Will Technology Change Our Practice?
To measure blood pressure in 1847, you inserted catheters directly into the artery. To draw blood in 1860, you perforated the skin with 12 small lancets, placed a hot cupping glass over the wound, extracted 3 to 5 oz of blood, and then dressed the wound with lint and plaster. Today, we have automatic noninvasive blood pressure monitors and, in the not so distant future, we will have a technique that will use sound to painlessly extract a number of important molecules through the skin and render the familiar needle prick obsolete. Will technology change nursing practice? It already has and you can bet it will continue to do so.
Technology-broadly defined to include information and communication technologies, biotechnologies, and nanotechnologies-will have a dramatic effect on the way nurses practice and learn. Technological advances will have positive, negative, and unintended consequences on nursing as a profession, as well as on healthcare providers, consumers, healthcare delivery systems, and society. Whether one believes technology is the ultimate bane or the ultimate boon to nursing, it is clearly the ultimate agent for change. This issue will examine issues related to how nursing shapes technology and how technology can and will be used to shape nursing.
In "The Development of a Patient Safety Program Across the Continuum of Care," Sydney Wertenberger, MSN, RN, CNAA and Jessi Wilson, MSW, LCSW examine the value of IT in the homecare venue. Their article describes the HOUSE (Home Operations Utilizing Safety Education) Program, which uses patient assessment, education, and other interventions to adjust the home environment to meet patients' needs. It explains how assessment and education cost-effectively and efficiently link inpatient, ambulatory, and homecare while reducing preventable injuries in a predominantly rural setting-all by using a handheld telephone. This is a perfect example of a simple technological solution to address patient safety issues in the home.
In another example of the value of handheld technology, "The Transforming Effect of Handheld Computers on Nursing Practice," Brent W. Thompson, DNSc, RN, explains how handheld computers have the power to transform nursing care. He points to increasingly decentralized communication, electronic health records, and nurses' greater need for information at the point-of-care as the reasons behind and for this new technology. Access to information at your fingertips allows nurses to practice as knowledge workers. He discusses the effects of handheld resources, calculators, databases, electronic health records, and communication devices on nursing practice and explains why nurse administrators must encourage and promote diffusion of this technology.
Karen L. Courtney, MSN, RN, George Demiris, PhD, and Greg L. Alexander, RN, discuss how information technology (IT) changes not just practice and processes but the actual way in which nurses interact with patients in, "Information Technology: Changing Nursing Processes at the Point-of-Care." They explain how a changing society, an increasingly complex healthcare environment, and the everworsening nursing shortage have created a need for a redesign of the healthcare system. They suggest we view IT as part of that redesign rather than as simply the automation of existing processes and allow it to change nursing processes within institutions, all the way to the point-of-care. To that end, they go on to say nursing can and should actually shape the design of IT. They also present a case study of nurses using IT in homecare.
IT's implications for practice transformation amid the nursing shortage and an aging population-two of the biggest challenges facing US healthcare-are the topics of the next two articles.
In "Cultivating Informatics Competencies in a Community of Practice," Amy J. Barton, PhD, RN, explains why nurses-both new and existing-must become well informed in the use of informatics to provide optimal care to their patients, despite the inadequate number of formal nursing informatics programs that exist across the country. She advocates for incorporation of informatics competencies into nursing curricula both at entry-level and via staff development to ensure a ready workforce. She recommends the use of a community or practice model to facilitate creative faculty development strategies.
In "Aging Well With Smart Technology," authors Penny Cheek, RN, BSN; Linda Nikpour, RN, BSN; and Heather D. Nowlin, RN, BSN discuss aging-in-place, an idea whose time has come as nursing homes become increasingly overburdened by too many patients and too few nurses. They introduce and explain smart home technology, which will make aging-in-place possible.
Amy Peck, RN, discusses what telehealth and telenursing can make possible in "Changing the Face of Standard Nursing Practice Through Telehealth and Telenursing." She delineates benefits and barriers to telehealth ubiquity. She raises such questions as, "How do nurses assimilate important nursing skills and common nursing practices and telehealth and telemedicine?" and "How can nurses simultaneously be relevant in the development of nursing practice and proactive in the development of telehealth and telenursing?"
Finally, "From Tele-ed to Telehealth: The Need for IT Ubiquity in Nursing," attempts to answer some of these questions by exploring IT as a core, intuitive capability for nursing, while Leah L. Curtin, ScD (H), RN, FAAN, explains the ethical implications of it all in, "The Intersection of Nursing, Ethics and Information Technology."
Business writer Tom Peters said, "Today, loving change, tumult, even chaos is a prerequisite for survival, let alone success." We may not have to love chaos, but we certainly must accept it as business as usual in today's world. Technology can help us survive, manage, and be successful in the midst of it.
If nurses are one of the knowledge workers in the healthcare delivery system, they must embrace information and communication technologies as an integral component of their practice. They must stop viewing the use of technology as another task to perform and think about the technology as an enabler to provide safe patient-centered quality care. In this issue, we have presented some of the transformative practice that can occur with information and communication technologies.
-Diane J. Skiba, PhD, FAAN, FACMI
Professor and Project Director, The I-Collaboratory, Partnership in Learning, University of Colorado at Denver and Health Sciences Center Colorado
-Roy L. Simpson, RN,C, CCMA, FNAP, FAAN
Vice President, Nursing Informatics, Cerner Corporation Kansas City, Mo