Rage Against the Machines

Jeanne Venella
JULY 12, 2018
art of nursing,big data nurses,nurse tech,hca news

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.”

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