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Technology-Enhanced Nursing: The Foundation of
Patient-Centered Care
Patricia Flatley Brennan, RN, PhD
University of Wisconsin-MadisonMadison, WI USA
Support provided by UW Madison, RWJF
achieving the audacious goal of health for all lies in
increasing the alignment between the
practice of nursing & the technologies
that support it, record it, and extend nursing’s reach into
the every-day lives of patients
academic nursing can make this happen!
Objectives for the day
1. Critically appraise the emerging technologies for their ability to achieve patient centered care.
2. Enumerate three policy agenda items related to technology enhanced practice that could benefit from greater input by schools and colleges of nursing.
3. Plan a strategy to leverage existing nursing educational efforts to create technology enhanced practice.
Patient centered, person-centered, individualized….
Recognizing Patients’ Health Problems as They See Them …knowing what problems are rather than what the diagnosis is (Starfield, 2011).
Clinical encounters reflect life-course Focus on health concerns & diseases as interrelated phenomena
Coding systems allow for specifications of people’s health concerns
Professionals are experts in clinical care
People are experts in every-day
living
Wisdom and guidance for assessing technologies in
support of patient-centered care
Automation must be guided by the overall purpose or mission of the nursing profession
A “prepared mind” (is necessary) to facilitate more interspecialty communications between various fields
The work of nursing and the work of NURSES IS NOT ONE AND THE SAME THING
The changes are such that the past offers no guides
for the future Cybernation should be studied from the
standpoint of how it fits or doesn’t fit into nursing’s purpose
Foremost in the nurse (__)’s broad framework when considering automated devices which they will select or help design is a belief in human dignity and man’s continuing personal development
Hildagarde Peplau1962
Now is the time for nurses to stop and take a look, to consider the clues
to large-scale automation to our society,
and to bring to bear their individual and collective judgments on
the profession’s stands relative to this phenomenon
And in 1996, Hilda said…Nursing has made great progress from
being an occupation to becoming a profession
in the 20th century. As the 21st Century approaches,
further progress will be reported & recorded in Cyberspace –
the Internet being one conduit for that. Linking nurses and
their information & knowledge across borders – around the world –
will surely advance the profession of nursing much more rapidly
in the next century. Used with Permission, Cheryl Forchuk UWO
So… Let’s explore a few technologies
remembering…
Nursing is the protection, promotion, and optimization of health and abilities,
prevention of illness and injury, alleviation of suffering
through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations.
So… Let’s explore a few technologies
remembering…The guidance lies within the definition…
Will the technology help nurses protect, promote, optimize
health & abilities, prevent illness & injury,
and alleviate suffering by aiding in the diagnosis and treatment of human
response and advocacy for all?
A future
http://youtu.be/jZkHpNnXLB0?hd=1
Which of the wonders of glass will serve nursing
best?
1. Thin, portable, 3-D projection tablets2. Wall-size, fully-interactive
whiteboards3. Multi-touch interactive table surfaces4. Gesture-flick interaction control5. Volumetric capture and 3D rendering
A cover for an insulin pump
A jacket that illuminates based on physiological
state
Pajamas implanted with cardiac sensors
A wearable breast pump (collection chamber not attached)
envisioning technology-enhanced nursing to support episodes of care
AND the Care between the CARE
January June December
Project HealthDesi
gn
Reaching people in every day
life
A Present
www.projecthealthdesign.org
http://bit.ly/TRIur2
What do Aaron’s nurses need to know to protect,
promote, etc?
1. The data has left the hospital 2. PC’s are sooooo yesterday3. Kids are users, too!4. Information must be actionable5. There’s no NANDA term for
“skateboard”
What is the role of academic nursing?
Accelerate knowledge development and transmission
Attend to BOTH the work of nursing and the work of nurses!
Use our power and status to ensure that public policies promote patient centered care through technology-enhanced nursing
Create a learning environment that fosters innovation and imagination
Policy Action – enabling technology-enhance
practice
Enumerate three policy agenda items
related to technology enhanced practice that could benefit from greater
input by academic nursing
Policy: the actualization of our mandate to advocate for all
Issues on the table:• Personal health records and a
patient’s abilities to access and control their health information
• Technical infrastructure to support patient centered care, everywhere
• Quality indicators, reported by patients, that help establish the cost and accountability for care
Making nursing’s voice heard in public policy:
public comment
Personal health records: Federal Register (http://www.ofr.gov)
Technical infrastructure: Regulations.gov
Quality Indicators: Patient-reported outcomes National Quality Forum
(www.qualityforum.org)
Personal Health Records
Technical Infrastructure
4.9 GHz Band The Fifth FNPRM seeks comment on various
issues relating to the 4.9 GHz band, including the relationship between the 4.9 GHz band and the 700 MHz public safety broadband network, which will be administered by the First Responder Network Authority (FirstNet), a newly formed independent authority within the National Telecommunications and Information Administration.
Quality Indicators
This is NOT just a technology/informatics concern…The policies that matter … matter to the
patients of all nurses
For example, Meaningful Use Medicaid: All clinicians who meet the criteria can
receive incentive payments Medicare: Nurse Practitioners and Midwives are
excluded from participation
Thus, what appears to be a policy issue related to Electronic Health Records can affect the care of ALL patients!
Up next week … EHR performance quality and test bed
The opportunities for public commentary will continue to
arise
The collective voice of academic nursing, applied to the challenge of patient centered care, holds enormous power
Must be a priority for leadership, but an accountability for the entire program Gov’t affairs, communications, faculty, associations
Set aside ONE HOUR A WEEK for policy – local, state, national – read, discuss, establish coalitions, prepare commentary
Creating a learning environment that supports
patient-centered care
Point of CarePoint of PracticePoint of Living
Plan a strategy to leverage
existing nursing educational efforts to create
technology enhanced practice.
Planning a strategy
Integrate, don’t assign Leverage partnerships Ensure that every initiative contributes
towards the future of patient centered care through technology enhanced practice
Create a learning environment that drives and rewards innovation
Integrate, don’t assign
Technology-enhanced practice is a clinical nursing challenge, not an informatics problem
Help faculty groups review syllabi for points of leverage: critical care – PHRs to support transitions Leadership – investigate job descriptions
for informatics expectations
Leverage Partnerships There’s really too much work to do. Ok. Patient centered care provides a rallying point for
interprofessional education Not just health sciences, but engineering, business,
architecture, law
Figuring out strategic partners for mutual impact acceleration Student, school, institution, profession
Within organizations, across practice, between institutions
Ensure that every initiative contributes towards the future of patient centered
care through technology enhanced practice
Establish a shared understanding of patient centered care
Mindfully explore the division, school or college’s willingness to forego old models for new approaches
Critically appraise recruitment, development and curriculum efforts for consistency
Recognize we are building practice models, not computer systems!
Create a learning environment that drives and
rewards innovation
Balance assessment skills with innovation ability It’s the difference between precision and exploration A culture of success-failure cycles is needed
Guide faculty and staff in the transition from knowing that and performing how towards envisioning what
Create learning environments that foster discovery
Signe Skott Cooper Hall
Center for Technology-Enhanced Nursing
•6 Exam Rooms•2 Physical Assessment Labs•4 Clinical Skills Labs
•Home Health Lab•Living Environments Lab “The Cave”•E-Nurse Space•Storage & Break out spaces
Hospital Suite• 4 Simulation Rooms• Patient Lift• Patient Toilet Room
• Nurses station• Medication Room• Moulage Room• Debriefing rooms• Guest Reception Area
Innovations For the Future
Creating the foundation for
patient-centered care
Begin right NOW!
What are you going to do?
… a patient-centered REAL homebecome a tools for health not simply a place for care
discovery.wisc.edu/lelhealthsystems.engr.wisc.eduwww.projecthealthdesign.org