SON Home | UW Home | MyUW | UW Bothell | UW Tacoma | HealthLinks | Contact the School | Search SON | Internal Headlines | Briefly | From the Deans Desk A Letter from 2032: the Age of Creative Health By Glen Hiemstra Sea-Belle Regional Health 5 Lake Washington Platform • Bellevue, WA V-PH 425-499-555-5555 November 25, 2032 Dear Nurses and Students of 2002: I work as director of nursing services for a large regional hospital. Today I received a most unusual assignment from my chief administrator: to write a letter to you about our world in 2032. I might know some of you because I was certainly alive and kicking in 2002, working as a "middle aged" nurse while completing a graduate degree. Presumably I am to tell you some of what has changed and not changed in the past 30 years. I wonder if you can imagine 2032 from your vantage point any better than people could have imagined 2002 way back in 1972. Well, here goes. The Day Begins On a warm fall day here in Seattle, Washington, my smart alarm has just scanned the net for problems that would affect those still driving automobiles and discovered that traffic has come to standstill on Interstate 405 due to a construction accident. After checking with the intelligent assistants of other participants in my morning meeting and confirming that a delay was acceptable, the alarm programmed an additional hour of sleep, which I greatly appreciate. I am 74 years of age and, even in my good state of health and arrested aging, an extra bit of sleep is most welcome. Still Working At the turn of the century, a person my age who was still working was considered either most unlucky, or quite eccentric. Now, just 30 years later, a 74-year-old who is not working is considered either unlucky or eccentric. This is quite a change, as you can imagine. Nearly 30 percent of the population in the United States today is over 65, three times the percentage in 2002. In some parts of the world the ratio is much higher. Researchers are still seeking that elusive average life span of 100 years, but the norm now is to live about 30 additional years if you make it to 65, which is more than 10 years better than in your time. Thus, notions of what retirement is and when it ought to begin have been shifting dramatically. Major Change To young people today, the world of 2032 seems as though it has always been this way. But we who were alive in 2002 know differently. Our society is now in the latter stages of the techno-socioeconomic-health care revolution that began about 1970. Digital, biological and nanotechnological advances were the driving forces. As with such revolutions through history, the result has been changes in how and where and when we work, where and how we live, how we make and buy and sell things, how we communicate and travel, and how long and how well we live. All of these have impacted health care and our profession. Intelligent Assistant Now that I am up, I ask my assistant about the patients that came in yesterday. He reports that he has reviewed their status as reported by assistants, nurses and physicians on duty; explored their genetic profiles (not many lack this most important record); researched the comparative success of various treatment options; and made a preliminary recommendation for each patient. I am most appreciative, and tell him so. Did I mention that my assistant is a computer, one of the many $1000 machines we now have which far surpass the human brain in processing capacity, a threshold we passed a decade ago? After scanning the reports, I instruct my assistant to contact other nursing assistants and ask them to provide specific care. This particular transaction, like many business transactions today, will involve little human contact. Often we cannot tell whether we are interacting with a human or an intelligent assistant. The only direct human contact is with the patient. As you know, health care in 2002 was behind other industries in the effective application of information technologies. Our field was, after all, very complex, and very dependent on human interactions. These two facts have really not changed. Nursing is still a complex profession, and human contact is still at its heart. The advances in digital technology that we were making in 2002 seem primitive by current standards. Back then, we were a little intimidated by the idea of nurses wearing wireless phones or PDAs (personal digital assistants) to enable us to access records, or quickly confer with others. Many of us suspected that such devices would get in the way of "real patient care," and longed for the old days without such technology. Today we are actively engaged with incredibly powerful, usually visual, and often holographic or three-dimensional computing and communication systems. What do they enable us to do? We can interact with patients from any location. We can provide instant education and training, both for our patients and for colleagues. We can tap into data banks of research to provide the best recommendations for treatment. When we are at work, we almost always wear augmented reality systems of some kind, typically a set of glasses or a virtual retinal scan device, that enables us to see the real world as it is, with an overlay of almost any kind of information we need in one corner of our visual field. Such systems were under development at the University of Washington and elsewhere in 2002, but were considered pretty crude. Few would have guessed how far the technology has come. Population Crisis: Healthcare Back in 2002 there were predictions that the United States would have 115,000 RN vacancies by 2010 and perhaps twice that many by 2020. The problem was world wide, and getting worse. It did indeed get worse. It took the collapse of the U.S. health insurance market between 2010 and 2015 to finally create major changes in our health care system. This shift also triggered a renaissance in nursing that continues to this day. Although the financial crisis in health insurance was the tipping point, two shifts in cultural values also played a role. Nearly a decade before 2002, a UW nurse researcher named Kristen Swanson described nursing as "enabling others to practice self care." Most of us knew in 2002 that the "wait for the disease, then treat the disease" model of health care was not optimal. We also knew that the growing expense of health care had contributed to the crisis in nursing. Although nurses had always focused on prevention, and hospitals and health care companies were full of slogans about wellness, the impact on the system was minimal. When the insurance industry collapsed, however, the public began to take self-care seriously. Moreover, they knew that nurses were best suited to promote and enable self care. This led to an elevation of our role and related wage increases. One other cultural shift was also important, and it had to do with technology. Leaps in Technology You might find it a little hard to believe in 2002, but while you were focused on stagnant technology stocks and the war on terrorism, technology research went forward. In fact, even in the depths of the technology economy bust, there were a record number of new technology patents filed. Eventually these patents led to further breakthroughs in computing, communications, robotics, informatics, telemedicine, cyber-health care, and so on. Such developments amplified our abilities as nurses and enabled certain tasks to be turned over to automated systems. But in health, as in other professions, we made an important discovery. We began to realize that even the most intelligent automated systems could not provide the human touch, face-to-face. Thus, touch began to be valued above all else in our high tech world. Professions that emphasized human touch, such as nursing, came into new prominence. We continue to have spot shortages, but the nursing crisis that consumed our attention in 2002 is well behind us. Population Crisis: Birth Rates Another population crisis, not involving nurses, was also just beginning in 2002. This one involved the declining world population. Surprised? By the year 2002, 61 nations had birth rates below population replacement levels. The U.N. was forecasting that our world population would reach a low point of about 8 billion between 2030 and 2040. But it happened much faster than that, dropping to 7.8 billion by 2030. No one is quite sure what to do about this, although some political leaders are already calling for programs to promote large families. How will the economy work when there are fewer customers each year? What does this mean for health care around the world? New Forms for Organizations These thoughts were on my mind as I traveled on to the hospital. I am one of a declining number of my colleagues who work for a hospital similar to those operating in 2002. Just as you might suspect, the work here is highly specialized, highly technological, very integrated with surrounding health care institutions and support professionals, and conducted in a way that leads to very rapid turnover in patients as care regimes are moved back to homes and ancillary clinics and locales. We have seen the emergence of several new forms of health-care enterprises. Free-lance specialists now work as part of roving health care teams. There are also corporation-sponsored specialists and a vast increase in hospitals privately endowed by the super rich in our society. This trend is the subject of my meeting this morning. Arriving at the office, I dial up global health experts from three continents in the hospital’s virtual presence room. We are discussing the world’s number one health challenge today, which is how to bring the benefits of genomics to the 55% of our global population who are medically underserved. There have been worldwide improvements in health care, especially after we got a handle on the AIDS crisis in Africa during the second decade of the century. But significant global health threats still exist, including heart disease; depression and psychiatric illnesses; stroke; war and interpersonal violence; and, interestingly, traffic accidents. We also have seen a sustained resurgence of interest in public health nursing. Continued rapid travel around a shrinking globe made virtually all health problems and diseases global by 2020. Only large scale public responses, including education, prevention, and treatment, have kept these problems under control. A revived public health system evolved that includes close cooperation among health providers. Growth in Biotechnolgy I mentioned earlier that three technologies have been key drivers of change within health care. Digital tech I have already covered, but I’ll bet you would like to hear what has happened with biotechnology, and with something you were just beginning to learn about in 2002, nanotechnology. Let’s start with biology. The human genome project and the genomic and proteomics revolutions that followed all took time. It was not until about 2015 that genetic therapies became commonly available, based on a better understanding of proteins and how they function. Routine genetic assays of people seeking health care, a full genetic record of each person who allowed it, and customized drug and other treatments became reality over the next decade. Stem cell therapy was available in limited ways by 2010, but it took another full decade of legal and ethical challenges before it became commonly available. Cloned organ transplants followed, as did artificial bio-organ transplants in 2025. Nanotechnology has turned out to have a powerful impact on health care. In the past five years tiny nano-scrubbers the size of a virus have been perfected. Injected into the blood stream, they locate plaque, deconstruct the constituent molecules, and flush it away. Although nano-size visualizing tools were beginning to be used in 2002, today we are also developing nano-suture assistants, nano bacteria and virus fighters, nano- cancer-cell destroyers and other minute tools. There is one piece of bad news here. Regarding both bio and nano technologies, a robust movement to stop developments in these fields grew up over the past three decades, reaching a peak between 2015 and 2025. Calling themselves the PHP (the Party for Human Purity), they used any and all means to stop biotechnology and nanotechnology research, including bombings and murders. This has been very frightening at times, as you may imagine. Project in Nursing Education Later in the morning I traveled to the University of Washington School of Nursing for a face-to-face meeting. We have joined a network of learning and health care enterprises to support the cyberlearning initiative for nursing. We consider it rather quaint that discussions about how to improve nursing education used to begin with how to improve nursing schools. Internet-based learning existed in 2002, but it was crude and of mixed quality. Although we have always known that lifelong learning is vital to our profession, in 2032 we know that it can happen anywhere. A common model is the one we are discussing in our meeting, a cyberschool in a regional shopping center offering learning opportunities to health care consumers, practitioners and educators. Universities themselves, among the most stable of all human enterprises, have also evolved in this direction. Although degree-granting institutions, like the University of Washington, are in some ways still traditional, more than a third of its students at any given time are taking classes elsewhere in the world. This is usually done using virtual presence technology, but large numbers of students and teachers also travel to other parts of the world to study. The UW School of Nursing offers instruction to students all over the world using advanced technology. As anticipated in 2002, there are now many more nurses with advanced degrees, primarily because our evolved system of health care has required more nursing leadership. Did I mention that I traveled to the University in my institution’s Moller Skycar? (Yes, I really do mean the Jetsons’ flying car come true. A test version was flown in July 2002. Visit www.moller.com to learn more.) Living Lightly Then it was noon and time for lunch. I joined some friends for a 40-minute jog, followed by a light and lively lunch at an outdoor café. If we have learned nothing else since 2002, we have learned to slow down. As in 2002, we can do so much more, so much faster, that there is a temptation simply to do so. But at my workplace we learned to get off that treadmill, and we are not alone in doing so. Professional Development Following lunch it is time for some professional development. Today we are delving more deeply into the form of intelligence called holisapience, developed by the 21st century Korean philosopher Sunghai Kimsunghai. Nearly all health-care professionals today are educated in systems thinking, chaos theory, techniques of anticipating second-order consequences of actions, self-organizing systems, and now, holisapience. The latter is a form of thinking that emphasizes seeing health challenges from many points of view simultaneously. Back in 2002 we examined health care from only two sides, traditional and nontraditional, or Western and non-Western. Holisapience is considered a high form of wisdom, and we’ll be learning about it for the next hour as we apply it to global health issues. Working within this format will hopefully improve our ability to solve problems by acting in more interconnected ways, a theme we have been focusing on for many years now. E-mail and Other Things That Do Not Change At 2:30 p.m. I pause for 30 minutes to catch up on mail. Yes we still do that, and like you I deal with both e-mail (often video) and voice mail. It is rare to deal with paper. What used to be on paper we tend to read on our hand-held slates, or on the nanopaper we can fold and carry in a pocket. This paper can be connected wirelessly to the net, so that a single sheet holds a report of unlimited pages. Vacation As the workday concludes, I take a moment to research a personal matter. I am looking forward to a vacation I am planning, something I have dreamed of since I built a spaceship of cardboard boxes lit by light bulbs in my basement in Idaho. I will be orbiting the Virgin Atlantis Hotel for two weeks in artificial gravity, with play-time in a weightless auditorium. I am a bit nervous, but figure I had better do it while I am still young. Perhaps I’ll see you there. Photographs and graphics relating to the Nomad™ personal display system were provided courtesy of Microvision, Inc. Return to Headlines Headlines | Briefly | From the Deans Desk   Copyright © 2010 University of Washington 1959 NE Pacific Street, Seattle, Washington 98195