The Influence of Technology on the Nurse's Technical-Clinical- Ethical Training

The Influence of Technology on the Nurse's Technical-Clinical- Ethical Training Margaret Heitkemper, RN, PhD, FAAN Elizabeth Sterling Soule Chair in Nursing Department Chair, Biobehavioral Nursing & Health Informatics University of Washington Seattle, Washington

University School of Nursing Greetings from Dean Azita Emami University of Washington School of Nursing.

University of Washington School of Nursing Programs Bachelor of Science in Nursing (BSN) Accelerated BSN Masters of Science in Clinical Informatics & Technology PhD Nursing Biobehavioral Nursing & Health Informatics Doctorate of Nursing Practice (DNP) Tracts Adult & Older Adult Primary Care Adult & Older Adult Acute Care Pediatric Nurse Practitioner Community Health Psychiatric Nurse Practitioner Midwifery Certificate Programs: infant mental health, palliative care

Catalysts shaping the future Changing demographics Population health Emerging health issues Technology Health system redesign Person-centered care Future of nursing report Interprofessional / Interdisciplinary collaboration Personalized health decision making Higher education reform Globalization Nursing practice Nursing research Nursing education Innovative, Person-centered, evidence-based models of care New RN and APRN roles with full practice authority Team leader/member in interprofessional teams Quality and continuity with improved outcome Enabling technology and systems science in practice Affordable, accessible, high quality and inclusive education Personalized, integrative, and technology-enabled learning Outcomes: creative and critical thinking, ethical and culturally inclusive foundations, team and communication skills, quality and system improvement, lifelong learning Affordable, accessible, high quality and inclusive education Personalized, integrative, and technology-enabled learning Outcomes: creative and critical thinking, ethical and culturally inclusive foundations, team and communication skills, quality and system improvement, lifelong learning Nursing Practice, Research and Education in the West: The Best Is Yet To Come, Young, Bakewell-Sachs, Sarna, Nursing Research 2017

Affordable, accessible, high quality and inclusive education Personalized, integrative, and technologyenabled learning Outcomes: creative and critical thinking, ethical and culturally inclusive foundations, team and communication skills, quality and system improvement, lifelong learning

Social Determinants of Health Age Sex Veteran status Disability County Poverty Lack of education An annual salary of less than 72,000 USD/year (228650.38 Reais is considered low income in Seattle Patient Protection and Affordable Care Act of 2010?

U.S. Regional Health Needs Western U.S. Alaska Arizona California Colorado, Hawaii Idaho Montana Nevada New Mexico Oregon Utah Washington Wyoming Smoking Obesity Physical inactivity Excessive drinking Chronic disease Alzheimer s 5 million Americans Depression 3 rd most common Substance abuse opioid epidemic

Center for Disease Control Obesity is a serious health concern. 2009 2010, >1/3 of adults, (78 million people), were obese ([BMI] 30 kg/m2). 1 out 5 youths (aged 2 19) was obese. Arthritis is the most common cause of disability. Of the 53 million adults with a arthritis, >22 million say they have trouble with their usual activities because of arthritis. Diabetes is the leading cause of kidney failure Lower-limb amputations other than those caused by injury, and new cases of blindness among adults.

Internet of Things (IoT) IoT is the use of devices interconnected through a network to be controlled remotely and link to online info. Nursing: implementation Insufficient technical discussion Differences in terminology Automation of the patient and hospital environment Effectiveness or efficacy in literature Collaboration with Engineering R. Mieronkoski et al. The internet of things for nursing care a scoping review, Intl J Nurs St, 2017

Smartphones In 2015, 100,000 medical applications available online Nursing: primarily use in acute care setting Goals improve patient safety and use of evidence-based practice Enhancement of student-instructor interaction Students state more useful than traditional textbooks Drug references easily accessible Negative perceptions of preceptors and patients

Exemplars of Technology Fall prevention & detection Activity monitoring Decision-making support Tracking (person & system) Periodical clinical reassessment Comprehensive assessment activities Secretion, wetness Hand hygiene Comfort Vital signs Wireless devices, heart rate, blood pressure, respirations Ambient sensors, temperature Triggers Soft sensing mattresses Challenge: algorithms to detect and suggest treatments

Digital Revolution Information overload Which is accurate, relevant Knowledge and skill of faculty technology fellowships (release time) Testing in real time Complex interactions

Home Care of Future

http://cmsdev.u.washington.edu/boundless/nursing-smart-home/

Nursing Education A transformative agenda is needed How to provide clinical experiences to students Clinical placements (number and quality) Simulated patient encounters Objective Structured Clinical Examinations (OSCEs) Began in medicine Use of actors (patients) or faculty/students Short stations and 2 evaluators Reduce variation in assessments knows how not does Advanced Practice students report better preparation for practice.

Ethical Considerations Security system: preserve privacy and trust Data breach Transparency Nursing competence

What do Undergraduate Nursing Students Want? More opportunities for international exchanges Greater emphasis on global health More acute care experiences including ICU and emergency departments Less textbook reading More flexibility (expense, travel time)

Technology Number of materials available to faculty and students Flipped classrooms Shifting the focus to application of content obtained prior to coming to class Virtual reality Simulation Education Innovators Renewed emphasis on Nursing Education Research

Tech-savvy nursing students A study from University of Washington Institute for Leaning & Brain Sciences finds that, when exposed to a computer programming activity 6-year-old girls expressed greater interest ing technology and more positive attitudes about their own skills than girls who didn t try the activity.

Catalysts shaping the future Changing demographics Population health Emerging health issues Technology Health system redesign Person-centered care Interprofessional / Interdisciplinary collaboration Personalized health decision making Higher education reform Globalization Future of nursing report Self management: Emphasis on Motivation/activation Self efficacy

Nursing Education - USA Institute of Medicine (IOM) The need for health care providers and systems to evolve to meet the increasingly complex needs of patients, families, and populations. Competencies: evidence-based practice, informatics, patient-centered care, quality improvement and teamwork and collaborations More nurses with BSN degrees (now 51%) Doubling of nurses with doctorates (8,267 in 2009 to 21, 280 in 2014) Quality and Safety Education for Nurses (QSEN) Quality improvement: quality improvement and safety Integration of these into Undergraduate and Graduate Curriculum On-going curriculum revision.

Current Challenges Are our programs static? Who is making curriculum decisions? Who is giving input? As we tweak or revise curriculum without assessing the current landscape, are the programs becoming fragmented? To date, many programs are content-oriented curriculum does this maximize critical thinking skills?

Faculty Shortage 2000: 24 faculty 2017: 17 faculty, more part time faculty, fewer for committees, work Impact of crisis: retirements New ways of collaboration NEXUS sharing of PhD courses across the nation; students enroll in courses offered through on-line at other universities. Specialty content areas.

NEXUS Future of PhD training

UW SON Learning Center

Diabetes U self management tools n i v e r s i t y Health information technology f W a s h i Cellular and/or automated telephone Internet-based applications Telemedicine telehealth Computer software proams with out internet University of Washington Learning Center -entrance

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Our goal is for the UW SoN to become a national leader in clinical simulation for nursing education. References

Additional skills Leadership Cultural inclusiveness Health disparities Effective communication Collaboration and teamwork Health economics Use off technology in care. Case based learning Competencies Development of the capacity for compassionate and ethical care. Inclusion of other disciplines

Opportunities to Collaborate UW Center for Global Health Nursing IPE: interprofessional education. Research Obrigado!