Tech Improves Care, Empowers Nurses? You Be the Judge

The true value of technology in healthcare becomes apparent when we imagine trying to do our jobs without information

systems, telemetry, Internet access, or a day without our laptops, cell phones, and handheld computers. We certainly

cannot leave such useful innovations behind. Yet, in a technology-rich oncology care environment, these advances make it easy to relinquish compassion and even avoid human interaction. Oncology nurses know better than anyone about the power of compassion and the intricacies of the nurse-patient relationship. Oncology nurses also know that technology enables care to be delivered in a more effective, efficient, and economical manner. Technology will never replace compassionate oncology nursing presence, but it can make the lives of bedside and outpatient oncology providers safer and easier. As changes in treatment and technology continue to drive oncology nursing care, it is worthwhile to consider the tension that still exists between technology and nursing care today.

Technology is a broad concept that deals with the creation, use, and knowledge of tools that enhance our ability to adapt to our environment. A strict definition is elusive; technology can refer to material objects, such as machines, but can also encompass systems, techniques, or specific areas, such as medical or communication technology.

Historical Perspective

During the 1970s and ’80s, oncology nursing literature focused on technology related to standard modalities of cancer treatment, primarily chemotherapy and radiation therapy. Beginning with the early years of cancer care, oncology nurses advanced the use of these technologies through involvement in clinical trials, side effect management, and identification of long-term/late eff ects of cancer treatments. Oncology nurses rapidly acquired expertise in the use and management of treatment and diagnostic equipment, such as radiation implants, ommaya reservoirs, venous access devices, reproductive technology, and computer use in pain management. Over the course of several decades, oncology nurses integrated numerous technological advances in radiation therapy, marrow and blood transplantation, access devices, and biotherapy into their nursing practice. From a historical perspective, the ongoing assimilation of technology into daily oncology practice positions nurses as both technology’s most loyal supporters and strongest opponents.

Nurses have historically struggled with two conflicting perceptions of technology: (1) it enhances and empowers nurses, or (2) it disrupts the holistic foundations of nursing and is a fundamental detriment to the social aspects of healthcare. In several published essays on technology in nursing, there is a disquieting reflection: is the machine an extension of the nurse’s hand, or is the nurse an extension of the machine, and is this troubling distinction reconcilable? When time is limited, nurses may prioritize technical functions that have more urgency than nurturing behaviors. Suffering is an inherent part of a life-threatening illness, and oncology nursing has both rewards and demands that are unique to the specialty. The challenge to “be with” the sufferer is at odds with the current emphasis on high-tech, aggressive care. The oncology nurse may use technology and “empty busywork” as a barrier against developing relationships that may be emotionally draining or make them vulnerable to the profound suffering of patients and families.

Bridging the Technologic-Humanistic Divide

Healthcare technology is neither inherently “good” nor “bad” because it is employed in the cultural and organizational context of the users. As such, the union of technology and humanistic caring in oncology nursing practice requires expertise and is facilitated by education, experience, research, and administrative considerations. Information technology (IT) and distance education provide healthcare providers with rapid access to the most up-to-date information regarding diagnosis, treatment options, and risk factors. As a result, patient care is enhanced by the timely communication of a cancer diagnosis, potentially earlier treatment, and knowledgeable oncology nurses. Bar codes on single packages of prescriptions, over-the-counter medications, and biologics with associated computerized medication administration systems may cut medication errors by up to 80%, thus reducing costs and emotional consequences for patients. Without IT, there can be no evidence-based nursing. As the advocates for quality oncology care, nurses make clinical decisions using the best available research evidence, practice expertise, and patient preferences.

To facilitate the successful implementation of an electronic health record (EHR) in a mid-size community hospital, a committee was formed to address staff and patients’ perceptions regarding the impact of a new bedside computer. The committee developed an educational sensitivity tool to enhance clinicians’ simultaneous interactions with patients and computers. This “Patient First” tool assisted staff with focusing on compassionate care, thus serving as an exemplar for the implementation of other technologies. As long as oncology nurses put the patient first, practical strategies to merge the benefits of technology with humanistic care will continue to emerge.

Leaders in nursing informatics believe greater use of technology will improve nursing care in three ways: (1) by counteracting human error, (2) by improving human behavior, and (3) by putting nurses where they can be most effective. Technology accomplishes these goals through software that translates data into information, and hardware that improves the way nurses collect data.

Reducing Human Error

Examples of ways to eliminate human-induced error include information-driven monitoring of indicators such as length of

stay, patient satisfaction, computerized chemotherapy order entry compliance, and educational strategies like distance learning that allow efficient use of scarce nursing faculty. Computerized physician order entry (CPOE) for cancer treatments prevents transcription errors and reduces duplication and healthcare costs. The American Association of Colleges of Nursing (AACN) encourages the use of distance learning technology as a way to improve the quality of and access to nursing education. Despite some financial, legal, and ethical issues, the AACN takes the position that this technology will “enhance the profession’s ability to educate nurses for practice, prepare future nurse educators, and advance nursing science in an era when the number of professional nurses, qualified nurse faculty and nurse researchers is well below national need.” The national shortage of nursing will result in fewer nurses who choose oncology nursing as a career and stay with it; therefore, technology-enhanced oncology education is essential to maintain qualified nurses and ensure quality cancer care.

EHR use continues to increase throughout the country, and is becoming the hallmark of technologically advanced healthcare facilities. EHRs are considered to provide “more safe, effective, patientcentered, timely, efficient, and equitable healthcare.”

Improving Human Behavior

Innovative education technology, information-driven management systems, and mapping outcomes for nursing practice are examples of technologies that can improve nursing behavior for better patient care. Traditional nursing actions, such as information retrieval from memory or textbooks, clinical calculations using a math calculator or paper and pencil, and communication via telephone, pager, and paper medical records can be streamlined with the use of handheld computers.

Nursing students increasingly employ laptops for note-taking in class and handheld computers to enhance clinical information retrieval. Nursing graduates expect automation and may be shocked to find that it may be limited or absent in their workplaces. In contrast, Ornes and Gassert describe the informatics content of 18 courses in a baccalaureate curriculum and conclude that students received limited informatics exposure and may be inadequately prepared to use IT. Mobile and wireless communications, electronic charting, and “smart” intravenous pumps can improve recruitment and retention by improving nursing job satisfaction and reducing workplace stress.

Automated, information-driven performance management systems can monitor a variety of interventions to improve patient health and safety. Indicators of nurse-sensitive patient outcomes (neutrapeniainduce infection rates, patient satisfaction, and pain management) assist oncology nurses in determining if their efforts improve care and why. Computerized equianalgesic conversions from a parenteral opioid to an oral form and pharmacoeconomic calculations can determine the cost of treatment These are only a few examples of how performance management software can improve patient care and advance best practices in oncology organizations.

Popularity Contest

Point-of-care data collection systems allow oncology nurses to document faster and better so that they have more time for patient care; telehealth provides care across miles; and the Internet offers the opportunity to disseminate targeted relevant information for better-informed patients and create global communication with oncology experts. Emerging telenursing technologies connect nurses and patients in alternate care sites and remote geographic areas, facilitating consultation among professionals, diagnosing and assessing disease, interviewing, historytaking, and prescribing cancer and supportive therapy.

Oncology patients require long periods of care with careful and consistent monitoring/education; thus, oncology nurses are well-positioned to translate their expertise to patients and other providers via telehealth technologies. Portable computing devices are growing by leaps and bounds in popularity among healthcare providers. Nurses are constantly challenged by requirements for current, reliable, and accurate information at the point of patient care. In contrast to quickly outdated professional books and journals, PDAs allow clinicians to access and document current information in real time with healthcare applications, such as pharmacologic databases, clinical decision-making support tools, and patient-tracking systems. Mobile healthcare computing devices (MHCDs) bring together an astonishing array of functions (pager, cell phone, PDA, Internet port), allowing the user to prescribe medications, enter patient orders, and track patient progress. These examples illustrate how availability of portable computer technology can improve and augment comprehensive healthcare in many settings.

Technology in cancer care continues to grow, with far-reaching implications for patient care. Oncology providers need to have a working knowledge of the latest communication technology, as well as medical technology. As competent users of emerging technologies, oncology nurses can comprehensively and compassionately care for the health, informational, and psychosocial needs of patients with cancer. Although the most sophisticated technology cannot replace simple compassion, it does provide exciting opportunities that give nurses the time and tools to be more caring. Nurses are able to maintain nursing presence by using technology to its fullest potential, but should not be controlled by it.

Ellyn Matthews, PhD, RN, CS, AOCN, CRNI, of the University of Colorado is a Director-at-large for the Oncology Nursing Society (ONS).