Where would you be without a “smart” phone to manage your life? We’ve adapted to noxious ring tones; how have we adapted to technology in nursing?
Almost 50 years ago, clinical automation entered mainstream health care. But it wasn’t until the 1980s that nurses went from being ignorant to curious and then excited about technology’s potential impact. Competencies for using technology were developed—but warning bells sounded about the potential for high tech to undermine “high touch.” Informatics programs at the masters and doctoral levels took hold and began to create a cadre of experts who would lead nursing’s data transformation. In 1992, ANA declared nursing informatics a specialty.
Throughout the 1990s, computers and digital technology penetrated all healthcare settings. Application of telehealth capabilities advanced distance education and remote clinical care, while clinical simulations revolutionized the classroom.
In the new millennium, the imperative to improve the quality of care established health information technology (HIT) and high-tech devices as the primary means of measuring and reporting outcomes as well as reducing error and waste. The push was on for data documentation systems to become true information systems by transforming data into information. From 2003 to 2008, three major nursing studies funded by the Robert Wood Johnson Foundation—“Transforming Care at the Bedside,” “Time and Motion,” and “Technology Drill Down”—underscored the benefits of technology in improving the safety of care and workflow efficiency for the nurse, among other benefits.
With technology avoidance no longer an option, nurses have a responsibility to use HIT and high-tech devices effectively while preserving patient-centeredness and the human interface in care. Early nursing informatics leaders emphasized the nurse’s role to provide care in response to human phenomena, but also to be expert in managing technological applications in the patient environment. The nurse ensures that the physical environment ameliorates potentially harmful effects of technology by making the technology as unobtrusive as possible and maintaining sufficient human contact. Nurses and other providers are just beginning to feel comfortable using technologies in the presence of patients and families, and are making an effort to preserve direct eye contact with them when using computers. Bridging the cyberspace of home telehealth or other remote monitoring methods remains a challenge.
Where is the nurse vulnerable to technology’s lure? We use technology and automation to increase speed, accuracy, efficiency, and reliability throughout health care. But we still must use our judgment when considering additional information obtained from information systems and devices, based on the context of care and patient nuances. When evaluating clinical alerts, alarms, and other messages, we must determine the relevance, quality, and reliability of the incoming information before taking action.
Some devices are replacing certain physical actions that nurses and assistants perform. For instance, “smart beds” can adjust surface firmness, measure weight, vibrate, turn, and provide sitting positions. But we must not be lulled into the complacency of substituting automated functions and forgoing direct observation of the patient’s skin condition, breathing, and physical mobility.
Other pitfalls are alarm fatigue and the perceived need for “workarounds.” Hypersensitive alarms and cumbersome design features create unwelcome interruptions and time-consuming distractions. As a result, nurses may silence alarms or disable safety features meant to act as safety valves—or may stop using the device altogether. Ongoing evaluation of technology adoption can yield important information to improve design and use.
Technology also is revolutionizing care and empowering consumers through virtual house calls, home monitoring, and wireless devices for mobile health care. Outside the hospital, technology sharpens communication for prevention, treatment adherence reminders, education, and old-fashioned follow-up. In the hospital, process-transforming technologies make care safer and give nurses more time at the bedside.
Technology and HIT—now inseparable from the caring process—are fueling a culture of innovation and change. By become fully engaged, nurses can help design and implement better systems and devices while ensuring the presence of the counterbalancing human interface in our practice.
Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC, is Editor-in-Chief of American Nurse Today.