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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