Jan 06, 2020
Rising to the case: Caring in the age of technology
Take away messages
- Technology may be detrimental to the nurse-patient relationship when nurses do not take action.
- Nurses need to reinterpret technology as a tool, not a solution, to improved care.
- With technology as a tool, nurses are the key to improved patient outcomes by interpreting the data and applying their experiential knowledge.
Technology is advancing at an exponential rate and is becoming ever more integrated into nursing research and practice. This integration is overwhelming nursing care, such that it interferes with the nurse–patient relationship. We need to rethink that relationship in this age of technology, and how the nurse might reinterpret technology to better provide patient care and foster human connections.
I will draw on a clinical example to demonstrate how technology can detract from the quality of the nurse–patient relationship, resulting in poor patient care. From this example I will describe how nurses need to be central in patient care as interpreters of technology, using it as a tool to improve individualized care and to foster better nurse–patient relationships.
The act of caring is often considered a moral commitment. I would add that at its very essence, care forms a basis for human connection. When technology is integrated into nursing care, we must consider the barriers it might pose to developing these human connections. We assume the end use of technology is to provide better care; however, this is not always the case. I propose that we need to revise our thinking and protect patient care through re-engaging our use of technology to improve human connections.
The problem with technology
There has been a shift in the way nurses care for patients. We now rely heavily on technology. An assessment of vital signs is one fundamental example of how care has been automated through technology and, more concerning, how the nurse is less physically connected with the patient.
As a nursing instructor in an undergraduate program, I have had the privilege of introducing students to vital signs assessments. Students often question—rightly—the need to learn how to take a patient’s blood pressure manually. They insist the automated machines are highly accessible and predominantly used in clinical settings. Although these students have a point, I cannot help but wonder if they are basing their argument on the false assumption that more technology means more efficient, or better, care.
To challenge this assumption, I highlight to students that there are clinical cases in which automatic assessments do not mean better care. From my background in high-risk obstetrics, I stress the importance of being able to take accurate manual blood pressures quickly in situations of hemodynamic instability, such as a severe postpartum hemorrhage. With extreme blood loss, a patient’s blood pressures can be so low that the machine will not read them accurately. This can lead to a delay in timely and necessary interventions.
I am not arguing that we should use only manual assessments. There are clear and obvious advantages to integrating technology into care: time and efficiency, to name two. Being able to program vital signs assessments every 15 or 30 minutes can allow a nurse to provide additional care for the patient. My concern is that we must be cautiously aware of the implications of integrating technology into practice and constantly question whether, in any given situation, it helps or hinders patient care and, consequently, the nurse–patient relationship.
Rethink nursing care
Nursing is and needs to be an interpretive practice. There is a human, experiential element in the way nurses process assessments and subsequently provide care. Every bit of information gathered through a nursing assessment is interpreted the instant it occurs. This is what nurses do, and generally we do it quite well. The nurse quickly decides which information is pertinent to the clinical situation and the care that ought to be provided, in addition to what needs to be documented and communicated to another health care provider. These decisions often happen so quickly and so fluidly that the nurse may not even realize this act is an interpretive one.
We need to be aware that with the integration of technology, there is a potential to become more removed from the act of caring. As in the case of the patient who is hemodynamically unstable, the nurse must be able to complete accurate assessments, which may actually be more accurate than the automated ones.
There is also a need for the nurse to be present to the individual patient’s experience. For example, a nurse might quickly interpret an erroneous reading from a blood pressure to be suspicious, given the patient’s signs and symptoms, and perform a manual blood pressure, among other assessments, to identify whether the patient is experiencing blood loss. This kind of quick assessment and interpretation may result in more timely interventions.
The idea of a more accurate assessment and interpretation is related to the concept of individualized care, which has been present in nursing theory and practice since the 1960s. However, today individualized care is an overused buzzword. It can even mean different things depending on the context. In the case of our hemodynamically unstable patient, the nurse could apply what was learned, specifically regarding the limitations of technology and the importance of being present to the patient’s experience. This approach creates an opportunity to readily recognize or interpret the patient’s signs and symptoms of hemorrhage (not just the blood pressure reading) and then provide customized or individualized care, in that case and those in the future. In this sense, the nurse would be applying the case to universals.
Rethink technology through individualized care
The process of applying what was learned from an individual case to universal cases is the expertise or experiential knowledge developed through practice. It is fundamentally based on cases, observations, and knowledge derived from the act of caring. This knowledge is cultivated, developed, and felt, and goes far beyond the act of simply gaining, acquiring, or accumulating experiences. It is the development of a person as a professional.
The process of developing expertise is never completed, as the traditional training pathways might have suggested. There is continual learning and the application of what was learned to become more proficient; the nurse is more able to interpret clinical situations accurately and act accordingly. This idea of experiential knowledge is fundamental to what I will describe as “rising to the case.”
I have adopted this phrase from the philosopher, John Caputo. He argued that we should not put great value or emphasis on universals compared to individualized experiences. As a nurse, one can easily see how a series of individual cases can have informed the policies (universals) that guide our care. The value of each individual case then has great potential to influence care.
Caputo’s argument is that we need to keep sight of that appreciation and value of experiential nursing knowledge and not place greater value on the policies. I would apply this idea further toward integrating technology into nursing care. I suggest that nursing care is at its best when it involves a caring interaction between a nurse and patient, in which the nurse is able to integrate technology, interpret the findings, and simultaneously draw on experiential knowledge to interpret situations for each individual case.
There is great value in experiential nursing knowledge. It places the patient at the centre and allows the nurse to use technology to interpret assessments and provide high-quality, individualized patient care. Nursing is and needs to be an interpretive practice. Given the increasing integration of technology into clinical work, nurses must regard it as potentially problematic because it can detract from the nurse–patient relationship. But when nurses use technology as a tool to provide more individualized care, they are applying experiential knowledge and providing better care.
We need to be sure that technology does not distance the nurse from the patient. Technology is only a tool to help us know the patient more fully, provide the best possible individualized care, and foster the nurse–patient relationship. As interpreters, nurses truly demonstrate their critical role in the impact on patient care and human connections.