"Technology-Enhanced Nursing: The Foundation of Patient-Centered Care"

1. Technology-Enhanced Nursing:
The Foundation of
Patient-Centered Care
Patricia Flatley Brennan, RN, PhD
University of Wisconsin-Madison
Madison, WI USA
Support provided by UW Madison, RWJF

2. 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!

3. 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.

4. 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

5. Professionals are
experts in
clinical care
People are
experts in
every-day living

6. 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

7. 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

8. 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
Hildagarde Peplau
1962

9. 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

10. 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.

11. 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

12. A future
 http://youtu.be/jZkHpNnXLB0?hd=1

13. Which of the wonders of glass
will serve nursing best?
1. Thin, portable, 3-D projection tablets
2. Wall-size, fully-interactive
whiteboards
3. Multi-touch interactive table surfaces
4. Gesture-flick interaction control
5. Volumetric capture and 3D rendering

14. A cover for an insulin pump

15. A jacket that illuminates based
on physiological state

16. Pajamas implanted with
cardiac sensors

17. A wearable breast pump
(collection chamber not attached)

18. envisioning technology-enhanced nursing
to support episodes of care AND
the Care between the CARE
January June December

19. Project
HealthDesig
n
Reaching
people in
every day life

20. A Present
www.projecthealthdesign.org
http://bit.ly/TRIur2

21. What do Aaron’s nurses need to
know to protect, promote, etc?
1. The data has left the hospital
2. PC’s are sooooo yesterday
3. Kids are users, too!
4. Information must be actionable
5. There’s no NANDA term for
“skateboard”

22. 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

24. 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

25. 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

26. 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)

27. Personal Health Records

28. Technical Infrastructure

29. 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.

30. Quality Indicators

31. 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

32. 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

33. Creating a learning environment
that supports patient-centered care
Point of Care
Point of Practice
Point of Living

34. Plan a strategy
to leverage
existing nursing educational
efforts to create
technology enhanced
practice.

35. 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

36. 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

37. 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

38. 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!

39. 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

40. Signe Skott Cooper Hall

41. 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

42. Hospital Suite
• 4 Simulation Rooms
• Patient Lift
• Patient Toilet Room
• Nurses station
• Medication Room
• Moulage Room
• Debriefing rooms
• Guest Reception Area

43. Innovations For the Future

44. Creating the
foundation for patient-
centered care
Begin right
NOW!
you
What are going to do?

46. … a patient-
centered
REAL home
become a
tools for
health not
simply a
place for
care

47. discovery.wisc.edu/lel
healthsystems.engr.wisc.edu
www.projecthealthdesign.org