The Impact of Emerging Technology On Nursing Care: Warp Speed Ahead

The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead 11/13/17, 1'19 AM
The Impact of Emerging Technology ^md

on Nursing Care: Warp Speed Ahead
Carol Huston, MSN, DPA, FAAN
Abstract
While myriad forces are changing the face of contemporary healthcare, one could argue that nothing
will change the way nursing is practiced more than current advances in technology. Indeed,
technology is changing the world at warp speed and nowhere is this more evident than in healthcare
settings. This article identifies seven emerging technologies that will change the practice of nursing;
three skill sets nurses will need to develop to acquire, use, and integrate these emerging
technologies; and four challenges nurse leaders will face in integrating this new technology.
Citation: Huston, C., (May 31, 2013) "The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead"
OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 1.
DOI: 10.3912/OJIN.Vol18No02Man01
Key words: Change, future, technology, genetics, genomics, Human Genome, 3-D printing, robotics,
nanomedicine, nanotechnology, biomechatronics, Kansei, biometrics, electronic healthcare records, computerized
physician/provider order entry, clinical decision support, nursing leadership, informatics, training, education
While myriad forces are changing the face of contemporary healthcare, one could
argue that nothing will change the way nursing is practiced more than current
advances in technology. Technology is changing the world at warp speed and Technology is
nowhere is this more evident than in healthcare settings. This article identifies changing the world
seven emerging technologies that will change the practice of nursing; three skill at warp speed and
sets nurses will need to develop to acquire, use, and integrate these emerging nowhere is this
technologies; and four challenges nurse leaders will face in integrating this new more evident than
technology. in healthcare
settings.
Emerging Technologies That Will Change the Practice of Nursing
There are many emerging technologies that will change the practice of nursing in the coming decade. Seven are
discussed here; genetics and genomics; less invasive and more accurate tools for diagnosis and treatment; 3-D
printing; robotics; biometrics; electronic health records; and computerized physician/provider order entry and
clinical decision support (See Table 1 for a discussion of the benefits and challenges of each).
Table 1. Seven Emerging Technologies that Are Changing the Practice of

Nursing
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Technology Benefits Challenges
Genetics and Genomics The majority of disease Many nurses currently in

risk, health conditions practice know little about
and the therapies used to genetics and genomics
treat those conditions and lack the competence
have a genetic and/or needed to effectively
genomic element counsel and teach patients
influenced by in this regard.
environmental, lifestyle,
and other factors
therefore impacting the
entire nursing profession
(Calzone et. al, 2010).
Less Invasive and More Non-invasive and The rate at which

Accurate Tools for minimally invasive tools noninvasive and minimally
Diagnostics and for diagnostics and invasive tools are being
Treatment treatment generally introduced makes ongoing
result in lower patient competency regarding
risk and cost. their use a challenge for
nurses.
3-D Printing
Bioprinters, using a "bio- Healthcare is just
ink" made of living cell beginning to explore the
mixtures can build a 3D limits of this technology.
structure of cells, layer by There are limits to the
layer, to form human materials which can be
tissue and eventually used for printing and
human organs for materials science is a
replacement (Thompson, laggard in 3D printing
2012). (Nusca, 2012).
Robotics
Robotics can provide More research is needed
improved diagnostic on comparative
abilities; a less invasive effectiveness of robotics
and more comfortable and human care
experience for the providers. Many
patient; and the ability to healthcare providers have
do smaller and more expressed concern about
precise interventions the lack of emotion in
(Newell, n.d). In addition, robots, suggesting that
robots can be used as this is the element that
adjunct care providers for will never replace human
some physical and mental caregivers.
health care provision.
Biometrics
Biometrics increase the The measurement of
security of confidential biometric markers may
healthcare information occur in less than ideal
and eliminate the costs of situations in healthcare
managing lost passwords. settings and in a rapidly

changing workforce, cost
may become an issue.
Electronic Healthcare
Records (EHR) Healthcare providers Implementation costs,
have access to critical getting computers to talk
patient information from to each other and debates
multiple providers, about who owns the
literally 24 hours a day, 7 data in the EHR continue
days a week, allowing for to challenge its required
better coordinated care. implementation.
Computerized
Physician/Provider CPOE and clinical decision The introduction of CPOE
Order; Entry (CPOE) and support fundamentally and clinical decision
Clinical Decision Support change the ordering support requires providers
process resulting in lower to alter their practice.
costs, reduced medical Resistance is common due
errors, and more to the time spent on order
interventions based on entry. Implementation and
evidence and best training costs are often
practices. significant.
Genetics and Genomics
The American Cancer Society (2011) suggests that genetic testing is already being used for many reasons. Some
of these reasons include:
its predictive value (identification of gene mutations that might put a person at risk of developing a disease such
as cancer, cystic fibrosis, sickle-cell anemia, or Tay-Sachs disease)
its ability to determine carrier status or whether a person has a gene mutation which could be passed on to a
child
prenatal screening to diagnose some conditions in utero
newborn screening (to determine the existence of a variety of inherited conditions such as phenylketonuria
[PKU], cystic fibrosis, or sickle cell disease)
as a means for checking cancer cells to determine prognosis or potential benefits of certain types of treatment.
Future applications of genetics and genomics will transform the health care system even further. Carroll (2011)
suggests that by the year 2020 the healthcare system will have transitioned from one which fix[ed] people after
they were sick (para. 1) to one of preventive, diagnostic, genomic-based medicine where patients will be treated
for conditions we know they are likely to develop.
Health care professionals already encounter patients who arrive for diagnosis or
treatment with their genotyping or genetic sequencing in hand. With websites
Health care such as 23andMe (2012), patients can send in a saliva sample and receive a
professionals comprehensive genotyping (DNA analyzed by genetic variants) with periodic
already encounter updates on the latest biomedical literature for less than $100. Clearly, having
patients who arrive genetic data can ultimately lead to better care and patient empowerment. But of
for diagnosis or concern are the ethical dilemmas associated with safeguarding such personal
treatment with information and potential emotional consequences of uncovering unknown medical
their genotyping or data without the guaranteed support of a primary care provider. Dilemmas such as
genetic sequencing these, and others we may not yet imagine, will pose significant challenges for all
in hand. healthcare professionals, including nurses.
Despite these concerns, there is no doubt that genotyping and genetic sequencing will continue to significantly
improve diagnostic and interventional medicine. Gene therapy is expected to make significant inroads in curing
cancer and preventing birth defects within the next two decades (American Association for Cancer Research, 2012;
Manchester University Scientists, 2013; Pearson & Flake, 2013, Pelletier, n.d.).
Genetic advances are also likely to eliminate the need for organ transplants since
new organs will be able to be grown from a patients own tissues. Researchers are
already beginning to grow individual tissues, tendons, and cartilages from stem Genetic advances
cells and several years ago, a kidney-like organ was grown from scratch in the lab are likely to
and used successfully in animals (Coghlan, 2012). In January 2013, Japanese eliminate the need
researchers announced that they had succeeded in growing human kidney tissue for organ
from stem cells for the first time; a potential breakthrough for millions with transplants since
damaged organs who depend on dialysis (Japanese Researchers Grow, 2013). new organs will be
Similarly, thyroid cells can now be grown in the lab, a new ear has been grown in able to be grown
the skin of a womans arm, and cells are being reprogrammed so that they can from a patients
turn into a variety of cell types. Leading scientists suggest that there may be no own tissues.
limit to the kinds of organs and body parts that can be grown from stem cells
(Complex Body Parts, 2012). This ability to grow major organs and body parts will
eliminate the need for external donors, and since organs are genetically matched
to the patient, the chance of rejection should become minimal or non-existent.
Stem cells and new biologic treatments will also impact the future of joint repair. Rath (2012) suggests that stem
cells will be used to generate replacement cartilage tissue to repair damaged joints, especially for osteoarthritis
patients. The process of autologous chondrocyte implantation (ACI) involves removing a small piece of healthy
cartilage from the knee and growing millions of new cartilage cells (chrondrocytes) in a lab, before reinjecting
them back into the knee. ACI will help people aged 15 to 50 with single cartilage defects no larger than 10
centimeters. Similarly autologous cartilage tissue implants, which use a combination of cell therapy and tissue
engineering techniques, will be the next logical step in tissue regeneration. Such experimental implants are
already in clinical trials (Rath, 2012).
The ability to clone teeth is also expected in the near future. Experts suggest that dentures are the past, dental
implants are the present, and teeth grown from stem cells could be the future (Cloning Teeth, 2012, para 2).
Clinical trials are already underway in Europe, where a fully functional and living tooth can be re-grown in around
two months. In addition, Onion (2012) notes that scientists hope that by locating the right biological triggers
people may one day be able to grow several sets of teeth instead of just two much like the way sharks, rodents
or stingrays grow several generations of teeth to replace teeth that are worn out or damaged.
Less Invasive and More Accurate Tools for Diagnosis and Treatment
Less invasive and more accurate tools for diagnostics and treatment will also
change nursing practice in the future. For example, heart disease is likely to be
Less invasive and diagnosed by a new blood test that eliminates the need for risky diagnostic
more accurate tools angiograms. A new 23-gene blood test checks for certain blood proteins linked to
for diagnostics and heart disease (Howard, 2011). In a recent trial, the blood test was 85% accurate
treatment will also in detecting potentially harmful blockages among patients.
change nursing
practice in the
future.
Tattoos have been developed that can monitor blood glucose without a finger prick, a huge advancement for the
26 million Americans with diabetes (Howard, 2011). The miniature tattoo, which is only a few millimeters in size, is
made up of nanosensors that contain a yellow-orange dye. The dye lights up when glucose levels are high and
becomes darker when the levels drop. The tattoos are applied once a week and are being piloted at Northeastern
University in Boston (Tattoos That Improve Health, 2010).
Magnets are also increasingly likely to be used as a treatment for major

depression (Howard, 2011). Cleared by the FDA in 2008, small electromagnets are
now placed on the scalp behind the left forehead as a therapeutic intervention for Tattoos have been
depression. These magnets deliver a tiny electric current to the part of the brain developed that can
linked to depression. It seems to work, although the mechanism for action is not monitor blood
fully understood. In fact, a large study found these magnets were three times glucose without a
more effective than a placebo and most importantly, they had no serious side finger prick, a huge
effects (Howard, 2011). advancement for
the 26 million
Americans with
diabetes.
Scanning technology is predicted to improve to the point that images of soft and hard tissues in the body will be so
clear that exploratory surgery and invasive procedures will virtually be eliminated within a few decades. The
Nuclear Energy Institute (n.d.) notes several current examples of state of the art nuclear medicine. Myocardial
perfusion imaging maps blood flow to the heart, allowing doctors to diagnose heart disease and determine the
most effective course of treatment. Todays bone scans can detect the spread of cancer six to 18 months before X-
ray imaging.
Researchers are also making strides to develop vaccines for some types of cancer. For example, Howard (2011)
notes that researchers are using the same technology used to create childhood vaccines to develop a prostate
cancer vaccine known as Provenge. Doctors remove some of a patients white blood cells, expose them to a
protein found in prostate cancer, and then inject the cells back into the body, where they prime the immune
system to attack the cancer. So while Provenge doesn't cure prostate cancer, it does reduce a patients overall
risk of death by 24% in a three year period. The drug was approved in 2010 for use with patients with metastatic
prostate cancer which had stopped responding to hormone treatments (Howard, 2011).
3-Dimensional (3D) Printing
3D printing, also known as additive manufacturing, "is a method of building objects layer by microscopic layer,
fusing each cross section of molecules until a complete object is formed" (Pellet, 2013, para. 2). Typically, this
requires scanning an existing object with a 3D scanner which gathers the data necessary to print on a 3D
bioprinter. The bioprinter prints the object by adding layer after layer of materials such as plastics, glass, metal, or
ceramics. Thus, three dimensional solid objects can be created from a digital model (Thompson, 2012).
The application of 3D printing in healthcare literally makes the body into a system
of interchangeable parts (Banham, 2013). For example, in February 2013, doctors
The application of and engineers in the Netherlands collaborated on the 3D printing of a prosthetic
3D printing in lower jaw, which was subsequently implanted into an 83-year-old woman who
healthcare literally suffered from chronic bone infection. The printer produced the prosthetic jaw from
makes the body 33 layers of titanium powder that were heated, fused together, and then coated
into a system of with bioceramic artificial bone (Banham, 2013). Artificial limbs can be created by
interchangeable the same technology, as can custom hearing aids and dental fixtures (Thompson,
parts 2012).
In February 2013, Scientists at Cornell University used 3D printing to create an ear remarkably similar to a natural
one. Using 3D images of a human ear, they printed a mold to be injected with gel containing collagen from rat tails
and then added cartilage from cow ears. It took half a day to design the mold, about a day to print it, 30 minutes
to inject the gel, and the ear was removed 15 minutes later (Cantor, 2013).
In addition, human organs can be bioprinted for transplant by 3D printing. This technology involves the creation
of replacement tissues and organs that are printed layer-by-layer into a 3-dimensional structure. The parts are
made from the organ recipient's own genetic matter, and precisely match the tissue or organ they replace
(Banham, 2013). To date, 3D printers are able to print simpler tissues like skin, heart muscle patches, and blood
vessels, although the printing of solid organs like hearts and livers is expected within a generation (Banham,
2013). Thompson (2012) agrees, noting that printing off a kidney or another human organ may sound like
something out of a science fiction novel, but with the advancements in 3D printing technology, the idea may not
be so far-fetched (para. 1).
Robotics
Robotics, as an emerging field in healthcare, will also greatly impact how nursing
is practiced in the future. Growth in robotics is expected due to workforce
shortages, a growing elder population, and a call for higher quality care not Growth in robotics
subject to human limitations. Areas of projected robotic growth include is expected due to
nanomedicine, biomechatronics, and the use of robots as direct care providers. workforce
shortages, a
growing elder
population, and a
call for higher
quality care not
subject to human
limitations.
Nanomedicine, which is the application of nanotechnology (the engineering of tiny machines or robotic devices) to
the prevention and treatment of disease in the human body, is an evolving discipline has the potential to
dramatically change medical science (Whatis.com, n.d.). Nanomedicine should be commonplace in another 2 to 3
decades, with engineered nanodevices, or nanomachines, repairing damage accumulated as a result of metabolism
(being alive) by performing nanorobotic therapeutic procedures on each of the ~75 trillion cells that comprise the
human body (Healthcare in the 21st Century, n.d.). Microbots and nanodevices, which will circulate in the
bloodstream, should be able to identify and repair systems early in disease processes to greatly reduce or
eliminate the risk of cancer.
By the early 2020s, molecular manufacturing will enable the first nanobots to be
inexpensively produced for use in medicine. Once in common clinical use,
Theoretically, nanobots will have an enormous positive impact on the lives of billions of people
nanobot technology (Healthcare in the 21st Century). Theoretically, nanobot technology could become
could become the the effective end of aging as well as the reversal of one's current biological age to
effective end of any new age that is desired.
aging...
There will also be more mergers of humans and machines through biomechatronics, which means creating
machines which replicate or mimic how the body works. For example, its likely by 2020 that pancreas pacemakers
for diabetics, mentally controlled electronic muscle stimulators for stroke and accident survivors, as well as
miniature cameras and microphones that can be wired into the brain, will exist, allowing blind people to see and
deaf people to hear (Huston, 2014).
Electroencephalography (EEG) technology already exists that uses mathematical algorithims to read minds,
restore brain-controlled ambulation to the paralyzed, move experimental wheelchairs by brainwaves alone, and
explore game control without a joystick (Isaacson, 2012; Anderson, 2012). Philip Low, the mathematician and
biology student cited as being the inventor of this EEG technology, plans to introduce Low's "iBrain 3" as the first
FDA-approved EEG device in 2013. This device, the size of a U.S. quarter, can be used for medical as well as
recreational purposes and is expected to possibly sell for less than $100 (Isaacson, 2012).
The first prototype of a bionic eye should be available by 2013 (Howard, 2011). The bionic eye works by having a
tiny camera is mounted on a persons glasses. The camera sends signals to an implant on the retina, which sends
impulses to the brain, which are perceived as images. About 30 individuals have received artificial retinas so far
and the technology continues to improve. Future adaptations of this eye have the potential to change lives for
people with macular degeneration, a disease that impacts 1.75 million Americans (Howard, 2011).
We expect to see many more robotics, and they will have developed to the point that the differences between
what these life forms and humans can do will be smaller than ever. For example, more robots will be used in
surgical procedures, since already they are more accurate and steadier than human caregivers (Huston,
2014) Robots will also increasingly be used to provide direct patient care. Service robots are being developed for
use as caregivers in Japan, particularly for the elderly. These robots help with tasks such as washing or carrying
elderly patients, although they are still not yet developed for commercialization. In July 2012, iRobot Corp unveiled
its most humanlike device yet: a 5-foot, 4-inch tall mobile robot which allowed doctors to examine diagnostic data
in real time and interact with patients anywhere in the world (Seiffert, 2012). The robot features a flat-screen on
top which pivots like a human neck, showing the physician's face and allowing him to look around the room and
talk to patients, family members, and other healthcare professionals. It includes sensors for mapping and
navigation and even carries a stethoscope.
Its the use of robots as direct service providers, however, that may most impact
nursing in the future (Huston, 2014). Currently, prototypes of physical care robots
are in development, but commercial production may still take some time. Mental Its the use of
service robots are already here and in use as therapeutic adjuncts in mental robots as direct
health care. service providers,
however, that may
most impact
nursing in the
future
One such mental service robot is Paro, the seal. Paro is fitted with sensors beneath its fur and whiskers and it
responds to petting by opening and closing its eyes and moving its flippers. Paro is used in Japanese nursing
homes and by autistic and handicapped children as a therapeutic robot. It retails for about $6,000 and several
thousand have been produced since 2004. Paro was used to provide comfort and reduce stress in nursing home
residents located near the tsunami- crippled nuclear power plant leaking radiation in Fukushima (Kyung-hoon,
2011). Residents named two of the Paro robots Love and Peace and treated them more like real animals than
robots.
Many healthcare providers have expressed concern about the lack of emotion in robots, suggesting that this is the
element that will never replace human caregivers. New technology in Japan, however, has resulted in a kind of
robot intelligence known as kansei, (KEN-ZI), which literally means emotion or feeling. Kansei robots monitor
human expressions, gestures, and body language and listen to people. They also sense human emotion through
sensors that monitor pulse rate and perspiration. When Ken-zi hears a word, it searches through its database of
more than 500,000 words and then it displays one of 36 expressions it thinks matches the word (Huston, 2014).
Robots will also increasingly be used as couriers. Robot couriers find and deliver medications, supplies, equipment,
and other goods so that scarce, valuable human resources do not have to leave the patient care area.
There will continue to be more high fidelity, robotic simulation used in nursing education to supplement clinical
nursing experiences. The newest simulation robots sweat, cry, turn cyanotic, and speak. But as with other
robotics, nurse leaders will be challenged to figure out how much simulation may be too much. Perhaps by 2020,
simulation will be so highly developed that most of students clinical learning can be done in a simulation
laboratory. It would certainly be safer for patients and could eliminate the scramble to find enough clinical
facilities. The nursing leadership challenge, however, is to determine the degree of real human interaction needed
for students to develop the art of professional nursing.
Biometrics
The healthcare environment will also continue to be rapidly transformed by new technology as a result of the need
to provide confidentiality and security of patient data, i.e., to comply with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) (Huston, 2014). HIPAA calls for a tiered
approach to data access in which staff members have access to only the
Experts suggest information that they need to know to perform their jobs. To that end, developers
that biometric of new technology must assure that access is both targeted and appropriate.
signatures will Biometrics, or the science of identifying people through physical characteristics
become common such as fingerprints, handprints, retinal scans, palm vein prints, voice recognition,
place in most facial structure, and dynamic signatures, is often suggested as a solution to the
healthcare information access problem. Experts suggest that biometric signatures will
organizations since become common place in most healthcare organizations since they will provide
they will provide the needed security for medical records (Krawczyk & Jain, n.d.).
the needed security
for medical records
Fingerprint biometrics is still the most common type of biometrics in healthcare, primarily because of its ease of
use, small size, and affordable price. Detection of facial geometry through facial landmarks such as approach
angles; eyebrow and mouth contours; skin texture analysis; and hairstyles, however, is also beginning to make
inroads into healthcare as a biometric measure (Huston, 2014).
Electronic Health Records
Even health records continue to evolve as a result of technology. Any changes in documentation of care have a
significant impact on nursing practice. The electronic health record (EHR) is a digital record of a patients health
history that may be made up of records from many locations and/or sources, such as hospitals, providers, clinics,
and public health agencies (Huston, 2014). The EHR is available 24 hours a day, 7 days a week and has built-in
safeguards to assure patient health information confidentiality and security. In January 2004, President George
Bush set a goal that most Americans would have an EHR by 2014. This goal was endorsed by President Barack
Obama and supported financially with $30 billion in stimulus funds to support hospital implementation over the
next several years. As a result, this optional improvement has become a near-mandatory initiative (Haughom,
Kriz, & McMillan, 2011).
Many federal programs currently exist to support EHR adoption, including those around meaningful use (capturing
the right data that can improve patient outcomes); the implementation of electronic information exchange;
consumer e-health; and workforce training (Centers for Medicare and Medicaid Services, 2010; Take 5 with a
Nurse Leader, 2012). Challenges continue to exist in understanding and demonstrating meaningful use; capturing
the relevant data electronically as part of clinical workflows; and not having the appropriate certified technology
(Miliard, 2012). In addition, most hospitals and health systems continue to doubt their ability to meet new
mandated EHR standards, with only 48% of healthcare leaders in a recent survey feeling confident in their
organizations readiness to meet Stage 1 meaningful use requirements (Miliard, 2012). Thirty-nine percent said
they were somewhat confident; three percent said they were not confident at all; and 10 percent indicated that
they did not know their level of readiness. Even with these concerns, nearly three-quarters (71 percent) of hospital
and health system leaders said they are more than 50 percent of the way to completing EHR system adoption
(Miliard, 2012).
Computerized Physician/Provider Order Entry and Clinical Decision Support
Computerized physician/provider order entry (CPOE) is a rapidly growing technology as a result of its designation
as one of three key patient safety initiatives by the Leapfrog Group, a conglomeration of nonhealth care Fortune
500 company leaders committed to modernizing the current health care system (Huston, 2014; The Leapfrog
Group, 2013). In addition, the Institute of Medicine (IOM, 1999) study To Err Is Human recommended the use of
CPOE to address medical errors.
CPOE is a clinical software application designed specifically for providers to write

patient orders electronically rather than on paper. With CPOE, providers produce
clearly typed orders, reducing medication errors based on inaccurate transcription. Clinical Decision
CPOE also gives providers vital clinical decision support (CDS) via access to Support will likely
information tools that support a health care provider in decisions related to be commonplace
diagnosis, therapy, and care planning of individual patients. Clinical decision within a decade...
support is defined broadly as a process for enhancing health-related decisions
and actions with pertinent, organized clinical knowledge and patient information to
improve health and healthcare delivery (Healthcare Information and Management
Systems Society, 2011, para 2). Like CPOE, CDS will likely be commonplace within a decade, giving providers the
promise for access at the point of care to cutting-edge research, best practices, and decision-making support to
improve patient care. Further research is needed, however, about the impact of CPOE on nursing and physician
workflow.
In addition, adoption of emerging technologies is challenging as well as expensive. The Healthcare Information and
Management Systems Society [HIMSS] (2012) notes that by the end of 2011, only six percent of U.S. hospitals
had achieved the desired stage 6 or stage 7 on their Electronic Medical Record Adoption Model (EMRAM). Stage 6
requires full provider documentation/charting (using structured templates) and the use of clinical decision support
related to protocols and outcomes in the form of variance and compliance alerts. A full complement of radiology
Picture Archive and Communication Systems (PACS) which displace all film-based images for radiology services
must also be available to physicians via an intranet. In stage 7, the hospital no longer uses paper charts to deliver
and manage patient care and has a mixture of discrete data, document images, and medical images within its
electronic medical record environment. Clinical data warehouses are used to analyze patterns of clinical data to
improve quality of care and patient safety and clinical information can be readily shared via standardized electronic
transactions with all entities within a integrated delivery system, or a health information exchange. Furthermore,
there is a continuity of data flows for patients between the inpatient, emergency department, and outpatient
service modalities (HIMSS, 2012).
Leaders often ask how organizations can be better ready to respond to emerging technologies such as those
described above. The answer to that question, at least in part, is forecasting what skills sets will be needed to
meet these emerging technologies and proactively addressing any skill set deficits of the human capital employed
in those organizations.
Nursing Skill Sets Needed to Appropriately Respond to Emerging Technologies
The capacity to manage human knowledge, and to convert it into useful products and services, is fast becoming
the "critical" leader skill of the age (National Defense University, n.d.). Leadership skills that will be required of
nurses to appropriately respond to emerging technologies include being able to use technology to facilitate
mobility, communication and relationships; having expertise in knowledge information, acquisition, and
distribution; and understanding and using genetics and genomics in nursing (see Table 2 for select examples of
these skill sets).
Table 2. Three Nursing Skill Sets Needed to Appropriately Respond to

Emerging Technologies
Nursing Skill Set Select Examples
Being able to use technology to facilitate Email, telehealth and telemedicine,

mobility, communication, and internet, cellular technology, text
relationships messaging, video conferencing, smart
phones, 3-dimensional printing, high
fidelity simulation, virtual realities such as
Second Life Virtual World, social media
networking, embedded sensor networks,
global positioning systems, bio-electronics
Having expertise in knowledge Information literacy, evidence-based

information, acquisition, and distribution practice, clinical decision support,
sensemaking, commercially purchased
expert networks, distributed expertise,
boundary spanning knowledge
management, knowledge engineering,
standardized guidelines, fuzzy case-based
reasoning, understanding of cognitive
science theory and complex adaptive
systems theory
Understanding and using genomics in Understanding of the Human Genome

nursing Project, genetic sequencing, service
delivery models that promote safe,
efficient, and effective utilization of
genetic/genomic information in care
decisions (First Genetics, 2008); ethical
issues related to genomics encountered
throughout the life continuum and around
the world (First Genetics, 2008); ethno-
cultural beliefs and practices for utilization
of genomic-based care; and resources
available to arm nurses with information
to learn about and teach genetics (First
Genetics, 2008).
Using Technology to Facilitate Mobility, Communication, and Relationships
One leadership skill set that is increasingly recognized as critical for nurses in the
21st century is the ability to use technology which facilitates mobility as well as
relationships, interactions, and operational processes (Huston, 2014). This skill set One leadership skill
is predicted to become even more critical in the approaching decade. One goal set that is
identified in the Healthy People 2020 initiatives is use of health communication increasingly
strategies and health information technology (IT) to improve population health recognized as
outcomes and health care quality, and to achieve health equity (Healthy People critical for nurses in
2020, 2012). Healthy People 2020 suggests that communication and health IT the 21st century is
that supports shared decision making between patients and providers can result in the ability to use
social support networks. In addition, health IT can deliver accurate, accessible, technology which
and actionable health information that is targeted or tailored; facilitate meaningful facilitates mobility
use of health IT; and promote exchange of health information among healthcare as well as
and public health professionals. Finally, well developed health IT can enable quick relationships,
and informed action to health risks and public health emergencies; increase health interactions, and
literacy skills; provide new opportunities to connect with culturally diverse and operational
hard-to-reach populations; and provide sound principles in the design of programs processes
and interventions that result in healthier behaviors (Healthy People 2020, 2012).
Nurses will need the skills to use IT at the advanced level required to support
these goals.
Having Expertise in Knowledge Information, Acquisition, and Distribution
One theory put forth to estimate how quickly knowledge information, acquisition, and distribution have grown with
computing technologies is Moore's law. This law, named after Intel co-founder, Gordon E. Moore, notes that over
the history of computing hardware, the number of transistors on integrated circuits doubles approximately every
18 months to 2 years. (National Defense University, n.d.) While Moores law was originally intended to apply to
only semiconductor circuits, many futurists have applied the law to digital computers and thus to knowledge
acquisition and reporting. This has led futurists such as John L. Peterson to suggest that memory capacity will
continue to double every 18 months for at least the coming decade and that knowledge growth is exponential
(National Defense University, n.d.). Carroll (2011), another futurist, goes so far as to suggest that learning is
what most adults will do for a living in the 21st century (para. 1).
Computers will also continue to play a significant role in knowledge acquisition and distribution since they have
significant potential to dramatically extend our memory capability and memory and cognitive capacity, two
elements that form the basis of our thinking process. As such, they will become a powerful tool to help nurses
become more efficient and effective and to leverage strategic leadership and decision making when properly
applied (National Defense University, n.d.).
Clearly then, nurses increasingly need to be experts at information management,

including knowledge acquisition and distribution. In a profession where knowledge
In a profession doubles every six years (Carroll, 2011), nurses can no longer be the keeper of
where knowledge knowledge. Instead, they must become the master of collecting and sharing that
doubles every six knowledge with others. The IOM (2010) agrees, suggesting that the ways in which
years, nurses can nurses were educated during the 20th century are no longer adequate for dealing
no longer be the with the realities of healthcare in the 21st century. As patient needs and care
keeper of environments have become more complex, nurses need to attain requisite
knowledge. competencies to deliver high-quality care including leadership, health policy,
system improvement, research and evidence-based practice, and teamwork and
collaboration.
Understanding and Using Genomics in Nursing
Calzone et al. (2010) suggest that despite a burgeoning body of evidence regarding the contribution of genetics
and genomics to health or illness, the evidence specific to outcomes of genomically-competent nursing practice
and the impact on the publics health is extremely limitedif not entirely absent. Yet, individual anecdotes point to
the remarkable potential for transforming health care by the genomically-competent nurse. Calzone et al. (2010)
go on to suggest that in order for people to benefit from widespread genetic/genomic discoveries, nurses must be
competent to obtain comprehensive family histories, identify family members at risk for developing a genomic
influenced condition and for genomic influenced drug reactions, help people make informed decisions about and
understand the results of their genetic/genomic tests and therapies, and refer at-risk people to appropriate health
care professionals and agencies for specialized care (p. 27) Education will, however, be required to assure that
the revolutionary advances in genetics and genomics reach the patients and families for whom they were
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANents/Vol-18-2013/No2-May-2013/Impact-of-Emerging-Technology.html Page 10 of 16
developed (Calzone et al. 2010, p. 28).
Calzone et al. (2010) argue that bringing all 2.9 million nurses in the U.S. workforce to the forefront of
genetics/genomic healthcare practice is needed, as nurses must elicit health related information, recognize what is
important, and subsequently act upon that information in caring for the patients they serve. In fact, Calzone et al.
(2010) suggest that nurses, other health care professionals and their employers will ultimately face liability if they
fail to incorporate genetic/genomic discoveries into practice. Thus this skill set is fast becoming essential.
Nursing Leadership Challenges in Integrating New Technology
What leadership challenges will nurses face in integrating new technology with the caring part of nursing? Who will
determine what cost-benefit ratio justifies the development and use of expensive technological innovations? Who
will be charged with overseeing the initial training of a technology enabled nursing workforce and for assuring
continuing competence in technology aided practice? Finally, what role will nurses play in helping to establish the
ethical parameters of technology in healthcare? This section discuses four nursing leadership challenges (table 3)
that exist in integrating new technology in nursing and healthcare.
Table 3. Four Nursing Leadership Challenges in Integrating New Technology
Balancing the Human Element with Technology
Balancing Cost and Benefits
Training a Technology Enabled Nursing Workforce and Assuring Ongoing Competency
Assuring that Technology Use is Ethical
Balancing the Human Element with Technology
What does all this expanding technology mean for nurses? Many things, but
perhaps most importantly, nurses need to make sure that the human element is
not lost in the race to expand technology. The human connection is the art of ...perhaps most
nursing and nurses need to be actively involved in determining how best to use importantly, nurses
technology to supplement, not eliminate, human resources. One of the most need to make sure
significant challenges nurse leaders will face then in the coming decade then will that the human
be to find that balance between maximizing the benefits of using the technology element is not lost
which exists, while not devaluing the human element. in the race to
expand technology.
Balancing Cost and Benefits
There are other leadership challenges that nurses must address in conjunction with a health care system so driven
by technology, such as cost. The U.S. health care system is already the most expensive healthcare system in the
world and technology is one of the leading cost drivers. These technologies are without a doubt saving lives and
improving the quality of life for millions, but sometimes technology development comes first and then a need is
created simply because the technology exists. In addition, access to technology is often dependent on a persons
ability to pay for that technology; many healthcare disparities still exist in this regard.
Training a Technology Enabled Nursing Workforce and Assuring Ongoing Competency
Judy Murphy, deputy national coordinator for Programs and Policy at the Office of
the National Coordinator (ONC) for Health Information Technology, Department of
...nursing is an Health and Human Services, in Washington, DC stated that I used to think we
information-based [nurses] provide healthcare first, and that the need for health information was
profession that secondary (Take 5 with a Nurse, 2012, para. 8). But, Murphy now argues that
provides health nurses cannot provide good care without having the right information to make the
care, and that it is right decisions when caring for individual patients (Take 5 with a Nurse, 2012).
technology that She concludes then that nursing is an information-based profession that provides
helps us bring all health care, and that it is technology that helps us bring all that information to the
that information to point of care.
the point of care.
Who is going to train all the healthcare professionals who will work with new emerging technologies? More
importantly, who will need to be responsible for assuring ongoing competency in a digital era where half of what
someone knows is obsolete in three years? Cipriano (2011) suggests that as technology and computing become
ubiquitous, all nurses will have to demonstrate competencies to maintain cutting-edge practices and that the call
to lead this change will likely fall to nurse informaticians. These leaders with expertise in informatics will be critical
to bridging the divide between clinicians and technology as well as leading delivery model transformation through
application of health IT (Cipriano, 2011).
Assuring that Technology Use is Ethical
Finally, nurse leaders must increasingly ask how and why technology should be implemented. What parameters
need to be put into place to determine its ethical use? Just because something can be done does not mean that it
should be done. In fact, the problems faced by organizational leaders regarding technology will increasingly be
what is called wicked- meaning that they have many causes, they are tough to describe, and there is no right
answer. In a recent speech, Thomas Baldwin, a professor of philosophy at Britain's York University, suggested that
new technologies bring significant hopes of curing terrible diseases as well as fears about the consequences of
trying to enhance human capability beyond what is normally possible (Kelland, 2012). Baldwin concluded that the
blurring of the line between man and machine will continue to pose concerns about the ethics of emerging
technologies in medicine and other fields. It is important for nurses to be a part of conversations to address these
ethical concerns.
Conclusions
Clearly, planning for the future is difficult even when environments are relatively static. When they are as dynamic
as healthcare and technology, the challenges multiply exponentially. National Defense University (n.d.) agrees,
suggesting that:
As the future is uncertain, the only thing relatively clear is that much of what we will experience in
the future will be different from the past. We must understand it is not information or even
technology that will produce this unprecedented change, but the impact of technology on all aspects
of human life; not computers or even bits and bytes, but the ability to apply and integrate rapid
technological change (para. 1).
The (2010) IOM report, The Future of Nursing, suggested that it is nurses who will be called up to fill expanding
roles and to master technological tools and information systems while collaborating and coordinating care across
teams of health professionals. Nurse leaders must begin thinking now about how
emerging technologies will change the practice of nursing and proactively create
the educational models and leadership development programs necessary to assure Nurse leaders must
that nurses will have the competencies they need to address these emerging begin thinking now
technologies. It must be nurses who are at the forefront in planning for and about how
preparing for these challenges. Nursing as a profession must not be reactive and emerging
allow others to assume this leadership role. technologies will
change the practice
Author of nursing...
Carol Huston, MSN, DPA, FAAN

E-mail: chuston@csuchico.edu
Carol Jorgensen Huston has been a professor of nursing at California State University, Chico (CSUC) since 1982
and the Director of that school since January 2010. Dr. Huston is the co-author of five leading textbooks on
leadership, management, and professional issues in nursing (a total of 16 editions). Dr. Huston served as the
2007-2009 President of the Honor Society of Nursing, Sigma Theta Tau International (STTI), and as Co-
Chairperson of the 2010 International Year of the Nurse (IYNurse) Initiative (a global partnership effort between
Sigma Theta Tau International Honor Society of Nursing; the Nightingale Initiative for Global Health; and the
Nightingale Museum of London).
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The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead 11/13/17, 1'19 AM

The Impact of Emerging Technology ^md

Carol Huston, MSN, DPA, FAAN

Table 1. Seven Emerging Technologies that Are Changing the Practice of

Technology Benefits Challenges

Genetics and Genomics The majority of disease Many nurses currently in

Less Invasive and More Non-invasive and The rate at which

managing lost passwords. settings and in a rapidly

Genetics and Genomics

Magnets are also increasingly likely to be used as a treatment for major

3-Dimensional (3D) Printing

Electronic Health Records

Computerized Physician/Provider Order Entry and Clinical Decision Support

CPOE is a clinical software application designed specifically for providers to write

Nursing Skill Sets Needed to Appropriately Respond to Emerging Technologies

Table 2. Three Nursing Skill Sets Needed to Appropriately Respond to

Nursing Skill Set Select Examples

Being able to use technology to facilitate Email, telehealth and telemedicine,

Having expertise in knowledge Information literacy, evidence-based

Understanding and using genomics in Understanding of the Human Genome

Using Technology to Facilitate Mobility, Communication, and Relationships

Having Expertise in Knowledge Information, Acquisition, and Distribution

Clearly then, nurses increasingly need to be experts at information management,

Understanding and Using Genomics in Nursing

developed (Calzone et al. 2010, p. 28).

Nursing Leadership Challenges in Integrating New Technology

Table 3. Four Nursing Leadership Challenges in Integrating New Technology

Balancing the Human Element with Technology

Balancing Cost and Benefits

Training a Technology Enabled Nursing Workforce and Assuring Ongoing Competency

Assuring that Technology Use is Ethical

Balancing the Human Element with Technology

Balancing Cost and Benefits

Training a Technology Enabled Nursing Workforce and Assuring Ongoing Competency

Assuring that Technology Use is Ethical

Carol Huston, MSN, DPA, FAAN

Banham, R. (2013). Printing a medical revolution. Retrieved from

Carroll, J. (2011). Blog. Retrieved from http://www.jimcarroll.com/category/trends/health-care-

Howard, B. (2011). Medicines bright future. AARP. 61-66.

Newell, L. (n.d.). Medical robotics. Retrieved from www.ehow.com/about_4673595_medical-robotics.html

Pellet, J. (2013). How 3D printing works. T. Rowe Price. Retrieved from

23andMe (2012). How it works. Retrieved from https://www.23andme.com/howitworks/

Whatis.com. (n.d.) Nanomedicine- definition. Retrieved from http://whatis.techtarget.com/definition/nanomedicine

2013 OJIN: The Online Journal of Issues in Nursing

Benefits of On-Site Clinics

Toward an Understanding of Wisdom in Nursing

Simulation in Nursing Practice: The Impact on Patient Care

Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations

Nursing Intellectual Capital Theory: Implications for Research and Practice

Nursing Control Over Practice and Teamwork

2017 The American Nurses Association, Inc. All Rights Reserved

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