Nurses, Caring and Machines
By Debra Clark
Technology continues to transform the health-care industry at a dizzying rate. But while many Canadian health organizations are second to none in terms of science and technical expertise, patients may not always find themselves at the centre of the system.
Don Juzwishin, director of Health Technology Assessment and Innovation with Alberta Health Services, supports innovative health care backed by research and the best evidence available, but he cautions that technology shouldn’t operate at the expense of the care and delivery process.
“My approach is to be critical about any technology that is going to be considered for introduction,” Juzwishin says. “We have to assume that technology is probably going to create new problems that have to be addressed, and that a critical approach needs to be taken in which we ask questions about clinical effectiveness, cost effectiveness and appropriateness,” he adds. “Because we have a publicly funded health-care system, public dollars need to be wisely spent, providing full transparency and accountability to the four million residents of Alberta.”
Juzwishin’s presentation, Nurses, Caring and Machines, was featured at MacEwan University’s 2015 Every Nurse Symposium, and focused on technology as a challenging part of the health-care system.
“The title of my session points to a paradox between the humanistic care nurses provide juxtaposed against the cold machine.” Juzwishin stresses that one of the dangers people fall into with contemporary healthcare delivery is thinking that machines have all the answers. “My point is that machines and technology are there to help nurses facilitate the care delivery process, but will never replace the nurse and the human dimension associated with that caring process,” he emphasizes. “I’m always reminding nurses that they are the master – the human being that controls the technology. Even though there might be a demand or incentive to adopt certain innovations, it may not always be the best thing to do.”
The importance of a nurse’s perspective
Juzwishin points to the introduction of hospital “computers on wheels,” or COWs, as one of many examples of technology that was brought into the work setting that perpetuated existing problems and created new complications. “In addition to being clumsy and difficult to move around, prior to its introduction, nobody thought about the fact there was an extension cord that would always be in the way – regardless of where it was. These sorts of usability issues need to be thought about when technology is being considered.”
Machines and technology are there to help nurses facilitate the care delivery process, but will never replace the nurse and the human dimension associated with that caring process
― Don Juzwishin, AHS
“Because nurses provide service across such a wide spectrum of the delivery process – working in everything from health promotion and disease prevention to screening and active interventions – their perspective needs to be introduced within the process, which is something that is done poorly at the moment,” Juzwishin says. “An administrator or clinician might think a new piece of equipment would be helpful to bring in, but if they haven’t talked to the nurses – the people who are going to have to use it and explain it to patients – they are shooting themselves…in the foot.”
Juzwishin encourages nurses not to be acquiescent and assume that someone else will ask the critical questions. However, he realizes it’s difficult for nurses to insert themselves into conversations about the adoption of technologies. As Juzwishin comments, “Nurses are busy just trying to keep their heads above water with their workload, so it’s my position that nurses and nursing students need to feel empowered and be prepared to demand and advocate for appropriate resources that will help drive the innovation agenda.” Juzwishin points out that there have been cases when suitable preparatory work was not done beforehand to validate the effectiveness of a particular technology, drug or innovation. “It comes back to the responsibility of a nurse to say, ‘Show me the evidence that says this is safe, clinically effective and cost effective.’”
Technology must help, not hinder, the connection between patients and health-care providers. Juzwishin explains that nurses need to be prepared to communicate with their patients that lasting and meaningful changes are possible, but that certain realities exist. “Nurses must be realistic about what new technologies can do and be able to communicate that to people in a way that is going to be understood and internalized,” he says. Invariably, science provides new avenues to help people live longer and healthier lives, but Juzwishin cautions that there are opportunists who make false promises about what technology can deliver.
Keeping an open mind is key
According to Juzwishin, a good health leader is someone who understands the interface between the caregivers and patients, and is not too far removed from care delivery. “It’s a major problem when leaders do not understand the issues and challenges staff face on a day-to-day basis,” he says. “For example, this is 2015 and we are still using 1980s technology when it comes to health information systems for patients across the province. Canada is one of the most resistant countries in the world when it comes to adopting a more efficient way of recording individual health information,” Juzwishin argues. “People should have their own up-todate electronic health record to be utilized for their care. Unfortunately, with a paper-based system, patients must repeat their personal history several times after being admitted to a hospital, for example. Nurses should feel empowered to use technology to help find a better way to deliver more effective and empathetic care.”
Nicole Simpson, coordinator with MacEwan University’s Centre for Professional Nursing Education (CPNE), says that, at the end of the day, she wants students to realize that technology changes rapidly and nurses can’t close their practice to new techniques or procedures following graduation. At CPNE, Simpson explains, “We mimic the latest technology available in the region with various simulations and labs. We’ve also talked about a course in technology assessment or understanding technology and those basics. This, we hope, will help nurses to be at the table when decisions are being made that will greatly impact their professional lives.” Simpson continues: “Our first step is to hold a Nursing Informatics Bootcamp on May 1, 2015. It’s specific to health informatics and the optimal use of the health-related data and information we collect.”
Undeniably, technology is rapidly changing the face of health care. But as Juzwishin and Simpson point out, providers have a responsibility to be critical about anything that is going to be considered for introduction so that it meets the needs of the clients as well as those providing care.
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