Is technology taking the 'care' out of nursing? As nurses continue to use increasingly complex technology to care for their patients, there is a danger that the art and science of patient-focused, humanist care may lose its significance.Technology is changing the face of nursing, to an extent I never realised when I began my nursing degree in 2002. I came into nursing later in Life, after an earlier career as a sales representative. I had the "people skills" but a slight mental block when it came to machines. As I soon discovered, nurses today are expected to practise prac·tise v. & n. Chiefly British Variant of practice. prac  tis·er n. in
clinical environments where technical competence technical competence,n the ability of the practitioner, during the treatment phase of dental care and with respect to those procedures combining psychomotor and cognitive skills, consistently to provide services at a professionally acceptable level. is highly prized. (1) At times over the last three years I have pondered if this may occur at the expense of caring, with the potential for caring to become an "optional extra". Nursing has already been defined by one commentator as "managing the technical tasks". (2) This could become the norm, with technology displacing patients as the focus of care. (3) Caring is central to nursing, but the relationship of technology to nursing care is causing much debate. (4) Care is a difficult concept to define and there is no clear agreement in the literature as to its meaning. This probably indicates that the concept of what makes up good nursing care varies between individuals and is dependent on the environment where it takes place. Some authors argue that, by using technology, nurses are losing their traditional/humanist caring rote rote 1 n. 1. A memorizing process using routine or repetition, often without full attention or comprehension: learn by rote. 2. Mechanical routine. and becoming more like technicians or "nurse robots". (5,2) On the other hand, others argue that technology and technological advances are reshaping the future of nursing care, to its true place somewhere in the middle of the two opposing views. (2) Former president of the International Council of Nurses, Kirsten Stallknecht, speaking to the American Nurses' Association in 2000, said: "We cannot allow technological leaps forward to add distance between patients and nurses. No automated system can replace human assessment skills, or be as effective as human touch." (6) She contends that nurses must be doubly vigilant in keeping the care in nursing. Some authors describe technology as being incompatible with traditional nursing care, and some even describe it as being morally wrong. (7,2) They challenge the use of technology in patient care, describing it as helping to destroy human dignity Human dignity is an expression that can be used as a moral concept or as a legal term. Sometimes it means no more than that human beings should not be treated as objects. Beyond this, it is meant to convey an idea of absolute and inherent worth that does not need to be acquired and by reducing patients to objects and preventing nurses from staying in touch with their patients' humanity. (8) Modern nursing has also been criticised for emphasising the importance of technical skills to the detriment Any loss or harm to a person or property; relinquishment of a legal right, benefit, or something of value. Detriment is most frequently applied to contract formation, since it is an essential element of consideration, which is a prerequisite of a legally enforceable contract. of caring, because of the push to make nursing a profession. (9) Some have described the technological age as signalling a period of renaissance that can finally cure nursing of the "sense of inferiority that has pervaded the profession for so long". (10) However where does this Leave "care"? For most nurses, caring about their patients is an expression of their caring natures--this is why I went into nursing. However, technology can challenge nurses to keep the personal care in their nursing care, particularly in "high-tech" areas like the intensive care unit (ICU ICU intensive care unit. ICU abbr. intensive care unit ICU see intensive care unit. ICU ). (11) Technical proficiency pro·fi·cien·cy n. pl. pro·fi·cien·cies The state or quality of being proficient; competence. Noun 1. proficiency - the quality of having great facility and competence in this context is indeed a form of caring, because having the knowledge, skill, judgment and experience necessary to respond in critical circumstances can save lives. By this definition, competence in technologies is compatible with caring. However, some decry de·cry tr.v. de·cried, de·cry·ing, de·cries 1. To condemn openly. 2. To depreciate (currency, for example) by official proclamation or by rumor. the use of any "high-tech" equipment, claiming it violates the sacredness of the body. (12) This view is supported by former ICU patients who, even though most were grateful for their treatment, felt the highly technical nature of the area impeded im·pede tr.v. im·ped·ed, im·ped·ing, im·pedes To retard or obstruct the progress of. See Synonyms at hinder1. [Latin imped their long-term psychological recovery. (13,14) Nurses were often so preoccupied with the machines, they sometimes neglected to take into account how helpless and exposed the patients felt. (13,15) Advances in technology raise many moral dilemmas for nurses, who are having to balance maintaining respect and dignity for their patients with the needs of the technology being used. Not letting machines dominate No one can dispute that nurses need increased scientific knowledge if they are to interpret data, such as that shown on an electrocardiogram electrocardiogram /elec·tro·car·dio·gram/ (-kahr´de-o-gram?) a graphic tracing of the variations in electrical potential caused by the excitation of the heart muscle and detected at the body surface. monitor, correctly. This is dangerous ground for nurses because looking at a screen to see how a patient is doing, particularly if the monitor is in an office, can be easier than making a personal observation. (7) Nurses new to an area such as ICU admitted in one study how much stress and fear they felt coming to terms with a heavy reliance on technology and technological skills. (11) They explained how easy it could be to be initially overwhelmed o·ver·whelm tr.v. o·ver·whelmed, o·ver·whelm·ing, o·ver·whelms 1. To surge over and submerge; engulf: waves overwhelming the rocky shoreline. 2. a. and to lose sight of the patient. However, a study in Norway comparing two critical care areas found that the nurses never let machines dominate, govern or replace their caring. (16) They achieved this by always asking relatives to bring photos of the patient to put around the bed to keep them focused. Thus, technology is not necessarily in conflict with humanised care, but should be seen as an integrated and integral part of nursing care. Nurses must ensure that machines do not completely dominate limited space. (16) Preserving humanity in the present technological age can and will continue to be a real challenge for nurses, particularly for those staff working within highly technical environments. When nurses are able to exhibit both technological competence and caring, they are transformed from being mere technicians to nurses who are able to care holistically. (17) However, nurses need to acquire many new skills to reach this point. The advent of technology into nursing has meant nurses need to master many new skills, including those needed to manipulate machinery and to problem solve their operation. (1) Nurses need to reflect on the moral and ethical issues that arise in these areas, particularly when technology has the ability to preserve and Lengthen length·en tr. & intr.v. length·ened, length·en·ing, length·ens To make or become longer. length en·er n. Life. Nurses also
need to be psychologically and technologically competent, so they can
effectively bridge the division between technology and caring.
The culture of technology has emerged out of a need for efficiency, safety and a social environment that has become dependent on electronic devices. (17) Most patients today would expect to see all kinds of technology in a hospital and they are often well informed, due to the easy availability of medical knowledge on the Internet. However, it does not appear to matter how well informed patients are--they still want nurses who really care and have time to Listen. This means nurses must update and acquire the skills necessary for balancing technology and patient needs. (1) New skills required By introducing new options in "care", it can be argued that technology not only makes clinical practice simpler and safer, but is often more accurate. However, recent anecdotal evidence anecdotal evidence, n information obtained from personal accounts, examples, and observations. Usually not considered scientifically valid but may indicate areas for further investigation and research. disputes this, with some asserting that the technology currently in use has done little to reduce nurses' workloads because of the extra skills required. (18) Some nurses may get so immersed im·merse tr.v. im·mersed, im·mers·ing, im·mers·es 1. To cover completely in a liquid; submerge. 2. To baptize by submerging in water. 3. in technology, they forget to care. There is no reason why caring cannot occur within the technological environment of modern health care. Nurses have the power to resist becoming simply technicians and can choose to keep the humanity in their nursing care, even in the face of a challenging nursing environment. Technology can be used positively to help nurses spend more time with their patients. Nurses are positioned at the axis point between technology and individuals, taking the primary role in interpreting and influencing the relationships between nursing care and technology. Technology will continue to be an important factor in the delivery of health care in this century, (1) potentially allowing nurses to spend more time with their patients. However nurses must remain vigilant and never forget their patients. Technology can enhance the care of patients by providing access to up-to-date information, such as online illness and drug information and providing the means to help save many patients. We are standing at the cusp of great technological advances. Nurses must not become so engrossed en·gross tr.v. en·grossed, en·gross·ing, en·gross·es 1. To occupy exclusively; absorb: A great novel engrosses the reader. See Synonyms at monopolize. 2. in new technology that patient-focused care is relegated to second place. Keeping the "care" in nursing care rests firmly in the hands of nurses. References (1) Barnard, A., Gerber, R. (1999) Understanding technology in contemporary surgical nursing: a phenomenographic examination. Nursing Inquiry; 6: 3, 157-165. (2) Malone, R. E. (2003) Distal distal /dis·tal/ (-t'l) remote; farther from any point of reference. dis·tal adj. 1. Anatomically located far from a point of reference, such as an origin or a point of attachment. nursing. Social Science & Medicine; 2317-2326. (3) Burger Lux, M. J., Heaney, R. (1986) For better and worse: The technological imperative in health care. Social Science & Medicine; 22: 12, 1313-1320. (4) Dean, B. (1998) Reflections on technology: increasing the science but diminishing the art of nursing? Accident and Emergency Nursing; 6, 200-206. (5) Sandelowski, M. (1999) Troubling distinctions: a semiotics semiotics or semiology, discipline deriving from the American logician C. S. Peirce and the French linguist Ferdinand de Saussure. It has come to mean generally the study of any cultural product (e.g., a text) as a formal system of signs. of the nursing /technology relationship. Nursing Inquiry; 6: 3, 198-206. (6) Stallknecht, K. (2001) American Nurses Association American Nurses Association, n.pr professional organization of registered nurses created to encourage high standards in nursing care, pro-mote nursing as a profession, and lobby Congress for issues of concern to nurses. Convention Speech--June 4, 2000. Online Journal of Issues in Nursing. http://www.nursingworld.org/ojin/keynotes/speech. Accessed on 17/8/04. (7) Barnard, A. Sandelowski, M. (2001) Technology and humane nursing care: (ir)reconcilable rec·on·cil·a·ble adj. Capable of or qualified for reconciliation: reconcilable differences. rec or invented difference? Journal of Advanced Nursing; 34: 3, 367-375. (8) Anderson, C. C. (2004) The post-modern heart: war veterans' experiences of invasive cardiac technology. Journal of Advanced Nursing; 46: 3, 253-260. (9) Rushworth, L. & Happell, B. (2000) 'Psychiatric nursing was great, but I want to be a "real" nurse': Is psychiatric psy·chi·at·ric adj. Of or relating to psychiatry. psychiatric adjective Pertaining to psychiatry, mental disorders nursing a realistic choice for nursing students? Australian and New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. Journal of Mental Health Nursing; 9: 3, 128-136. (10) Barnard, A. (1999) Nursing and the primacy pri·ma·cy n. pl. pri·ma·cies 1. The state of being first or foremost. 2. Ecclesiastical The office, rank, or province of primate. of technological progress. International Journal of Nursing Studies; 36: 6, 657-652. (11) Alasad, J. (2002) Managing nursing in the intensive care environment. The nurses experience. International Journal of Nursing Studies; 39: 4, 407-413. (12) Darbyshire, P. (1999) Nursing, art and science: revisiting the two cultures. International Journal of Nursing Practice; 5: 3, 123-130. (13) Hagland, N. (1995) Nurse-patient communication in intensive care: a low priority? Intensive and Critical Care Nursing; 11: 2, 111-115. (14) Russel, S. (1999) An exploratory study of patients' perceptions, memories and experiences of an intensive care unit. Journal of Advanced Nursing; 29: 4, 783-789. (15) Butter, K. (1995) Psychological care of the ventilated ven·ti·late tr.v. ven·ti·lat·ed, ven·ti·lat·ing, ven·ti·lates 1. To admit fresh air into (a mine, for example) to replace stale or noxious air. 2. patient. Journal of Clinical Nursing; 4: 6, 398-400. (16) Bunch, E. H. (2002) High technology and nursing: ethical dilemmas An ethical dilemma is a situation that will often involve an apparent conflict between moral imperatives, in which to obey one would result in transgressing another. This is also called an ethical paradox nurses and physicians face on high-technology units in Norway. Nursing Inquiry; 9: 3, 187-195. (17) Locsin, R. (2001) The culture of technology: Defining transformation in nursing from "The Lady with a Lamp to Robonurse". Holistic Nursing holistic nursing, n philosophy of nursing that seeks to facilitate patient healing by creating a caring, interactive atmosphere; incorporates energy field principles, patient em-powerment, scientific knowledge, and personal interaction to assist patients Practice; 16: 1, 1-4. (18) Bleich, M. & Hewlett, P. (2004) Dissipating the 'Perfect Storm'--Responses from nursing and the health care industry to protect the public's health. Online Journal of Issues in Nursing; 9: 2, Man 4. Accessed 1/8/04 www.nursingworld.org/ojin/topic2. Lynda Shivas, RN, BN, is a new graduate, now nursing at Rimutaka Prison in Upper Hutt Upper Hutt, city (1996 pop. 36,717), S North Island, New Zealand, in the Hutt River Valley. It is primarily residential but has some light industries. . |
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