Contribution to 2020health’s recent report ‘Too posh to wash? Reflections on the future of nursing’
By Gloria Dowling MBA BSc (Hons) RGN MIHM ABCI, NHS Specialist Advisor to London Resilience Team (LRT), NHS London
Advances in technology have changed the face of nursing. Technology to help with patient care – in the form of pumps, monitors and infusion devices have all grown exponentially over the years. Next, we had technology to help with communication and record keeping. There to help with ‘streamlining’ recordkeeping, ease the burden of bed management and patient flow through the hospital. There to help us finally decipher a junior doctor’s handwriting, and in turn reducing the risk of misinterpretation and therefore providing a safer environment for the patient. However, in the 90s the new ward computer sat on the desk, gathering dust as we occasionally turned it on to see what it could do for us.
How much things have changed since then, how far we have come. Or have we?
There is a difficult juxtaposition between nursing and technology. Nurses are the patients’ advocates, first and foremost. As we progress through our careers, we progress from managing a handful of patients on a ward or clinical environment, to managing all the patients and staff in that area. We become managers, executives, conductors, statisticians, chief cook and bottle washers; at the very heart of the successful running of the hospital, clinic or theatre in any healthcare organisation. We have done it all by holding a wealth of information in our heads, flexing and juggling on a minute-by-minute basis. Success depended on the individual skills and ability to adapt to this tall order.
Our training and experience as nurses ensured we developed these competencies. To manage an individual patients’ care, we also had to conduct, manage, flex, juggle and above all maintain all the relevant information in our minds to ensure we did not forget any aspect of the
patients care, but also anticipate what may happen and adversely impact their recovery.
The question is, what has all this got to do with technology and nursing care? I believe the two are intrinsically linked. We now have help to ensure nothing is forgotten – electronic reminders, flags, calendars, and appointments. We have help to anticipate any future issues for our
patients – monitoring and trending, for example. There is a wealth of knowledge at our fingertips – no longer trekking to a library to photocopy a tome of articles – type your query into a search engine and answers appear. Prescriptions are filled using barcode technology. References can help ensure the right dose is delivered to the right patient at the right time.
None of this will ever remove the need for good clinical judgement, but it can and will assist and help with the sifting and organising of all the relevant information we gather about our patients. It will change the way we manage the patient environment.
The power of the possible was revealed to me when working as a nurse advisor on the NPfIT programme. The main objective was to have one centralised patient record, accessible from wherever the patient was located in England. So if Mrs Jones was registered with a GP in London and became ill and admitted to hospital in Carlisle, the hospital could easily access all her patient records and so treat her safely and effectively. That was the theory.
The practical aspects were more opaque. Records were traditionally maintained in many and varied ways – most were developed from templates with local adaptations, useful to the local clinicians, but sometimes a mystery to those outside the locality. Agreement on the shape and
form of even the front page of the electronic record caused endless debate – one voice of dissent could put the brakes on a potential breakthrough. Success was achieved in some areas – booking systems, PACS – radiology; the advent of the mobile reading device for x rays was revolutionary – truly. It demonstrated the potential. Maybe the project was too far, too fast. The vast majority of senior clinical staff in 2012 did not start their careers using technology. In that environment, it is easy to see why clinicians might view advances in this kind of technology
with suspicion and trepidation. We must ensure information technology is an integral part of the nurse education programme.
Nurses have always been (and have wanted to be) at the patient’s bedside. Anything that comes between the nurse spending time with the patient is traditionally viewed with suspicion. Even in the days before computer meetings, writing up reports, care plans and handovers, being held
away from the bedside or out of sight of patients, caused anxiety in the patient and suspicion in other staff. Yet using mobile devices would help with keeping the nurse by the patient’s side. Most people can use a smartphone, as they are intuitive, so it’s a small step to imagine a nurse
carry a mobile device that enables him/her to remain close to patients, and contains all the information they could possibly need. Light, portable devices are in some cases small enough to fit in a pocket. In conjunction with an array of advances already in place (wireless communications, workflow management systems, wireless patient monitoring, electronic prescribing & administration with bar coding and electronic clinical documentation (California Healthcare Foundation, 2008)) handover, accurate and safe care planning, prescribing and monitoring can all potentially be done in one place. With the ability to cross-reference and manage all the information sifting sorting and organising, “integration can add significant value to the way nurses co ordinate and provide care” (California Healthcare Foundation, 2008).
And therein lies the paradox. Technological advances that can assist, organise and provide more safety in delivering care are often rejected on the basis that they are unreliable or can give cause for misunderstanding when in reality they are poorly understood. Indeed, questions are asked about why staff are logging onto devices instead of spending time with patients. The perception is that this is not care. What’s to be done?
We can employ ‘champions’ as role models; those clinicians who can not only see the bigger picture and the potential, but who can also motivate and influence staff to feel more positive and confident in utilising all the technological advances available to them. We must take time to make it work. Above all, explain to patients and nurses how they can benefit. Encourage a multidisciplinary approach to the use of electronic devices and persuade professionals that this is the future – for it surely is – and then take it to the patient’s bedside. Technology is not going away, and, as a profession, we must embrace it. There is no alternative.
References
California Healthcare Foundation, 2008, Equipped for Efficiency: Improving Nursing Care through Technology
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