The Re-Birth of Telemedicne

Telemedicine is a rapidly medical application for the Medical Profession. It is where medical information is transferred via telephone, Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.

Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communication or new technology and to produce the delivery of clinical care.

Around the globe, technology is rapidly implementing Telemedicine and new form of health care has begun. telemedicine is spreading across the globe as fast as satellite communications systems can transmit them. Telemedicine has reached around the world and has helped to link all peoples together in the struggle to understand and treat disease and promote health. Telemedicine is not just a single technology. It is part of a greater process, and it has spawned the creation of a chain of care unlike any in history (Roine, Ohinmaa & Hailey, 2001). New health information technologies are introducing the world to the value of knowledge in the promotion of health and prevention of disease (Coile, 2000). Telemedicine has experienced a steady growth over the past decade as telecommunication technology has advanced and as costs have declined (Wooten, 2001). Patient care, medical research, medical education, and the administration of health services are beginning to undergo revolutionary changes as information technologies advance (Wallace, 2001).

Telemedicine has evolved and impacted the practice of nursing, both now and in the future. Currently there is no universally accepted definition of telemedicine. Various authorities have developed definitions, and these in, in turn, have been adopted by researchers and authors throughout the literature. Telemedicine is broadly defined as the provision of health care services across some distance (Greenberg, 2000). More recently, telemedicine has been defined by the specific elements of service that are provided. Ashley (2002) defines telemedicine as “the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communication.”

This definition provides a much clearer picture of the wide range of services encompassed in telemedicine. It seems that the pace of technology is so rapid that what may be new and innovative one day becomes routine the next day, and by the following week, is considered ineffective or outdated. This seems to be the case with terminology also. The term telemedicine has been replaced by the more inclusive term “telehealth”. Both are used for electronic communication networks to transmit data or information that focuses on health promotion, disease prevention, diagnosis, consultation, education, and/or therapy.” The term telemedicine, however, continues to be used widely around throughout globally.

Telemedicine began approximately 50 years ago. The first mention of telemedicine in medical literature can be found in references to transmission of radiological images by telephone in 1948 (McCarty & Clancy, 2002). The early roots of telemedicine came from the manned space flight program where scientists sought methods to monitor, diagnose and treat astronauts. The modern-day portable cardiac monitor and defibrillator are a byproduct of that scientific research (Bahshur, Reardon & Shannon, 2000).

In the 1980’s, federal funds for demonstration projects were eliminated and telemedicine essentially disappeared from the scene (McCarty & Clancy, 2002). A rebirth of telemedicine occurred in the 1990’s with the advancement of the Internet, and increased federal, state, and military support (McCarty & Clancy, 2002). In the past few years the development of telemedicine has increased significantly. Technology Health Care organizations have implemented numerous programs for clinical and non-clinical purposes (Jen-Hwa-Hu & Yam-Keung Chau, 1999). Most authorities agree the increasing innovations in computers, networks technologies and other equipment are responsible for the rebirth of telemedicine applications (Roine, Ohinmaa & Hailey, 2001). Ashley (2002) believes that recent technological advances such as fiber optics, satellite communication, and compressed video provide the environment for telemedicine to continue to grow rapidly.

Currently every state in this country has at least one telemedicine program. Bahshur and colleagues (2000) believe that telemedicine is “a product of the information age, just as the assembly line was a product of the industrial age.” The way that we provide and receive health care is being changed by new information technologies and telecommunications (Stuckey, 1998). For example, CT scans, ultrasounds, and nuclear medicine images are already digitized. Radiologists can transmit images to any location that has a computer with a corresponding program and sufficient memory to put the image on the screen (Welsh, 1997). Still images and other digital information can be transmitted from one professional to another for the purposes of consultation or referral through “store and forward” telemedicine (Petersen & LaMarche, 2000). New modes of medical practice with new names have sprung up. These include teleradiology, teleneurosurgery, telepsychiatry, and teledermatology. Primary and secondary care providers can now generate electronic referrals, conduct e-mail consultations, and participate in video conferencing (Wallace, 2001).

Procedures and treatments that have traditionally required direct physical contact by a practitioner can now be performed via telemedicine. For example, blood glucose can be monitored, and visual observation of insulin syringes prior to injection can be conducted from a remote location (Klonoff, 2003). The Kaiser Permanente organization demonstrated that patients with newly diagnosed chronic conditions could be equipped with home videophones, electronic stethoscopes, and digital blood pressure monitors, and assessments could be performed and data transmitted to evaluate cardiac and respiratory function (Wooten, 2001). Biofeedback can now be conducted using telemedicine (Earles, Folen & James, 2001). Inmates now receive health care services through telemedicine (Strode, Gutske & Allen, 1999). Tele-home-health, population based telemedicine, interactive video conferencing and store and forward image and record transmission have made it possible to deliver health care services across distances (Petersen, & LaMarche, 2000 & Strode et al., 1999).
For the most part, consultations via the Internet or video conferencing are the major ways that health care services are currently provided via telemedicine (Ashley, 2002). Coile (2000) notes that more than 18 million Americans go on line each year seeking health information and advice.

The Internet may represent the next great frontier for health care (Coile, 2000). There has been observation of internet sites that provide information about diseases, diagnosis and treatment, disease prevention, health promotion, and individual health risk assessment and profiling services (Maddox,2002) . These services are being coined “online health or e-health (Wooten, 2001).” In addition, patients are seeking online medical care services ranging from one-time interactions for a second opinion to access to prescription drugs or psychotherapy (Miller & Derse, 2002).

With the increased use of online and distance health care education has come the development of sophisticated virtual simulation technology (Wooten, 2001). Internet based technology allowing virtual simulation of tissues and blood flow is now available over the Internet (Pushkin, 2001). Technology has boosted the Re-birth of Telemedicine. A remarkable number of locations are accessible via the Internet. Connections may not always be reliable, however, connectivity allows for flexibility across the globe in consultation for health policy, hospital organization, or even unique therapies for rare diseases (Edworthy, 2001). Health care providers and the public world-wide have increasing electronic access to scientific literature (Wallace, 2001). They can access a wealth of medical information, reports, articles, and research about conditions, treatments, and providers (Hodge, Gostin & Jacobson, 1999). For instance, the implementation of educational web servers in Kosovo, established with satellite links just a few months after conflict had ceased, allowed local physicians to gain access to current literature and websites in place of their 10 year old journal collection (Edworthy, 2001). The Swinfen Trust, a medical charity organization, maintains an ongoing project to support practitioners in developing countries such as Bangladesh, by providing advice to doctors through a panel of volunteer consultants from industrialized countries via the Internet and satellite video conferencing (Wooten, 2001). Internet has been observed that low bandwidth internet can reach into remote areas, some of them with troubled political situations and uncertain economic environments, to bring connectivity to places like Uzbekistan, Cambodia and Kosovo (Edworthy,2001).

Telemedicine has begun to impact many aspects of health care in developing countries. Roine and colleagues (2001) report that telemedicine is expected to increase the fairness and equality of the distribution of services all over the world because accessibility of health services, especially in remote areas can be improved. Edworthy (2001) states that telemedicine may allow developing countries to “leap frog over their developed neighbors in successful health care delivery.” This is because individuals in developing countries may adapt more readily to obtaining primary and specialty care services without having to leave their small communities to travel to large urban centers. One of the most recent global technological advancements has occurred with telesurgery. In 2001, doctors in New York City removed the gallbladder of a 68 year old woman in Strasbourg, France. This was accomplished through a unique system with a control console that sent high-speed signals to robotic surgical instruments over a fiber optic network that transmitted signals so quickly that doctors could see the movements of the instruments on a video screen 155 milliseconds after making them (Alpert, 2001). Through advancements such as this, telemedicine has the potential to make a difference in the health care of not only Americans, but people all over the world. It is likely to be a valued option for those with rare medical disorders and those seeking advice from leading experts who may be geographically far away (Miller & Derse, 2002) Telemedicine may in fact have a more profound impact on developing countries than on developed ones (Edworthy, 2001). The World Health Organization is pursuing strategies that will help to build international cooperation and affiliations, and increase the proliferation of telemedicine in developing countries (Miller & Derse, 2002 & WHO 56th World Health Assembly, 2003).

Advances in the technology of telemedicine may eventually eliminate or simplify many of the aspects of health care that do not work very well. Emergency rooms and physicians offices may ultimately see a reduction in patient visits because of telemedicine (Welsh, 1997). Strode, Gutske & Allen (1999) predict that telemedicine technology will expand into cable-based interactive video and internet protocols. The feel of a lesion, or even muscles and bones will soon be capable of being transmitted over the Internet (Pushkin, 2001). Ashley (2002) identifies three main benefits of telemedicine that will impact the world of medicine and health care delivery. The benefits include: elimination of distance as a factor in treating patients, allowing access to health care where it is otherwise unavailable, and allowing more access to health care and health care information (for providers and patients). Some of the major challenges facing the adoption of telemedicine include cost and access, reimbursement, risk management issues, and human issues. Miller & Derse (2002) foresee that the global nature of the Internet is going to require international cooperation to promote enforcement, mandated disclosure to identify legitimate providers, and intensive efforts to educate and the public. Technology and telemedicine has great potential for reducing disability and avoidable death, improving the quality of life and prolonging the healthy and productive life span of all people (Hofman, 2001). Telemedicine has great promise for the future of health care, but Bahshur and colleagues (2000) caution that telemedicine, like HMO’s and managed care, could become a source of discontent with an unfulfilled promise if it is not used wisely.

Nursing caring of patients began in the home and moved to the hospital, only to move back to the home again. It is now making a move to a place Sandelowski (2002) describes as being “created and sustained by computers,” a virtual world, “entered equally from anywhere, where nothing is forgotten and yet everything changes.” Technology is expected to change the provision of health services and the practice of health professionals (Maddox, 2002). Consumers expectations and behaviors are expected to change as a result of ready access to information not previously available (Maddox, 2002). Social and professional expectations are expected to change, especially in relation to sharing individual, organizational and scientific health information and performance data (Maddox, 2002). There is much hesitation and concern, along with curiosity and anticipation about telemedicine. Incorporation of telemedicine into clinical practice has been slow, despite the fact that many clinical services can be provided through telemedicine (Petersen & LaMarche, 2000).
The most obvious impact of telemedicine on the practice of nursing can be seen in the development of telenursing. Robbins (1998) incorporates Henderson’s definition of nursing, and describes telenursing as the “use of technology to assist nurses to assist people, sick or well, in the performance of those activities contributing to health.” The technologies involved in telenursing range from sophisticated cameras and video display with real time interaction to the telephone system (Robbins, 1998). Telephone triage is the largest and most recognized component of telemedicine. Nurses use the telephone to deliver an extraordinary variety of nursing care and nursing services nationwide (Greenberg, 2000). In fact, in 1997 the American Academy of Ambulatory Care Nurses (AAACN) defined telephone nursing and established practice standards for nurses in the performance of telephone nursing (Greenberg, 2000). Numerous concerns have been voiced about the practice of telephone nursing and telenursing in general.

The most serious concerns are centered on the potential for nurses to lose sight of the caring and enabling side of their work (Nolan, 2000). There is concern that the dehumanizing affects of increasing technology will endanger the nurse/patient relationship, and that the quality of nursing care will deteriorate (Greenberg, 2000). Kelley (1999) emphasizes the importance of the nurse-person process according to Parse’s theory and stresses that individuals experience a true presence and are invited to explore and clarify issues, concerns, hopes, and desires through the nurse-patient relationship. Many in nursing fear that the nurse “presence” will be lost as the emphasis on technology increases. Benner (2000) emphasizes that “many qualitative distinctions can only be made by observing differences through touch, sound, or sight, as in skin turgor, color, and capillary refill.”

The provision of nursing care through a mediating source such as a telephone, computer, video link, or the Internet has the potential to create a dramatic shift in the relationships of patients and their providers (Miller & Derse, 2002). When one looks at the subject from this perspective, it appears that telemedicine technology is relatively simple compared to the telemedicine provider/client relationship. It follows then, that the provider community is often perceived as reluctant to accommodate telemedicine in routine practice. Thede (2001) notes the provider/client relationship encompasses all of the aspects of direct care plus the varied information that is made available electronically to both patients and providers.
The dynamics of the provider/patient relationship are changing dramatically as a result of the unprecedented amount of health care information that self informed consumers can access via the Internet (Maddox, 2002). Patients are increasingly more informed about disease conditions, medications, options for treatment, and investigational research (Wallace, 2001). Most of this information is obtained directly from the Internet. Consumers have access to an extraordinary array of information online, however, consumers have a limited capacity to evaluate the quality of information that is available online (Miller & Derse, 2002). The provider/patient relationship has traditionally been one that is based on professional expertise and client need (Drevdahl, 1999). This is especially true of the nurse/patient relationship. Consumers are now more informed as they enter the nurse/patient relationship and, in some cases, may even have knowledge and expertise beyond that of the nurse’s about a specific disease process or treatment. This presents a dramatic change and a significant challenge for nurses. Nurses are challenged to evaluate their traditional practices and are increasingly expected to update their skills and knowledge. In addition to being aware of the information that consumers may be exposed to, nurses must become familiar with the most recent evidence-based medicine and research findings. This can be a alarming task because new websites devoted to health care information are being born every day.

The value and responsibilities of the nurse as “knowledge worker” are becoming exceptional. As health care environments are destabilized and patients rapidly move between settings, the focus of nursing as a “basic human encounter” (Benner, 2000) begins to blur. Indeed, Nolan (2000) points out that nurses may be losing the fight to retain the humanistic qualities of caring in this increasingly technologically oriented age. Most telemedicine practice is based on limited sensory data, therefore, successful telenursing depends upon the assessment and decision-making skills of the nurse (Greenberg, 2000). Benner (2000) sees excellence in nursing practice as “habits of thought and action, clinical grasp and clinical forethought.” The rapid advances in technology and the accompanying changes in nursing practice present a challenge to nurses to maintain the traditional habits of thought and action and excellence in assessment and decision-making. Crow (2001) warns that even though most of the functions provided by nurses are not likely to be replaced by technology, nurses who do not adapt to technological advances are likely to be replaced by those who do.

The impact of telemedicine on nursing practice has yet to be fully realized. For the most part, technological innovations have occurred through the implementation of new systems in old settings (Stumpf, Zalunardo & Chen, 2002). This has required nurses to significantly change skills and practice at the same time they are continuing to provide traditional nursing care. It should not be surprising that there is perceived reluctance to accommodate telemedicine into routine practice. In most cases, implementation of new technology has preceded research and feasibility (Bahshur, Reardon & Shannon, 2000) leaving practitioners to implement with little or no policy or protocol to guide them. Greenburg (2000) emphasizes the necessity of protocols and algorithms as reliance on nursing judgment increases with telemedicine. The stresses, however, are that protocols and algorithms might developed outside of nursing leading to the regulation and control over nursing practice by others, and may affect the quality of nursing care. This is because protocols and algorithms developed outside of nursing are often used to direct nursing process, not guide it (Greenberg, 2000). Benner (2000) foresees the perils in this and warns there is a danger that “clinicians will assume that simple rational calculation can be applied without astute clinical reasoning about the patient’s condition and response across time.”

The growth of telemedicine introduces questions of efficiency, quality and equitable access. These have the potential to impact the ethical foundations of nursing practice. Nurses have traditionally been at the forefront of creating preventive health services and advocating for effective health policies at the national, state, and institutional levels. The technology of telemedicine represents a new and valued resource in health care. Currently, availability is limited by lack of public funding and specific commercial interests. The concern for nursing lies in the potential for this technology to create another underclass that will lack the ability to use telemedicine as result of educational or financial limitations (Bahshur, Reardon & Shannon, 2000). That is to say many telecommunications structure are necessary to conduct telemedicine in rural areas is still unaffordable or inadequate despite public policy (Pushkin, 2001). On the other hand, Maddox (2002) points out the troubling potential for the development and use of telemedicine predominantly by those who have no choice. Interestingly, United States government incentives such as grants and contracts, have led to the distribution of telemedicine programs to a relatively restricted number of health care settings such as prisons, rural areas, and university medical centers. As a result, government funding of telemedicine projects has pushed this technology to be used with underserved or difficult to serve populations (Robinson, Savage & Campbell, 2003). Virginia Henderson once declared that the essence of nursing was “to provide 24 hour humanistic care to conspicuously neglected groups (Mariner, 1986).” The nursing profession may be called once again to advocate for equal care and services for newly emerging “noticeably neglected groups” in the age of telemedicine.
More and more, patients are seeking advice and medical care online from practitioners they have never met. For nursing, telemedicine means practice across state boundaries and expanded involvement in patient care (Simpson, 2001). The National Council of State Boards of Nursing has started to address how to change the regulation of nursing practice within the frame of technologic advancements, however, presently there are no mechanisms to extend effective regulatory oversight to the provision of medical care that crosses state boundaries (Miller & Derse, 2002). One of the defining characteristics of the caring aspect of nursing practice has been the motivation to protect the welfare of others and assists others to grow and actualize the self (Crow, 2001). Nurses are faced with the challenge of determining how these technologies can be used to maximize health benefits and enhance the felt presence of the nurse, but they also have an interest in understanding how these technologies can undermine the ethics and foundations of nursing practice (Sandelowski, 2002). Issues relating to confidentiality of data protection, rights of access, documentation, accountability, and informed consent have a major impact on the ethical practice of nursing through telemedicine. Commercial interest and consumers may not wait for the nursing profession to guide the ethical and orderly development of technological health care. Telemedicine can not be expected to improve the quality of health care when the quality of information and services has not been established and, although telemedicine can ignore or transcend traditional geographic boundaries, practical boundaries still exist in terms of interstate licensure, legal liability, and other administrative regulations (Bahshur et al. 2000).

In 1997, the Balanced Budget Act opened the door for telemedicine reimbursement for health care practitioners, including nurse practitioners (Pushkin, 2001). Reimbursement by Medicare gave validation to the growing use of telemedicine (Strode, Gutske & Allen, 1999). The implications of this are far-reaching, including the provision of quality health care by nurse practitioners through telecommunications technology to underserved populations in rural locations where there would otherwise be no access to care. The concept of telemedicine represents a complex and radical change in the traditional practice of advanced nursing. The use of informatics changes the scope of health care delivery for Licensed Vocational Nurses(LVN), however, it does not change the scope of practice. For nurse practitioners, real time telemedicine is the use of computer and video links to aid decision-making (Wooten, 2001). Whitten (2000) notes that telemedicine can enable APNs to provide primary care in remote locations by reducing isolation for rural health care providers and increasing collaboration between providers.
Telemedicine has already impacted the practice of advanced nursing in a number of ways. Group practices consisting of physicians and nurses are now able to access patient information from an at-home database when they are on-call or covering for one another (Wooten, 2001). This assures that the practitioner has sufficient knowledge of the patient to enable accurate treatment. In order for nurses to fully adopt telemedicine technology, however, the capabilities of the equipment must be such that the information transmitted is at least as complete as, and equal in quality to, the information transmitted in the traditional setting (Bahshur et al. 2000).

The information technology of telemedicine has the potential to impact advanced nursing practices in a number of ways. It may help to improve overall quality and satisfaction with care provided by nurses by enhancing the patient’s voice in decision-making through the provision of access to information (Greenberg, 2000). Legislative changes have provided opportunities for nurses to expand their current modality of practice and have provided a potential financial opportunity as well. As expectations of consumers continue to increase, technological changes can profoundly impact the nurses ability to deliver higher quality health care quicker and more efficiently (Dowie, 2001). Potentially serious conditions can be diagnosed at earlier stages when they are easier and less expensive to treat (Petersen & LaMarche, 2000). The technology of informatics has a multitude of uses in advanced practice nursing including: patient identification and demographics; longitudinal patient record; clinical data for acute episodes of care; diagnostic and therapeutic decision support; referral and procedural scheduling; documentation; research; academic administration and literature review and writing; budgeting; costing; charging; contracting; paying; and profit taking (Welsh, 1997).

Rather than struggling against the technological advances of telemedicine, nursing should begin to accept the parameters and practice arrangements that would meet acceptable standards of nursing practice. The nursing profession needs a new paradigm. Professional standards and models for virtual and technologically mediated health care need to be developed. Coiera (2002) stresses that telemedicine is “really about health service design and delivery, and not about the enabling technology.” If clear foundational principles that would guide the design of technologically enhanced nursing practice are not formulated and promulgated, there is a risk that outside influences will guide the design for nursing. The caring practice of nursing could be in significant jeopardy if this should occur. Benner (2000) warns that “failing to attend to caring practices will continue to fuel a technical cure approach to health care…”
that nurses should advocate for the creation of a new and dynamic vision of nursing in which the skills of caring are fully valued and acknowledged (Nolan, 2000). Clearly, technology should be used as a tool to extend and enhance care delivery and must not be used as a substitute for nursing care (Greenberg, 2000). As Dowie (2001) states, “history is full of examples of the incumbents of dominant technologies preferring to die than to adapt.” In order for Nursing to avoid this mistake, there must be both learning and leadership.

Maddox (2002) poses many thought-provoking questions for Nursing in the age of telemedicine. These include questions about the kind of policies that will be needed and how nurses should advocate for them, what steps need to be taken to ensure that none are denied knowledge about widely available health improvements, what measures should be put in place to ensure no one is left out of the system due to reluctance or illiteracy, and whether access to electronic information should be considered central to accessing the full array of health services in the future. The struggle to find answers and create solutions to these issues could drive health care providers farther apart. In 1997, Welch predicted that informatics would have the potential to empower some more than others. Nurses have the potential to become highly active and empowered providers in the age of telemedicine, however, futuristic models of care will need to be developed. Peplau believed that nursing should be an engagement in a significant, therapeutic, and interpersonal interaction with each patient (Mariner, 1986). In this next phase of technological care, Nursing should seek to promote practice models and settings through direct and mediated sources that will facilitate the human need to develop interpersonal relationships.

Nursing must be a strong advocate for public policy and legislation that addresses the establishment of a public framework for accountability to protect the interests of patients, that offers legal assurance to professionals who meet the standards, and that assures equal access to quality health information (Miller & Derse, 2002). Nursing leadership is an essential component of this process in order to promote policy action that assures health through reallocation of resources and organizational change (Milio, 2001). “Until our public language and public caring practices are visible and supported by organizational design, education and research, caring practices will continue to be vulnerable to under funding at the expense of high-end technical medical care (Benner, 2000).”

Nurses should realize that now is the time to step forward and actively participate in the integration of telemedicine into current practices in an effort to expand their scope of services and allow patients an additional way to access health care providers. The Internet offers the potential to engage patients more fully as partners in medical decision making and in their course of treatment (Miller & Derse, 2002). Primary care in the home could once again become a possibility. Nurses could theoretically conduct house calls and nursing home visits via telemedicine. Nurses could use telemedicine as an adjunct to traditional disease management because nurses have the knowledge and ability to direct successful disease management outcomes (Anonymous, 2000).
Advanced practice nursing has always been guided by theory, however, new questions about what nursing practice should be and how nursing theory should both guide and evaluate nursing practice are emerging with the changing roles and the restructuring of practice (Kelley, 1999). Theory and practice are directly connected. Practice flows from theory and theory guides practice. Theory making and theory testing is a dynamic and continuous process (Drevdahl, 1999). Kelley (1999) declares that “nursing theory must provide the substance.” Nursing theory should potentially serve as the basis for advanced nursing practice as we move deeper into the technological changes in health care. To prevent being viewed as “midlevel providers” and to affirm that nurses are health care providers who are nurses, nursing theory and nursing science must serve as the basis for advanced practice (Huch, 1995).

This will not be a simple task. The greatest struggle will be in determining how to integrate these technological concepts into nursing’s theories. The emergence of telemedicine has the potential to “threaten the foundation of nursing’s disciplinary perspective on theory-guided practice (Fawcett, Watson, Neuman & Hinton, 2001).

Nursing just might be the world’s oldest true profession. As the profession of nursing steps into the next 100 years, it is appropriate to conclude that nursing practice is in rise of a new futuristic medical period. There is little doubt telemedicine, in whatever form it ultimately takes, will impact the practice of nursing. At a minimum, new technology will stimulate the profession to grow and define itself as a new one.

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Sept 07, 2008

The intent for this Blogg is to research and show how Technology has impacted the Nursing Field. Nursing is one of the fields that has transitioned into a New Technology World. Technology really is not new to the Nursing field because Nurses have used IV therapy in the post war years, and used compact digital point-of-care devices, nurses have become accustomed to using technology adapted from many arenas - space travel, warfare, and the medical arts – for the provision of patient care (PDA, 2001). technology has created an industry that now drives both the cost and the standard of healthcare. But while nurses were transfusing arterial lines and PA waveforms, and mastering microchip driven IV pumps, other significant aspects of their work, specifically documentation and communication have remained, as a rule.“The development of computer technology has paralleled [the] evolution from performing the dull and routine to challenging the entire range of human abilities” (Delaney, 601).

Technology is shaped by society in stages. Initially, technology does work that was previously done by people. That is, technology simply replaces a manual method of doing some activity. As technology allows work to be accomplished that previously was not possible, true innovation occurs. Finally, adoption becomes so complete that all dimensions of society itself are transformed by the technology” (Delaney, 602).Technology has made it possible for Nursing to evolve into a new technical experience. Many changes have occurred and are still being developed because of technology.

As technology advances, so does Nursing. Technology has many modern and useful methods to make Nursing a more Productive and effective field. Not only doe it help the field but it also plays a huge role in the patient care. Patients are able to receive better health care because of technology. Many life's have been saved and cured due to technology.

Nursing started out as a career that was based on a collection of specific skills trained to do specific tasks, but with broad advances in facts and technology, Nursing has evolved into a profession where nurses work to promote health, prevent disease, and help patients cope with illnesses. A nurse fill’s the needs of a patient, which cannot be met by either a family member or any other member of their community. Nursing is a helping profession, that is providing a wide variety of services that contribute to the health care and well being of the patient.

A career in nursing was once considered just an aid but it is now known as vital and crucial part of the health care system (Perry, 25).
In choosing nursing as my career goal, I have come to learn that there are many advantages to this widely diverse career. Since healthcare for a patient can vary from mental treatment to the treatment of a critical patient close to death, there are many different kinds of fields and levels in nursing to consider. There are Licensed Practical Nurses, which take care of the patient under the Registered Nurse’s commands, and there are nurses who study a specific area and only focus on that, like a Nurse Practitioner. Nurses can advance, in management, to assistant head nurse or head nurse. From there, they can advance to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment.

In majoring to become a nurse, one must also know that as a nurse, you are becoming part of a team that must work together in order to ensure 100% patient care and treatment. The health care team consists of the physician, who is a professional with earned doctorates in medicine; the physician’s assistant, who is trained to support a physician as needed; the allied health professionals, therapists, whom is licensed to assist in the examination, testing and treatment of physically disabled people who need special exercise to be treated; the pharmacist who is also licensed to formulate and give out medications; the social worker who is trained to counsel clients and their families; and the chaplain, who offer spiritual support and guidance to patients and their families (Perry 24-25).

According to the Bureau of Labor Statistics, nursing will be one to the top ten fastest growing professions in the United States in the next decade. By the year 2008, thousands of nurses will be needed. About 450 thousand registered nurses and one 136 thousand licensed practical nurses will be needed. According to the National Council of State Boards of Nursing, the number of first-time, U.S. educated nursing school graduates who sat for the NCLEX-RN, the exam taken to get license as registered nurse, decreased by thirty one percent from 1995 to 2002. That is a total of about thirty thousand students less than expected amount.

Work Cited:

Delaney, C. (1989). Computer Technology. In McCloskey, J.O., & Grace, H.K. (Eds.), Current Issues in Nursing (pp. 601-606). St. Louis: CV Mosby.
PDA (2001) cortex. Nurses and Technology.
The Tiresias Press, New York. 1996
Perry G. Anne and Patricia A. Potter. Fundamentals of Nursing 2nd edition. The C.V.
AACN-Media Relations. “Nursing Shortage Fact Sheet”. April 21, 2003.
www.aacn.nche.edu/Media/Backgrounders/shortagefacts.htm
All Nursing Schools. “Choosing a Nursing Program” and “Types of Nursing Programs”.
Million Nurse March: Quick Stats. “Did You Know…”.2000.
www.millionnursemarch.org/quickstasts/
NurseWeek. “Salary Wizard”. 2003.
http://nurseweek.salary.com/salarywizard.
www.nurseweek.com/careers/

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