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 (telehealth), 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 telecare 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 [1].

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 [2].

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 [2].

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 [2].

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 [3].

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 [3].

ICT USAGE IN NURSING CARE:

1. Nursing Administration:

Computers are used in the administrative areas of nursing for basic tasks that once were done on paper. Staffing and scheduling systems are used to construct daily, weekly or monthly schedules. Many scheduling systems also collect data on individual employees such as the amount of sick time used or vacation hours accumulated. Staffing and scheduling systems often provide a variety of reports to the administrative nurse. Budgeting and financial tracking are another way in which computers are used in nursing administration [4].

2. Education:

Computers are valuable for patient and nursing education. Hospitals often use computer programs to teach patients about chronic disease management or to provide educational handouts. Preprinted documents such as discharge or preoperative instructions can also be stored in the computer and printed as necessary. Nurses use computers for a variety of continuing education programs as part of the re-licensure process and can also complete educational programs on the computer to obtain advanced degrees [5].

3. Clinical Use:

Clinical applications of computers in nursing are numerous. Physicians prescribe medications and treatments on the computer, and the nurse can either transcribe those orders onto paper tools or print the paper documents for use in patient care. Staff nurses can order medications or supplies on the computer, look up drug interactions or research medical condition. Many nurses use hand-held computers such as personal digital assistants to communicate with physicians about the patients in their care [6].

4. Electronic Medical Records:

Nurses use computers for documentation with an electronic health record or electronic medical record. When an organization uses an EMR, all documentation related to patient care, diagnostic testing, specialty referrals or any other aspect of patient care or management is done on the computer. The computers can be stationed at the bedside, used on mobile carts or might be in the form of a portable electronic tablet that the nurse carries in lieu of a clipboard with paper documents [7].

Technological advancements for nurses:

1. Enhanced communication:

When nurses received pagers back in the 1980-1990’s, they were able to increase patient care. Each health care professionals are accompanied with cell-phones with ability to order medicine all at the same time. Most hospitals have advanced communication systems. By smart phone technology usage health care professionals are able to receive messages from patients. Forget those old-fashioned pagers. All health care professionals are in touch with all patients. Its’ efficiency at its finest and the nursing staff of today wouldn’t know how to do it any other way [8].

2. Electronic records:

Written medical records are older paper communication among nurses. Electronic Medical Records (EMR) is becoming more popular among health care professionals to track patients’ information. It enables to communicate among patients’ and health care professionals [8].

3. GPS tracking:

Hospital efficiency has been increased through GPS tracking. Tagging and tracking medical equipment is much easier than it was before. It sounds like a simple matter, but being able to centrally monitor equipment has increased bed management and patient care incredibly [8].

4. Enhanced Diagnostic devices:

Take for instance diagnostic exams. These can now be performed non-invasively. Enhanced diagnostic devices are becoming more popular in health care sectors to govern the disease a patient is affected with. More painless diagnostic devices are being devised and used effectively [8].

5. Drug delivery:

Drug delivery devices release medication into the patients at the required times. An effective drug delivery system schedules the dosage of drugs intended for patients. This reduces the chance of a patient error, potential lawsuits, and also allows the nurses to focus on other areas that need their attention [8].

6. Smarter alarm systems:

Older days, nurses have to monitor the patient continuously 24*7 without taking any rest. Smarter alarm system is used to monitor patient vital signs. All vitals run through one system. Checking blood pressure or pulse rates has never been so easy. This integrated system measures physiological indicators. If there is a real cause for alarm, the machine will let the nurse know. These alarm systems are more modernized and efficient [8].

7. Lifting patients with ease:

Technology is changing nowadays to monitor patients effectively and provide a viable way of lifting them in bed. However, a nurse must stay up to date on these methods, as well as work in a center that is open minded and willing to invest in technological advances. By keeping in-par with technology advancements, a nurse will be able to cope with hospital environment and provide effective career advancements [8].

Practice of nursing – emerging technologies:

There are many emerging technologies that will change the practice of nursing in the coming decade. The following table discuss on the emerging technologies of nursing practice [9].

Technology	Benefits	Challenges
Genetics and Genomics [9]	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.	Some nurses are unaware of genetics and genomics services.
Less Invasive and More Accurate Tools for Diagnostics and Treatment [2]	Non-invasive and minimally invasive tools for diagnostics and treatment generally result in lower patient risk and cost.	It poses challenges among nurses in usage of diagnostic tools.
3D Printing [10]	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 [11]	Robots provide efficient diagnostic procedures; a less invasive and more comfortable experience for the patient; and the ability to do smaller and more precise interventions. Robots can be used as an agent for monitoring patients.	More research is needed on comparative effectiveness of robotics and human care providers. Since robots lacks emotions, this suggests that this is the element that will never replace human caregivers.
Biometrics [11]	Biometrics increases the security of confidential healthcare information and eliminates the costs of managing lost passwords.	In a rapidly changing workforce, cost may become an issue.
Electronic Healthcare Records (EHR) [11]	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 [11,12]	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.

CONCLUSION:

This article summarizes on the recent Information and Communication Technology (ICTs) advancements in Nursing. The article presents current technology advancements and emerging advancements in nursing care.

REFERENCES:

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11. Bourhis, R., Roth, S., and MacQueen, G. (1989). Communication in the hospital setting: A survey of everyday language use amongst patients, nurses and doctors. Social Science and Medicine, 28(4), 339-346.

12. Brown, S. J. (1995). An interviewing style for nursing assessment. Journal of Advanced Nursing, 21, 340-343.

Received on 02.07.2018 Modified on 20.07.2018

Int. J. Nur. Edu. and Research. 2019; 7(1): 119-122.

DOI: 10.5958/2454-2660.2019.00024.3