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

Goals zDefine nursing’s social role. zDescribe the present and future role of information technology in the practice of nursing zIdentify modifications in nursing practice to capitalize on information technology

Nursing the diagnosis and treatment of human response

Nursing’s Social Responsibility

diagnose and treat human responses

Critical Events in YOUR Nursing Life zThink of an incident during the last 4 days in which you fulfilled nursing’s social role yBe as explicit as possible - time of day, who involved, how you felt zNow -- identify three points in this incident at which information or communication was important zCould you get what you wanted? Express what you had to say? Know what you needed to know?

Informatics needed to support Nursing’s Social Role zIdentify & describe phenomena indicative of the human response y INFORMATICS NEED: Produce a language zDiscover & evaluate therapeutic interventions to treat human responses y INFORMATICS NEED: Create therapeutics Record interventions, Monitor responses zCollaborate with other disciplines to fulfill health care goals yINFORMATICS NEED: Communicate

Information Technology today zPromises almost met yComputer-based patient records xDataRepositories xFormal languages yTelemedicine xRemote access to expertise and consultation xConsumer Health Informatics zThe Challenges ySecurity yAuthentication yThe digital Divide yLegacy 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 zDistributed records management systems yW3EMRs and CareWeb: Web front-end to legacy information systems zAuthentication and Authorization yHealtheon zConsumer Health Informatics yCareLink yCHESS yHeartCare

HeartCare: Meeting the Challenges of CABG Recovery zMonitor, Manage, Mend, Motivate zDemands in the discharge encounter zPatient-centered, tailored information

HeartCare Evaluation Plan zRandomized Field Evaluation y6 Months experimental period y140 adults recovering from CABG surgery zThree Groups yHeartCare: WWW-based recovery support yCHIP, An Audiotape Intervention yUsual Care

The HeartCare Intervention zHome-based Unit: yWebTV(C) box & 19” television zServer supplies: xMonitor & Recovery Information Four periods: Wks 1-2, 3-6, 7-12, & xProfessional & Peer contact

Tailoring Recovery Resources to Patients zEstablishing the tailoring model yPatient Profiles yAccess (TM) database zDelivering WWW resources ‘on-the- fly’, across the recovery period yActive server pages sorting nurse- identified or developed WWW pages

Patient ID Login Is Female Preferred Name DoB DoD Reading Level Information Method Patient Condition Condition Sequence Description Condition Keyword Page Patient’s Menu WWW Knowledge Resources URL Screen Title Male? Female? Reading Level Core CreationDate Title Organization Comments Hcare Menu Name Sequence DaysBegin DaysEnd TimePeriod Tailoring Health Information

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

SMART Patients

z Self-assured z M otivated z A ware z R esourceful z T alented

Remember they may also be: z Scared z M inors! z A nxious z Reluctant z Time consuming

Common behaviors of SMART patients zself triage zvalues and preference clarification zparticipative zcollaborative zindependently engage in health promotion

What they aren’t : zcomplacent zquiet zunchallenging zsimilar

Clinician’s responses to the SMART patient: z engaging z tolerant z dismissive z condescending

The Challenges for Clinicians zUse technology to help make patients SMART zTreat them as a resource zChange our practice activities to capitalize on their talents zReorganize our practice environments

Clinical Practice Issues zHenderson “...what the patient can do...” zRe-examining every action yFind the right balance of workers zTrusting our colleagues zTiming of interventions yWhat must be done now, what should wait for later?

Nursing Roles zContent Expert zEnvision a clinical practice that makes use of the patient as a resource zRe-organize care and care activities to incorporate patients

Constructing a Health Care Delivery System responsive to SMART Patients rests on effective, appropriate IT!

Critical Event, Take II zRecall the event identified earlier yReview the information intensive and communication sensitive elements zCircle those for which today’s presentation suggested a solution zStar one for action on Monday zList at least one IT-related aspect zList at least one System Level aspect zList at least one clinical aspect

Patient-Centered Systems zClinical Records z Network Communication zConsumer Health Informatics

Clinic Hospital Physician Office Pharmacy Furtive Records Dentist Patient-Centered Information Systems

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

zSlides and references will be available on Monday November 1 at