The following question was asked of the readers of the Journal of Gerontological Nursing:
In what ways is technology assisting you with your practice?
Human behaviors comprise three domains: cognitive, affective and psychomotor. Nurses consistently use a combination of these activities in the practice of their profession, regardless of whether they are employed in research, education or clinical practice. In responding to this question, many of us who learned certain psychomotor tasks with one set of equipment and/or materials can quickly relate the vast improvements in efficiency and accuracy to the ongoing advancements made by technology. Technology has also triggered the Information Age and with that the field of informatics, with an impact on our world that continues to proliferate. Learning how to work smarter also inspires our self-confidence as we re-recognize how applying principles of reengineering enhances our knowledge and skills.
However, after deliberate and careful reflection on this question, I have determined that the most influential way that technology has assisted me with my practice is in the refinement of my thinking skills. Comprehension, that second level of cognition, is complicated stuff! With every generation of technological advancements my ability to understand how to use them to make a difference had been at risk for further regression because I was not aware of and could not articulate the patterns of configuration and directions of processes that were necessary in order for me to comprehend at a most basic level. As I used technological vocabulary to express what I did not understand, I have learned a great deal about my own patterns of storage and retrieval. Developing metaphors that could become icons has helped me to navigate the world of technology as well as the labyrinth of my brain. Metacognition has enhanced my functioning as well as made it more complicated, but I do not complain. It has made me all the wiser about my own strengths and limitations.
Barbara Hassinger Conforti, MSN, RN, CS, CRNP
Lancaster Institute for Health Education
Our nursing home is affiliated with a hospital, and we have a computer link so we can obtain laboratory results quickly and start treatment earlier.
Donna Savacool, BSN, MSEd, RN
Tioga Nursing Facility
Waverly, New York
I am the Staff Development Coordinator at a nursing home in Wichita, Kansas. Our nurses make use of computer technology to save time during the nursing process. Care planning and documentation are done on computers; so are some basic nursing tasks, such as transcribing physician orders and ordering laboratory work. We can communicate via an intranet with our regional consultants and any of our almost 600 facilities nationwide. This allows us to share our varied areas of professional expertise. By using the "high tech" of computers we are able to spend more time delivering "high touch" to our residents and their families.
Pat Goertz, RN, MSN
Staff Development Coordinator
Lincoln East Nursing Home
I think technology is very important. We need technology for procedures such as IV pumps, tube feeding, nursing care plan, ordering stock medications, documentation and for laboratory work. We keep a collection of data and we need to find information and update it quickly and accurately. If we need to search any topic, we can find it with the computer or the Internet. If we don't know technology, that means we don't know anything. In my practice, computers save time and make calculations easier and accurate. If we don't use technology for our practice, that means we are out of date. Technology improves the quality of life in our practice.
Athilthaen Atchawong RN
Good Samaritan University
As training coordinator for our state licensing and certification program for nursing homes, I rely on e-mail, the Internet, PowerPoint and Microsoft Word for preparation of training materials, research, and collection of data. Access to Minimum Data Set data reports such as quality indicators are required as part of the LTC survey process. I can't imagine how I could complete my tasks without technology-CDROM-based training programs, et al.
Marjorie Ray, RN, BSN
Aging and Adult Services Administration
Department of Social and Health Services
Advanced technology is vital today in the field of nursing. With an increased number of elderly patients, the need for quick, safe and effective nursing has been called upon. The increased technology allows us to retrieve vital signs, laboratory results, and diagnostic test results quickly. This is very helpful in the event of an emergency. Although these new "things" are effective, we mustn't forget the issue of safety and how this draws us back, as nurses, to our basic skills and techniques for caregiving.
Kimberly Ann Johnson, RN
The Pines at Davidson
Davidson, North Carolina
I just changed jobs within the nursing home from Night Supervisor to Staff Development Coordinator. My greatest challenge, with the multiplicity of tasks I must perform, is to get staff, especially the CNAs, to inservice programs. In an attempt to provide the ongoing education, I am bringing the mountain to the CNAs by doing short programs on the unit with the use of a laptop computer utilizing PowerPoint. I am in hopes of eventually procuring a projector for better visibility, but in the meantime I am reaching more staff.
Judy Roy, BSN, RN
Staff Development Coordinator
Maine Veterans Home
Technology is assisting me with my current practice in many ways, and I can foresee that it will continue to aid me in developing processes for my future practice as well. Currently I work in home health. We have computers from which we can access all patient files. This means that we do not have to run to get a chart when a client or physician calls. We also have information for patient teaching available to all nurses so that they can access it at any time. Handouts can be printed to give to the patient, or nurses can use them to teach if the client may not be able to read or comprehend written instructions.
We also have access to the Internet. With this capability, information on any topic can be found, printed and modified for patient or employee teaching.
Our corporation has an intranet site which is very informative. There is information to help managers write a non-punitive performance evaluation. A virtual learning library is available and has information to help any employee learn more about their role in the company and what is expected. They can learn how to improve their skills in any area, and can send e-mails to any corporate department for more information.
E-mail is also an important part of our interoffice functioning. Communication is improved because the written word is available, as well as the spoken directive.
The computer program also allows our company to schedule patient visits and track these visits so none are missed. An employee's payroll is entered from the same form that is used to document the home visit.
In the future I will continue to use the computer in my new role as Advanced Registered Nurse Practitioner specializing in gerontological nursing. Hand-held devices are already available, which allow one to take notes so that charting can be done at a later time. This will be especially helpful for nurse practitioners who will be visiting patients who live in nursing home or other facilities. The information can easily be carried back to the physician's office and transcribed to the patient's chart.
When I reach my goal of opening my own clinic, the computer will be used to its maximum potential. I feel very strongly that the computer is a great help if used properly. It definitely has made my current job easier, and continues to help me through my graduate studies.
Teresa G. Neal, BSN, RN, C
Director of Clinical Management
This question was submitted by Christine Kovach, PhD, RN, Associate Professor, Marquette University College of Nursing, Milwaukee, Wisconsin. Her commentary follows:
As the respondents described, technology has a wide array of uses in clinical practice. Technology applications in clinical practice include patient monitoring equipment, quick computerized access to assessment data from other departments and sites, telemonitoring from home, improved documentation systems, decision and care planning support systems, and interventions such as automated drug dispensers. Technology should support the nursing process and improve the connection between nurses and patients.
The term telehealth refers to using communication and information technology to deliver health care and health care information over large or small distances (Hannah, Ball, & Edwards, 1998). The American Nurses' Association (1999) published a report of the Interdisciplinary Telehealth Standards Working Group that includes principles designed to protect the patient receiving telehealth services, and provide guidance to practitioners, professions, and government agencies. One need in this emerging era of telehealth applications is the need to protect patient confidentiality. With the increased ease of access to both individual patient and aggregated patient data, there is a need to determine the point at which informed consent to access data needs to be obtained.
The use of technology should improve patient care. In many instances technology also may increase efficiency and reduce cost. Nurses need to examine their practice and begin developing new mechanisms by which technology can assist and inform practice. We are moving into an era of increased patient self-management of health care needs. Technology may be useful in helping support patients' selfmanagement. However, unless research is conducted to validate the effectiveness of a given technology, we will not have evidence to support the use of these applications. One of the most promising uses of computerized databases is the further delineation of nursing practices and demonstration of the value of nursing's
contribution to health through outcome data.
We also must work to prevent unintended negative consequences of increased use of technology. Technology should not harm the nurse-patient relationship or reduce our view of the patient to "parts." Technology should not result in fragmentation of care and use of aggregated data should not mask important individual variations.
The era of technology is upon us. Nurses have done a good job of incorporating technology into practice to support patient care. We must continue down this path by educating clinicians, developing standards for technology use, researching the effectiveness of technology applications, and developing our common nursing language that supports these efforts.
- American Nurses' Association. (1999). Core principles on telehealth. Report of the Interdisciplinary Telehealth Standards Working Group. March 25, 1998. Washington, DC: American Nurses' Publishing.
- Hannah, K.J., Ball, M.J., & Edwards, MJ. (1998). Introduction to nursing informatics. New York: Springer.