Paper presented at ICADI 2010

1. The Implications of Advancing
Technology on Nursing Care
and Older People
Professor Alison While
Dr Guy Dewsbury

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. 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. Aims
• To determine the potential of eHealth to
nursing practice.
• To examine the evidence relating to
eHealth and nursing

5. Methods
Key terms for literature search:
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“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. 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. eHealth mapping
• Health Promotion
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Self purchase
Promoting self care
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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
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•
Remote assessments and monitoring
NHS Direct / NHS 24
•
mHealth
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Telemedicine
mHealth
Telehealth and Telecare
Teleconsultations
Telephone Triage
Video conferencing
Support for Long term Conditions
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Whole System Demonstrator pilots
Remote assessments and monitoring
Telehealth and Telecare
– Whole System Demonstrator pilots
– Teleconsultations
• Contribution to service organisation
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Signposting
Internet information and advice
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• Clinical Intervention
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Telephone Triage
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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
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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. ICT and potential applications to
nursing practice
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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.
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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. ICT use in nursing
practice
Generic
practice
High ICT use
Call centre
triage nurse
Low ICT use
Advanced
practice

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. 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. The virtualisation of
nursing
One to a large number telenursing
One to a small
number – ward
nursing
One to one
nursing

13. ICT in healthcare delivery
over time

14. Future of nursing care
Remote
nursing
Remote
monitoring
Virtual
prescriptions
Nursing
processes
Virtual
discussions
and health
promotion
Telediagnosis
Teleconsultations

15. The new nursing practice
Internet
information
and advice
Promoting
selfdirected
care
New ICT in
the
workplace
eHealth
and the
nursing
process

16. Context of eHealth
• Effectiveness.
• User accessibility.
• User feasibility.

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. 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. Also…
• Older people not homogenous group.
• Large variety of skills, attitudes, access
to ICT.
• NHS not the only suppliers of health
information.

20. And…
• Changing work practice.
• Training.
• Device/software design.

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.