Nursing meets the Millennium: Future of Nursing in the Information Age

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Nursing meets the MillenniumFuture of Nursing
in the Information Age

• Patricia Flatley Brennan, RN, PhD, FAAN
• Moehlman Bascom Professor
• School of Nursing and College of Engineering
• University of Wisconsin-Madison

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Goals

• Define nursings social role.
• Describe the present and future role of
  information technology in the practice of nursing
• Identify modifications in nursing practice to
  capitalize on information technology

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Nursing

• the diagnosis and treatment of human response

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Nursings Social Responsibility
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Nursings Social Responsibility

• diagnose and treat human responses

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Critical Events in YOUR Nursing Life

• Think of an incident during the last 4 days in
  which you fulfilled nursings social role
• Be as explicit as possible - time of day, who
  involved, how you felt
• Now -- identify three points in this incident at
  which information or communication was important
• Could you get what you wanted? Express what you
  had to say? Know what you needed to know?

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Informatics needed to support Nursings Social
Role

• Identify describe phenomena indicative of the
  human response
• INFORMATICS NEED Produce a language
• Discover evaluate therapeutic interventions to
  treat human responses
• INFORMATICS NEED Create therapeutics Record
  interventions, Monitor responses
• Collaborate with other disciplines to fulfill
  health care goals
• INFORMATICS NEED Communicate

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Information Technology today

• Promises almost met
• Computer-based patient records
• DataRepositories
• Formal languages
• Telemedicine
• Remote access to expertise and consultation
• Consumer Health Informatics
• The Challenges
• Security
• Authentication
• The digital Divide
• Legacy systems

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Moving the site of care
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On the horizon...

• Integration of different data types, with
  particular emphasis on time-variant data
• Intelligent agents and meta-data that support
  efficient use of knowledge resources (text,
  images, sound)
• Merging of public health and personal health data
• Re-engineering of clinical practice to capitalize
  on informatics advances

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Promising (ie, not yet here)IT Applications

• Distributed records management systems
• W3EMRs and CareWeb Web front-end to legacy
  information systems
• Authentication and Authorization
• Healtheon
• Consumer Health Informatics
• CareLink
• CHESS
• HeartCare

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HeartCare Meeting the Challenges of CABG
Recovery

• Monitor, Manage, Mend, Motivate
• Demands in the discharge encounter
• Patient-centered, tailored information

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HeartCare Evaluation Plan

• Randomized Field Evaluation
• 6 Months experimental period
• 140 adults recovering from CABG surgery
• Three Groups
• HeartCare WWW-based recovery support
• CHIP, An Audiotape Intervention
• Usual Care

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The HeartCare Intervention

• Home-based Unit
• WebTV(C) box 19 television
• Server supplies
• Monitor Recovery Information
• Four periods Wks 1-2, 3-6, 7-12, 13-26
• Professional Peer contact

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Tailoring Recovery Resources to Patients

• Establishing the tailoring model
• Patient Profiles
• Access (TM) database
• Delivering WWW resources on-the-fly, across
  the recovery period
• Active server pages sorting nurse-identified or
  developed WWW pages

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Tailoring Health Information
Patient ID Login Is Female Preferred
Name DoB DoD Reading Level Information Method
Condition Condition Condition
Sequence Description
Patient Condition
Condition Keyword
WWW Knowledge Resources URL Screen
Title Male? Female? Reading Level Core CreationDat
e Title Organization Comments
Keyword
Keyword Page
Hcare Menu Name Sequence DaysBegin DaysEnd TimePer
iod
Patients Menu
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Contemporary Health Care rests on a successful
partnership between Clinicians, Delivery
Systems,and Patients
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SMART Patients
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SMART Patients

• Self-assured
• Motivated
• Aware
• Resourceful
• Talented

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Remember they may also be

• Scared
• Minors!
• Anxious
• Reluctant
• Time consuming

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Common behaviors of SMART patients

• self triage
• values and preference clarification
• participative
• collaborative
• independently engage in health promotion

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What they arent

• complacent
• quiet
• unchallenging
• similar

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Clinicians responses to the SMART patient

• engaging
• tolerant
• dismissive
• condescending

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The Challenges for Clinicians

• Use technology to help make patients SMART
• Treat them as a resource
• Change our practice activities to capitalize on
  their talents
• Reorganize our practice environments

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Clinical Practice Issues

• Henderson ...what the patient can do...
• Re-examining every action
• Find the right balance of workers
• Trusting our colleagues
• Timing of interventions
• What must be done now, what should wait for later?

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Nursing Roles

• Content Expert
• Envision a clinical practice that makes use of
  the patient as a resource
• Re-organize care and care activities to
  incorporate patients

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Constructing a Health Care Delivery System
responsive to SMART Patientsrests on
effective, appropriate IT!
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Critical Event, Take II

• Recall the event identified earlier
• Review the information intensive and
  communication sensitive elements
• Circle those for which todays presentation
  suggested a solution
• Star one for action on Monday
• List at least one IT-related aspect
• List at least one System Level aspect
• List at least one clinical aspect

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Patient-Centered Systems

• Clinical Records
• Network Communication
• Consumer Health Informatics

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Patient-Centered Information Systems
Clinic
Physician Office
Computer-based Patient Record
Pharmacy
Dentist
Furtive Records
Consumer Health Information
Hospital
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Seen any SMART patients lately?

• ...theyre there,
• everywhere!

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• Slides and references will be available on Monday
  November 1 athttp//heartcare.ie.wisc.edu