Nursing meets the Millennium:Future of Nursing in the Information AgePatricia Flatley Brennan, RN, PhD, FAAN

Moehlman Bascom ProfessorSchool of Nursing and College of EngineeringUniversity of Wisconsin-Madison

GoalsDefine nursing’s 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

Nursing

the diagnosis and treatment of human response

Nursing’s Social Responsibility

Nursing’s Social Responsibility

diagnose and treat human responses

Critical Events in YOUR Nursing Life

Think of an incident during the last 4 days in which you fulfilled nursing’s 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?

Informatics needed to support Nursing’s Social RoleIdentify & 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

Information Technology today

Promises almost met Computer-based patient records

DataRepositoriesFormal languages

TelemedicineRemote access to expertise and consultationConsumer Health Informatics

The Challenges Security Authentication The digital Divide Legacy systems

Moving the site of care

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

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

HeartCare: Meeting the Challenges of CABG Recovery

Monitor, Manage, Mend, Motivate

Demands in the discharge encounter

Patient-centered, tailored information

The HeartCare InterventionHome-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

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

Contemporary Health Care rests on a

successful partnership between

Clinicians, Delivery Systems,

and Patients

SMART Patients

SMART Patients

Self-assured Motivated Aware Resourceful Talented

Remember they may also be:

Scared Minors! Anxious Reluctant Time consuming

Common behaviors of SMART patients

self triagevalues and preference clarificationparticipativecollaborativeindependently engage in health

promotion

What they aren’t :

complacentquietunchallengingsimilar

Clinician’s responses to the SMART patient:

engaging tolerant dismissive condescending

The Challenges for Clinicians

Use technology to help make patients SMART

Treat them as a resourceChange our practice activities to

capitalize on their talentsReorganize our practice environments

Clinical Practice Issues

Henderson “...what the patient can do...”

Re-examining every action Find the right balance of workers

Trusting our colleaguesTiming of interventions

What must be done now, what should wait for later?

Nursing Roles

Content ExpertEnvision a clinical practice that

makes use of the patient as a resource

Re-organize care and care activities to incorporate patients

Constructing a Health Care Delivery

System responsive to

SMART Patientsrests on

effective, appropriate IT!

Critical Event, Take II

Recall the event identified earlier Review the information intensive and communication

sensitive elements

Circle those for which today’s presentation suggested a solution

Star one for action on MondayList at least one IT-related aspectList at least one System Level aspectList at least one clinical aspect

Patient-Centered Systems

Clinical Records Network Communication

Consumer Health Informatics

Clinic

Hospital

Physician Office

Pharmacy

FurtiveRecords

Dentist

Patient-Centered Information Systems

Seen any ‘SMART’ patients lately?

...they’re there,

everywhere!

Slides and references will be available on Monday November 1 at

http://heartcare.ie.wisc.edu