WEEK 14: THE FUTURE OF NURSING & HEALTH CARE TECHNOLOGY & RESEARCHJoshua Black, Jeffrey Parobechek, & Kelli Wilkinson
Robotics in Surgery Biomechatronics- merges the human with the machine. Expert systems- computer applications that perform tasks otherwise performed by human experts. The thought of using robots is to improve patient outcomes and increase their quality of life. The first surgery that a robot assisted in was in the 1980s. This robot placed a needle into a brain in order to obtain a biopsy.
Robotics in Surgery The next surgery to be assisted with a robot was heart bypass surgery in 1998. The first time a robot performed a surgery on its own was in Italy in 2006. Duke University has been developing 3D technology and an artificial intelligence program in order to create robots that can perform surgeries in dangerous situations and remote locations.
Robots in Diagnostics and Therapy Robots are now being used for cancer treatments. They are known to be more accurate and steady and so are preferred when administering a radiation beam to a tumor. In cardiology, robots are being designed to be inserted into the chest cavity through a small incision giving it access to the heart. This tiny snake-like robot would be able to attach pacemakers, inject medication, and target specific points for cauterization. These surgeries normally require the patient’s lungs to be deflated, decreasing their risk of survival, but with the use of the robot, this will no longer be necessary.
Robots as Direct Care Providers Service robots- robots that provide direct patient care and are becoming more popular. These are especially gaining popularity in the elderly. They can be divided into physical and mental service. Physical service robots are being designed to help the elderly get around the house and assist blind people. Paro, a mental service robot, was designed by a Japanese senior research scientist named Takanori Shibata. Paro can “remember its name and change its behavior based on how it is treated” (Huston, 2010, p. 217).
Robots as Direct Care Providers The amount, or lack of, emotion provided by a robot is something that raises the concerns of health care professionals. It is understood that in this aspect, nurses will never be replaced by robots. Although this is true, a robot intelligence system called, “kansei” meaning “emotion or feeling” was developed. According to Huston (2010), “Kansei robots use vision systems to monitor human expressions, gestures, and body language and voice sensors to pick up on intonation and individual words and sentences” (p. 218).
Biometrics Biometrics- “the science of identifying people through physical characteristics such as fingerprints, hand prints, retinal scans, voice recognition, facial structure, and dynamic signatures” (Huston, 2010, p. 219). This system was created by HIPPA in order to ensure that health care professionals were granted access to only the information they need to perform their jobs. Finger print biometrics are the most common because of “its ease of use, small size, and affordable price” (Huston, 2010, p. 219).
Smart Cards and Smart Objects Smart cards- “credit card-sized devices with a chip, stored memory, and an operating system that record a patient’s entire clinical history” (Huston, 2010, p. 219). The card is offered to patients in order to allow them to access their health information. Smart objects- “are everyday objects injected with easy-to-use software that give devices a degree of intelligence” (Huston, 2010, p. 219). Examples: smart hospital room, smart bed.
Limitation of using robots Lack of tactile feedback- however, the three- dimensional aspect can compensate. Increased cost- while they may cost more money, it is important to keep in mind about the decrease in cost do to the patient’s decrease of time spent in the hospital and time to return to work. The robots also have a high productivity level. A bulky system and limited vaginal access- it is more difficult to access the uterine area with a robot system compared to a laparoscopic system but that issue will hopefully be resolved in the near future.(Akl & Magrina, 2009)
Point of Care Testing Systems that are located on or near the patient to allow for quicker results to allow for more timely decision making and treatment. Some such devices include: Blood Glucose testing Blood Gas Urine Albumin Coagulation test Many other being developed and tested
Point of Care Testing Advantages& Disadvantages Key advantage is results in a timely manner without having to move the patient or draw samples and wait for the turn around time from the laboratory to get the results. The use of POCT also allows for critical decisions to be made in treatment much sooner and improving patient care One of the disadvantages is that some of the devices that have been designed do not produce as accurate results as found in the laboratory which can lead to poor clinical decisions(Green 2010) .
Electronic Health Records Digitized record of patients history from not just one location but many locations and sources combined. Access is available 24 hours a day, 7 days a week for both health care providers but also to patients. Built in safeguards to protect patient health information confidentially and securely.
Eight Core Functions of EHR1. Health information and data.2. Results management3. Order entry/management4. Decision support5. Electronic communication6. Patient support7. Administrative process8. Reporting and population management(Huston, 2009, p. 224)
Electronic Health Record Benefits The ability to integrate computerized physician order entry. Reduce medication errors by the use of electronic medication orders (Shawahna, 2011) The addition of clinical decision support software which would benefits both physician and nursing decisions (Albert 2011). Portability of all health records with availability to allow better decisions to be made by medical staff. Providing a more clear medical history without information being altered or lost in ever interview. Important information like allergy information being available on patients who are unable to communicate that information.
Electronic Health RecordsConcerns The large capital investment to provide the infrastructure for an electronic records system. Cost being prohibitive for small rural hospitals and the creation of a two tiered healthcare system between rural and larger urban areas. Resistance from staff to use the EHR including by nurses(Louise, 2011).
Telehealth and Telenursing Telehealth Telecommunication technologies are used to deliver health- related services or to connect patients and healthcare providers to maximize patients’ health status (McGonigle & Mastrian, 2009). Nelson (2003) Predicted that most health care in the future will essentially be removed from traditional office environments and be provided either virtually through videophones and monitoring equipment or at ambulatory centers in places such as shopping centers and kiosks (Huston, 2010, p. 225).
Telehealth and Telenursing Telenursing Use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse or between any number of nurses (McGonigle & Mastrian, 2009).
Telehealth Benefits Health care provider Lower costs Higher quality care New strategies to deal with health disparities regardless of location Patients Increased flexibility More one on one care(Huston, 2009, p. 226)
Telehealth Benefits Nurses Greater access to patients’ conditions and needs Respond to needs in a more timely manner Have information provided faster than that of a face-to-face interaction Can track patients’ responses to treatment and medications faster Can get information from patient at their home in a comfortable, natural environment Require less time spent on tasks Able to track a patients’ condition more frequently than face- to-face visitation Inexperienced nurses are able to get advice from a more experienced nurse that is able to monitor the patient electronically(McGonigle & Mastrian, 2009)
How Telehealth Works Equipment used for interaction with patients Telephone Computer stations hooked up in the patient’s home Video monitor Moveable color video camera Speakerphone Microphone Medical peripherals Blood pressure and pulse meter, Stethoscope, Pulse oximeter, scale, and glucometer. Data collection by patient Records of heart rates, blood pressures, blood glucose levels, and other diagnostically necessary readings Data transmitted through computer station Gives the patient’s information in real-time(Huston, 2009, p. 226)
Telehealth and TelenursingOutcomes Telehealth Relatively new and research is still determining performance indicators and appropriate measures of quality More research on which approach is most effective is needed to limit barriers. (Huston, 2009, p. 226)
Telehealth and TelenursingOutcomes Telenursing Outcomes determined by patient satisfaction included increased involvement in health care decision making, reduced travel time and expense, increased time with health care providers, improved health care, improved quality of life, and increased medical record data for clinical decision making. Studies have shown positive outcomes of home health nursing in the diagnoses of diabetes, mental health, high-risk pregnancy monitoring, heart failure, other cardiac conditions, and smoking cessation. University of Missouri Sinclair School of Nursing found that the use of telehealth had significantly delayed hospital readmission rates more effectively than traditional care. Prinz et al. suggested that telehealth is not always guaranteed to less expensive for the patient than traditional care because reimbursement from insurance is not guaranteed. (Huston, 2009, p. 226)
Is New Technology Worth theCosts? The rapid introduction of new technologies is a significant factor in high health costs. Studies show that the cost of new technology initially raises costs, but saves money in the long run and reduces the chance of medical errors. It has been shown that the use of more technology leads to better outcomes. Critics argue that the use of new technology is not only expensive, but needs constant upgrades and education is never ending to truly have nurses to be competent in use.(Huston, 2009, p. 227)
Effect of the internet on health care The patient is now more informed about decision making in care rather than being dependent on the providers alone. The “Expert patient” is a patient who is confident, skilled, has information, and knowledge to participate in their own health care. They are more active in decision making. Improves access to information and communications in the health care field. Some providers worry that patients will start to self- diagnose and not get the appropriate care.(Huston, 2009, p. 228)
Nursing informatics Specialty that integrates nursing science, computer science and information science to manage and communicate data, information, and knowledge in nursing practice. Nurse informaticists are typically involved in implementation of the electronic health records. Field is growing and all nurses will need a background in informatics in order to practice.(Huston, 2009, p. 229)
Nursing informatics Future of informatics The Technology Informatics Guiding Education Reform (TIGER) Initiative was developed in 2006 to point out the critical components for enabling nurses to use informatics. 7 components were identified to improve use of informatics and education to provide safer, higher quality care. See the assigned reading on how future nursing educators perceive informatics.(Huston, 2009, p. 229)
Discussion Question Discuss the pros and cons about robots performing surgeries. Would you want a robot to perform surgery on you or a loved one? Talk about how in your clinical experience you have experienced either positives or negatives related to EHR. Also please talk about your observations of the nursing staff’s comments and interactions using the EHR system at their facility. After reading “How do future nursing educators perceive informatics? Advancing the nursing informatics agenda through dialogue” state your opinion on the future of informatics. How do you think informatics has positively and negatively impacted the nursing community? Can you see yourself entering in the field of nursing informatics? Please support your answer with the journal article or your text.
References Akl, M., & Magrina, J. (2009). Will robots transform gynecologic surgery?. Contemporary OB/GYN, 54(9), 26. Albert, B. L., & Huesman, L. (2011). Development of a Modified Early Warning Score Using the Electronic Medical Record. Dimensions Of Critical Care Nursing, 30(5), 283-292. doi:10.1097/DCC.0b013e318227761d Green, J. L., Reifler, L. M., & Heard, K. J. (2010). Validity of a point of care device (Cholestech LDX) to monitor liver enzyme activity (aminotransferase measures) during a clinical trial. Contemporary Clinical Trials, 31(4), 279-282. doi:10.1016/j.cct.2010.04.001 Huston, Carol J. (2009). Professional Issues in Nursing: Challenges and Opportunities (2nd ed.). Philadelphia, PA: Lippincott, Williams and Wilkins. Louise, W., Jaco Van, Z., & Antony S., S. (2011). What Is the Point of the Point-of-Care? A Case Study of User Resistance to an e-Health System. Telemedicine Journal & E-Health, 17(1), 55-61. McGonigle, D. & Mastrian, K. (2009). Nursing informatics: and the Foundation of knowledge. Boston, MA: Jones and Bartlett Publishers Shawahna, R., Rahman, N., Ahmad, M., Debray, M., Yliperttula, M., & Declèves, X. (2011). Electronic prescribing reduces prescribing error in public hospitals. Journal Of Clinical Nursing, 20(21/22), 3233-3245. doi:10.1111/j.1365-2702.2011.03714.x