The Implications of Advancing Technology on the Nursing Care of Older People

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The Implications of Advancing Technology on the Nursing Care of Older People

  1. 1. The Implications of Advancing Technology on Nursing Care and Older People Professor Alison While Dr Guy Dewsbury
  2. 2. 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
  3. 3. 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.
  4. 4. Aims • To determine the potential of eHealth to nursing practice. • To examine the evidence relating to eHealth and nursing
  5. 5. Methods Key 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”
  6. 6. Results Over 750 papers identified - limited empirical papers. Most commentary or opinion papers. Contradictory evidence. Positive • Telemonitoring • Workload decrease Negative • High cost • No benefit • No evidence of user perspective
  7. 7. 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 • Assessment • • Remote assessments and monitoring NHS Direct / NHS 24 • mHealth – – Telemedicine mHealth Telehealth and Telecare Teleconsultations Telephone Triage Video conferencing Support for Long term Conditions – – Whole System Demonstrator pilots Remote assessments and monitoring Telehealth and Telecare – Whole System Demonstrator pilots – Teleconsultations • Contribution to service organisation • • Signposting Internet information and advice – – • Clinical Intervention • • • • • • • Telephone Triage • 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
  8. 8. 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. 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.         Health promotion Telephone, text, email intervention / prompts. Health portals delivering personalized health promotion. Virtual health promotion using webcasts and podcasts. 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.
  9. 9. ICT use in nursing practice Generic practice High ICT use Call centre triage nurse Low ICT use Advanced practice
  10. 10. 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.
  11. 11. 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.
  12. 12. The virtualisation of nursing One to a large number telenursing One to a small number – ward nursing One to one nursing
  13. 13. ICT in healthcare delivery over time
  14. 14. Future of nursing care Remote nursing Remote monitoring Virtual prescriptions Nursing processes Virtual discussions and health promotion Telediagnosis Teleconsultations
  15. 15. The new nursing practice Internet information and advice Promoting selfdirected care New ICT in the workplace eHealth and the nursing process
  16. 16. Context of eHealth • Effectiveness. • User accessibility. • User feasibility.
  17. 17. 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.
  18. 18. 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?
  19. 19. Also… • Older people not homogenous group. • Large variety of skills, attitudes, access to ICT. • NHS not the only suppliers of health information.
  20. 20. And… • Changing work practice. • Training. • Device/software design.
  21. 21. 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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