This document provides an overview of various technologies impacting nursing and healthcare, including robotics in surgery, robots used for diagnostics and therapy, robots as direct care providers, biometrics, smart cards/objects, point of care testing, electronic health records, telehealth/telenursing, and nursing informatics. It discusses the benefits and limitations of these technologies, as well as their implications for nursing practice and patient outcomes.

1. WEEK 14:
THE FUTURE OF
NURSING & HEALTH
CARE TECHNOLOGY &
RESEARCH
Joshua Black, Jeffrey Parobechek, & Kelli Wilkinson

2. 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.

3. 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.

4. 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.

5. 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).

6. 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).

7. 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).

8. 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.

9. 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)

10. 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

11. 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) .

12. 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.

13. Eight Core Functions of EHR
1. Health information and data.
2. Results management
3. Order entry/management
4. Decision support
5. Electronic communication
6. Patient support
7. Administrative process
8. Reporting and population management
(Huston, 2009, p. 224)

14. 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.

15. Electronic Health Records
Concerns
 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).

16. 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).

17. 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).

18. 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)

19. 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)

20. 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)

21. Telehealth and Telenursing
Outcomes
 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)

22. Telehealth and Telenursing
Outcomes
 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)

23. Is New Technology Worth the
Costs?
 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)

24. 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)

25. 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)

26. 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)

27. 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.

28. 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