+ Recommendations for RN Training for School Telehealth

RNs are the hands of the distant telehealth providers and should be comfortable with examination techniques to be able to use the equipment properly and provide the distant providers with the clinical information needed to determine a diagnosis.

Recommendations from the field, RNs should learn:• The exam process of the distant providers they will be working with (extent

determined by provider and RN as advanced training is required for exams- see resources below)

• How to remove cerumen from ear canals• How to hold the equipment

and• Take time for both the RN and the distant site provider to work in the same

space, practicing with the equipment together• Have a process for CLIA waived lab training and competencies

+ Resources for online training and reference guides:

Physical Exam Guidebook

Seidel’s Physical Examination Handbook, 8e (Seidel, Mosby’s Physical Examination Handbook) (Paperback) by Ball, Dains, Flynn, Solomon and Stewart ISBN: 978-0-323-16953-0 List price: $47.96

Click here to order from Amazon or copy and paste the link into your browser:https://www.amazon.com/gp/offer-listing/0323169538/ref=dp_olp_all_mbc?ie=UTF8&condition=all

Publisher: Elsevier https://evolve.elsevier.com/cs/product/9780323169530?role=student

School Telehealth - Getting Started:

Tip Sheet #5 - Training: Telehealth RNs

School Telehealth Programs use registered nurses (RNs) working under physician standing orders to provide high quality, comprehensive health care to students while they are at school. For care that is needed beyond what a RN can provide, they use specialized video and audio connections to link youth at the school clinic to primary care providers located in a pediatric or school-based health center in their community.

Physical Exam Videos

Heart:

Heart Sounds Made Easy (8:51 min) – https://www.youtube.com/watch?v=EAxYycyclwE • Good visual tour of the anatomy on an plastic thorax model – presenter shows where to listen in relation to the underlying

anatomy

Auscultation of Heart Sounds (6:07 min) – https://www.youtube.com/watch?v=83CBjj9dMRc • Shows placement of bell of stethoscope on a live adult male and includes audio of sounds that may be heard when actually

listening to heart sounds. Shows step by step progression of listening for heart sounds with audio examples.

Heart sounds training website and audio: http://www.easyauscultation.com/heart-sounds

Lungs:

Learn Pediatrics UBC CA – Respiratory Auscultation (1:05 min) - https://vimeo.com/18674367 • Overview of exam components and purpose demonstrated on a child. Each step is explained.

Lung and Thorax Exam (14:33 min) – https://www.youtube.com/watch?v=9yvbsSRlAyY • Jessica Nishikawa, DNP, demonstrates the techniques of the Lung and Thorax assessment on a young adult.

Lung sounds training website and audio: http://www.easyauscultation.com/lung-sounds

Otolaryngology:

Ear examination (3:10 min) - https://www.youtube.com/watch?v=FE0sot4OoAE • Brief narration of how to perform the exam, image of healthy tympanic membrane with anatomy labeled.• Specific tips on holding the otoscope for right and left ears and verbal description of the differences between children and adults

on how to hold and pull on the pinna of the ear to straighten the canal for better viewing.

American Academy of Otolaryngology • Episode 1 – The Ear Exam (10:26 min) - https://www.youtube.com/watch?v=2js72BYjZAw• Thorough overview of external and internal ear anatomy and performance of the otic exam (with advice for pediatric

distinctions) along with explanation of what the clinician might see and what that may indicate. • Episode 2 (12:24 min) – The Oral Cavity and Neck Exam https://www.youtube.com/watch?v=u6Kx8J-9yek• Episode 3 – The Face and Nose Exam (9:06 min) - https://www.youtube.com/watch?v=oNBrUpKAd_U

Abdomen:

Abdominal Exam (12:38 min) – https://www.youtube.com/watch?v=FgcqkU5jOQg • Jessica Nishikawa, DNP, demonstrates some of the techniques of the abdominal exam.

Musculoskeletal:

Paediatric Gait Arms Legs Spine (pGALS) videos for musculoskeletal (MSK) exams UK: • Assessment of musculoskeletal complaints in school-age children (3:44 min) -

http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals/pgals-introduction.aspx• Assessment of gait (1:11 min) -

http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals/pgals-gait.aspx • Assessment of spine (1:14 min) -

http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals/pgals-spine.aspx • Assessment of hands and arms (3:14 min) -

http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals/pgals-arms.aspx • Assessment of feet and legs (2:26 min) -

http://www.arthritisresearchuk.org/health-professionals-and-students/video-resources/pgals/pgals-legs.aspx