Palliative Care Process for Patient with Chronic Disease using Online Media Telenursing

The Covid-19 pandemic has become a worldwide concern due to the outbreak that continues to spread and takes many victims, especially in Indonesia (Indonesian Covid-19 Handling Commission, 2021). This pandemic has had a negative impact on every aspect of the economy, social and culture, education, defense and security, and the main focus is the health sector. Covid-19 has brought challenges to health workers, in terms of providing nursing care and their work environment. Health services that are not ready to deal with COVID-19 have caused an increase in cases in Indonesia (Azwar & Setiati, 2020). 

However, the challenge of providing palliative care to patients with chronic diseases is still not a major concern. Whereas patients with a diagnosis of chronic disease are patients who have a high risk of being infected with the Covid-19 virus. Nurses must be able to ensure that patients with chronic diseases continue to receive optimal care, although on the other hand they must also maintain and provide nursing care to patients who are positive for Covid-19 in order to improve their quality of life. Therefore, changing the way of service in order to protect patients must be a separate focus.

According to WHO (World Health Organization) palliative care is an approach to improving the quality of life of patients and their families dealing with problems related to life-threatening illness, through the prevention and cessation of suffering through early identification, assessment and optimal treatment of pain and other problems, physical, psychosocial and spiritual. The goal of palliative care is to reduce the suffering of patients, improve their quality of life, and provide support to their families.

That is why, the above is the background for the author to conduct a literature review on the impact of Covid 19 on palliative services for chronic disease patients and the work environment in the nursing work unit. In addition to the above, there are also reasons that strengthen why during the Covid-19 pandemic, chronic disease patients still get palliative services that are not optimal, namely due to the lack of manpower and the availability of personal protective equipment in the nursing area during the pandemic.

In addition, people's fear of going to health facilities is one of the reasons that support them not to go to health facilities. This happens because in the community's mindset, someone who comes to a health facility is very vulnerable to contracting Covid-19. Therefore, nurses must be able to adapt quickly to changes and provide optimal nursing services by not forgetting to protect themselves from cross-infection.

Along with the development of the times, especially in this 4.0 era, along with increasingly easy access to information technology, it is used in the health sphere to help answer all existing health problems. This is also seen as an opportunity to improve the quality of nursing care and increase the reach of nursing services, especially for people throughout Indonesia, including people in remote and remote areas (Scotia, 2014). 

Nurses must be able to think creatively in providing nursing care by collaborating on highly sophisticated technology. One of the innovations in providing technology-based health services is telenursing. Telenursing is a component of telehealth where nurses meet the basic needs of clients by using communication information technology and web-based systems remotely. Telenursing is defined as a fusion of telecommunication and nursing services whenever there is substantial physical distance between nurses or between patients and nurses (Amudha, Nalini, Alamelu, Badrinath, & Sharma, 2017).

Technologies that can be used in telenursing vary widely, including: telephone, personal digital assistants, smartphones, facsimile machines, tablets, computers, internet, video and audio conferencing, teleradiology and computer information systems. 

The forms of telenursing can be in the form of triage telenursing, call-center services, consultation through a secure email messaging system, counseling through hotline services, audio or videoconferencing between patients and health workers or with fellow health workers, discharge planning telenursing, home-visit telenursing and development websites as information centers and real-time counseling for patients (Coach, 2015). 

The growth of telenursing is currently categorized as very fast in many countries due to several influencing factors, namely the achievement of cheaper health care costs, an increase in the number of elderly and chronic disease populations, and an increase in health care coverage for long distances such as in rural, small or populated areas. rarely. Telenursing coverage in care is through the use of telephones for health services and orientation (Souza et al., 2019).

Telenursing is able to be a solution for nurses in providing palliative services to patients with chronic diseases during this pandemic. The application of telenursing in providing nursing services will increase client satisfaction and increase active family participation, especially in the palliative care process. Telenursing can help solve the shortage of nurses, shortage of wards due to being filled with Covid-19 patients, reduce and maintain distance, visit times and look after patients who have been discharged from the hospital (Padila et al., 2018).