Invited Guest Editor
Hill, T. (2013). Invited Editorial: Caring and Technology. Online Journal of Nursing Informatics (OJNI), 17 (3). Available at http://ojni.org/issues/?p=2856
Nursing has frequently been named the most trusted profession. A central theme of nursing is Caring. The integration of the electronic medical record as a means of data collection and improving patient safety is reaching maturity. While nurses are becoming highly skilled and competent in nursing informatics, the question that bears answering is, Can technology and caring coexist? Due diligence to each is necessary for complete mastery; the patient cannot be left behind to meet guidelines of documentation, data mining and data retrieval. If technology in nursing is to improve quality patient care outcomes, then certainly caring for the patient is part of this equation, if not the central theme. One of the best ways to assess a patient is by looking directly at them. Nurses have been witnessed completing assessments with little hands on with the patient. Has the use of the electronic medical record taken away from direct observation and face to face interaction? Is the face to computer model becoming more dominant with the evolution of technology? One way to ensure that caring is not lost in the infrastructure of the electronic system is a notion of Shared Competence in the use of the electronic medical record. The theoretical background for the harmonious integration of technology and caring rests in the work of Watson’s Human Caring Theory that has received continual notoriety since its publication in 1988. The Caritas Processes most needed to support a caring relationship with the patient are (1) Embrace altruistic values and practice loving kindness with self and others, (2) develop and nurture helping, caring relationships, and (8) create a healing environment for the physical and spiritual self which respects human dignity. In order to carry out these processes, nurses need face to face, caring, loving interactions with their patients.
Nurses identify with caring at the core of their profession. Parcells and Locsin (2011) posited that the use of the mid-range theory, technological competency as caring in nursing, provides a rich understanding of how technology and caring can be integrated in competent nursing care. As technology continues to evolve, the priority must always remain with the patient. Nursing as a profession has an obligation to interact with clients in the moment. Data collection and assessment is more meaningful when a trusting relationship is built between nurse and client. Caring is the foundation of this relationship. Boykin and Schoenhofer (2001) described people as being caring based on their values and virtues as human beings. The authors also stated that people are whole and complete in the moment. If a nurse is engaged in entering data into a computer during an assessment and is not clearly engaged with the patient, this can be seen as a lack of commitment, dedication, or good nursing care. Technological competence can allow the nurse to provide a caring environment while caring for the patient. Through caring and trusting relationships, nurses can know their patients in the moment and across the spectrum of time. Locsin (2005) stated that this allows for continuous appreciation of persons from moment to moment. However, if the focus of the interaction is a computer and monitor, this appreciation becomes lost.
Nurses who are savvy with electronic medical record documentation can assess their patient in the moment with specific attention paid to appreciation for medical status, attention to touch and deliberate care, and honor of patient’s experiences. Trusting bonds will form between nurse and patient if the nurse relates to the patient in the here and now and interacts with technology outside of the performance of patient assessment. The development of a psychometric tool by Parcells and Locsin (2011) allows for the focus of nursing care to shift toward “the fullest appreciation of professional nurse caring competence through technological knowing. The realization that technology and machine skill competence is only a tool to optimal patient care is imperative. The use of electronic medical records management systems to collect data is a skill that can be mastered so that caring is continually integrated into the moment to moment interactions between nurse and patient.
In conclusion, devotional, committed relationships between nurse and client are essential to increased patient care outcomes and building trust. Patients deserve a unique, caring, and unquestioning relationship with the nurse that allows for optimal health and wellness. Maintaining focus on the actual patient while integrating technology as a tool to provide safe and competent care is vital in meeting the needs of the patient. Competence in technological knowing allows for continual movement between tasks and improved presence with patients through process mastery. Only through a connection between technology and caring can the true humaneness of relationship building occur.
Boykin, A., & Schoenhofer, S.O. (2001). Nursing as Caring: A model for transforming practice. Boston, MA: Jones & Bartlett.
Locsin, R.C. (2005). Technological competency as caring in nursing. Indianapolis, IN: Sigma Theta Tau International.
Parcells, D. A. & Locsin, R.C. (2011). Development and psychometric testing of the technological competence as caring in nursing instrument. International Journal for Human Caring, 15(4), 8-13.
Watson, J. (1988). Nursing: Human science and human care. New York, NY: National League for Nursing.
Dr. Hill has been a registered nurse since 1991. She received her BSN from Capital University in Columbus, Ohio in 1990, returned to complete her MSN in 2007 and graduated from Capella University in 2012 with a PhD in Education: Nursing Education specialization.
Dr. Hill began her nursing career at Children’s Hospital in Columbus, Ohio; she was a staff nurse on a renal/metabolic unit. She cared for children with conditions such as diabetes, renal failure, cystic fibrosis, leukodystrophy, seizure disorder, and cancer. After caring for clients with renal disease, she quickly became interested in dialysis. Following four wonderful years at Nationwide Children’s Hospital, she took a position in dialysis. The remainder of her clinical career was in various positions related to outpatient/inpatient free standing hemodialysis clinic. Dr. Hill served as a staff nurse in the acute and chronic setting, caring for both peritoneal and hemodialysis patients and currently works in an acute dialysis setting as a per diem staff nurse.
Her love of teaching began in 2003 when she started teaching clinical for a local school of nursing. She then moved to Chamberlain College of Nursing in 2007 and is currently a full-time nursing faculty member. Dr. Hill began her career at Chamberlain teaching in the ASN online program and has taught in the ADN onsite and online, BSN onsite, RN-BSN online option and the MSN online programs. Dr. Hill’s research interests include caring in nursing education, effective education in an online associate degree program, and nursing informatics education for nursing students.