Television, personal computers and electronic devices have transformed America into a high-tech society. Computers have revolutionized American life and, according to futurist Alvin Toffler, this "third wave," based on a vision of an information-driven society, is forcing major cultural changes.

First, health care professionals and their patients have become informaticians. We will have the comfort of physician and advanced practice nurse house calls-albeit electronic-and everyone will have access to health information once closed to consumers. Telematics will become the universal tool as we strive to deliver high-quality care. As technology in electronic equipment has provided better care capability and informatics has affected all aspects of health care communication, the nursing practice has been transformed.

The electronic health record includes wellness and other related information and is maintained through cooperation between the individual who controls his or her health information and the caregiver. Individuals will maintain their medical information in addition to behavioral, dietary, drug- and exercise-related, environmental and sexual information. They will share this information according to care needs.

This will affect the need for nurses and nursing care, much as the present computerized systems-through administrative simplification, the electronic data interchange and work redesign-have downsized hospital nursing.

Second, do we need so many nurses in a technological environment? While this environment may reduce the number of nurses needed per capita, the kind of nursing practiced is much different. Nurses definitely have to analyze, synthesize, computerize, but still be able to catheterize.

Our care focus priorities are in constant revision. How do you integrate technology and caring in a manner that will preserve and enhance human dignity, uniqueness and freedom? Caring is not just what we do-it is who we are. Sometimes, nurses think we are the only ones who know how to care. Caring comes in different sizes and kinds from various parts of the world, and oftentimes from people we hardly know, as evidenced in the worldwide response after Sept. 11.

I cannot thank readers enough for the calls and responses to me when I wrote about my son, who has schizophrenia. Caring is the essence of any relationship, whether it be caregiver and care receiver, parent and child, father and mother, sister and brother, friend and friend, or even animal and owner. "Actions speak louder than words" is a phrase we often hear but seldom allow to enter our lives with deep meaning and conviction.

Caring reflects human compassion and support for the human consciousness. It requires attention, prudence, forethought, circumspection, precaution, caution, accuracy, exactness, minuteness, attention to detail-the daily work of every nurse.

The challenge for nursing is to respond to the technological environment like a wheel of fortune spinning its opportunities to advance nursing to new heights.