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The future of PHC nursing - Get ready for an explosive growth in technology
By Primary Times Chief Writer Melanie Irwin
Source: APNA Primary Times Summer 2022-23 (Volume 22, Issue 2)
The previous edition of Primary Times celebrated APNA’s 21st birthday with a look back at our past and the changing face of nursing in primary health care (PHC) in Australia since the late 1990s. In the first of a series of articles on the future of PHC nursing, we consider the role of new digital technologies in health care and the predicted impacts of these innovations on the day-to-day work of PHC nurses around the country.
Australia’s health-care system faces a challenging future. Several intersecting factors are already putting pressure on the system, and this is set to intensify. As life expectancy increases and the population ages, more people with chronic disease will require complex care in a range of settings.i The burden of mental illness is also growing, with more than 2 in 5 Australian adults experiencing a mental disorder at some point.ii Increased globalisation will result in more widespread infectious disease outbreaks, like the ongoing COVID-19 pandemic.iii In addition to this, extreme weather events and natural disasters related to the climate crisis are expected to have significant public health consequences, especially for vulnerable groups.iv Many Australians have already experienced some of this devastation with the Black Summer fires of 2019–2020 and the east coast floods of 2022.
The outlook is not all doom and gloom, though. The good news is that we already have a world-class workforce of PHC nurses who are knowledgeable, skilled and willing to do more to meet the health-care needs of Australians. In addition to this, advances in digital technology, including smart apps, artificial intelligence (AI), and virtual reality (VR), are already transforming many aspects of person-centred health care, and these advances are set to escalate. Let’s take a look at what the future holds for digital health and PHC nursing.
Mobile health
‘Mobile health (mHealth)’ is a general term that refers to the use of mobile and wireless technologies for health purposes.v Telehealth is a type of mHealth that many Australians are now familiar with, and many people use mHealth apps to track their health and fitness activity, sleep cycles and/or menstrual periods. Innovations in mHealth are increasing exponentially and are now targeting several issues that impact the work of nurses, including ‘improved data management, enhanced communication between clinician and recipient of care, reduced hospital admissions, increased medication regime adherence, and remote monitoring.’5 As so many Australians live in rural and remote locations and traditionally have had to travel long distances to access health care, the growth of mHealth in Australia will have wide-ranging benefits for much of the community.
According to Dr Jen Bichel-Findlay, chair of the Australasian Institute of Digital Health’s Nursing and Midwifery Digital Health Network, nurses also stand to benefit significantly from mHealth: ‘Some of the most time-consuming and tedious tasks (e.g., collecting blood pressure data) can now be achieved remotely by smartphone apps and other small devices,’ Jen says. ‘This gives nurses more time and energy to do other things, such as analyse and contextualise the data. Patient care is becoming more efficient, and the work is becoming more interesting for nurses, thanks to digital health.’
Wound care is another treatment that is evolving with new technologies. ‘Smart’ dressings have real-time monitoring ability: built-in sensors can determine whether a wound is healing effectively without the need to remove the dressing. A mobile app can collect the wound’s physicochemical data and send it to the clinical centre.vi This is a significant innovation, especially in the treatment of elderly patients, who may have delicate skin.vii It will also reduce the frequency of home visits and/or patients’ trips to the clinic or hospital.6
AI and machine learning
AI is a swiftly evolving discipline that enables computers to simulate human thinking and behaviour; and machine learning (ML) is a type of AI for accurate decision-making based on algorithms.viii Advances in AI and ML are already impacting health care in so many ways. One example of ML that complements the work of nurses is the health-care chatbot, an avatar who chats with users and facilitates remote monitoring through an app on their device.8 ‘The chatbot can identify the user’s mood or health status according to their voice intonation’, Jen explains. ‘This technology is being used in health care for the elderly, and also for adolescents with mental health conditions. If something is not quite right, the bot will recognise this and notify the community nurse, who can follow up with the recipient of care, and visit them if necessary. It means that the nurse can direct their care where it is needed most urgently. This is another example of improved efficiency.’
Immersive technology
Immersive technology (VR and augmented reality) is another innovation that we can expect to see more of in health-care settings in the near future. Bradley Chesham is a nurse with more than 15 years’ experience and is the founder of Bundle of Rays, a tech firm that specialises in using immersive technology to expand the possibilities for health-based education. Brad says that this technology is now becoming mainstream in Asia and the United States. In South Korea, some health-care organisations are already building their own VR apps.
Patient care is becoming more efficient, and the work is becoming more interesting for nurses, thanks to digital health.
‘The whole premise for immersive technology is collaboration’, Brad says. ‘You don’t have to travel. You don’t have to be in a big city. The technology reduces space and time. We’re all using video conferencing to collaborate remotely; however, VR enables a more meaningful and realistic exchange between people in different locations. With the headsets on, our avatars are photorealistic representations of ourselves. They look like us. They sound like us, and it actually feels like we’re in the same place. We can choose to meet anywhere in the world, and it feels like we’re actually there.’
Brad explains that all the large global corporations (e.g., Facebook, Sony, Nike and Microsoft) are transitioning to the next phase of the internet, a network of 3D virtual worlds called the ‘metaverse’. You can already walk into a VR Nike store and buy shoes, and it’s only a matter of time before the metaverse becomes part of our everyday health-care experience.
This technology will enable PHC nurses across the country to work collaboratively and access the most relevant educators, specialists and other resources so that they can provide the best possible patient care.
‘The Mt Isa Health Service in Queensland covers 300,000 square km’, Brad says, ‘and they’re going to be using VR to collaborate and to train their staff. For example, their nurses could do training sessions with experts in Brisbane, or London. The training could involve a full simulation of a cardiac arrest, and they could practise the treatment multiple times until they get it right. That’s a perfect-use case for this type of technology.’
Brad says that immersive technology has great potential for digital therapeutics too. ‘PHC nurses can use the technology for their meetings, education and training; and then the headsets can be cleaned and shared with patients for various treatments. If a nurse is providing a child’s vaccination, the headset can be used for paediatric distraction. If a patient requires physiotherapy, the nurse can set them up with the equipment for a series of fun and engaging physical activities that are tailored to their rehabilitation.’
As with most digital technologies, VR hardware is becoming cheaper and smaller, and we can expect to see it become more mainstream here in Australia soon. And even though this technology requires a reliable internet connection, Brad says that it’s already working in remote locations, where users can connect to the metaverse using wi-fi dongles and other devices where necessary. We can also expect to see greater coverage and faster speeds in satellite internet solutions very soon, which will significantly improve connections for those in regional and rural Australia.ix
Participatory health care
All of these digital technologies enable a more collaborative approach to treatment and health care between the clinician and the recipient of care. With current and projected workforce shortages in health care, it will be increasingly important for Australians to take greater responsibility for their own health, and mHealth and other innovations are already facilitating this.
In the United States, the era of digital health has seen the rise of the ‘e-patient’: patients who use information from the internet and other digital tools to become powerful agents in the management of their own health, in partnership with their clinicians. This social movement has been described as ‘the most important technocultural medical revolution of the past century’ and it’s important that health practitioners can respond to their e-patients with a positive attitude.x
‘E-patient Dave’ is a well-known example. After beating Stage IV kidney cancer in 2007, Dave deBronkart became a leading advocate for participatory health care and his public speaking and writing on the topic have been very influential.xi He emphasises the importance of communication and cooperation for enhanced provider–patient engagement and patient empowerment.
Interoperability
The interoperability of digital health systems is a crucial factor in their implementation. High-tech apps and gadgets are not much good if they can’t share data quickly and easily with other systems and other organisations, where applicable. Patient information needs to be brought together from multiple reliable sources in order to produce better decisions and improved patient outcomes.xii
According to Jen Bichel-Findlay, there’s still some room for improvement when it comes to digital interoperability in Australia’s health systems: ‘Non-interoperable devices are attractive to organisations because they’re cheaper’, Jen explains. ‘The government really needs to set minimum standards for interoperability so that digital health systems can have the greatest impact.’
Nurses are irreplaceable
Advanced chatbots and photorealistic avatars can’t offer the care and empathy that another human can provide, and nurses can rest assured that these new technologies are not going to take their jobs. As noted above, the PHC nurse’s role will only expand and become more sophisticated as more of these innovations are adopted by health-care organisations. The goal of digital health is to achieve a ‘machine–human’ synergy, where the skills and knowledge of clinicians are complemented and enhanced by technology to produce the best possible outcomes for patients.8 These changes are also generating new career opportunities for nurses, with specialist fields opening up, such as health informatics, which applies the concepts and technologies of the information age to improve health care.
‘Primary health care is the perfect context for new technology’, says Jen Bichel-Findlay. ‘Small organisations can trial and adopt new systems more easily than large bureaucratic organisations like hospitals. And so many consumers can benefit from remote care and other mHealth innovations.’
Digital health and new technologies will certainly play a crucial role in keeping Australians healthy in the years to come, and this is really just the beginning. Get ready for an explosive growth in technology.1
APNA’s Digital Health Community of Practice online platform provides an accessible environment for nurses to increase their knowledge relating to the use of digital health systems and processes within the PHC environment. Find out more at www.apna.asn.au/profession/communities-of-practice/digital-health-cop.
References
[1] S Schwartz, Educating the nurse of the future: Report of the independent review into nursing education, Commonwealth of Australia, Canberra, 2019.
[2] Australian Institute of Health and Welfare (AIHW), ‘Mental health: prevalence and impact’, AIHW website, 2022, viewed 22 September 2022. www.aihw.gov.au.
[3] SJ Bickley, HF Chan, A Skali, D Stadelmann and B Torgler, ‘How does globalization affect COVID-19 responses?’, Globalization and Health, 2021, 17(1), 57.
[4] S Kadandale, R Marten, SL Dalglish, D Rajan and DB Hipgrave, ‘Primary health care and the climate crisis’, Bull World Health Organ, 2020, 98(11), 818–820.
[5] J Bichel-Findlay, ‘The impact of mHealth on nurses and midwives’, Australasian Institute of Digital Health website, 15 November 2021, accessed 9 November 2022. https://digitalhealth.org.au
[6] H Ehtesabi, SO Kalji and L Movsesian, ‘Smartphone-based wound dressings: A mini-review’, Heliyon, 2022, 8(7):e09876.
[7] J Bichel-Findlay, personal communication.
[8] C Yin, ‘Impact of artificial intelligence and machine learning on nursing and midwifery’, Australasian Institute of Digital Health website, 10 June 2022, accessed 9 November 2022. https://digitalhealth.org.au
[9] B Chesham, personal communication.
[10] T Ferguson and G Frydman, ‘The first generation of e-patients’, BMJ, 2004, 328(7449):1148–1149.
[11] Dave deBronkart, www.epatientdave.com n.d., accessed 9 November 2022.
[12] Australian Digital Health Agency (ADHA), ‘Interoperability and data quality’, ADHA website, accessed 7 November 2022. www.digitalhealth.gov.au
