the implications of advancing technology on the nursing care of older people
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The Implications of Advancing Technology on Nursing Care and Older People
Professor Alison While
Dr Guy Dewsbury
Context of healthcare
Current and future issues
• Less nurses
• Less doctors
• Less money
• Better informed patients
• Increased patient expectations
• Growing older population
• Growing population with long
term conditions
Possible solutions
Growing older population
• United Nations Department of Economic
and Social Affairs/Population Division
(2004).
• World Health Organisation (2003)
• US Statistical Office (Kinsella & He,
2009)
• Department of Health (2008) High
quality care for all.
Aims
• To determine the potential of eHealth to
nursing practice.
• To examine the evidence relating to
eHealth and nursing
MethodsKey terms for literature search:
• “eHealth”
• “mHealth”
• “telecare”
• “telehealth”
• “EPR” and “electronic patient record”
• “EHR” and “electronic health record”
• “telenursing”
• “electronic health”
• “technology and health”
• “health information systems” and “HIS”
Results
Positive
• Telemonitoring
• Workload decrease
Negative
• High cost
• No benefit
• No evidence of user
perspective
Over 750 papers identified - limited empirical papers.
Most commentary or opinion papers.
Contradictory evidence.
eHealth mapping• Health Promotion
• Self purchase
• Promoting self care
– NHS Midlife Check
– NHS Direct / NHS 24 / NHS Choices
– intelihealth.com
– National Institute for Health
• Individual or groups
– Longevity of change
– Participation
– Nudging and Incentivisation
– Role of information
– Support
• Clinical Intervention• Telemedicine
• mHealth
• Telehealth and Telecare
• Teleconsultations
• Telephone Triage
• Video conferencing
• Support for Long term Conditions
– Whole System Demonstrator pilots
– Remote assessments and monitoring
• Assessment
• Remote assessments and monitoring
• NHS Direct / NHS 24
– Telephone Triage
• mHealth
– Telehealth and Telecare
– Whole System Demonstrator pilots
– Teleconsultations
• Contribution to service organisation
• Signposting
• Internet information and advice
– Health portals
– Google Health
– Microsoft Health Vault
– Web based interventions
– Specific Health promotion sites
– Healthfinder.gov
– Web MD
– NHS Direct / NHS 24 / NHS Choices
– BBC health
– Patient UK
– Bespoke web information sites
• New Technologies in the workplace
– Secure broadband networking
– Electronic Health Record EHR /EMR
– Electronic Patient Record EPR
– Electronic appointment booking
– Electronic prescription service
– Picture archiving
– Communication systems
– Quality management and analysis systems
– Internal and external email systems
ICT and potential applications to nursing practice
Assessment Remote signposting including contact
with health care professionals or other agency.
Telephone triage. Telemonitoring. Internet self-assessment. Portable mHealth. Mobile apps for clinical monitoring.
Health promotion Telephone, text, email intervention /
prompts. Health portals delivering personalized
health promotion. Virtual health promotion using
webcasts and podcasts.
Clinical Intervention Remote consultations (may include
MDT). Remote titration of therapy including
prescriptions where needed. Remote psychological therapies e.g.
motivational interviewing, CBT. Remote carer support.
Service organisation Electronic health records (electronic
patient records). Care pathway management. Care systems governance (audits etc). Professional clinical networks
(discussion boards etc.). e- CPD for professionals.
Generic
practice
Advanced
practice
High ICT use
Low ICT use
Call centre
triage nurse
ICT use in nursing
practice
EPR and EHR• Uslu & Strausberg (2008) clear economic benefits
associated with the use of EPR in their literature
review
• de Veer & Franke (2010) 685 Dutch nurses held a
generally –ve view of EPR due to perceived
increased admin tasks especially where lack of
familiarity with the use of EPR
• Successful implementation of EPR requires:
recognition of existing work routines, training needs of
staff plus promotion of the benefits to both staff and
patients.
Managing LTC
• Remote monitoring of vital signs.
• Progress management of conditions.
• Promoting self-care.
• Providing signposting.
• Gate-keeping to other services.
• More data needed to increase evidence
base.
The virtualisation of nursing
One to a large number -telenursing
One to a small number – ward
nursing
One to one nursing
ICT in healthcare delivery over time
Future of nursing care
Nursing processes
Remote nursing
Remote monitoring
Virtual discussions and health promotion
Teleconsultations
Telediagnosis
Virtual prescriptions
The new nursing practice
eHealth and the nursing process
Promoting self-
directed care
Internet information and advice
New ICT in the
workplace
Context of eHealth
• Effectiveness.
• User accessibility.
• User feasibility.
Benefits of eHealth
Nurse
• More accurate data to
deliver evidence-based
nursing.
• Ability to care for many
more people.
• Greater information
sharing.
• Less travel and time
consuming paperwork.
Older or disabled person
• More opportunity to
manage own condition.
• Greater ability to
understand and find out
medical information.
• Ability to see and share
health information with
friends and family.
• Ability to remain at home.
Key issues
• How do older/disabled people use
technology to support and maintain their
own health?
• Will older/disabled people be able to
embrace new technologies to support
themselves?
• How can nurses increase ICT usage in
their professional practice?
Also…
• Older people not homogenous group.
• Large variety of skills, attitudes, access
to ICT.
• NHS not the only suppliers of health
information.
And…
• Changing work practice.
• Training.
• Device/software design.
Conclusion• Nurses are largest workforce of
healthcare delivery system.
• Future of healthcare systems depends
upon efficiencies and effective use of
limited resources.
• Nurses need to embrace new ICT.
• But we need to mitigate negative effects
on older/disabled patients.
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