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
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
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
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
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
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 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
Tailoring Recovery Resources
to Patients
Establishing the tailoring model
Patient Profiles
Access (TM) database
Delivering WWW resources ‘on-thefly’, across the recovery period
Active server pages sorting nurseidentified 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 triage
values and preference clarification
participative
collaborative
independently engage in health
promotion
What they aren’t :
complacent
quiet
unchallenging
similar
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 resource
Change our practice activities
to capitalize on their talents
Reorganize our practice
environments
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?
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
Constructing a
Health Care Delivery
System
responsive to
SMART Patients
rests 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 Monday
List at least one IT-related aspect
List at least one System Level aspect
List at least one clinical aspect
Patient-Centered
Systems
Clinical Records
 Network
Communication
Consumer Health
Informatics
Patient-Centered Information Systems
Clinic
Physician
Office
Pharmacy
Dentist
Hospital
Furtive
Records
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
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Implications of Information Technology and Consumer