Presented by Karen V. Duhamel, RN, MS, CCM

1

THE LEARNER WILL…. Gain a historical perspective on noted technological innovations by nurses from 1850 to present

Consider how modern technologies have enhanced care delivery

Reflect on the pros and cons of technology in nursing, the ethical implications and technological needs voiced by nurses

Gain a greater understanding of who’s pushing for technology in nursing and what is Nursing Informatics

Consider future technological trends in nursing

2

3

According to Merriman-Webster’s Dictionary (2009):

<medical technology> b : a capability given by the practical application of knowledge

-What does technology mean to you in your work setting?

4

5

Nursing from 1850 to 1900 concerned with providing care to physical needs of patient and maintaining a hygienic environment

Some nursing inventions and innovations during this time:bedpans, bandages; surgical splints, nursing bottle; hospital bed prototype; foot cradles; abdominal, uterine and breast supports; invalid chair; portable tub wheeled to bedside; syringe; safety pin; diapers; improvements to stethoscope (invented in 1816 by M.D.); medicine spoon and vial holder, etc.

Proliferation of hospitals began around 1870 which coincided withfirst formally trained nurses

6

Nursing the equipment” according to Sandelowski (1997) became the emphasis of nursing care since WWII

In the 1950’s to 1960’s, technological advancements involving new medicines (particularly antibiotics), IV therapy, and administration of blood products became available

From 1965 to 1980, machines of all kinds – from dialysis to cardiac monitors to fetal monitors and automatic recording devices; Hospice created (1967)

From 1980’s to present, technological advancements include: computers in healthcare, safer medication administration and patient safety monitoring devices; EMRs/EHRs; wireless charting devices; robotic assistants; clinical decision-making tools and telehealth services

7

More inventions and innovations by nurses 1990’s to present:

1990’s: Burns Wean Assessment Protocol/Program (BWAP) to wean patients off ventilators; Perioperative nurse invents Omni-Jug for drainage of arthroscopic fluid, the Puddle Guppy that aspirates fluid from hospital floors and the Aqua-Box that disinfects fluid waste prior to sewage disposal; blood draw protector called Med Search Hand Guard ( or hemoshield); Bath-Bag; Bili-Bonnet

2000’s: eMAR medication bar coding; Cardibra for female post-op cardiac patients;

8

Wireless devices: PDAs, Hand-held Computers, Smart phones

Real-time equipment and supplies location systems

Delivery robots for interdepartmental services, such as meal delivery, hospital lab deliveries, laundry services

Workflow management systems such as automated census boards

9

Wireless patient monitoring systems for prevention of falls

Electronic medication administration with bar coding

Electronic clinical documentation with clinical decision support capability

Interactive patient systems: a digital platform for two-way communication and delivery of multimedia content at the bedside to assist in rendering care and educating patients

10

PC-based simulations; i.e., Healthstream software

Virtual Patient Simulation

Task Trainers

Human Patient Simulation; i.e., Simman, Simbaby

Standardized Patients (SP)

Integrative systems

11

12

According to Dr. Carol Bickford of the ANA (2005), nurses want tools that help with patient-centered care including:

Stronger collaboration between manufacturers and nurses when designing tools for care delivery

Better software integration; i.e., biometric fingerprinting/eye-scanning of nursing personnel, to save time and numerous log-ons/log-offs

Charting devices that allow for the telling of each patient’s “story” of care instead of individual system updates; i.e., a “whole person” view

Continued emphasis on self-directed learning through Web-based training programs

The Best of Information Technology (IT): intuitive interfaces, wireless connectivity, seamless integration of software applications and the ability to access data when and where it is needed

13

PROS CONS

14

Potential breaches in confidentiality via phone, fax and emails-HIPAA violations can be up to 6 digit dollar amounts depending on severity of violation

Tele-health nursing: duty to care and patient abandonment-occurs once you start a professional relationship with the patient

Patient education materials from credible websites; i.e., MedlinePlus; WebMD; MayoClinic, etc.

The nurse must “uphold the overall well-being of the patient and advocate for the patient, not the technology” (Drought & Liaschenko, 1995)

15

The American Association of Colleges of Nursing (2002) recommended incorporation of technology into nursing education

The Institute of Medicine (2003) named five core competencies needed by health professionals, one of which is Informatics competency

The Australian Nursing Federation (2005) recommended Information Technology and Information Management Systems be incorporated into all lifelong learning opportunities for nurses

16

“It’s using data to translate into information to make decisions when providing patient care”

-Professor Maria Pietrantuono University of Hartford (2009)

17

Innovators: venturesome, eager to try new things

Early Adopters: role models in their departments; usually the first to “buy-in” to new technology; become the“Subject Matter Experts” on their units

Early Majority: adopt new ideas just before the masses

Late Majority: skeptics; require intense communication to learn new technologies

Laggards: very last to change; distrust change

18

HIGH MEMBERSHIP PROVIDER LIST

Provider ID PPO HMO TOTAL Provider Region Specialty State Zip code77623XXXX 112 0 112 Jabe, MD SW FP TX 1234522930XXXX 339 64 403 Dan, MD SW FP TX 1234522924XXXX 159 19 178 Maureen, MD SW FP TX 1234543663XXXX 106 0 106 Mark, MD SW IM TX 1234531786XXXX 33 3 36 Fort, MD SW FP TX 1234533245XXXX 69 1 70 Fran, MD SW FP TX 1234572500XXXX 39 0 39 Kyle, MD SW IM TX 1234521720XXXX 252 93 345 Joe, MD SW FP TX 12345

HOW I USE INFORMATICS IN MY JOB:

19

PATIENT HEALTH QUESTIONNAIRE-9 (PHQ-9)

-Medical questionnaire consisting of 9 questions that address various symptoms related to Depression per the DSM-IV-TR

-Patient’s response to each question is scored from 0 (absence of symptom) to 3 (prevalence of symptom). Total scores for each rating are tallied for Total PHQ9 score

-Scoring grid on form indicating absence to severity of Depression

-Medical provider has option of referring patient into telephonic case management for medication/treatment plan compliance

-Status reports faxed to provider after each contact with patient

20

ALCOHOL/DRUG ABUSE SCREENING PROGRAM

21

FORECASTED SEVERITY

8.542 October 20098.130 September 20098.175 August 2009

HEALTH PROFILE CONDITIONS

1.Depression 45% Benefit Usage2.Migraines 43% Benefit Usage3.Gastritis 12% Benefit Usage

PHARMACY PROFILECelexa 20mgs qd Last filled October 20, 2009Replax 40mgs qd Last filled October 20, 2009Nexium 1 tab qd Last filled October 20, 2009

LAB PROFILEService Start Date: October 20, 2009Laboratory Test: Hgb/HctLaboratory Results: 14.8/38.6Laboratory Abnormal Results: N/A

HEALTH RISK ASSESSMENT

22

TRANSLATES INTO….

23

Sources: NIDA and NIAAA (1998); Journal of Clinical Psychology 1993;54(11) pp. 405-426

24

25

Nursing inventions and innovations in context to time period

Technology in nursing today focused on improving patient safety and care delivery outcomes

Nurses want the best technology that makes sense for them and is geared towards their specific care needs

Technology in nursing has pros/cons and ethical implications

Nursing Informatics = gathering and translating data into improving patient care

Future technology in nursing will become more computer-based andautomated

26

27

Barnard, A.& Locsin, R. (2007). Technology and nursing: Practice, concepts and issues. In A. Barnard and R. Locsin(Eds.). Houndmills, Basingstocke, Hampshire, United Kingdom: Palgrave Macmillan.

Drought, T.S. & Liaschenko, J. (1995). Ethical practice in a technological age. Critical Care Nursing Clinics of North America, 7(2), 297-304. Hiestand, W. (2000). Think different: Inventions and innovations by nurses, 1850-1950. The American Journal of Nursing, Vol. 100, No. 10,100th Anniversary Issue(Oct 2000), pp.72-77.

Medical technology (2009). In P. B. Gove & H.B. Woolf (Eds.), Merriam-Webster's Collegiate® Dictionary, Eleventh Edition. Springfield, MA. Retrieved from Internet November 12, 2009.

Sandelowski, M. (1997). Making the best of things: Technology in American nursing, 1870-1940. Nursing History Review 5 (1997), pp. 3-22.

YouTube video (2008, June 5). Did you know? [Video file]. Retrieved from http://www.youtube.com/watch?v=KRFRrJlicgE.

YouTube video (2008, March 10). Microsoft’s future vision: Healthcare. [Video file]. Retrieved fromhttp://www.youtube.com/watch?v=V35Kv6-ZNGA&feature=PlayList&p=13AD60E168A30822&playnext=1&playnext_from=PL&index=7.

U.S. Dept of Commerce Patent and Trademark office (1999). Buttons to biotech: 1996 update report with supplemental data from 1998, U.S. patenting by women, 1976 to 1996. (Feb 1999).

28