Discussing the Relationship between Nursing and Technology

Relationship Between Nursing and Technology

To date, nurses have rarely been “at the table” in regard to developing much of the biomedical technology that affects their practice. Nursing most often inherits or receives technology developed by other discipline. Medical technology is NOT nursing technology, and yet it is most often imposed on nurses. At point of patient care, nurses use technology to improve the quality/client care and generate data about nursing outcomes. The need for nursing informatics is clear, as is the need for nurses to embrace technology and care.

Despite such developments there are several factors that may be contributing to a technology lag:

The need for faculty with the necessarily knowledge, skills and practice competences required for the development in areas of e-Health (electronic health), including informatics, technology, and Information and Communication technology (ICT). The need for ongoing literacy education with respect to e-Health to the demographic profile of the profession.(ie. Older nurses 50-54 years of age have had to become techno-literature through individualized continuing education and staff development efforts.) Nurses serve as cultural brokers between technology and patients. Why? Nurses translate technology for patients and provide explanations about the technology. The relationship between technology and nursing is evolving and at a crossroads.

Nursing Informatics

Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data. The reason why nursing informatics is hard to define because it’s a moving target. Booth (2006) suggests that “e-Health” serves as the umbrella term for many of these concepts, including ICT. Information is key to effective decision making and integral to quality nursing practice. In their evolving roles as “knowledge workers” nurses are increasingly being called on to access information systems to facilitate evidence-based practice. More patients are becoming more comfortable with IT and expectations will be placed on nurses to have similar skills.

****Nursing informatics, the integration of information technologies and communications into nursing practice, has a profound effect on nurses and the organizations in which they work. ****

Applications of Nursing Informatics and Technology in Practice

Different Components of Healthcare Delivery through Technologies

Telehealth:

Encompasses a broad range of health service delivery system provided through distance or electronic technology. It has the potential to provide borderless, seamless, and accessible healthcare in all reaches of the country, delivering fast, accurate diagnoses and treatments in situations where face to face visits may not be possible. Within telehealth, the need remains for nurses to practice according to the established standards of practice, codes of ethics, legislation, and competencies of their regulatory bodies.

Nursing Telepractice: is a nursing-specific application of telehealth that includes all client-centered forms of nursing practice and the provision of information, conferences and courses for health care professionals occurring through, or facilitated by the use of telecommunications or electronic means. IE - Mobile phones and PDA technology exist to communicate health info. Such as ECG, BP readings, to clinicians anywhere in the worlds from a mobile consumer. Nursing telepractice uses the nursing process, to assess, plan, implement care through the provision of information, referral, education and support, evaluation and documentation.

Care delivery by Telephone: use of telephone for providing public health or private duty nursing. Today, there’s 8 provinces and 1 territory that offer 24/7 access to nurses by telephone:

Manitoba Health Links- have experienced RNs with broad range of expertise
British Columbia’s HealthGuide NurseLine- nurses uses software to assist in guiding pts health care
Telephone nursing uses nursing assessment to guide or coach the decision making of the pt. Concurrently with an empowerment approach rather than directed decisions.

Limitation of Telephone nursing: inability to see or incorporate nonverbal patient behaviours that challenges their assessment skills. The Aboriginal Nurses Association of Canada supports the use of telehealth practices to improve the health o First Nations, Métis and Inuit communities. Although pts. From these communities and others without phones, computers, or computer skills are at a disadvantage”digital divide”- marginalize ppl in remote communities who do not have access to that technology.

Electronic Mail and the Internet: are means of providing telehealth services in an e-Health world. With email, pts. And nurses have some flexibility in regard to the timing of consultations, inquiries, and responses. Issues of Privacy and Confidentiality remain unresolved. Liabilities for care practices and potential misdiagnoses or care provided through distance or electronic technology are issues warranting careful exploration.

Health-Seeking Behaviours: the Internet has provided the opportunity for health-seeking behaviour by patients, often before contact with a health professional. The internet also offers privacy, immediacy, breadth of information, different perspectives, and infinite repetition of information. The amount of information, quality of presentation, and often-conflicting info. Can create confusion. The Canadian Health Network provides recommendations on locating trustworthy health information on the internet. (ie. Canadian Virtual Hospice- for people dealing with life-threatening illness and loss this is a credible and well-recognized health service offered by healthcare professionals.

Online Support Groups: often done through online synchronous chat rooms and asynchronous interaction, which provide patients with the opportunity to seek support and consult others independently. Future research will need to explore the role that nurses play in such online support groups, how effective groups are conducted, and the roles of such groups in health promotion.

**** Despite the challenges of this technology, email, the internet, and telehealth practices have the potential to substantially DECREASE the indirect and social COST of HEALTHCARE, Associated with travel to healthcare facilities and absenteesism from family, school or work may be reduced. This cost savings is particularly relevant to patients and families isolated by geography or care needs.****

Economic Aspect

Electronic Health Recorods (EHR) is the health record of a person that is accessible online from many separate, interoperable automated systems within an electronic network. Characteristics of EHRs: Electronic, Longitudinal, Accessible, and Comprehensive. Canada Health Infoway supports the federal, provincial and territorial governments to improve accessibility, safety and efficiency of healthcare by developing private and secure EHRs. Advantages of EHR: easy access for clinicians to have the information to enable them to make informed decisions. Disadvantages of EHR: limited pt. Access to health records, privacy and security.

Issues in the Application of Biomedical Technology and Nursing Practice

Biomedical research done by Cooper and Powell revealed how this technology created extreme uncertainty and profound physical, emotional, psychological, and spiritual vulnerability among patients undergoing bone marrow transplantation.

Ethical Deilmmas: ethical and moral knowledge moves nurses to action in relation to technology (ie. Use of Reproductive technology, availability of genetic testing for women—need counselling as a woman decides what is best for herself. ) Also, the need of government, resource availability, funding, and community values to influence the utilization and distribution of technologies.

Decision Making: regarding access to available biomedical technology has further ethical implications when technology is costly or of limited supply. Who should have access? Who should develop access criteria? Determination of access under high-demand: A Review board that establishes criteria in reviewing who will be the candidates or access to the technology, Nurses may be a member, in order to provide info, advocacy, and emotional support to patients and families denied access to these services.

Issues in the Allocation of Technology in Education

Largest dilemma?? – is an accurate identification of the future competencies that will be required to function in technology-infused workplace. Empirical evidence shows that although nursing students had access to computers in primary and secondary schools, they had limited opportunity to use them for tasks other than word processing. Generation X – post secondary students (young adults in their late 20’s to mid 30’s) and Generation Y –( in their early to mid 20’s), exhibit unique learning characteristics and needs. Wants quick access to info, has little tolerance for delays, and prefers interactive, collaborative learning styles. Simulated Learning: nursing has adopted simulated learning because of the concern for pt. Safety and quality care; this is also related to the increased number of students with decreased faculty and reduced access to clinical sites. Early studies have shown that critical thinking, clinical judgement, and confidence levels can increase when nursing students are expose to computer based simulation.

Distance Learning Option: technology-based method enables us to conceive o education without the restrictions of the classroom. It has been suggested that engaging students in e-learning can make learning fun and relevant, deliver learning faster, encourage “just in time” learning, and provide opportunities for multitasking, networking, and interactivity.

Learning Distribution System: there are four general categories of distributed learning system that support instructional delivery and communication
Print based – not a popular method of choice due to expensive and extensive infrastructure and is also limited to occasional telephone contact and written feedback on submitted assignments.
Audio-conferencing- two-way telephone interaction suited to students who cannot attend courses offered on campus or who do not have access to computer technology. One drawback is the lack of visual stimuli.
Video-conferencing- digital video technology to deliver two-way audio signals , use of multimedia presentations and interactive capabilities. Has expensive technologic infrastructure and ongoing cost are usually limited to long-distance telephone charges and tech support. More complex technology.
Web based/blended- Blackboard, WebCT—combination of audio, video, and computer applications, creating multi-dimensional course delivery options.

**** Technology without education may negatively affect clients, families, healthcare professionals, and the health system in untoward ways****

Issues in Adopting Technology in Nursing Education

Using advanced instructional technology in higher education also challenges educators to rethink the teaching and learning enterprise.
Changing Models and Roles: teachers are moving from the “tell’em and test ‘em” model to becoming facilitators of the learning process and being “guides on the sides” Changing responsibilities and relationships can affect the receptivity of students and faculty to embark on Web-based teaching and learning.

Carryover to Curricula: Access to empirical evidence and medical/nursing information has been shown to have a positive effect on reducing medication errors, delivery of more comprehensive care, improving the continuity of care, and reducing stress levels in healthcare practitioners.
Demands on Time and Career Activities: The use of technology may actually increase the amount of time needed for teaching this takes faculty away from other aspects of their academic roles.

Gains and Losses: Education through technology becomes a reality for underrepsented population- students in remote areas (ie. Aboriginal community)

Isolation: The inherent nature of distance education includes the geographic separation of students from faculty and from other learners this can often contribute to feeling of social and psychological isolation. Transactional Distance- caused by miscommunication and psychological gaps occurring between learners and instructors.

Effects of Advanced Instructional Technology on Career Choices: Research to date supports the effectiveness of technology in conveying factual information student satisfaction is also reported. Educators should consider the core values and social processes of the profession before using technology in the curriculum. (Because Little evidence exist re: students progress in affective domain criteria)

**** Technology is fundamental to ensuring that nursing remains at the forefront of healthcare****

Future of Technology in Education and Practice

Technology will continue to evolve and advance; the explosions of a digital society have brought about significant transformations in the way people interact, access and process information, and solve problems. The Impact of nursing science on practice technology: the development of nursing science that is knowledge relevant for nursing practice will have an impact on the development and use of technology in nursing practice. Research into the effectiveness of advance technology in nursing education will provide valuable information in refining how we incorporate technology into delivering nursing knowledge in undergraduate programs.

Extent of Informatics in Curricula:

The need for more education, support, and research for optimal utilization of computer technology and information systems for practicing nurses, educators, and undergraduate and graduate students.

Potential for Greater Learning Access:

Faculty and student roles will change as the means of communication takes different forms.
Technology is a means toward the goal of health and quality patient care; thoughtful development and use can serve nursing and recipients of care well.