Will Technology Change Our Practice?
In the past decade, our society has been transformed into a high-tech one. Personal computers have revolutionalized American life and, according to futurist Alvin Toffler, this "third wave," based on a vision of an information-driven society, is forcing major cultural changes. The "American Idols" competition on television, with cell phone text messaging voting, invites everyone to use technology in a way that motivates the consumer to be an active participant.
All healthcare providers and their patients have become informaticians. This challenges every nurse to be technologically competent in whatever field of practice as well as theoretically competent in the linking of continuous caring as integrated in technology. Nursing Administration Quarterly (NAQ) Vol 9:4, 1985, "The Essence of Nursing in High Technology," featured a leading article by Virginia Henderson, wherein she wrote, "High technology in healthcare is posing many philosophical, ethical, moral, and economic questions. It is encouraging that more and more healthcare providers, including nurses, are conducting conferences on ethics. But nursing must also come to grips with the economics of healthcare, or the question of how health dollars should be spent. Should money be spent on the extension of life by technology for the very rich or on the improvement of the quality of life for all?" She also affimed her concept of nursing: "The unique function of the nurse is to do for others what they would do for themselves if they had the strength, the will and the knowledge; and to do it in such a way that the recipient of the service acquires independence as soon as possible, or an ability to cope with a health handicap, or to die with dignity when death is inevitable [horizontal ellipsis]. The essence of nursing is hard to preserve in high technology, but if the latter is to succeed, effective nursing in conjunction with it is essential [horizontal ellipsis]. High technology has made the nurse's role simultaneously more important and more difficult and stressful."
Roy Simpson, coeditor of this issue, also had an article in that early issue of NAQ. Roy Simpson, RN, CMAC, FNAP, FAAN, Vice President of Nursing Informatics, Cerner Corporation, has dedicated his career to leading nursing in informatics and technology. In 1999, he received Rutger's University Informatics award for pioneering efforts in the field of nursing informatics. Roy is responsible for strategic sales and planning for the patient care enterprise as well as industry related to Cerner's professional practice. He has been the informatics columnist for NAQ since its inception. With more than 30 years of experience in nursing informatics and executive administration, we are most fortunate to have him as coeditor of this issue.
Joining him as coeditor is Diane J. Skiba, PhD, FAAN, FACMI, Professor and Healthcare Informatics Option Coordinator, University of Colorado at Denver and Healthcare Sciences Center. She has taught nurses in the field of nursing informatics since 1982. She is currently funded by the Health Resources & Services Administration (HRSA) Division of Nursing Advanced Nurse Education Training grant to prepare nurses in the field of informatics. This grant supports their online master's-degree program and funds the I-Collaboratory, an online community, to support informatics learners. She is Chair for the National League for Nursing's Educational Technology and Information Management Advisory Council, and has been Chair of the Nursing Informatics Work Group of the American Medical Informatics Association. As a nonnurse, Diane Skiba was inducted into the American Academy of Nursing as an Honorary Fellow in 2000. This editorial team truly reflects the integration of technology and nursing.
A recently published Sigma Theta Tau book, Technological Competency as Caring in Nursing: A Model for Practice, by Rozzano Lecsin, PhD, RN, is written as a testimony to the struggle of practicing nursing as knowing persons and to understanding technological competency as caring in nursing. In 2002, the American Academy of Nursing sponsored an invitational conference, "Using Technology to Enhance Patient Care Delivery." The opening session discussed the possibility of a technology-assisted work environment that improves practice and patient care outcomes. At that conference, Carol Bradley, an editorial board member of NAQ, and current Chief Nursing Officer, Tenet, Calif, spoke of technolgy as a catalyst to transforming nursing care. Clearly, this topic reflects a major transformation in nursing administration and is essential to our practice future. Even automated charting has been demonstrated to lessen nurse burnout, and improve nurse retention rates.
There is no doubt that the practice of nursing in all settings has changed with increasing technology. But should we have concerns for the ethical domain of nursing practice as well as the transmission of moral and ethical consciousness to the patient and family as we increase our use of high technology, especially in the realm of extension of life when all clinical signs seem to indicate end of life? I for one want the point of care at the end of life to be in my home or where I reside. We have had so much debate-and even political interference-over a person's right to refuse technology as an extension of life that nursing leadership may well be the catalyst for the role of nurses in preserving appropriate and constructive use of technology. Knowing when to act and when to wait is the touchstone for the future of nursing in a high-tech world.
-Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-chief, Nursing Administration Quarterly