Virtual Reality
Television, personal computers, and electronic devices have transformed America into a high-tech society. Video instant messaging brings face-to-face communication around the world via computers. Computers have revolutionized American life, and, according to Toeffler, this "third wave" is based on a vision of an information-driven society and is forcing major cultural changes. 1 Health care professionals and their patients have become informaticians. It will not be long before we will have the comfort of physician and advanced practice nurse house calls, albeit electronic, and everyone will have access to health information once declared off limits to consumers. Telematics will become a universal tool as we strive to deliver high-quality care. Just as technology in patient care electronic equipment has provided better quality care capability and informatics has affected all aspects of health care communication, nursing practice has been transformed.
The electronic health record includes wellness and other related information and is maintained through the cooperation between the individual who controls his or her information and the caregiver. Individuals (the baby boomer generation in a technology environment) will maintain all their medical information in addition to behavioral, dietary, drug-related, exercise-related, environmental, and sexual information. They will share this information according to care needs. This will affect the need for nurses and nursing care, much as the present computerized systems-through administrative simplification, the electronic data interchange, and work redesign-have downsized hospital nursing. 2
Recently, the American Academy of Nursing convened an interdisciplinary conference focused on using innovative technology to enhance patient care delivery. Linda Burnes Bolton, DrPH, RN, FAAN, chaired this exciting meeting that gathered nurses, pharmacists, physicians, hospital engineers, and others in Washington, DC, July 12-14, 2002. The purpose of the conference was to begin harnessing the strength of technology in redesigning the practice environment and care delivery system to create a more efficient and effective climate for professional nursing practices. Conference participants supported the establishment of a system that: (1) uses technology to improve productivity through automation; (2) improves medication administration processes; and (3) provides interactive, automatically recorded data at the point of care. As a participant, I was somewhat disappointed that most of the discussion was directed to hospital practices and electronic innovations to enhance patient care. The reality is that our future health care delivery will be provided out of the hospital, and we will most likely have massive intensive care systems as acute care progresses. The rest of care will be provided in homes, assisted living care centers, long-term care facilities for the chronically disabled, and communities, including nurses. Our needs will be for the greatest "virtual reality" in enabling nurses to deliver this care to citizens wherever they may be.
As we pursue this futuristic view of health care, two Nursing Administration Quarterly editorial board members have taken on the leadership for this issue-Joan O'Leary and Alice Vautier. Joan O'Leary, RN, EdD, president and chief executive officer of O'Leary and Associates and a long-time member of the NAQ editorial board, is an administrative consultant with expertise in the management of a complex science center, numerous hospital and university affiliations, and strives for a continuous creation of a professional practice environment in the midst of increasing technology. Alice Forsha Vautier, RN, EdD, is associate administrator, Patient Services, and chief nursing officer, Emory Hospitals, and associate dean, Nell Hodgson Woodruf School of Nursing, Emory University, Atlanta. Her extensive nursing experience includes roles as senior nursing consultant, associate director of nursing, assistant vice president, nursing educator, and staff nurse. Alice brings a sense of integration of technology and patient care to her leadership role at Emory as nursing moves into virtual reality with simulation techniques and distance learning, as well as technological advances in patient care.
Some suggest that, with all this advanced technology, we will not need as many nurses, and the severe shortage of nurses will be mediated by technology use with possible robots. Although the technological environment may reduce the numbers of nurses needed per capita, the kind of nursing practiced is much different; nurses definitely have to analyze, synthesize, and computerize, but still need to be able to catheterize. Our care focus priorities are in constant revision. How do we integrate technology and caring in a manner that will preserve and enhance human dignity, uniqueness, and freedom? Caring is not just what we do; it is who we are. Sometimes nurses think we are the only ones who know how to care. Caring comes in different sizes and kinds from various parts of the world, and, often, from people we hardly know, as evidenced in the worldwide outpouring of caring in response to September 11, 2001. Caring reflects human compassion and support for human conscience to uphold the rights and dignity of all. The challenge for nurses is to respond to the technological environment like a wheel of fortune spinning its opportunities to advance nursing practice to mercurial heights.
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