This chapter discusses emerging technologies and their impact on knowledge generation in nursing. It outlines the history of technology development and informatics applications. Some current technologies are described like decision support systems and wireless sensors. The chapter predicts continued technological advancement and discusses how this may change the role of nurses and overload providers with information. Communities of practice and e-portfolios are presented as ways to manage knowledge. The future is uncertain but technologies may make knowledge more accessible and ubiquitous.

1. Chapter 28
Emerging
Technologies and
the Generation
of Knowledge

2. Objectives
• Outline the history of technology
development and informatics applications.
• Describe some of the state of the art
technologies of today.
• Predict the evolution of technology and its
impact on knowledge generation in nursing.

3. Thoughts About the Future
• We envisage a future with a high degree of continuing
technological development and general worldwide
economic growth, and an absence of some of the
possibilities that might bring much of our global
infrastructure crashing down around our ears.
• We assume there will not be widespread global social
breakdown, the predicted possible pandemics of avian and
swine influenza, and other problems, will not happen, or
catastrophic climate change will not produce as rapid
effects as the worst prognostications suggest. However, we
are aware many of these things could happen, to some
degree or other.
• We do know that change is coming, and much of it is far
enough advanced as to be virtually unavoidable.

4. Looking Back From the Future
• Visions of societies of the future, both utopias
and dystopias, have been produced by many
people.
• The future will be on us more rapidly than
many expect, and, as nurse informaticians, we
need to be at least aware of, if not directly
involved in determining, the many new
emerging technologies and their possibilities
for use within our domains of interest and
practice.

5. Historical Overview
• From the early 1900s through the 1950s, a number of
hardware developments emerged with respect to
computing
– Colossus
– Mark I
– Electronic Numerical Integrator and Computer (ENIAC)
– Universal Automatic Computer (UNIVAC).
• Technology applications “exploded” in the 1990s with
the advent of increasingly sophisticated hardware,
software, cheaper memory and speed, and the
decreased cost of digital computer technology.

6. Historical Overview
• This shift of information access, acquisition, and
interpretation, for both provider and patient, may
result in overload in terms of content and
comprehension.
• Managing this overload will increasingly consume
both providers and patients.
• How this issue will be managed is of great
concern whether by an increased use of
technology or a regression away from technology.

7. Some technologies we have today
• Computerized decision support systems
• Wireless speech recognition and touch screen triage
support systems in emergency departments in Taiwan
• Nurse-managed telehealth services in United Kingdom
dermatology clinics
• Use of open-source software for development of Web-
based nursing informatics education in Germany
• Nurse-led development of a personal health record
system in the United States
• Demonstrated uses of wireless biomedical sensors for
invasive monitoring in Norway

8. What Will Affect the Future
• Among the key issues that emerged from the discussions that are
important for the international nursing informatics community to
explore in coming years were:
– The development of the concept, and a possible model, of u-nursing
(ubiquitous nursing), which, as well as having implications for the
practice of nursing, also has profound implications for all aspects of
the education and continuing professional development of nurses
– The role of the nurse changing to become more of a knowledge
professional, working in partnership with the patients and their other
caregivers
– The continuing growth of patient informatics, perhaps as a growth and
evolution of the current concept of consumer health informatics, and
with the increasing centrality of the patient as the controlling force in
the whole enterprise
– The vast impact that genomics will have on all aspects of life, and in
particular health care

9. Some Emerging Technologies
and other Issues that will
Impact Nursing and Health Care
• Information and communications technologies
• Clinical Decision support systems
• Nanotechnology
• Beyond Web 2.0
• ePortfoilios
• Communities of practice

10. Communities of Practice (CoP)
Wenger (n.d.) defines a CoP: “Communities of
practice are groups of people who share a
concern or a passion for something they do
and learn how to do it better as they interact
regularly" (¶1).

11. Communities of Practice (CoP)
Nursing is a profession that is particularly suited to
the development of CoPs, especially in light of the
new knowledge generated and disseminated every
day. The many nursing List-Servs are evidence of the
growing practice of sharing knowledge in a CoP.
Caring, a nursing informatics organization, has a very
active List-Serv where members post questions to
other members and request information and
experiences related to informatics.

12. E-Portfolio for
Professional Development
• To support professional networking involves a
predetermined and focused purpose
• Fosters better communication between
oneself and a mentor
• Establish how what a nurse is doing fits into
the goals of the institution or perhaps an
institution for which the individual would like
to work.

13. Professional E-Portfolio
is evidence based and uses this evidence to
make a case that highlights one’s capacity to
not only perform but also grow and develop
professionally within one’s chosen field.

14. E-Portfolio Process
4 steps involved in developing an e-portfolio are
recursive in nature in that during the process one
can backtrack to fill in missing pieces or
reevaluate earlier decisions that were made

15. 4 Steps
1. Collect
2. Select
3. Reflect
4. Connect

16. A Technology Wish List
1. The kind of computer interface used in the film Minority Report: no
mouse, no keyboard, just gesture-based interactions with virtual
images projected into a vertical space at head height.
2. Ubiquity of computational devices to the extent that conversation
and discussion of these devices will disappear from everyday social
interactions – the technology will be transparent or invisible.
3. The ability to access information when and where we want it,
irrespective of modality thereby maximizing mobility and other
personal resources. This may lead to cell phones becoming the main
avenue of access for more than text messages, speech, and video
clips. Knowledge acquisition and utilization will then become
ubiquitous and pervasive; new work roles will emerge to cope with
this new and different technology.

17. Summary
• We know that the future will be different; however, it is
likely that, in the foreseeable future, let us say the next
10–15 years, many of the changes that are likely to
occur are already in development or will be
extrapolations of current developments and trends.
There is always, however, the possibility of new
developments, or unexpected consequences, of the
development of emerging technologies.
• In an ideal world, we would like to see solutions to see
the development of easy to use tools for nurses to
manage the coming knowledge “explosion” as more
information becomes available to support diagnosis,
treatment, and care.

18. Thought Provoking Questions
• This chapter raises several important issues related to
nursing knowledge, not the least of which might be the
uniqueness of nursing knowledge. Is this uniqueness
requisite for future care by nurses or nursing
informatics specialists?
• Given that the future is relatively unpredictable, what
might be said regarding what can be predicted and to
what degree of certainty?
• Will the new tools and technologies that nurses might
use to manage the “knowledge explosion” be sufficient
on their own, and how will they need to interact with
human factors?

19. Thought Provoking Questions
• What would be the top five pieces of evidence that you
would select to be featured in your own portfolio? Why
did you select these pieces of evidence? What was it
about them that made you think they would represent
who you are?
• Some institutions that require students to develop e-
portfolios as a part of their program of study also may
use this evidence of student learning to evaluate the -
program quality or generate evidence for accreditation
reports. What do you think should be the driving
purpose behind requiring e-portfolios—professional
development planning or institutional evaluation?
What are the merits of each approach?