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Brave
new world
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| In, let’s say, 2060, give or take 30 years, a 95-year-old retired nurse ambles into the waiting area of a local nurse-run clinic. She feels terrible, she tells the receptionist. "I want to talk to a real person, not a face on a computer." He scans her medical history from a band on her wrist, then summons a nurse. The nurse invites the woman to sit and calls up her information on a handheld computer. She uses another scanner to obtain vital signs and blood work from a microchip implanted in the woman’s body. There’s no evidence of bacteria or a virus. Genetic information does not predispose her to heart disease. She’s taken all her medications without problems. The nurse is tempted to send the woman home and have her contact her personal caregiver by computer, but the woman has made it clear she wants to see someone in person. So the nurse takes the patient’s hand, looks her in the eye and asks questions. Welcome to nursing in the new millenium. If trends continue, most nurses will see patients in their homes and community nursing centers, predict researchers, nursing educators and others who ponder the profession’s future. Hospitals will be reserved for the very ill. As people live longer, managing multiple chronic illnesses will become a major task of health care. Gene therapy and vaccines may end illnesses such as AIDS and cancer, but new and resistant diseases will keep popping up. Monitoring devices such as implanted microchips and cameras will allow caregivers to track patients’ health conditions in their homes and stop problems before they start. Technology already is available for health care workers to monitor patients’ glucose levels, blood pressure and other vital signs from their homes. "Smart toilets" measure urine sugar. "Smart medicine cabinets" let people know what pills they need to take. At a recent conference on cybermedicine, researchers discussed virtual clinics that would connect health experts to astronauts on a three-year mission to Mars, said Tom McKay, Ph.D., RN, director of nursing and health services at Hartnell College in Salinas, Calif. In fact, technology now exists to do most things in any futuristic scenario, said Kathleen Young, MA, RN, who teaches infomatics at Western Michigan University School of Nursing. At the beginning of her class, Young has students write about what health care technology might look like in 20 years. She encourages "Star Trek" and "The Jetsons" fantasies like the one above. By the end of the session, most students realize that the technology they wrote about is already here, she said. "We just haven’t put it all together." "Do you live alone?" the nurse asks. The patient replies that her husband died recently. She has trouble sleeping. But last night, a friend gave her an herbal tea that seemed to help. Bells go off in the nurse’s head. The woman can’t remember the name of the tea, so the nurse calls the friend on her computer and gets a picture of dried herbs over the screen. She sends it to a toxicologist at a nearby hospital and an on-call herbal specialist in another state. The herbalist responds first. When mixed with one of the patient’s medications, an ingredient in the otherwise harmless tea causes a life-threatening reaction in some people. The woman’s genetic code shows she is one of them. The toxicologist, herbalist and pharmacist consult with the patient’s personal caregiver, also a nurse, on how to adjust medications. The clinic nurse explains to the patient what’s going on. Within minutes, a robot delivers a vial. The nurse scans it to make sure it matches her information, then sprays it into the patient’s mouth. The traditional hierarchy of the medical world is already changing, said Julie Fairman, Ph.D., RN, FAAN, associate professor at the School of Nursing at the University of Pennsylvania in Philadelphia. Nurses are sharing more duties with physicians, and in the case of nurse practitioners and advance practice nurses, becoming primary caregivers. In the future, she said, "maybe physicians will look more like nurses and vice versa." Most likely, nurses in the future will be part of a team of caregivers from around the globe, said Greer Glazer, Ph.D., NP, RN, FAAN, legislative editor of the Online Journal of Issues in Nursing and director of Parent-Child Nursing at Kent State University in Ohio. "You’ll have the expert at the touch of a button." A central monitoring station linked to the community where all kinds of health care providers check in with their patients and with each other, Glazer predicted, could replace traditional nursing stations. Hospital nurses already use cell phones and wear devices that track where they are on the floor, Young said. Eventually, she said, nurses probably won’t need a nursing station, just "a very large tool belt." The nurse walks her patient to an observation room, where she will be monitored for reactions. In the bright room, other patients are reading medical journals or plotting personal health charts. Cameras and monitors give constant readings on their conditions. A patient educator talks with the woman about sleep disorders. He gives her a list of herbal remedies that won’t interact with her medications. He also helps her contact a grief counselor for a brief online session. When the woman’s son comes to pick her up, the nurse stops by to talk to both of them. "I was really scared at first," the woman tells her son as they walk to the door. "But when that nurse took my hand, I knew I’d be all right." Baby boomers and their children, accustomed to the best, already are demanding a greater say in their health care. Nurses are naturals to partner with patients to help make health decisions they can live with, said Carol Bickford, Ph.D., RN, senior policy fellow in the Department of Nursing Practice for the American Nurses Association. To meet the challenges and take advantage of the opportunities ahead, nursing students will need to assess not just patients, but technology, McKay said. They must become lifelong learners, constantly processing information. They must be prepared for constant change, said Carolyn Williams, Ph.D., RN, president of the American Association of Colleges of Nursing. "What we teach them in the first year of nursing may change by the time they graduate." The next generation of nurses also must make their voices heard in discussions of health care policy and issues, said Katherine Kany, RN, a senior labor relations specialist for the ANA. They must help answer questions such as: How do caregivers keep patient information private? Who pays for heath care and who receives it? Is the public willing to pay for the human face nursing puts on health care? Whether the future is as bright as the one in our scenario or fraught with disappointment will depend less on technology and more on social and political questions about its use, nursing educators and policy makers say. Most important, Young said, nurses must keep passing the torch containing what all the technology in the world can’t replicate: human touch, human instinct and human spirit. "Hopefully, the device won’t become the patient," she said. "The device is just a tool." |
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