International Journal of Research Studies in Medical and Health Sciences Volume 5, Issue 12, 2020, PP 8-15 ISSN : 2456-6373

Information Technology in Nursing

Siniša Franjić Independent Researcher, Croatia. *Corresponding Author: Siniša Franjić, Independent Researcher, Croatia.

ABSTRACT Modern medicine has developed dynamically and rapidly. Its rapid improvement puts this branch of science in the most advanced positions of world science and new innovative trends. Undoubtedly, this is directly related to the social aspect of medicine. Every day and every hour, innovations in medicine are increasingly affecting the quality of life of the population of planet Earth. Today, modern innovative technologies restore the health to a large number of patients every day. Keywords: Nursing, Medicine, Health, Technology

INTRODUCTION The use of technology in health care has increased dramatically over the past several We are in the midst of an information revolution years [2]. Nurses now use electronic charting to in modern society that is transforming the ways document the care they are providing to their that we communicate and organize information patients. The information they record can be [1]. Nowhere is the adoption of new information accessed by the rest of the health-care team to technologies more evident than in the delivery make decisions regarding care. Having the of care and the promotion of health. There has ability to access patient information at any point been a rapid growth in the development and use of care improves communication among of new health information technologies, such as providers and allows for care to be provided in a electronic medical records, online support groups, more timely manner. Telehealth is a and the omnipresent availability of health sophisticated way to use technology to improve information via specialized web sites. E-health diagnosis and treatment of health conditions. It encompasses a range of overlapping disciplines allows individuals to receive medical and that relate to the application of information, nursing services from distant geographic computer and communication technology to the regions. Telehealth providers can remotely delivery of health care and the promotion of interview a patient, review an x-ray or health. laboratory tests, or suggest treatments and E-health communication strategies include, but procedures. This technology includes devices to are not limited to, health information on the remind patients to take medications, provides Internet, computer assisted learning, online Web-based video office calls, and provides support groups, online collaborative communities, equipment that can monitor a person‘s vital information tailored by computer technologies, signs at home and send electronic results to the computer-controlled in-home telephone doctor‘s office. counseling, biometric assessment and TELEHEALTH transmission, and patient–provider e-mail Telehealth is the provision of health services at contact. Each of these e-health technologies has a distance using a range of digital technologies the potential for helping to promote pain and mobile technologies [3]. This can be to management to the extent that they can provide promote self-care, for example, to enable a consumers with relevant information to increase patient to monitor their own vital signs such as understanding of their pain experience, help blood pressure, or from a monitoring consumers explore different strategies for perspective, physiological data could be reducing their experience of pain, coordinate the transferred to a remote monitoring centre to delivery of effective and timely palliative care, allow for health professionals to intervene if and provide consumers with needed social measurements fall outside of expected support. parameters. The RCN (Royal College of

International Journal of Research Studies in Medical and Health Sciences V5 ● I12 ● 2020 8 Information Technology in Nursing

Nursing) suggests telehealth is not a new informatics. These nurses know how to apply IT technology or branch of health care, but should to enhance their clinical skills and work with be integrated within existing healthcare nurses across the healthcare continuum to infrastructures. The services could involve integrate nursing science, computer technology, consultation, patient monitoring, diagnosis, and information science resulting in improved prescriptions or treatment and can be done in communication, documentation, and efficiency. real time or delayed through media such as Possessing knowledge in these three areas teleconferencing, videoconferencing or the positions nurse informaticists to lead the Internet. It should be a targeted approach to development of an emerging concept in enhance service delivery focused around the healthcare—―clinical intelligence‖ (CI). service user, enabling a more efficient and Telenursing is also a nursing specialty and is effective use of clinical resources. slowly making its way into community nursing The ability for someone to monitor a critically courses [2]. The newest trends in telehealth ill patient from another site has created the focus on the patient in order to provide patient opportunity to develop what is being called the care in patients‘ homes instead of the provider‘s electronic ICU (eICU) [4]. The eICU includes setting. A simple example of a licensed practical both monitoring equipment and video cameras nurse (LPN) using telenursing occurs when an connected to a separate monitoring center. In the order is requested and received via text or e- monitoring center, an expert ICU nurse assumes mail. Another example of telenursing is an LPN the role of overseeing the electronic monitoring in a physician‘s office who coaches a patient of patients, analyzing data, and recognizing with a chronic condition over the phone. A more patterns. The eICU nurse uses the video monitor in-depth example of telenursing is an LPN who to view a patient as well as review monitor is physically in a remote location with a patient information. The bedside nurse manages the and is able to attach monitoring equipment to direct care of two or three patients. The eICU the patient for a physician in another location to nurse communicates with the bedside nurse to monitor that patient‘s disease or condition. alert that individual to problems that occur and These types of telenursing allow for more may initiate calling a physician if necessary. frequent contact, frequent monitoring of Working together, the bedside nurse and the compliance, and identifying potential problems eICU nurse form a strong team to ensure that the before they occur. It also tends to eliminate patient receives optimum care. unnecessary visits, emergency room visits, and some hospitalizations. It is cost effective and is The nurse‘s role in the care of the patient has starting to be recognized for reimbursement by evolved, and with that has come a change in the insurance companies and Medicare. The biggest way nurses think about and use technology to stumbling blocks to this technology currently improve healthcare delivery [5]. Every nurse are reimbursement, research, legal, and today needs to be proficient in collecting and technical issues. Can you imagine the impact reviewing data and information related to their this kind of care is currently having in allowing patients. The clinical practice requirements for for follow-up appointments for veterans and in nursing promote the development of skill sets providing health care in disaster areas? Imagine important for informatics practice. The nursing the impact it could have on overall health process of assessment, problem identification, promotion and on our nation‘s current mental and care planning, combined with how nurses health care crisis. The use of telehealth has the set priorities and always evaluate, prepare potential to revolutionize many areas of health nurses to be early adopters and to employ and care by reaching more patients in a timely and adapt the ―systems life cycle‖ approach for effective manner. delivering informatics projects. Telenursing is a relatively young field; Project management—a vital skill in managing consequently, further long-term studies with IT projects by establishing timelines, regard to legal issues, cost, and safety are milestones, task dependencies, and resources— required before the technology can be integrated is more easily grasped by clinicians who have into the mainstream health-care system [6]. worked in areas of care requiring constant Telenursing services are not going away, but the priority setting and evaluation, such as field is evolving. As with many young emergency or critical care. disciplines, telenursing seems to redefine itself A nurse professionally trained in informatics is on a fairly regular basis – changing to meet the part of a greater discipline of healthcare demand of managing more and larger

9 International Journal of Research Studies in Medical and Health Sciences V5 ● I12 ● 2020 Information Technology in Nursing specialties. Telenursing is growing worldwide Components of Electronic Health Records must annually, due, in large part, to the approval of evaluate their care settings to ensure that the procedures. In addition, given better acceptance placement of hardware devices for accessing the among nurses, physicians, hospitals, and EHR is supportive of the nurses, providers, and patients, this growth will likely increase. It must all other health care professionals‘ workflows. be noted that the growth of telenursing will directly support and help the growth of nursing, MODERN MEDICINE because telenursing is, of course, an integral part The power of modern medicine thus rests on its of nursing. causal efficaciousness without the need for a concordance of belief between healer and EHR patient [8]. As a result, in the modern concept of Electronic communication and electronic the therapeutic, truth is displaced as a value and connectivity is an essential component to any the patient‘s autonomous agency is electronic system, including EHRs (Electronic marginalized. The patient does not need to Health Records)[7]. The electronic connectivity believe, understand, or know, because modern is the ability for a health care organization to medicine operates outside the sphere of support the use of an EHR through the use of communal or personal validation, relying Internet access and in some cases phone lines instead on scientific knowledge to treat disease. (e.g., if using mobile devices). The connectivity The modern concept of the therapeutic thus has also includes the information technology (IT) little need for widespread social understanding infrastructure to support the users of the EHR or support, relying instead on a narrower and and other electronic information systems. The specialized scientific standard of truth. infrastructure includes hardware and software Specialized scientific knowledge rather than a technologies, physical space for the hardware, communal system of belief is pivotal. Of course, financial resources, and information technology one might object that this scientific standard of professionals with the expertise to support the truth is itself socially accepted. That is certainly electronic connectivity infrastructure within a true, but the acceptance is predicated on a global health care organization. The size of the health and mostly blind faith in scientific progress and care organization will have an impact on the technology rather than on an understanding of size of the IT infrastructure. Electronic even key scientific concepts and acceptance of communication could be represented as scientific beliefs. The acceptance of science is electronic mail or messaging through the EHR. thus predicated less on the meaningful way that Other options include the electronic transmission it explains common social experience than on its of patient information between information power as technology. There exists a striking gap systems. The electronic transmission of patient between scientific and everyday modes of information between and across information explanation that permeates the modern view of systems requires the use of interfaces and EHR therapy as well. interoperability. Depending upon the health care Since the therapeutic has become appropriated organization, the technical infrastructure for as a concept of specialized professional Internet access may already be established or knowledge, the sick person is conceived to lack many not exist at all. The evaluation of the the personal resources to help herself. On this technical infrastructure to support an EHR is an view, then, autonomy is by definition waived or essential first step to determine what additional compromised by illness. The sick individual requirements will need to be installed and tested becomes fully a patient and so ceases to be an in addition to the EHR itself. agent. In this regard it is enlightening to note The definition of an EHR implies the that informed consent is a uniquely modern dependence on electronic connectivity. Thus development. Informed consent requires electronic connectivity within the health care disclosure of information regarding the organization is a prerequisite for a successful treatment proposed, its risks and benefits, as implementation and adoption of an EHR. Based well as the alternative treatments available to on the needs of nurses, providers, and other patients in order to allow them to accept (or health care professionals, health care reject) the treatment based on their personal organizations should be ensuring that there is preferences and values. Informed consent Internet access that is supported from wired and reflects not only the prominence of individual wireless connections. If wireless connections are self-determination in the modern world; it not possible, the health care organization functions precisely in a social context in which

International Journal of Research Studies in Medical and Health Sciences V5 ● I12 ● 2020 10 Information Technology in Nursing solidarity or shared commitment to a belief building programmes and in target/standard system is rare. To be a therapist of individuals, setting accompanied by matching increased who are independent and isolated from a wider diversity of supply with an ability to respond to community of meaning, thus requires that the the new diversity of demand in preventive and therapist be similarly severed or disconnected curative medicine–tackling the underlying from the community at large. The predictable causes of health inequalities as well as providing result is that not binding sentiment, but critical the best care [10]. Decreased tolerance of failing detachment becomes the attitude presumed to be services will also be a core component of the conducive to a sense of well-being in the government‘s strategic health care plan. A new modern view. quality commission will therefore be introduced with tougher powers to impose fines and close Nurses have identified both positive and down services in the case of poor standards. negative effects of technology on their practice Foundation hospitals will also be able to take [9]. On the positive side, nurses have reported over failing hospitals to turn around their that technology has increased their efficiency performance and in the case of primary care, and saved them time, as well as helped them there will be greater diversity of supply and keep their patients safe by detecting subtle strengthening of the power of PCT changes in their patients‘ condition so that they commissioners to ensure that GP or community could intervene early to prevent deterioration, health care services can be improved or replaced injury, complications, and infection. Technology where they fail to respond to local patient/user also contributed to shortened hospital stays by demand. promoting healing and helping nurses prepare patients for discharge. In addition, the new Major advances in technology and technologies better prevented nurses from bioengineering have also brought about injuring themselves while providing care. significant changes in treatment patterns and However, there are negatives associated with the modes of delivery. For example with cutting- new technologies, such as the challenges edge techniques – ranging from genetics to stem associated with broken equipment, how to cell therapy – and life-saving drugs to prevent, operate/use complicated equipment, and how to alleviate or cure conditions such as Alzheimer‘s keep up to date with changing technologies. disease, it is likely that many of today‘s diseases Another downside of technology is that it can be will succumb to either eradication or addictive. Professionals and the public have come amelioration. Investment in the implementation to believe that technology can solve all problems. of world-class research programmes will We live in a culture fascinated with new accompany the government‘s health care technology, almost to the point at which there is investment plan and new academic health overconfidence in what technology can achieve science centres will be sponsored for and an overreliance on its use. Many people implementation within our most prestigious believe that technology can address and correct foundation trusts and their partner universities. what is wrong, repair what is broken, and cure These will facilitate the discovery of new what ails us. Health care professionals are technologies, which, in turn, will enable increasingly reliant on these technologies as clinicians the ability to diagnose and intervene their primary source of information. At times, at the earliest possible opportunity. technology has diverted nurses‘ attention away The intersection of integrative healthcare and from the patient as a person. In other words, informatics challenges us to consider the nurses often find themselves watching a complementary nature of the limits to human machine instead of observing, interacting with, cognitive processing ability and the robust and developing a relationship with the person computational capacity of current technology who is attached to the machine. Direct care of [11]. This broader perspective more intimately the patient has been replaced by care of the captures and defines the human linkage with patient via a machine! When nurses view technology, and fosters rigorous discernment of patients in this way, what patients and their the advantages and disadvantages of technology families have to say can be more easily ignored to humans and integrative healthcare. or discounted. Integrative nursing offers a perspective of whole HEALTH SERVICES person/whole system healing that can humanize and enrich healthcare informatics. We propose The new health service reforms have been that interdependence between integrative underpinned by greater investment in hospital healthcare and informatics asks us to protect and

11 International Journal of Research Studies in Medical and Health Sciences V5 ● I12 ● 2020 Information Technology in Nursing be stewards of a relationship between TELECARE informatics and integrative health with a strategy that benefits humans. Telecare is defined as the use of communications technology to provide health HEALTH CARE and social care direct to the patient [3]. Earlier development of telecare also referred to Technology is also an important part of future assistive technology and smart homes or smart endeavors [12]. Technology can provide technology. Assistive technology is another improvements in care, as seen in both acute and collective term for devices for personal use to long-term care settings, and improved access to enhance people‘s functional ability. It may care as seen in the increase of programs include fixed assistive technologies such as stair delivered by Internet and other telehealth lifts or portable devices such as bath seats. approaches. A good example of improving Therefore, this can include telecare, but is not access to care includes programs to increase limited to the kind of technology normally health of rural populations. Examples include considered within eHealth. Telecare Services improving cardiovascular health and weight loss Association (2016) summarise the definition of and maintenance for older rural women. telecare as ‗support and assistance provided at a Increasingly, research is defining programs that distance using information and communication can be scaled up and successfully delivered technology. It is the continuous, automatic and using technology. Telehealth nursing programs remote monitoring of users by means of sensors for children and families have been tested to enable them to continue living in their own successfully and are finding their way into home, while minimising risks such as a fall, gas practice. and flood detection and relate to other real time emergencies and lifestyle changes over time‘. A patient-focused health care system would necessarily involve cultural competence and ‗Telecare‘ is an umbrella term referring to the understanding of social and community technical devices and professional practices attributes in determining health outcomes [13]. applied in ‗care at a distance‘, care that supports The translation of increasingly sophisticated chronically ill people living at home [14]. With science and technology into personalized care telecare, the formal or informal carer is not in has been the premier goal of health equity. The the same place as the person receiving care. past decade has brought new tools and a new Instead, carers use new communication tools language into this arena. There is promise for such as webcams, electronic monitors, email extending better health care for all with and websites to interact with patients, transmit scientific advances. With every advance comes data and provide instruction. Strictly speaking, a prospect of side effects. Personalized medicine the telephone is also a distant-care device and it is an approach that brings high levels of is often central to making telecare practices technology and data sophistication to the field of work. The term telecare, however, commonly prevention, prediction, and treatment. It is refers to the new technical arrangements for care or, as the critics might say, to a new hype in sometimes called ―precision medicine.‖ care. Personalized medicine as a general term suggests greater empathy, patient involvement, Hype is indeed a part of the introduction of and reciprocity in health care services. Although telecare in health care. Innovations in telecare it can and should include those things, the have seen optimists and pessimists hurrying predominant tool in personalized medicine is the onto the soapbox to proclaim their opposing application of genomic science. It is not part of views. Innovative practices are by definition not a generalized effort for empathy, involvement, well researched, and these soapbox speeches and reciprocity. The particular mapping of emphasise either their pros – the promises individual DNA provides more data about telecare is bound to fulfil – or their cons, the individuals, families, and communities. There is nightmares it will inevitably bring. dramatic promise in scientific circles about Older people, instead of moving into a care capabilities associated with genetic mapping. In institution when their minds and bodies start to some conditions, such as the field of fail, will have to stay at home, surrounded by all pharmacogenomics for companion drugs based kinds of cold mechanical devices, receiving no on genotyping of certain cancers, application of support from caring people. Carers of these the science yields better clinical decision alienated people will only discover that making and better health outcomes. someone has passed away when the sensors stop

International Journal of Research Studies in Medical and Health Sciences V5 ● I12 ● 2020 12 Information Technology in Nursing reporting movement and vital signs. conferences external to the healthcare Professionals, often nurses, lie awake, institution; and academic programs that lead to a imagining the fate of neglected patients and BSN, MSN, MBA, or doctoral degree (DNP or overlooking serious problems because nobody PhD). All certainly have significant value. actually bothers to go out and see these Ideally, you should take advantage of the vulnerable patients any more. offerings as your professional needs, time, resources, and personal circumstances allow. BIG DATA Technology has added to the repertoire of With the ubiquitous availability of health-related available options. In the past, nursing education data such as insurance claims, discharge has been offered in lecture-based formats for abstracts, electronic health records, personal learning. However, many nurses expressed a fitness devices or mobile phone applications, the clear preference for hands-on or case-based amount of health data is increasing in size, but learning opportunities. The growing popularity also in speed and in complexity [15]. ―Big data‖ of simulation labs both in nursing schools and in provides new opportunities for nurse clinicians hospitals speaks to the value of both learning and researchers to improve patient health, health and applying new knowledge in a realistic services and patient safety. Following this clinical scenario. High-fidelity manikins offer unprecedented amount and complexity of opportunities for full participant engagement in information available from different types of the scenario and hands-on competency data sources, the processing and the analysis of development in relation to acquiring or honing big data challenges traditional analytical practical skills. The use of healthcare actors who methods. For these reasons, a range of analytical play a patient role provides nurses with approaches such as text mining and machine challenging situations in which interpersonal learning often developed in bioinformatics or communication skills may be challenged and engineering fields become of highest relevance ultimately improved. These types of learning to nurses wanting to work with big data. experiences are frequently conducted using teams that include physicians, nurses, and allied The rapid digitization of health and health care health personnel to promote more effective data is leading to a dramatic growth of teamwork, collaboration, and the development information on all levels of the healthcare of interdisciplinary competence in patient care. system. In 2012 it was estimated that worldwide size of digital healthcare data reached 500 FUTURE petabytes, corresponding to more than 13 years Technology has historically relieved people of of HD video and is expected to be multiplied by backbreaking drudgery and dreary monotony, 50 in 2020. providing them with more free time to pursue Alongside the question of what constitutes ‗big personal relations and creative activities [17]. data‘ and where big data is generated from, a Nurses, too, when relieved of routine and time- range of analytical techniques, often labeled as consuming clerical or managerial paper ―data science‖, have emerged. Those techniques handling chores, can devote more time to the deal with difficulties from big data files, but also unique problems and needs of individual generate new opportunities with big data and patients or clients. Increasingly, across the data from traditional research designs. In the world, the managerial and clerical paper- following sections, we will give a brief handling tasks of nursing are being performed overview about the common sources of big data by information systems. In addition, robotics and typical analytical techniques and provide (e.g., lifting and turning patients, delivering two examples where these techniques have been medications or meals, and recording applied in nursing research. Finally, we will temperature, pulse, and other physiological briefly discuss the challenges of big data and measurements) might assist with the physical give a perspective of how data analytics from care category of nursing tasks. Similarly, big data might influence nursing and nursing decision support systems may actively assist research. with nursing judgments. Relieved of routine and less complex chores, the EDUCATION professional nurse having enhanced information There are multiple formal and informal learning management skills and working in an venues for emergency nurses [16]. These environment enhanced by information systems include hospital-based in-service education, will be expected to carry out higher level, more both of the mandatory and elective varieties; complex activities that cannot be programmed.

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Citation: Siniša Franjić, “Information Technology in Nursing”, International Journal of Research Studies in Medical and Health Sciences. 2020; 5(12): 8-15. Copyright: © 2020 Dr. Siniša Franjić, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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