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CRANAplus Fellow Isabelle Skinner on Telehealth’s trajectory

14 Aug 2023

CRANAplus Fellow in Focus Isabelle Skinner, is a nurse midwife turned remote area nurse turned educator. In this summary of her nursing life, Isabelle touches on her passion for telehealth and wound care, particularly in relation to diabetes.

Isabelle, cur­rent­ly Nurs­ing Direc­tor Edu­ca­tion and Research for the Tas­man­ian Health Ser­vice North West, served for a num­ber of years on the CRANAplus Board and has been President. 

She was involved in estab­lish­ing the first REC course and vol­un­teered a lot of time to sup­port the devel­op­ment of the remote health suite of cours­es through the Cen­tre for Remote Health. 

As a fledg­ling nurse, Isabelle was inspired to pur­sue a career in remote nurs­ing in Aus­tralia after vis­it­ing Papua New Guinea where she wit­nessed the chal­lenges faced by com­mu­ni­ties in remote areas. 

I realised then that I want­ed to [be a remote area nurse] in Aus­tralia,” she says, I didn’t need to go over­seas. And that became my dri­ving goal.”

After work­ing in the North­ern Ter­ri­to­ry and north­west West­ern Aus­tralia, where she gained invalu­able expe­ri­ence work­ing with Abo­rig­i­nal health work­ers, Isabelle moved into Abo­rig­i­nal health edu­ca­tion and then high­er edu­ca­tion and set up the nurs­ing pro­gramme at the Notre Dame Uni­ver­si­ty in Broome, pri­or to becom­ing the WA government’s first tele­health coordinator. 

From those ear­ly days she has gone on to have a career as a nurs­ing and mid­wifery aca­d­e­m­ic and senior health leader.

I didn’t even know what tele­health was back then,” she says, list­ing the numer­ous chal­lenges in those ear­ly days of advo­cat­ing this new type of ser­vice: from band­width lim­i­ta­tions and inad­e­quate sys­tems and pro­to­cols to estab­lish reli­able con­nec­tions with spe­cial­ists, to its reluc­tant uptake by the med­ical profession.

Tame by today’s stan­dards, the steps of progress were inno­v­a­tive and ground­break­ing at the time, she says.

I had always been inter­est­ed in wound care for peo­ple liv­ing with dia­betes because of the real­ly poor out­comes, abysmal out­comes actu­al­ly, and very com­plex issues,” Isabelle says. We had to come up with solutions.”

An ini­tial solu­tion to telehealth’s tech­ni­cal chal­lenges was the use of dig­i­tal imag­ing soft­ware. In terms of limb ulcers in peo­ple with dia­betes, it was a case of tak­ing a pho­to and using a 1cm sticky label to cal­i­brate wound images and com­mu­ni­cate through tele­health con­sul­ta­tions to deliv­er effec­tive care remotely.

The uptake of tele­health has been a slow burn, but it’s final­ly pay­ing off,” says Isabelle.

With remote com­mu­ni­ties, the val­ue of tele­health was clear to us who were out there, but when you have five mil­lion peo­ple liv­ing in a city and the view that they can go to a near­by clin­ic, com­pared with 100 peo­ple in a remote com­mu­ni­ty, the small pop­u­la­tion size raised ques­tions about cost-effec­tive­ness and resource allocation.

It took the COVID-19 pan­dem­ic to move tele­health into the main­stream, because peo­ple in the cities couldn’t leave their homes and [realised] that tele­health was valuable.”

Work with a RAN or mid­wife who deserves to be recog­nised for their con­tri­bu­tion to improv­ing remote and iso­lat­ed health care? Nom­i­nate them, or your­self, for CRANAplus Fel­low­ship.