Rage Against the Machines

Preserving the art of nursing in a high-tech age.

Twelve years ago, Bernard Tyson, CEO of Kaiser Permanente, underwent double bypass surgery as a result of a massive heart attack. The competence of his care team and advanced technology certainly saved his life, but Tyson credited a simple human connection for giving him the reassurance he needed to get through this experience.

“In my most vulnerable moment, a nurse came in and saw me in the condition I was in, and she did not say a word. She just simply touched my hand. I knew she knew what was going on,” he said in a 2016 interview with Eric Topol, MD.

The gesture wasn’t prescribed. It wasn’t anything that would eventually make its way into an electronic health record (EHR). But for a patient filled with fear and uncertainty, that human connection was all that really mattered.

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According to Sue Dean, MA, RN, and Joanne Lewis, PhD, RN, “Touch in nursing is often associated with tasks in delivering physical care or clinical procedures, but we know it is much more than that. It provides a deep connection with our patients and can improve the patient experience. When used appropriately, touch is one of the most therapeutic nonverbal means of communicating and it is invaluable in enhancing the nurse-patient relationship.”

Digital technology has fundamentally transformed healthcare. Use cases abound of improved patient outcomes, lowered costs, and the elimination of critical gaps in the care continuum. Advancements in tools that enable better collaboration, management, and support have become essential for frontline clinical staff to deliver superior care.

However, amid the justified excitement these tools have inspired, clinicians, particularly nurses, have expressed concern that person-centered interactions and observation—the art of nursing—are being pushed farther and farther from the bedside.

Many nurses are ending their shifts realizing that direct patient care makes up a small percentage of their day. A 2017 study by Higgins, et. al, found that nurses spent up more than 20 percent of their shift just documenting within the EHR compared to less than 9 percent interacting with patients.

The dominance of technology can also make patients feel dehumanized—cogs in an impersonal digital machine.

“We are heavy into how technology will enable us to do a better job in taking care of each individual and millions of people, but not at the expense of the human touch,” Tyson noted. “The human touch will always be the deciding factor of how people feel about the care that they are getting.”

The Forgotten Value of Nurses’ Intuition

These concerns predate the digital era. In 1980, Virginia Henderson, arguably one of the most influential nurses of the 20th century, warned of the necessity of preserving the “essence of nursing in a technological age.”

Nurses need to find ways to integrate technology into patient-facing interactions and use advancements without surrendering intuition and observation.

This is harder than it looks.

Technology prizes speed, accuracy and efficiency. Intuition—or “gut feeling”—is an evolved response that often kicks in long before logical thinking and analysis. Observation requires time invested in learning more about the patient in ways that go beyond crunching data. In an increasingly fast-paced hospital environment, these skills can seem more like luxuries than the critical traits that make for an effective nurse.

However, high-quality nurse-patient interactions have shown to positively affect both patient satisfaction and their perception of the amount of time spent engaging with nurses. Higgins, et. al, observed that “patients reported that an average of 74 minutes with their assigned nurse, and 90 percent rated their satisfaction with that amount of time as excellent or good,” even though observers noted the nurses’ actual time spent interacting with patients was half that estimate.

“Quality of time, in addition to perceived duration,” the authors noted, “may be fundamental to the patient experience, and consideration of timing and sequence of interactions might help to override physical time constraints.”

Finding Balance

The relationship between technology innovations and human-centered interactions isn’t a zero-sum game, but it does require a sense of proportion. Here are some practical ways healthcare’s stakeholders can ensure that the human-connection is not lost in patient care.

Make Technology Human-Centered. Health systems should obviously look to solutions that solve a problem. But is that enough? The right technology solution will also promote ease of use and a clinical workflow that maximize face-time with patients.

Take this issue of alarm management. Nursing staff are charged with the proper setting of the alarms and the prompt response when any of the devices send an alert. As the presence of alarm equipment continues to grow, nurses find their workflow and ability to engage with patients disrupted as they chase down hundreds of alarms, most of which require no intervention with the patient. Smart alarm technology identifies clinically actionable events and significantly reducing the overall number of alarms without increasing risks to patients.

Find the Right Vendor Partner. Health IT implementations can be expensive, complex, involve dozens of stakeholders and are often up against aggressive deadlines. Technology can also be disruptive and bring new uncertainties to the entire organization. However, the quality of the relationship with the vendor supplying the solution can make a huge difference.

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Any hospital or health system has business and clinical needs and cultures that make them different from other organizations. A partner with deep knowledge of the unique aspects of your organization not only will help you avoid common mistakes, but also keep you focused on detailed integration points and workflows. An excellent vendor also acts as a consultant and educator, making hospital staff comfortable with new technology and uncovering strategies for optimizing workflow.

The importance of evaluating the vendor as much as the product they are delivering cannot be stressed enough. Vendors that lack expertise, training capabilities, and clear steps toward go-live and beyond are critical red flags.

Take a Team-Approach to IT. It’s easy to consider a new hardware or software solution and imagine its transformative potential. Healthcare tradeshows brim with thousands of devices, enterprise systems, and software applications marketed as painless solutions for any clinical challenge facing a hospital or care unit. But a poorly implemented system that did not evaluate the impact to the clinical workflow can just as easily exacerbate inefficiencies and reduce the overall quality of patient care.

Involving direct-care staff is critical to the success of any new technology. How will this new technology impact how nurses deliver patient care? What adjustments in workflow and practice need to be made—at go-live and beyond? Starting with these questions fosters buy-in from the staff who will be utilizing this equipment.

Hospitals should incorporate clinical workflow as quickly and as early as possible in the process. Designating a nursing champion—or super-user—at the outset allows other nurses and direct-care clinical staff to receive information, training, and support during all phases of adoption.

Richard Hader, RN, CHE, CPHQ, PhD, wrote: “It’s imperative that we use… technology to enhance human interactions, not deteriorate them. Many of us have witnessed clinical situations in which patients experienced fatal events—even though all of their ‘numbers’ fell within the normal limits. Vigilance will allow us to use technology as a supplement to care, not a substitute for it.”

Human touch is and always will be the hallmark of nursing. The technological explosion in nursing is inevitable. While onboarding technology in nursing practice, it is very important that we consider how this impacts nurses’ workflow and then the nurse—patient relationships. We cannot lose touch.

The key to preserving human-centered care in the digital age is to make humans the center of all care processes.

Jeanne Venella, DNP, MS, RN, CEN, CPEN, is Chief Nursing Officer at of Bernoulli, a leader in real-time connected healthcare. She can be reached at [email protected].

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