Technology can help Nurses Improve Patient Care

 

Dr. V. Indra^1*, S. Urmela²

¹Adjunct Faculty CUM SME, Texila American University, Coimbatore, India

²Ph.D Scholar, Pondicherry University, Puducherry

 

ABSTRACT:

 

 

INTRODUCTION:

Information and communication technologies (ICTs) embody all digital technologies that support the electronic capture, storage, processing, and exchange of information in order to promote health, prevent illness, treat disease, manage chronic illness, and so on. In the health sector, ICTs refer to a set of projects or services that allow for remote care (tele-health), interdisciplinary clinical support, as well as knowledge transfer. The use of ICTs has the potential to promote patient-centered healthcare at a lower cost, improve quality of care and information sharing, educate health professionals and patients, encourage a new form of relationship between patients and their health providers, reduce travel time, etc.

 

Despite these well-known advantages, the implementation of ICTs in practice remains difficult and involves changes at different levels, including with respect to patients, healthcare providers, and healthcare organizations. Nurses constitute the largest health provider group of the healthcare workforce and as such represent an important target for the ICT implementation process. Nurses are compelled to deal with the introduction of ICTs within nursing care, such as tele-care technology, which can have impacts on nursing practices. These technologies change the notions of place and presence and create distance between nurses and patients. Consequently, direct care cannot be provided in the traditional way (face-to-face) that nurses are used to.

 

Although there are several systematic reviews on the effects of ICTs on healthcare professional practices, most of them focus on physicians. Our preliminary searches found only three reviews that specifically targeted nurses. One Cochrane review assessed the impact of different nursing record systems on nursing practice and healthcare outcomes [1].

 

The general public believes that technology will improve health care efficiency, quality, safety, and cost. However, few people consider that these same technologies may also introduce errors and adverse events. Given that nearly 5,000 types of medical devices are used by millions of health care providers around the world, device-related problems are inevitable. While technology holds much promise, the benefits of a specific technology may not be realized due to four common pitfalls: (1) poor technology design that does not adhere to human factors and ergonomic principles, (2) poor technology interface with the patient or environment, (3) inadequate plan for implementing a new technology into practice, and (4) inadequate maintenance plan.

 

Patient care technology has become increasingly complex; transforming the way nursing care is conceptualized and delivered. Before extensive application of technology, nurses relied heavily on their senses of sight, touch, smell, and hearing to monitor patient status and to detect changes. Over time, the nurses’ unaided senses were replaced with technology designed to detect physical changes in patient conditions. Consider the case of pulse oxymetry. Before its widespread use, nurses relied on subtle changes in mental status and skin color to detect early changes in oxygen saturation, and they used arterial blood gasses to confirm their suspicions. Now pulse oxymetry allows nurses to identify decreased oxygenation before clinical symptoms appear, and thus more promptly diagnose and treat underlying causes.

 

While technology has the potential to improve care, it is not without risks. Technology has been described as both part of the problem and part of the solution for safer health care, and some observers warned of the introduction of yet-to-be errors after the adoption of new technologies. For example, nurses and other health care providers can be so focused on data from monitors that they fail to detect potentially important subtle changes in clinical status. Problems may emerge based on the sheer volume of new devices, the complexity of the devices, the poor interface between multiple technologies at the bedside, and the haphazard introduction of new devices at the bedside. Despite the billions of dollars spent each year on an ever-increasing array of medical devices and equipment, the nursing profession has paid little attention to the implementation of technology and its integration with other aspects of the health care environment. Patient care technologies of interest to nurses range from relatively simple devices, such as catheters and syringes, to highly complex devices, such as barcode medication administration systems and electronic health records.

 

The other two systematic reviews concerned the use of electronic health records by nurses. The mixed review method by Stevenson et al. included five studies (two quantitative and three qualitative studies) and highlighted nurses’ experience of using electronic patient records (EPR) in their practice. Nurses expressed their dissatisfaction regarding EPR systems for many reasons: they did not support their everyday clinical practice because they lacked patient overview, they did not support individualized care, they were not user friendly, and they were not always bedside accessible. Also the computer systems were considered unreliable. Another systematic review examined the impact of electronic health records (EHR) on time efficiency of physicians and nurses from a total of 23 studies (11 of these studies assessed time efficiency among nurses). The main findings pointed out that using bedside terminals and central station desktops saved 24.5 and 23.5 % of the time nurses spent documenting during their shift.

 

These three reviews were published between 2005 and 2010, targeted specific technologies and showed modest impacts on various aspects of nurses’ practice. In general, these practices were not well defined in the reviews, and there was no conceptual framework enabling reflection on the way ICTs could influence specific aspects of nursing practices and nursing care. The knowledge generated from these reviews remains sparse because each technology is used in a specific utilization context and for a particular task (e.g., documentation, data collection, nursing diagnosis); therefore, each ICT application may impact distinct dimensions of nursing care[2].

 

EMERGING TECHNOLOGIES THAT WILL CHANGE THE PRACTICE OF NURSING:

There are many emerging technologies that will change the practice of nursing in the coming decade. Seven are discussed here; genetics and genomics; less invasive and more accurate tools for diagnosis and treatment; 3-D printing; robotics; biometrics; electronic health records; and computerized physician/provider order entry and clinical decision support.

 

 

Technology[3]	Benefits[4]	Challenges[5]
Genetics and Genomics	The majority of disease risk, health conditions and the therapies used to treat those conditions have a genetic and/or genomic element influenced by environmental, lifestyle, and other factors therefore impacting the entire nursing profession.	Many nurses currently in practice know little about genetics and genomics and lack the competence needed to effectively counsel and teach patients in this regard.
Less Invasive and More Accurate Tools for Diagnostics and Treatment	Non-invasive and minimally invasive tools for diagnostics and treatment generally result in lower patient risk and cost.	The rate at which noninvasive and minimally invasive tools are being introduced makes ongoing competency regarding their use a challenge for nurses.
3D Printing	Bioprinters, using a "bio-ink" made of living cell mixtures can build a 3D structure of cells, layer by layer, to form human tissue and eventually human organs for replacement.	Healthcare is just beginning to explore the limits of this technology. There are limits to the materials which can be used for printing and materials science is a laggard in 3D printing.
Robotics	Robotics can provide improved diagnostic abilities; a less invasive and more comfortable experience for the patient; and the ability to do smaller and more precise interventions. In addition, robots can be used as adjunct care providers for some physical and mental health care provision.	More research is needed on comparative effectiveness of robotics and human care providers. Many healthcare providers have expressed concern about the lack of emotion in robots, suggesting that this is the element that will never replace human caregivers.
Biometrics	Biometrics increases the security of confidential healthcare information and eliminates the costs of managing lost passwords.	The measurement of biometric markers may occur in less than ideal situations in healthcare settings and in a rapidly changing workforce, cost may become an issue.
Electronic Healthcare Records (EHR)	Healthcare providers have access to critical patient information from multiple providers, literally 24 hours a day, 7 days a week, allowing for better coordinated care.	Implementation costs, getting computers to talk to each other and debates about who “owns” the data in the EHR continue to challenge its required implementation.
Computerized Physician/Provider Order; Entry (CPOE) and Clinical Decision Support	CPOE and clinical decision support fundamentally change the ordering process resulting in lower costs, reduced medical errors, and more interventions based on evidence and best practices.	The introduction of CPOE and clinical decision support requires providers to alter their practice. Resistance is common due to the time spent on order entry. Implementation and training costs are often significant.

 

 

NURSING SKILL SETS NEEDED TO APPROPRIATELY RESPOND TO EMERGING TECHNOLOGIES:

The capacity to manage human knowledge, and to convert it into useful products and services, is fast becoming the "critical" leader skill of the age. Leadership skills that will be required of nurses to appropriately respond to emerging technologies include being able to use technology to facilitate mobility, communication and relationships; having expertise in knowledge information, acquisition, and distribution; and understanding and using genetics and genomics in nursing[5].

 

Nursing Skill Set[6]	Select Examples
Being able to use technology to facilitate mobility, communication, and relationships	Email, tele-health and telemedicine, internet, cellular technology, text messaging, video conferencing, smart phones, 3-dimensional printing, high fidelity simulation, virtual realities such as Second Life Virtual World, social media networking, embedded sensor networks, global positioning systems, bio-electronics.
Having expertise in knowledge information, acquisition, and distribution	Information literacy, evidence-based practice, clinical decision support, sense-making, commercially purchased expert networks, distributed expertise, boundary spanning knowledge management, knowledge engineering, standardized guidelines, fuzzy case-based reasoning, understanding of cognitive science theory and complex adaptive systems theory.
Understanding and using genomics in nursing	Understanding of the Human Genome Project, genetic sequencing, service delivery models that promote safe, efficient, and effective utilization of genetic/genomic information in care decisions; ethical issues related to genomics encountered throughout the life continuum and around the world; ethno-cultural beliefs and practices for utilization of genomic-based care; and resources available to arm nurses with information to learn about and teach genetics.

 

 

NURSING LEADERSHIP CHALLENGES IN INTEGRATING NEW TECHNOLOGY:

What leadership challenges will nurses face in integrating new technology with the caring part of nursing? Who will determine what cost-benefit ratio justifies the development and use of expensive technological innovations? Who will be charged with overseeing the initial training of a technology enabled nursing workforce and for assuring continuing competence in technology aided practice? Finally, what role will nurses play in helping to establish the ethical parameters of technology in healthcare? The four nursing leadership challenges that exist in integrating new technology in nursing and healthcare[7].

·        Balancing the Human Element with Technology

·        Balancing Cost and Benefits

·        Training a Technology Enabled Nursing Workforce and Assuring Ongoing Competency

·        Assuring that Technology Use is Ethical

 

CONCLUSION:

The approach offered for nurses is consistent with the following four-pronged strategy developed by the World Health Organization Medical Devices and Equipment team:

·        Policy: 

Nurses providing direct patient care should be involved in setting and evaluating institutional, organizational, and public policy related to technologies.

 

·        Quality and Safety:

Nurses providing direct patient care can ensure that the technologies they use meet international quality and safety standards and technical specifications needed to perform in the clinical environment in which they are used.

 

·        Access: 

Nurses providing direct patient care can ensure that institutional decisions are made with their input and the input of other critical stakeholders.

 

·        Use: 

Nurses providing direct patient care should be involved in their intuitional policies and processes related to maintenance, training, monitoring, and reporting adverse events related to technology.

 

REFERENCES:

1.       Sullivan DH. Technological advances in nursing care delivery. Nurs Clin North Am 2015 Dec; 50(4):663-677.

2.       World Health Organization. 2016. e-Health URL: http://www.who.int/topics/ehealth/en/

3.       Monteiro AP. Cyborgs, biotechnologies, and informatics in health care - new paradigms in nursing sciences. Nurs Philos 2016 Jan; 17(1):19-27.

4.       Eng T. The e-Health Landscape: A Terrain Map of Emerging Information and Communication Technologies in Health and Health Care. Princeton, NJ: The Robert Wood Johnson Foundation; 2001.

5.       Carrington JM, Tiase VL. Nursing informatics year in review. Nurs Adm Q 2013; 37(2):136-143.

6.       Mair F, May C, Murray E, Finch T, Anderson G, O'Donnell C, et al. NETSCC. 2009. Understanding the implementation and integration of e-Health services.

7.       Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academic press; 2011.

 

 

Received on 15.02.2018           Modified on 29.03.2018

Accepted on 28.04.2018     © A&V Publications all right reserved