needs at vulnerable times. Hospice agencies may provide private online support groups to caregivers who are not able to leave the home. Providing early bereavement support will facilitate the caregiver’s grief journey. Providing online teaching tools on personal care for their loved one could potentially
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
decrease the fear they will do something wrong. Placing evidence-based educational material on a hospice agency’s Web site will provide teaching material that represents the agency’s philosophy of care and which can be accessed at any time. The use of Skype would be more cost-effective compared to purchasing videophones. The ability of the informal caregiver to see a “face” can decrease stress and make after hour calls more efficient and welcome. The ability to “see” the patient could decrease the expense involved with in-home after hour visits made by staff. Skype “visits” may also allow for an expanded role of mid-level healthcare providers in EOL care. It is said if Facebook was a nation it would be the third largest country (Brody & Kipe, 2012). Incorporating Facebook in EOL care would reach those caregivers who could benefit from the perceived support offered by supporters clicking on “likes,” a popular feature of Facebook. Clinicians could encourage the use of Facebook to caregivers as a tool to get support from friends and family. Facebook never closes, allowing the caregiver to look at posts, blog their feelings, or reach out for support.
The Issues of HIPAA and Technology The Health Insurance Portability and Accountability Act (HIPAA) is a federal law providing patients control in regards to their protected health information. This law allows only the patient to release their health information except in healthcare operations. It does allow internal sharing of the information between hospital to physician, from physician to hospital, and payment companies for reimbursement (Hinmon, 2011). How does this affect the use of technology in this new electronic age? The industry is starting to understand the importance of using social media to contact potential and current patients; in 2011, there were more than 900 U.S. hospitals engaging patients through social media (Hinmon, 2011). The plan of action to insure the privacy of the patient is educating the staff in the proper use of social media and technology. The National Council of State of Boards of Nursing has developed a campaign on how to educate nurses in the changing world of social media. Some of the key points to the campaign are to be proactive, develop a policy, and instruct on HIPAA laws (Spector & Kappel, 2012).
vol. 32 • no. 5 • May 2014
The key factor in strengthening the use of social media and technology in hospice is education. With the requirement of electronic medical records, hospitals are already following the mandatory compliance issues. The biggest concern with HIPAA violation and telemedicine is enhancing security. These issues can be overcome by encrypting all communication from the computers so if hacked the hacker cannot read the coded message, digital identity card for remote patients or login passwords, point-of-service computers should be user authenticated, and the computer network should be protected by a firewall (Gaya, n.d.). Beyond the security of the computers the simplest tool to use is the patient/caregiver consent form. Explaining to the patient and the caregiver the optional areas of service that may be provided to them if they choose.
Conclusion The options of electronic technology and social media are readily available to use as tools to enhance the support to caregivers at EOL. As clinicians there is a need to examine new tools to improve care. All types of avenues in providing care and support need to be explored. Technology will make the care not only more available, but faster as well. For the informal caregiver the ability to “connect” to someone is essential in their ability to continue to provide the care in the home to their dying loved one. Tammi Watkins, MSN, APRN, CHPN, is a Hospice Nurse Clinician, Hospice of Olathe Medical Center, Olathe, Kansas. The author declares no conflicts of interest. Address for correspondence: Tammi Watkins, MSN, APRN, CHPN, 2333 W. Piatt Lane, Olathe, KS 66061 ([email protected]). DOI:10.1097/NHH.0000000000000058 REFERENCES
Abutaleb, Y. (2013). Two-fifths of U.S. adults care for sick, elderly relatives. Retrieved from http://www.huffing tonpost.com/2013/06/20/caregivers-adults-care-forelderly-relatives-sandwich-generation_n_3469779. html#slide=more263315 Agar, M., Currow, D. C., Shelby-James, T. M., Plummer, J., Sanderson, C., & Abernethy, A. P. (2008). Preference for place of care and place of death in palliative care: Are these different questions? Palliative Medicine, 22(7), 787-795. doi:10.1177/0269216308092287
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
307
Brody, D. (2010, October 1). Social media: A key component to the psychiatrist’s practice. Psychiatric Times, 29(10), 45. Brown, J. (2012). Plain language initiative supports seniors’ medication management [Supplemental material]. Managed Healthcare Executive, 22(5), 10. Retrieved from http://managedhealthcareexecutive. modernmedicine.com/managed-healthcare-execu tive/news/plain-language-initiative-supports-mtm Collins, L. G., & Swartz, K. (2011). Caregiver care. American Family Physician, 83(11), 1309-1317. Retrieved from http://www.aafp.org/afp/2011/0601/p1309.html Fox, S., & Jones, S. (2009). The impact of online health resources. Retrieved from http://www. pewinternet.org/Reports/2009/8-The-Social-Lifeof-Health-Information/05-The-Impact-of-OnlineHealth-Resources/1-About-one-in-ten-online-healthinquiries-have-a-major-impact.aspx Gaya, J. (n.d.). Telemedicine-enhancing network security to achieve HIPAA compliance. Retrieved from http:// www.ezinearticles.com/?Telemedicine Grant, M. S., & Wiegand, D. L. (2011). Palliative care online: A pilot study on a pancreatic cancer Website. Journal of Palliative Medicine, 14(7), 846-851. doi:10.1089/jpm.2011.0036 Hinmon, D. (2011). Steps#4 understand the rules for a HIPAA-compliant social media strategy. Retrieved from http://www.hivestrategies.com Lamers, W. M., Jr. (2005). Answering questions on a hospice foundation web site: The first five years. Journal of Pain and Palliative Care Pharmacotherapy, 19(2), 37-40. doi:10.1300/J354v19n02_07 National Hospice and Palliative Care Organization. (2012). NHPCO facts and figures: Hospice care in America (Fact sheet). Retrieved from http://www.nhpco.org Pew Internet and American Life Project. (2012). Mobile health 2012. Retrieved from http://www.
308
Home Healthcare Nurse
pewinternet.org/Reports/2012/Mobile-Health/ Main-findings Proot, I. M., Abu-Saad, H. H., Crebolder, H. F., Goldsteen, M., Luker, K. A., & Widdershoven, G. A. (2003). Vulnerability of family caregivers in terminal palliative care at home; balancing between burden and capacity. Scandinavian Journal of Caring Sciences, 17(2), 113-121. doi:10.1046/j.1471-6712.2003.00220.x Psychology Dictionary. (2013). Caregiver burden. http:// psychologydictionary.org/caregiver-burden/ QuoteGarden.com (n.d.). Quotations about taxes. Retreived from http://www.quotegarden.com/taxes.html Sollitto, M. (2013). Survey results: Internet is #1 way caregivers get support. Retrieved from http://www. agingcare.com/Articles/Internet-is-the-NumberOne-support-tool-for-caregiver Spector, N., & Kappel, D. M. (2012). Guidelines for using electronic and social media: The regulatory perspective. Online Journal of Issues in Nursing, 17(3), 1. doi:10.3912/OJIM.Vol17No03Man01 University of Michigan Health System. (2013). With new $1.7 M collaborative grant, U-M, John Hopkins researchers will develop dementia treatment tool for family caregivers. Retrieved from http://www.uofm health.org/news/archive/201306/new-17m-collabor ative-grant-u-m-johns-hopkins-researchers US Legal. (2013). Informal caregiver. Retrieved from http://definitions.uslegal.com/i/informal-caregiver/ van Ryn, M., Sanders, S., Kahn, K., van Houtven, C., Griffin, J. M., Martin, M., ..., Rowland, J. (2010). Objective burden, resources, and other stressors among informal cancer caregivers: A hidden quality issue? Psychooncology, 20(1), 44-52. doi:10.1002/pon.1703 Whitten, P., Holtz, B., Meyer, E., & Nazione, S. (2009). Telehospice: Reasons for slow adoption in home hospice care. Journal of Telemedicine and Telecare, 15(4), 187-190. doi:10.1258/jtt.2009.080911
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Decreasing Informal Caregiver Burden With
SOCIAL MEDIA T
he inclusion of electronic technology in hospice services started in the 1990s with the use of videophones; however, a major obstacle for expansion of telehospice is clinicians’ perceptions that it is an inconvenience for patients (Whitten et al., 2009). Hospice agencies are using more technology but the inclusion of diverse types of technology has not been widely explored or used. With the increased usage of social media and readily available electronic
technology in most homes in the United States, the option exists for the hospice industry to provide enhanced support at end of life (EOL).
Growth of the Informal Caregiver One of the challenges of EOL care in the home is providing constant support to the informal caregiver. The informal caregiver is usually an unskilled family member, who contributes to and is involved in the caretaking responsibilities
Tammi Watkins, MSN, APRN, CHPN 304
Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
of someone in need (US Legal, 2013). Informal caregiving grew by 10% between 2010 and 2013 (Abutaleb, 2013). In 2008, it was estimated there were 44 million informal caregivers in the United States; 4 million of them were caring for someone with cancer (van Ryn et al., 2010). The age of most caregivers is estimated to be between 30 and 64 years (Abutaleb, 2013). The demand for informal caregivers is expected to rise by 85% over the next several decades (Collins & Swartz, 2011). It is estimated that family caregivers provide approximately $375 billion in healthcare savings nationwide. The projected increase in family caregivers is a result of shorter hospital stays, changes in insurance reimbursement, limited hospital discharge planning, and the aging of the U.S. population (Collins & Swartz, 2011). In 2011, the National Hospice and Palliative Care Organization (NHPCO) estimated 44.6% of all deaths in the Unites States received hospice care (National Hospice and Palliative Care Organization [NHPCO], 2012). In that same year, the median length of hospice care received was 19.1 days and 35.8% of the patients received hospice care for less than 7 days (NHPCO, 2012). The trend of short-term usage of hospice services impacts the caregiver and the patient. The stress for informal caregivers has been compounded by other issues as well: the caregivers and care recipients may be older and have a higher level of disability, and the duration, intensity, and the burden of care has increased (Collins & Swartz, 2011). Also the financial cost of providing care has risen and the use of paid formal caregivers has declined (Collins & Swartz, 2011). The growing need for informal caregivers validates looking at new and different options in providing caregiver support.
Caregiver’s Burdens Benjamin Franklin once stated “the only things certain in life are death and taxes” (QuoteGarden .com, n.d.) but the question for many is where they will die and with whom they will die? In a study by Agar et al., the majority of patients expressed wanting to die at home and one of their concerns was how their wish to die at home would impact their informal caregivers. In the same study, the importance of place of death was asked of patients and the caregivers at the beginning of the illness and again near the EOL.
vol. 32 • no. 5 • May 2014
At the beginning, more than 85% of both patients and caregivers wanted the patient to die at home; at the end the numbers dropped to 71% for the patient and to 66% for the caregiver. Another important finding was that the caregiver’s preference for providing home care decreased from 92% at the beginning of illness to 42% when death approached (Agar et al., 2008). A study in the Netherlands explored the experiences of caregivers and the continuous balance of care burden with the capacity to cope (Proot et al., 2003). The authors describe nine factors caregivers needed to balance, and if the balance was not achieved it placed the caregiver at risk for fatigue and burnout. The nine factors were accepting restricted activities, the burden of care, fear, insecurity, loneliness, facing death, lack of emotional support, and the need for practical and information-related support (Proot et al., 2003). These studies support the need to decrease caregiver burden. The field of psychology defines caregiver burden as the “fatigue, stress, and all other psychological symptoms experienced first-hand by parents, siblings, and other family members” (Psychology Dictionary, 2013). The hospice field needs to improve hospice patient and family satisfaction by reducing the stress of caring for someone at EOL. One solution is social media and electronic technology in the home.
Current Social Media and Electronic Technology Usage Personal Domain Usage
An article by Fox and Jones (2009) determined most caregivers get their healthcare information from the Internet. The article discussed key findings in studies concerning caregivers and their online usage: • 44% used the Web to research another’s personal health history; • 26% tried to find someone with similar health concerns; • 28% use social networking sites to get health updates; • 38% consulted review of drugs or medical treatments; • 75% researched a specific disease or medical problem; • 67% of caregivers who have Internet access look online for health information (Fox & Jones, 2009).
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
305
The growing need for informal caregivers validates looking at new and different options in providing caregiver support. According to a 2012 study by the Pew Research Center, 58% of U.S. adults own a cell phone and half of those are smartphones (Pew Internet and American Life Project, 2012). The study also reported the following information concerning smartphones: • In 2010, although the same percentage of U.S. adults owned cell phones only 17% reported using it to access health information; the number in 2012 has increased to 31% of adults accessing health information. • Usage appeals to certain groups of health consumers: caregivers, people with recent medical crisis, and those who have experienced a recent, significant change in their physical health (Pew Internet and American Life Project, 2012). The Internet is used by caregivers not only to search healthcare issues, but also as a way to find support and decrease the feeling of isolation. A survey performed by AgingCare.com found 65% of people caring for elderly parents used the Internet as their primary source of support and encouragement and most of the activity occurred late at night and/or early morning (Sollitto, 2013). Medical Domain Usage
The growth of social media is extending into the healthcare world and the literature suggests it could be beneficial in EOL. It is not uncommon for hospitals, clinics, or private practices to have Facebook pages. With the changing paradigm of healthcare and shorter time frames in which to provide care, there is a need to have other options available. Medical professionals are seeing more patients in less time. The use of social media may allow clinicians to stretch their contact with patients and caregivers, as well as offer a means of providing education and support.
306
Home Healthcare Nurse
Researchers from Johns Hopkins University and the University of Michigan were recently awarded a $1.7 million grant to create an online tool to help dementia caregivers track, treat, and understand the challenging behavioral symptoms of dementia (University of Michigan Health System, 2013). Another online tool is being developed by the insurance company United Healthcare along with Northwestern University and AARP to develop a Web and mobile application to help patients manage their daily medication regiments based on research by the Pew Research Center (Brown, 2012). The Hospice Foundation of America, a notfor-profit foundation, has an open forum on their Web site called “Ask a Question” where individuals may ask pertinent questions answered by a physician (Lamers, 2005). A Web site in Canada, the Canadian Virtual Hospice, has been answering online questions since 2004; in 2009 they answered 1,000 questions and received 25,000 visits a month (Grant & Wiegand, 2011).
How Will Social Media and Electronic Technology Improve Hospice Services? The use of social media will allow hospices to provide more and varied caregiver support 24/7 by alternative avenues other than faceto-face home visits. The expansion of social media and technology could increase the contact time clinicians such as the social workers, dieticians, and spiritual counselors have with the caregivers. Increasing the support from all clinicians may be an important factor in greatly decreasing the risk of caregiver fatigue and burnout. The incorporation of smartphones, Skype, or social media opens the door for clinicians to have face-to-face or instant communication with caregivers. Hospice care is available to patients 24/7, but there is a lag between the call after hours and when the clinician arrives at the home. Being able to provide instant visual connection through FaceTime or Skype can strengthen the support the caregiver needs at vulnerable times. Hospice agencies may provide private online support groups to caregivers who are not able to leave the home. Providing early bereavement support will facilitate the caregiver’s grief journey. Providing online teaching tools on personal care for their loved one could potentially
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
decrease the fear they will do something wrong. Placing evidence-based educational material on a hospice agency’s Web site will provide teaching material that represents the agency’s philosophy of care and which can be accessed at any time. The use of Skype would be more cost-effective compared to purchasing videophones. The ability of the informal caregiver to see a “face” can decrease stress and make after hour calls more efficient and welcome. The ability to “see” the patient could decrease the expense involved with in-home after hour visits made by staff. Skype “visits” may also allow for an expanded role of mid-level healthcare providers in EOL care. It is said if Facebook was a nation it would be the third largest country (Brody & Kipe, 2012). Incorporating Facebook in EOL care would reach those caregivers who could benefit from the perceived support offered by supporters clicking on “likes,” a popular feature of Facebook. Clinicians could encourage the use of Facebook to caregivers as a tool to get support from friends and family. Facebook never closes, allowing the caregiver to look at posts, blog their feelings, or reach out for support.
The Issues of HIPAA and Technology The Health Insurance Portability and Accountability Act (HIPAA) is a federal law providing patients control in regards to their protected health information. This law allows only the patient to release their health information except in healthcare operations. It does allow internal sharing of the information between hospital to physician, from physician to hospital, and payment companies for reimbursement (Hinmon, 2011). How does this affect the use of technology in this new electronic age? The industry is starting to understand the importance of using social media to contact potential and current patients; in 2011, there were more than 900 U.S. hospitals engaging patients through social media (Hinmon, 2011). The plan of action to insure the privacy of the patient is educating the staff in the proper use of social media and technology. The National Council of State of Boards of Nursing has developed a campaign on how to educate nurses in the changing world of social media. Some of the key points to the campaign are to be proactive, develop a policy, and instruct on HIPAA laws (Spector & Kappel, 2012).
vol. 32 • no. 5 • May 2014
The key factor in strengthening the use of social media and technology in hospice is education. With the requirement of electronic medical records, hospitals are already following the mandatory compliance issues. The biggest concern with HIPAA violation and telemedicine is enhancing security. These issues can be overcome by encrypting all communication from the computers so if hacked the hacker cannot read the coded message, digital identity card for remote patients or login passwords, point-of-service computers should be user authenticated, and the computer network should be protected by a firewall (Gaya, n.d.). Beyond the security of the computers the simplest tool to use is the patient/caregiver consent form. Explaining to the patient and the caregiver the optional areas of service that may be provided to them if they choose.
Conclusion The options of electronic technology and social media are readily available to use as tools to enhance the support to caregivers at EOL. As clinicians there is a need to examine new tools to improve care. All types of avenues in providing care and support need to be explored. Technology will make the care not only more available, but faster as well. For the informal caregiver the ability to “connect” to someone is essential in their ability to continue to provide the care in the home to their dying loved one. Tammi Watkins, MSN, APRN, CHPN, is a Hospice Nurse Clinician, Hospice of Olathe Medical Center, Olathe, Kansas. The author declares no conflicts of interest. Address for correspondence: Tammi Watkins, MSN, APRN, CHPN, 2333 W. Piatt Lane, Olathe, KS 66061 ([email protected]). DOI:10.1097/NHH.0000000000000058 REFERENCES
Abutaleb, Y. (2013). Two-fifths of U.S. adults care for sick, elderly relatives. Retrieved from http://www.huffing tonpost.com/2013/06/20/caregivers-adults-care-forelderly-relatives-sandwich-generation_n_3469779. html#slide=more263315 Agar, M., Currow, D. C., Shelby-James, T. M., Plummer, J., Sanderson, C., & Abernethy, A. P. (2008). Preference for place of care and place of death in palliative care: Are these different questions? Palliative Medicine, 22(7), 787-795. doi:10.1177/0269216308092287
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
307
Brody, D. (2010, October 1). Social media: A key component to the psychiatrist’s practice. Psychiatric Times, 29(10), 45. Brown, J. (2012). Plain language initiative supports seniors’ medication management [Supplemental material]. Managed Healthcare Executive, 22(5), 10. Retrieved from http://managedhealthcareexecutive. modernmedicine.com/managed-healthcare-execu tive/news/plain-language-initiative-supports-mtm Collins, L. G., & Swartz, K. (2011). Caregiver care. American Family Physician, 83(11), 1309-1317. Retrieved from http://www.aafp.org/afp/2011/0601/p1309.html Fox, S., & Jones, S. (2009). The impact of online health resources. Retrieved from http://www. pewinternet.org/Reports/2009/8-The-Social-Lifeof-Health-Information/05-The-Impact-of-OnlineHealth-Resources/1-About-one-in-ten-online-healthinquiries-have-a-major-impact.aspx Gaya, J. (n.d.). Telemedicine-enhancing network security to achieve HIPAA compliance. Retrieved from http:// www.ezinearticles.com/?Telemedicine Grant, M. S., & Wiegand, D. L. (2011). Palliative care online: A pilot study on a pancreatic cancer Website. Journal of Palliative Medicine, 14(7), 846-851. doi:10.1089/jpm.2011.0036 Hinmon, D. (2011). Steps#4 understand the rules for a HIPAA-compliant social media strategy. Retrieved from http://www.hivestrategies.com Lamers, W. M., Jr. (2005). Answering questions on a hospice foundation web site: The first five years. Journal of Pain and Palliative Care Pharmacotherapy, 19(2), 37-40. doi:10.1300/J354v19n02_07 National Hospice and Palliative Care Organization. (2012). NHPCO facts and figures: Hospice care in America (Fact sheet). Retrieved from http://www.nhpco.org Pew Internet and American Life Project. (2012). Mobile health 2012. Retrieved from http://www.
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Home Healthcare Nurse
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