We could have guessed that it was true; we have all probably joked, grumbled, or griped about it at least once in our career. We know that the amount of documentation and paperwork (or electronic charting) that accompanies a nursing procedure can be cumbersome. Excellent assessors that we are, our estimations were correct: a study by the American Hospital Association found that one half to one full hour of paperwork is associated with every hour of patient care. Health care providers are regulated by thirty federal agencies, while Medicaid and Medicare rules fill over 130,000 pages of text. Add to that the privacy laws imposed by the Health Insurance Portability and Accountability Act (HIPAA) and patients' increasing interest in their health care (and their right to see their health care information), and one can see how documentation and technical accuracy can very easily become the focus of what went on with a patient's care (Sokol and Molzen, 2002). Control, cost containment, and complexity, enveloped in uncertainty and chaos, are becoming the norm (Watson, 2000). Physicians also are affected. A study found that 31 percent of 4,500 physicians surveyed would choose a different career if given the opportunity (Neuwirth, 1999, p. 79). When the tired, disgruntled, and disenchanted physician is unable to maintain satisfactory relationships with patients, the quality of patient care suffers immensely (Neuwirth, 1999). We can infer similar impacts for nursing care.
Sokol and Molzen (2002) seek to explain the relationship between information technology and modern health care, particularly from the legal standpoint of medical errors and malpractice. They inform us that health care has been relatively slow to adopt technology, falling behind, for example, the automobile and steel industries. In one way, this may be advantageous, as "blindly following fads is a recipe for disaster" (Chesbrough and Teece, 2002, p. 127). As technology advances, health care systems adopt the new opportunities at varying paces; one facility may be years from converting to a "paperless" system, while others have surged ahead with computer-based medical records, handheld devices for charting, computerized physician order entry, and digitalization that allows routine tracking of patient whereabouts. A growing reality, telemedicine, is another technology trend that provides remote transmissions between multiple caregivers or between caregivers and patients. Some patients may even have clinical indicators such as blood pressure and blood glucose monitored via a telemedicine device (Sokol and Molzen, 2002).
It seems to be taken for granted that technological ability will increase in just about every industry, including health care, and that it must increase to contain costs, introduce efficiencies, and provide faster access to needed data. Few would deny that the health care industry, if it has not already, should make efforts to catch up with the rest of the industrialized world when it comes to technology. Perhaps the sheer individuality of each incident of nursing or medical practice has impeded achievement of this goal somewhat. The increased emphasis on quality, consistency, and avoidance of error, however, has no doubt accelerated it (Sokol and Molzen, 2002).
Turkle (2003) points out that in society at large, technology has moved from an acknowledged external presence to an intimate acquaintance. It is not unusual for computer game enthusiasts to "spend hours playing out parallel lives" (Turkle, 2003, p. 43), assuming fantasy identities in imaginary worlds created for them on the Internet; or for children to bond with artificial beings that appear lifelike, such as mechanical pets. In short, "technology is increasingly redefining what it is to be human" (Turkle, 2003, p. 44). Of course, technology is said to be what defines us as humans because it reflects who we are and what we are capable of producing. It is driven by our needs and desires. The idea that it defines us raises another question: who are we becoming, and what do we want? The ethical and emotional issues our technology can raise are just beginning to come to light (Flower, 2000). Technology, in defining us as humans, also demonstrates what we know and what we can do. On the obverse, the results effectively negate some of the human side. Earlier, I gave the example of how ATMs have replaced and supplemented many of the functions once exclusively reserved for bank personnel, but ATMs are only one example of how we interact with machines rather than people. Online credit reports, telephone prescription refill services, instant weather warnings delivered to our pagers, automated drive-through car-wash bays, and pay-at-the-pump gasoline islands have provided us with options to replace the human touch in our everyday lives. There are countless additional examples of this trend. Additionally, sometimes we feel enslaved as instant response becomes more and more possible and expected. Pagers and cellular telephones are available to keep us close to work no matter where we are. This feeling of constantly being monitored, known as "techno stress," has been shown to contribute to anxiety and anger in the workplace (Helge, 2001).
Journals related to the health profession emphasize the need to prepare medical and nursing students for the technological age (including information technology) in health care (De Ville, 2001; McCannon and O'Neal, 2003; McNeil, Elfrink, Bickford, and Pierce, 2003). There is a concern that nurses are not properly prepared and that they do not have the foundation of skills and knowledge necessary to cope with the environments they will encounter after graduation. Notwithstanding these concerns, technological advances have been encroaching on the environment for some time. In many hospitals, electronic blood pressure cuffs—which record pressures and pulse, sound an alarm when limits are exceeded, and take and record multiple sequential readings—replaced manual blood pressure cuffs years ago; the manual cuff is reserved for instances when a patient's limbs are compromised or there is a need to verify a questionable reading by the machine. Even body temperature is monitored digitally (who can remember the last time they waited five minutes for a reading from a mercury thermometer?), and intravenous medications are delivered via preprogrammed pumps, sometimes three or four at a time. Mechanized alternating pressure stockings and passive joint motion devices have been around a long time, as have alternating pressure mattresses and beds, eliminating some of the need for repositioning and passive motion exercises that once took place much more frequently at the bedside by trained personnel.
Most would probably agree that these technological advances are good and that they promote efficiency, consistency, and quality in care. To nurses and other medical professionals or paraprofessionals scrambling to make rounds on a packed medical/surgical unit or seeing six to eight patients an hour in a clinic, the thought of manual vital signs and constant surveillance of each patient's position and motion would be overwhelming. We need technology to make our jobs possible, not just easier. On the other hand, one might ask the question, what will happen to the familiar infrastructure of our hospitals in light of these changes? The answer is that the familiar is rapidly becoming obsolete (Porter-O'Grady and Afable, 2002).
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