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.