title: Competencies required for nursing telehealth activities: A Delphi-study.
abstract: BACKGROUND
  Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education.
  
  
  METHODS
  In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%.
  
  
  RESULTS
  Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth.
  
  
  CONCLUSIONS
  Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.
authors.affiliation: Research Center for Innovations in Health Care, Faculty of Health Care, Utrecht University of Applied Sciences, The Netherlands. Electronic address: thijs.vanhouwelingen@hu.nl.
authors.forename: Cornelis T M
authors.initials: CT
authors.lastname: van Houwelingen
authors.affiliation: Bachelor of Nursing, Faculty of Health Care, Utrecht University of Applied Sciences, The Netherlands.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Moerman
authors.affiliation: Research Center for Innovations in Health Care, Faculty of Health Care, Utrecht University of Applied Sciences, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Roelof G A
authors.initials: RG
authors.lastname: Ettema
authors.affiliation: Research Center for Innovations in Health Care, Faculty of Health Care, Utrecht University of Applied Sciences, The Netherlands; Eindhoven University of Technology, Department of the Built Environment, Eindhoven, The Netherlands.
authors.forename: Helianthe S M
authors.initials: HS
authors.lastname: Kort
authors.affiliation: Medical Education at University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Olle
authors.initials: O
authors.lastname: Ten Cate
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D032921:Consensus; D003697:Delphi Technique; D004509:Education, Nursing, Continuing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000379:methods*
keywords: Community-dwelling patients; Education; Entrustable professional activities; Healthcare technologies; Home care; Nursing informatics; Technology competencies; eHealth; eSkills