Thinking Outside the Box: Combining Caring And Technology

By Patti Gardner, MSN, CNM, PMHNP-BC

Combining caring and technology is a challenge for most nurses practicing today. While basic nursing care has not changed, new technologies are introduced at a rate that far surpasses what most of us are comfortable with. As a result, many of us struggle with providing what we know is good care while still meeting the demands of the organizations we work for and the licensing and governing bodies that guide our practice.

The debate about the use of technology in nursing practice is very much alive in both current and past literature, with mixed reviews for both sides. Zuzelo, Gettis, Hansel and Thomas (2008) found that technology had many positive effects onpatient care: assisting nurses in documenting more accurately, keeping patients safe and reducing lengths of stay.

There were also many negative effects identified by the nurses in the study: frustration with the amount of time that was required to learn new equipment, work environments that did not support the technology, and the demands of computerized documentation that require entries every two hours.

The nurses in this study also felt that as technology increased, their clinical judgment and hands-on skills were being adversely affected. For example, nurses reported having difficulty when a Dynamap was unavailable for taking blood pressures, as they had become so accustomed to having the machine to take and record readings automatically.

In a study of critical care nurses’ experiences using technology, nurses reported sharing knowledge and expertise and working as a team when technical competence was essential (McGrath, 2007). Experienced nurses supported novice nurses, realizing how difficult nursing can be for those just starting out. The nurses in this study responded to increasing technological care for their patients by being truly present and connecting with both their patients and families.

In another study of caring and technology, the authors noted the tension nurses feel in their attempt to provide both caring and technical nursing care to patients across all areas of nursing (Bull & Fitzgerald,2006). Nurses themselves recognized that technology has the potential to take them away from patients and erode quality nursing care, undermining patient well-being.

Nurses described spending extra time with patients and really making an effort to get to know them as individuals and what’s important to them, to try and overcome these kinds of challenges.

Although I’m a technology junkie, I worked labor and delivery for many years both as a staff nurse and then later with nursing students. I struggled with the amount of time technology seemed to take nurses away from patients. I went to midwifery school in an attempt to try and stay at the bedside and provide hands-on care, using the least amount of intervention and technology needed. My personal struggle continued as I found myself working with high-risk patients and nurses who knew no other way, having been educated in an environment that focused on technology.

In 2005, I was selected to participate in Sigma Theta Tau’s Maternal Child Leadership Academy, along with my mentor, Dr. Mary Beth Stepans. Over the course of 18 months, we brought together a team of nurses who developed an evidence-based program to engage bedside nurses to offer intermittent auscultation (IA) to low-risk laboring women, rather than electronic fetal monitoring (EFM). IA is performed with a Doppler and requires the nurse to sit with and touch laboring women. EFM requires the woman to wear a belt and be connected to the monitor at her bedside, thereby restricting her ability to move about during labor. EFM can be monitored from the nurses’ station or another patient room. One of the bigger goals of this project was to encourage more presence of the nurse at the patient’s bedside.

Nurses who participated in the project agreed to participate in a focus group at the end of the project. When the project began, those nurses who were experienced in providing intermittent auscultation, just like the nurses in the studies reviewed for this article, reported feeling excited about using IA and providing more hands-on care. Those nurses who were inexperienced reported feeling fearful and uncertain.

Over time, the nurses reported that IA took them out of the box of what they were used to, and it became an exciting way to help someone through labour without the restrictions that EFM brought. The nurses identified feeling proud at having implemented an evidence-based practice in the organization and increasing awareness for all nursing staff on the unit that IA was a safe choice for many women. Nurses involved in this project reported: “I felt like I was really helping someone do what they wanted to during labor;” “It was personally fulfilling to help women do what they should be doing naturally;” and “This rekindled my interest in nursing research.”

There were barriers to the project, though. Nurses involved in the project felt resistance to change from nursing staff members, physicians and administration. There were nurses who had not worked in any other environment than this one and did not believe the evidence that IA, in comparison to EFM, was both safe and offered less risk for additional interventions. The nurses in the study identified some physicians as “not trusting the nurse’s judgment,” as some still wanted information recorded on the paper strip. One physician refused to allow IA. The nurses also felt that hospital staffing patterns did not accommodate spending more time with a patient at the bedside. Despite the barriers, the nurses involved in the project were clear: “IT’S THE WOMAN’S CHOICE.”

I was really proud to have been involved in this project and to have worked with such a great group of nurses. They found a way to minimize the use of technology in a high-tech area without compromising patient safety. They reported having felt challenged to think outside the box, but when they did, they brought about big change that increased patient satisfaction as well as their own personal satisfaction in giving good nursing care.

Being mindful of the challenges we face as nurses as we combine the use of technology into the way we take care of people is the first step to changing care delivery. Technology can help nurses provide good care in many ways if we use it with discretion and remember how much the nurse’s presence and caring touch is important to those in our care. Nursing faces many challenges, but as the nurses in this project demonstrated, you can make a change that impacts patient care if you’re willing to think outside the box!

References

Zuzelo, P., Gettis, C., Hansell, A. & Thomas, L. (2008). Describing the influence of technologies on registered nurses’ work. Clinical Nurse Specialist, 22(3), 132-140.