Publication Date

Spring 2020

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Lisa Walker-Vischer

Second Advisor

Teresa Paguio-Palarca

Third Advisor

Eduardo Arvizu


Telehealth, Access, Etiquette, Behavior, Perception


Problem: NP’s must be proficient in the behaviors that are required for a successful patient encounter to provide the full benefit of nurse practitioner (NP) telehealth. Consequently, it is imperative for NPs to understand telehealth etiquette behaviors which include the technical and non-technical skills that are necessary for an effective NP-patient patient telehealth encounter (Haney, Kott & Fowler, 2015). Telehealth has been incorporated into healthcare delivery and its use is expanding. In the United States, it is predicted to be used by seven million patients in 2020 (US Department of Health and Human Services, 2018). Appropriate access to health care is a necessity for the advancement of good health. Some common healthcare impediments are lack of available appointments, clinician shortages, inadequate transportation, and rural geographic challenges. Studies in the literature support the benefit of telehealth for reducing issues of inaccessible healthcare. NP telehealth is proven to improve the health care gap that exists when there is reduced health care access. Yet there is limited telehealth behavior education in the NP curriculum (Henry, Ames, & Vozenilek, 2018). A goal of this descriptive research on the NP perceptions of telehealth etiquette was to explore the research topic of nurse practitioners’ perceptions on telehealth etiquette and actual telehealth etiquette behaviors.

Methods: This is a qualitative, descriptive study to explore perceptions of NPs on telehealth and the phenomenon of telehealth behaviors. Qualitative data on nine nurse practitioner’s perception of telehealth was collected during individual semi-structured interviews. The 10-question interview spanned approximately 30 minutes and was recorded on zoom web-based software. The recordings from the video-audio interviews were transcribed and thematic analysis used to reach data saturation. Data was categorized using content analysis of themes.

Results: All of the study’s NP interview responses were in accord with the theme that telehealth behaviors are unique and are necessary for an effective patient encounter. Responses generated themes to represent etiquette behaviors as a professional skill to be included into nursing education and professional competencies. Themes: 1) Telehealth etiquette specific knowledge base, 2) Telehealth etiquette NP skill competencies, 3) Identification of etiquette behaviors for successful implementation, 4) Evaluation illuminate’s voids where education is needed, 5) Physical assessment can be difficult without touch.

Discussion: Data from the study was categorized into five major themes. The themes that developed from the interview corroborated the assertion that telehealth requires specific training to master specific behavior skills in addition to the technical required learning elements. The response data indicated the NPs perception that telehealth practitioners need telehealth training to learn both the technical and human behaviors that are required for telehealth delivery. Applicable NP educational training on telehealth would benefit patients and the nursing profession. Improvements that contribute to the progress of telehealth are also improvements for patient health care access.


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