护理如何保持相关性？
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Digital technologies increasingly affect nursing globally. Examples include the growing presence of artificial intelligence (AI) and robotic systems; society’s reliance on mobile, internet, and social media; and increasing dependence on telehealth and other virtual models of care, particularly in response to the covid-19 pandemic.
Despite substantial advances to date, challenges in nursing’s use of digital technology persist. A perennial concern is that nurses have generally not kept pace with rapid changes in digital technologies and their impact on society. This limits the potential benefits they bring to nursing practice and patient care. To respond to these challenges and prepare for the future, nursing must begin immediate transformation into a digitally enabled profession that can respond to the complex global challenges facing health systems and society.
Many exemplars show how digital technologies already bring benefit to nursing practice and education.1 For instance, telehealth programs where nurses provide daily monitoring, coaching, and triage of patients with several chronic diseases have helped reduce emergency department admissions.2 Mobile devices, in particular smartphones and health applications, are enabling nurses to offer remote advice on pain management to adolescent patients with cancer34 and supplement aspects of nursing education by providing innovative pedagogical solutions for content delivery and remote learning opportunities.5
The development and application to nursing of systems based on AI are still in their infancy. But preliminary evidence suggests virtual chatbots could play a part in streamlining communication with patients, and robots could increase the emotional and social support patients receive from nurses, while acknowledging inherent challenges such as data privacy, ethics, and cost effectiveness.6
Digital technologies may, however, be viewed as a distraction from, or an unwelcome intrusion into, the hands-on caring role and therapeutic relationships that nurses have with patients and families.7 This purported incompatibility with traditional nursing ideals, such as compassionate care, may explain some nurses’ reluctance to adopt digital approaches to healthcare.89 In addition, nursing’s history was as structurally subordinate to other healthcare disciplines,10 and the profession is still cementing its relationship and leadership in health systems.
The specialty of nursing informatics has long advocated for the integration of technology to support the profession, but it has comparatively few practitioners globally. Nursing informaticians are predominantly based in the United States, where the discipline seems to have originated, but many other countries and regions are expanding their digital nursing workforce and involvement with informatics.1112
Slow progress in some areas has been due to a lack of leadership and investment that supports nurses to champion and lead digital health initiatives. Globally, uncertainty remains regarding the next steps the nursing profession should take to increase and optimize its use of digital technology. This challenge is exacerbated by the global diversity of the profession, including unequal access to resources such as technological infrastructure maturity and expertise. Huge differences exist among countries and regions of the world in terms of the digitalization of healthcare processes, access to internet connectivity, and transparency of health information processes.
The nursing literature contains many analyses of digital technologies used to support or extend the profession, including practice (eg, hospital information systems, electronic health records, monitoring systems, decision support, telehealth); education (eg, e-Learning, virtual reality, serious games); and, rehabilitative and personalized healthcare approaches (eg, assistive devices sensors, ambient assisted living).1 Table 1 summarizes the potential benefits, challenges, and implications of emerging innovations to practice.
We must urgently create educational opportunities at undergraduate and graduate levels in informatics, digital health, co-design, implementation science, and data science.39 These should include opportunities to work with and learn from computing, engineering, and other interdisciplinary colleagues. For instance, nursing will need a critical mass of practitioners who understand how to use data science to inform the creation of nursing knowledge to support practice. 40 These practitioners will also need savviness and courage to lead the development of new models of patient care enabled by digital technologies.4142
Determining how, where, and why technology like AI should be used to support practice is of immediate interest and a growing competency requirement in health sciences and informatics education.43 Nursing education should evolve its competencies and curriculums proactively for the increasing use of digital technologies in all areas of practice39 while incorporating novel pedagogical approaches—for example, immersive technologies such as virtual and augmented reality—to deliver aspects of simulation based education.4445
Recently, the American Association of Colleges of Nursing released core competencies for nursing education, explicitly identifying informatics, social media, and emergent technologies and their impact on decision making and quality as critical to professional practice.46
All levels of nursing leadership must advocate more actively for, and invest resources in, a profession that is both complemented and extended by digital technology. The profession needs to evolve its use of digital technology by continuing to champion and support nurses to become knowledgeable in, and generate new scientific knowledge on, data analytics, virtual models of care, and the co-design of digital solutions with patients, differences across contexts and regions permitting.
Advancement of leadership competencies in existing informatics technologies, such as clinical decision support systems, electronic health records, and mobile technologies, is also essential: these kinds of systems will undoubtedly come with increasing levels of AI functionality. Possessing a critical mass of nursing leaders who understand the intended and unintended consequences as well as opportunities of these kinds of technologies is vital to ensure the quality and safety of nursing.
The increasing presence and recognition of the importance of chief nursing informatics officers is a step in the right direction.47 Further, providing opportunities for nurses of all specialties to contribute to the development and implementation of digital health policies, locally and nationally, could increase future use of digital technologies in nursing.
The influence of AI on human decision making and labor are areas in need of immediate inquiry to support nursing practice for the next decade and beyond. AI technologies could provide the profession with huge benefits in data analytics and advanced clinical decision support.
Although many of the purported potential benefits of AI (eg, improved patient outcomes, streamlined workflow, improved efficiency) have yet to be fully shown in nursing research,6 it is inevitable that AI technologies will be used more regularly to support and extend nurses’ cognitive, decision making, and potentially labor functions.15
These opportunities bring new and dynamic practice considerations for nursing and interprofessional expertise. One example relates to the potential automation of inequity and injustice within systems and decision support tools containing AI4849: self-evolving algorithms in systems sometimes unintentionally reinforce systemic inequities found in society.
Increased use of AI also brings novel policy, regulatory, legal, and ethical implications to the fore. The nursing profession must examine its role, processes, and knowledge against emerging ethical frameworks that explore the opportunities and risks that AI and similar innovations bring, while advocating for patient involvement in AI development and application. Floridi and colleagues offer tenets regarding AI development and the ethical considerations in using such innovations in their call to develop AI technology that “secures people’s trust, serves the public interest, and strengthens shared social responsibility.” 50 They also advocate that as guiding principles, AI should be used to enhance human agency, increase societal capacities, cultivate societal cohesion, and enable human self-realization, with an emphasis on instilling and reinforcing human dignity.50 Further research, funding, and thought leadership in this domain are needed to help support the development of new practice policy, regulatory frameworks, and ethical guidelines to guide nursing practice.
The profession must reframe how nurses interact with and care for patients in a digital world. The sheer variety of “do-it-yourself” health and wellness applications (eg, personalized genetic testing services, virtual mental health support), mobile and social media applications (eg, mHealth, wearables, online communities of practice) and other virtual healthcare (eg, telemedicine, virtual consultations) options available to consumers is impressive.
All this may seem antithetical toward the traditionally espoused nursing role—therapeutic relationships in physical interactions—but patients are increasingly empowered, connected to the internet, and demanding personalized or self-management healthcare models that fit their busy and varied lifestyles.
To maximize its impact on patient care, the profession should continue to develop virtual care modalities that exploit internet and mobile technology, drawing on its experiences with telehealth and remote models of care.51 These care models might also be extended through virtual or augmented reality technologies or integrated with assisted living or “smart home” systems,52 and potentially other precision and personalized healthcare solutions that leverage genomic and other biometric data.
Care approaches, interpretations of privacy, and technological interoperability functionalities should be co-designed among the interprofessional healthcare team, patients, and carers53 and available where patients want them, ideally in both physical and digital realms. Deeper discussions and scientific research regarding access, cost, electronic resource use or wastage, and equity implications of the increasing digitalization of nurse-patient relationships will also need to be thoroughly explored.
The profession requires a cultural shift. Its membership and leadership must demand the evolution of digital systems better to meet contemporary and emerging needs.
Too often, technology to support nursing is poorly configured, resourced, or not upgraded to respond to practice and societal trends. Nurses still commonly use practice systems that are lacking basic usability (eg, contributing to alert fatigue, reinforcing disruptive workflow processes) or generate added documentation burdens because of poor configuration and optimization.54
There is huge variation globally in access to, integration of, and sustainability of digital technology.555657 Solutions vary and are context specific. Renewed awareness of digital technology’s use brought about by the covid-19 pandemic offers an impetus for change that nurses should embrace.
Tasks undertaken by nurses that do not add enough value to patient care present opportunities for partial or full divestment,58 and may be better integrated into future technology enabled processes or delivered by other care providers.
The profession should revisit cultural interpretations of how technology such as drones, robots, and other AI enabled systems can be considered complementary to nursing practice and process, rather than as competition or adversaries. Collaboration with technology developers, providers, and patients will be essential to ensure success.
Although some outdated nursing activities and processes made redundant or less relevant will likely be missed by some in the profession, digital technology provides opportunities to support new models of care and approaches to nursing practice. We must not allow cultural and historical interpretations of nursing to upend or impede progress.
Nurses entering the profession today will undoubtedly witness substantive disruption and change from digital technology by the time they are mid-career.59 Without immediate action, the nursing profession stands to miss a remarkable opportunity to generate new roles, knowledge, and relationships within future health systems and societies saturated by digital technologies.
Nursing will continue to offer value and importance to healthcare systems in the coming decades. However, the profession must consider its role, knowledge, and relationships with technologies and patients to remain relevant in digitally enabled societies and healthcare systems and continue to provide compassionate care in a digital world. Without proactive strategic self-reflection, planning, and action, nursing will fail to control its trajectory across the chasm separating the past, present, and future of practice.
Nursing must accelerate the transformation to a digitally enabled profession by investing in informatics education, research, and practice
Nurses should upskill in data science and other digital health topics to ensure emerging technologies such as AI are developed appropriately and safe for nursing practice and patient care
Nursing must invest in and lead digital health developments and collaborate with others to develop and deliver digital tools that patients and the public need
Nurses should champion informatics across all areas of professional practice, create leadership opportunities in digital health, and inform health policy in this area
全文翻译（仅供参考）
Richard Booth 及其同事写道，转型为数字化职业将使患者护理的利益最大化
数字技术对全球护理的影响越来越大。例子包括人工智能 (AI) 和机器人系统的日益普及；社会对移动、互联网和社交媒体的依赖；越来越依赖远程医疗和其他虚拟护理模式，尤其是在应对 covid-19 大流行时。
尽管迄今为止取得了重大进展，但护理使用数字技术方面的挑战仍然存在。一个长期存在的问题是护士通常没有跟上数字技术的快速变化及其对社会的影响。这限制了它们为护理实践和患者护理带来的潜在好处。为了应对这些挑战并为未来做好准备，护理必须立即开始转型为数字化职业，以应对卫生系统和社会面临的复杂全球挑战。
许多例子表明数字技术已经为护理实践和教育带来了好处。1例如，护士对几种慢性病患者进行日常监测、指导和分类的远程医疗计划有助于减少急诊科的入院人数。2移动设备，尤其是智能手机和健康应用程序，使护士能够为青少年癌症患者3 4提供有关疼痛管理的远程建议，并通过提供内容交付和远程学习机会的创新教学解决方案来补充护理教育的各个方面。5
基于人工智能的系统在护理方面的开发和应用还处于起步阶段。但初步证据表明，虚拟聊天机器人可以在简化与患者的沟通方面发挥作用，机器人可以增加患者从护士那里获得的情感和社会支持，同时承认数据隐私、道德和成本效益等固有挑战。6
然而，数字技术可能会被视为分散或不受欢迎的侵入护士与患者和家人的实际护理角色和治疗关系。7这种据称与传统护理理念（例如同情护理）不兼容的原因可能是一些护士不愿意采用数字化医疗保健方法的原因。8 9此外，护理的历史在结构上从属于其他医疗保健学科，10并且该行业仍在巩固其在卫生系统中的关系和领导地位。
护理信息学专业长期以来一直倡导技术整合以支持该专业，但在全球范围内从业者相对较少。护理信息学家主要位于美国，该学科似乎起源于美国，但许多其他国家和地区正在扩大其数字护理人员队伍并参与信息学。11 12
某些领域的进展缓慢是由于缺乏支持护士支持和领导数字健康计划的领导力和投资。在全球范围内，护理专业为增加和优化其对数字技术的使用而应采取的下一步措施仍然存在不确定性。该行业的全球多样性加剧了这一挑战，包括对技术基础设施成熟度和专业知识等资源的不平等获取。世界各国和地区在医疗过程的数字化、互联网连接的接入和健康信息过程的透明度方面存在巨大差异。
护理文献包含许多用于支持或扩展专业的数字技术分析，包括实践（例如，医院信息系统、电子健康记录、监控系统、决策支持、远程医疗）；教育（例如电子学习、虚拟现实、严肃游戏）；以及康复和个性化医疗保健方法（例如，辅助设备传感器、环境辅助生活）
该表并非详尽无遗，但研究主题的多样性表明该行业认识到数字技术的价值和挑战。鉴于证据，为了使该行业取得进一步进展，我们建议在五个领域采取重点和立即行动。由于全球护理的异质性以及数字技术融入医疗保健，这些建议应根据区域背景和专业背景进行限定。
我们必须紧急在信息学、数字健康、协同设计、实施科学和数据科学方面的本科和研究生阶段创造教育机会。39这些应该包括与计算、工程和其他跨学科同事一起工作并向其学习的机会。例如，护理将需要大量从业人员，他们了解如何使用数据科学为护理知识的创造提供信息以支持实践。40这些从业者还需要智慧和勇气来领导数字技术支持的新患者护理模式的开发。41 42
确定应如何、在何处以及为何使用人工智能等技术来支持实践是当务之急，也是健康科学和信息学教育日益增长的能力要求。43护理教育应积极发展其能力和课程，以便在所有实践领域中越来越多地使用数字技术39，同时结合新颖的教学方法（例如，虚拟和增强现实等沉浸式技术）来提供基于模拟的教育的各个方面。44 45
最近，美国护理学院协会发布了护理教育的核心能力，明确指出信息学、社交媒体和新兴技术及其对决策和质量的影响对专业实践至关重要。46
各级护理领导必须更积极地倡导和投资资源，以数字技术作为补充和扩展的职业。该行业需要通过继续支持和支持护士了解数据分析、虚拟护理模型以及与患者共同设计数字解决方案，并产生新的科学知识，来发展其对数字技术的使用，以及跨领域的差异。环境和地区允许。
提高现有信息学技术（例如临床决策支持系统、电子健康记录和移动技术）的领导能力也至关重要：这些类型的系统无疑会随着 AI 功能水平的提高而出现。拥有大量了解这些技术的预期和意外后果以及机会的护理领导者对于确保护理的质量和安全至关重要。
对首席护理信息学官员重要性的日益关注和认可是朝着正确方向迈出的一步。47此外，为所有专业的护士提供机会以促进地方和国家数字健康政策的制定和实施，可以增加数字技术在护理中的未来使用。
人工智能对人类决策和劳动的影响是需要立即调查的领域，以支持未来十年及以后的护理实践。人工智能技术可以为该行业提供数据分析和高级临床决策支持方面的巨大好处。
尽管人工智能的许多声称的潜在好处（例如，改善患者治疗效果、简化工作流程、提高效率）尚未在护理研究中得到充分体现，6但人工智能技术将不可避免地被更频繁地用于支持和扩展护士的工作。认知、决策和潜在的劳动功能。15
这些机会为护理和跨专业专业知识带来了新的和动态的实践考虑。一个例子涉及系统和包含人工智能的决策支持工具内的不公平和不公正的潜在自动化48 49：系统中的自我进化算法有时会无意中加强社会中发现的系统性不公平。
人工智能的更多使用也带来了新的政策、监管、法律和道德影响。护理专业必须根据新兴的伦理框架检查其角色、流程和知识，这些框架探索人工智能和类似创新带来的机遇和风险，同时倡导患者参与人工智能的开发和应用。Floridi 及其同事在呼吁开发“确保人们的信任、服务于公共利益并加强共同的社会责任”的 AI 技术时，提出了有关 AI 开发的原则以及使用此类创新时的道德考虑。50他们还主张，作为指导原则，人工智能应被用于增强人类能动性、提高社会能力、培养社会凝聚力、实现人类自我实现，重点是灌输和加强人类尊严。50该领域需要进一步的研究、资金和思想领导，以帮助支持制定新的实践政策、监管框架和道德准则，以指导护理实践。
该行业必须重新定义护士在数字世界中与患者互动和照顾患者的方式。种类繁多的“自己动手”健康和保健应用程序（例如个性化基因检测服务、虚拟心理健康支持）、移动和社交媒体应用程序（例如移动健康、可穿戴设备、在线实践社区）和其他虚拟医疗保健（例如，远程医疗、虚拟咨询）可供消费者选择的选项令人印象深刻。
所有这些似乎都与传统上支持的护理角色（身体互动中的治疗关系）背道而驰，但患者越来越有能力，连接到互联网，并需要适合他们忙碌和多样化生活方式的个性化或自我管理的医疗保健模式。
为了最大限度地发挥其对患者护理的影响，该行业应继续开发利用互联网和移动技术的虚拟护理模式，借鉴其在远程医疗和远程护理模式方面的经验。51这些护理模式还可以通过虚拟或增强现实技术进行扩展，或者与辅助生活或“智能家居”系统相集成，52以及利用基因组和其他生物识别数据的其他潜在的精准和个性化医疗保健解决方案。
护理方法、隐私解释和技术互操作性功能应在跨专业医疗团队、患者和护理人员之间共同设计53，并在患者需要的地方提供，最好是在物理和数字领域。还需要彻底探讨有关访问、成本、电子资源使用或浪费以及日益数字化的护患关系对公平影响的深入讨论和科学研究。
这个职业需要文化转变。其成员和领导层必须要求更好地发展数字系统以满足当代和新兴需求。
很多时候，支持护理的技术配置不当、资源不足或没有升级以响应实践和社会趋势。护士仍然普遍使用缺乏基本可用性的实践系统（例如，导致警报疲劳、加强破坏性工作流程）或由于配置和优化不当而产生额外的文档负担。54
在数字技术的获取、集成和可持续性方面，全球范围内存在巨大差异。55 56 57解决方案因环境而异。covid-19 大流行带来的对数字技术使用的新认识为护士应该接受的变革提供了动力。
护士承担的对患者护理没有足够价值的任务提供了部分或全部撤资的机会，58并且可能会更好地融入未来的技术支持流程或由其他护理提供者提供。
该行业应该重新审视关于无人机、机器人和其他人工智能系统等技术如何被视为对护理实践和流程的补充，而不是作为竞争或对手的文化解释。与技术开发人员、提供者和患者的合作对于确保成功至关重要。
尽管一些过时的护理活动和流程变得多余或不太相关，但行业中的某些人可能会遗漏一些，但数字技术为支持新的护理模式和护理实践方法提供了机会。我们绝不能让对护理的文化和历史解释颠覆或阻碍进步。
今天进入该行业的护士无疑会在他们进入职业生涯中期时见证数字技术带来的实质性颠覆和变化。59如果不立即采取行动，护理专业将错失在数字技术饱和的未来卫生系统和社会中产生新角色、知识和关系的绝佳机会。
在未来几十年，护理将继续为医疗保健系统提供价值和重要性。但是，该行业必须考虑其角色、知识以及与技术和患者的关系，以在数字化社会和医疗保健系统中保持相关性，并继续在数字世界中提供富有同情心的护理。如果没有主动的战略自我反思、计划和行动，护理将无法控制其跨越过去、现在和未来实践的鸿沟的轨迹。
护理必须通过投资信息学教育、研究和实践来加速向数字化职业的转变
护士应提高数据科学和其他数字健康主题的技能，以确保人工智能等新兴技术得到适当开发并安全用于护理实践和患者护理
护理必须投资和引领数字健康发展，并与他人合作开发和提供患者和公众需要的数字工具
护士应支持所有专业实践领域的信息学，在数字健康领域创造领导机会，并为该领域的健康政策提供信息
原文链接：
https://www.bmj.com/content/373/bmj.n1190
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