The Perils and Promise of Technology in Palliative Nursing

I freely admit I have a love-hate relationship with technology. There are many days I dream of collecting all the electronic devices in my surroundings and throwing them off a cliff. As I prepare this editorial, I yearn for my 1975 model Royal typewriter that used to occupy my desk-the one I used to prepare my master's thesis. That typewriter weighed about 60 lb, 5 times more than all the devices in my current possession. In those 60 lb of typewriter, I could feel the weight of my purpose in the world. There was a sense of power in that typewriter that simply doesn't feel the same on my computer screen. And the aroma of ink ribbons and "white out" [horizontal ellipsis] I could go on for many pages summarizing how much I really detest technology and how much I miss my typewriter, but I will spare you. I will just share that when I got my first Blackberry, I really thought I had arrived at the level of technical genius.

My aversion to technology is likely deeply embedded in whatever genetic material in my being also led me to hospice nursing. As a new graduate, I knew with certainty that I did not want to master all the technology of the ICU or live amid the intensity of the operating room. I had no desire to excel in interpreting lab tests and arrhythmias. I wanted to care for people who were dying, get them out of the hospital, and support their families as they died at home. I wanted to hold the weight of their living and dying in my arms and contribute some meaningful chapter to their story. I saw technology as a barrier to human connection-a force to be avoided.

But just when I am solidly confirmed in my low-technology philosophy, something comes along that makes me yield to the possibility that technology might be a good thing-even in care of the seriously ill and dying. Something like this issue of the Journal of Hospice & Palliative Nursing.

In the pages of this issue, I see the best of technology including studies and projects applying virtual reality for patients, audio diaries for family caregivers, and teleconferencing that is transforming the practice of palliative nursing care in Eastern Europe. I read about the ability of simulation learning to prepare nursing students to care for dying patients, and thus, I am reminded that technology has the ability to change practice, for the better. And, despite all of our collective angst about the challenges of implementing electronic medical records, I read the articles in this issue that report on the ability of technology to support depression screening in hospice, use data to evaluate limited code status, and monitor care for IV drug users in Appalachia.

And so I'm forced to reckon with my long-held resistance to technology and entertain the notion that maybe, if used wisely, it can be used as a vehicle to bring us closer to those in our care. The challenge ahead will be to maintain the "low tech/high touch" of our field while also harnessing all the possibilities of this new era. These articles assure me-and assure the field-that technology can create a re-envisioned narrative of dignifying death in nursing and forging new roles, such as the DNP, which can strengthen nursing care through technological leadership and dexterity.

The public media is full of reports about depersonalized care and patients' encounters with clinicians who never took their eyes off the computer screen. Caregivers have shared on social media platforms their traumatic memories of grieving family members who believe that technology replaced compassion. These stories reflect the dangers of technology. But I believe that a nursing profession committed to the moral center of palliative care can offer real-time and person-centered solutions.

Today as I read the remarkable work of palliative care nurses in this journal, I am inspired. We can demonstrate how high technology and high touch might cohabitate. We can choose to keep the patient at the center of care and make technology our ally. Maybe it's okay to surrender the typewriter while finding new ways to share the stories of our patients and their families.

Betty Ferrell, PhD, FAAN, FPCN, CHPN

Editor-in-Chief