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

1. Nursing meets the Millennium:Future 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

2. Goals • Define 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

3. Nursing the diagnosis and treatment of human response

4. Nursing’s Social Responsibility

5. Nursing’s Social Responsibility diagnose and treat human responses

6. 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?

7. Informatics needed to support Nursing’s 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

8. 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

10. Moving the site of care

11. 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

12. 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

13. HeartCare: Meeting the Challenges of CABG Recovery • Monitor, Manage, Mend, Motivate • Demands in the discharge encounter • Patient-centered, tailored information

14. 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

15. 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

20. Contemporary Health Care rests on a successful partnership between Clinicians, Delivery Systems,and Patients

21. SMART Patients

22. SMART Patients • Self-assured • Motivated • Aware • Resourceful • Talented

23. Remember they may also be: • Scared • Minors! • Anxious • Reluctant • Time consuming

24. Common behaviors of SMART patients • self triage • values and preference clarification • participative • collaborative • independently engage in health promotion

25. What they aren’t : • complacent • quiet • unchallenging • similar

26. Clinician’s responses to the SMART patient: • engaging • tolerant • dismissive • condescending

27. 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

28. 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?

29. 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

30. Constructing a Health Care Delivery System responsive to SMART Patientsrests on effective, appropriate IT!

31. 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 Monday • List at least one IT-related aspect • List at least one System Level aspect • List at least one clinical aspect

32. Patient-Centered Systems • Clinical Records • Network Communication • Consumer Health Informatics

33. Patient-Centered Information Systems Clinic Physician Office Computer-based Patient Record Pharmacy Dentist Furtive Records Consumer Health Information Hospital

34. Seen any ‘SMART’ patients lately? ...they’re there, everywhere!

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