Telemedicine is the use of medical information exchanged from one site to another through electronic communications to improve a patient’s clinical health status. “Tele” is a Greek word meaning “distance and “mederi” is a Latin word meaning “to heal”. Time magazine called Telemedicine “healing by wire”. Hence Telemedicine refers to the use of communications and information technologies for the delivery of care. Telemedicine is an open and constantly evolving science, as it incorporates new advancements in technology and responds and adapts to the changing health needs and contexts of societies.

The state of Himachal Pradesh is a mountain State with hilly and treacherous terrain. Health care needs in mountainous, remote and isolated areas with rugged terrain face a lot of challenges. The Government had envisaged overcoming these challenges using Telemedicine as a tool to enable quality health care service delivery to the population. The government has launched eSanjeevani app for allowing Telemedicine in the country to digitally connect patients with doctors.

Telemedicine can lower healthcare costs, drive up efficiency and revenue, provide better access to healthcare services to patients and ultimately get happier, healthier patients who stay in your organization. Telemedicine can open up many treatment doors, but it is not the same as a brick and mortar doctor office. If someone prefer a more personal or face-to-face relationship, Telemedicine might not be the option for them.

Objectives

• To assess the level of knowledge regarding Telemedicine among students of B.Sc. Nursing 3^rd and 4^th year of S.N.G.N.C, I.G.M.C, Shimla (H.P.)

• To develop and administer a Structured Teaching Programme on knowledge regarding Telemedicine among students of B.Sc. Nursing 3^rd and 4^th year of S.N.G.N.C, I.G.M.C, Shimla (H.P.)

• To assess the effectiveness of Structured Teaching Programme on knowledge regarding Telemedicine among the students of B.Sc. Nursing 3^rd and 4^th year of S.N.G.N.C., I.G.M.C, Shimla

To determine the association of posttest knowledge with selected socio-demographic variables regarding Telemedicine among B.Sc. Nursing 3^rd year and 4^th year students.

• Research Approach: Quantitative approach 

• Research Design: Pre-experimental (one group pre-test post test) design 

• Setting of the Study: Sister Nivedita Government Nursing College, Indira Gandhi Medical College, Shimla (H.P)

• Study Population: Students of B.Sc. Nursing 3^rd and 4^th year

• Sample Size: About 60 students of B.Sc. Nursing 3^rd and 4^th year

• Sampling Technique: Convenient sampling technique

• Informed Consent: Was taken from the students and confidentiality was maintained

Inclusion Criteria

Students of B.Sc. Nursing 3^rd and 4^th year, who are studying in S.N.G.N.C, I.G.M.C, Shimla, H.P, students who are willing to participate and students who are present at the time of study.

Exclusion Criteria

Students who are not willing to participate in the study and students who are not present at the time of study.

Development of Tool

A self-structured knowledge questionnaire was constructed to assess the knowledge related to Telemedicine among students of B.Sc. Nursing 3^rd and 4^th year. The tool was developed after extensive review of literature, expert’s opinion and researchers own experience to increase the knowledge students regarding Telemedicine. The self-structured knowledge questionnaire was divided into two parts:

• Part I: It deals with demographic variables such as age, academic year, educational qualification, previous knowledge, source of information, workshop/seminar attended, existence of Telemedicine unit nearby and session attended in Telemedicine department regarding Telemedicine.

• Part II: It consists of self-structured knowledge questionnaire regarding Telemedicine

Validity of tool- by the experts in this field

Permission: Obtained from the concerned authorities.

The collected data is tabulated, analyzed, organized and presented under the following headings:

• Section I: Findings related to classification of socio-demographic variables in terms of frequency and percentage
• Section II: Findings related to pre-test knowledge score of B.Sc. Nursing 3^rd year and 4^th year students regarding Telemedicine
• Section III: Findings related to post-test knowledge score of B.Sc. Nursing 3^rd year and 4^th year students regarding Telemedicine

• Section IV: Findings related to the effectiveness of Structured Teaching Programme regarding Telemedicine

• Section V: Findings related to association of post-test knowledge regarding Telemedicine among students of B.Sc. Nursing 3^rd year and 4^th year with selected socio- demographic variables

Section I: Findings Related to Classification of Socio-Demographic Variables in Terms of Frequency and Percentage 

The data represented in the Table 1 revealed that maximum number of students 48(80.0%) were in the age group of >20-23 years followed by 10 (16.7%) were in the age group of 18-20 years and 2(3.3%) study subjects were from age group of >23.As per academic year, equal study subjects were taken from B.Sc. Nursing 3rd year and 4th year i.e. 30 (50%). With regard to educational status, majority 59 (98.3%) of the students were 10+2 and only 1(1.7%) student was graduate and none of them under “others” i.e.0 (0%). As per monthly income, 34(56.7%) students having family income more than 20,000, 20(33.3%) were having income RS 10001-20,000, 5 (8.3%) were having income RS 5001-10,000 and only 1(1.7%) were having income less than 5000. Maximum number of the students 37(61.7%) had no previous knowledge regarding Telemedicine whereas 23(38.3%) had some previous knowledge regarding Telemedicine.  As per source of information, 11(18.3%) students had information form internet, 7 (11.7%) students had information from clinical experience in hospital, equal study subjects had information from journal and TV respectively i.e. 2(3.3%), 1(1.7%) had information from other sources and none of the student had information from magazines and newspaper.Out of 60 students, 59(98.3%) students had not attended any seminar/workshop regarding Telemedicine whereas 1(1.7%) student had attended seminar/workshop regarding Telemedicine. Majority of the students 38(63.3%) knows that there is Telemedicine unit nearby them whereas 22 (36.7%) does not have any knowledge about any Telemedicine unit near them. Majority of the students 59(98.3%) had not attended any session in Telemedicine department whereas 1(1.7%) student has attended session in Telemedicine department.

Table 1: Frequency and Percentage Distribution of Characteristics of Selected Socio-Demographic Variables

Table 2:  Frequency and Percentage Distribution of Pre-Test Knowledge Score of Students of B.Sc. Nursing 3^rd Year and 4^th Year according to their Level of Knowledge Regarding Telemedicine

Table 3: Frequency and Percentage Distribution of Post-Test Knowledge Score of Students of B.Sc. Nursing 3^rd Year and 4^th Year according to their Level of Knowledge Regarding Telemedicine

Table 4: Frequency and Percentage Distribution of Pre-Test and Post Test Knowledge Scores of the Students of B.Sc. Nursing 3^rd Year and 4^th Year Regarding Telemedicine

Table 5: Descriptive Statistics Findings on Effectiveness of Structured Teaching Programme Regarding Telemedicine

*Significance Level 0.05

Section II: Findings Related to Pre-Test Knowledge Score of B.Sc. Nursing 3^rd Year and 4^th Year Students Regarding Telemedicine

Table 2 depicts that in pre-test score, 4 (6.7%) of students had poor knowledge, 55(91.7%) students had average knowledge and only 1(1.7%) student had good knowledge regarding Telemedicine.

Section III: Findings Related to Post-Test Knowledge Score of B.Sc. Nursing 3^rd Year and 4^th Year Students Regarding Telemedicine

Table 3 shows post-test knowledge score, none of sample falls in poor category. 15 (25%) were having average knowledge and 45(75%) of the sample having good knowledge regarding Telemedicine.

Section IV: Findings Related to the Effectiveness of Structured Teaching Programme Regarding Telemedicine

Table 4 shows that in pre-test score, 4 (6.7%) students had poor knowledge, 55(91.7%) students had average knowledge and only 1(1.7%) had good knowledge regarding Telemedicine. 

Post-test knowledge score, none of sample falls in poor category. About 15 (25%) were having average knowledge and 45(75%) of the sample having good knowledge regarding Telemedicine. Hence after the introduction of Structured Teaching Programme, knowledge score increased.

Table 5 shows that by using paired t-test, it was found that there is a significant change in post-test knowledge score of samples. The pre-test and post-test mean score for knowledge regarding Telemedicine were 15.1 and 21.7 respectively. Standard deviation for pre-test and post-test was 3.007 and 2.702 respectively. Range for pre-test was 7-22 and for post-test it was 15-27. Mean difference was 6.600. Paired t-test value was 20.404 and table value was 2.00 at a level of significance level 0.05. The calculated t-test value was more than table value which shows significance. Hence it was revealed that Structured Teaching Programme was effective in increasing the knowledge of students. Hence H₁ was accepted.

Section V: Findings Related to Association of Post-Test Knowledge Regarding Telemedicine among Students of B.Sc. Nursing 3^rd Year and 4^th Year with Selected Socio- Demographic Variables

Findings shows that there is no significance association between the score level and demographic variables (age, academic year, educational qualification, previous knowledge, source of information, workshop/seminar attended and existence of Telemedicine unit nearby and session attended in Telemedicine department. The calculated chi-square values were more than the table value at the 0.05 level of significance. Hence H₂ was rejected.

On the basis of findings of present study, the following conclusion was drawn:

• The pre-test knowledge score of students was 50.30% and post-test knowledge score of students was 72.30%. There was significant difference (6.600) in pre-test and post-test knowledge of B.Sc. Nursing 3^rd year and 4^th students after giving structured teaching program

• The knowledge of students was not appropriate before administration of structured teaching program but after the administration of structured teaching program the knowledge of students increased gradually which means that the intervention   given   to    the students    was effective.

 Therefore, it was concluded that a brief structured teaching programme is an effective intervention for improving knowledge regarding Telemedicine 

Recommendations for the Future Studies

A similar study can be conducted in different setting at a large scale. A study can be done to assess the attitude and perception of nursing students towards Telemedicine. A quasi-experimental study can be conducted to assess the knowledge of students. A similar study can be replicated on large sample to draw more definite conclusions. A similar study can be conducted on nursing staff and also among rural population.

Ethical Consideration

Approval from the ethical and research committee of Sister Nivedita Govt. Nursing College Shimla and ethical committee of IGMC was taken to conduct the research study. Permission for data collection was obtained from the Principal of Sister Nivedita Govt. Nursing College, IGMC, Shimla.

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