The general public believes that technology will improve the efficiency, quality, safety, and cost of health care. Only some people, however, consider that these same technologies may introduce errors and adverse events. 1 Device-related issues are unavoidable because millions of healthcare providers worldwide use nearly 5,000 different types of medical devices. 2 While technology holds great promise, its benefits may not be realized due to four common pitfalls: (1) insufficient technology design that does not adhere to human factors and ergonomic principles,3 (2) insufficient technology interface with the patient or environment,3 (3) preliminary plan for implementing new technology into practice, and (4) insufficient maintenance plan.4
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Patient care technology has become more complex, altering how nursing care is conceptualized and delivered. Before the widespread use of technology, nurses relied heavily on their senses of sight, touch, smell, and hearing to monitor and detect changes in patient status. Over time, a technology designed to see physical changes in patient conditions replaced the nurses’ unaided senses. 5 Take the example of pulse oximetry. Before it was widely used, nurses relied on subtle differences in mental status and skin colour to detect early changes in oxygen saturation, and arterial blood gasses were used to confirm their suspicions. Now, pulse oximetry allows nurses to see low oxygenation levels before clinical symptoms appear, allowing them to more quickly diagnose and treat underlying causes.
While technology has the potential to improve healthcare, it does not come without risks. Technology has been described as both a problem and a solution for safer health care, with some observers warning of the introduction of yet-to-be errors following the adoption of new technologies. 6 Nurses and other health care providers, for example, may be so focused on data from monitors that they fail to detect potentially significant subtle changes in clinical status. The sheer volume of new devices, the complexity of the devices, the poor interface between multiple technologies at the bedside, and the haphazard introduction of new devices at the bedside may all lead to problems. Despite spending billions of dollars each year on an ever-expanding array of medical devices and equipment, the nursing profession needs to pay more attention to technology implementation and integration with other aspects of the healthcare environment.
Nurses are interested in patient care technologies ranging from relatively simple devices like catheters and syringes to highly complex devices like barcode medication administration systems and electronic health records.
7 Technology can be broadly defined to include clinical protocols and other “paper”-based tools. Still, for this chapter, we will concentrate on the equipment and devices nurses are likely to encounter while providing direct patient care. This chapter aims to provide a conceptual model for technologies that nurses are likely to meet and to outline strategies for promoting their effective and safe use.
Navigate to: Conceptual Framework
A conceptual framework was developed based on a literature review that depicts the relationship between nurses’ use of technologies, moderating and mediating factors that affect the service, and potential nurse, patient, and organizational outcomes (Figure 1). This model was created independently, but it is similar to the work of Fuhrer and colleagues8, who made a patient-centric framework for assistive technology device outcomes. We included vital nursing processes and products for which technology has a significant impact on care delivery and the prevention of adverse events.
Figure 1: Technology, Nursing, and Patient Safety Conceptual Model
This conceptual model situates technology use in nursing practice and provides a framework for investigating both the short- and long-term effects of technology use on the patient, the nurse, and the organization. Fuhrer’s model focused on assistive technologies, which are a range of interventions for promoting independence and function with a disability, such as structural and nonpermanent alterations to the physical environment, equipment attached to the physical environment, devices used by individuals, and behavioural modification. This model is expanded to include the full range of technologies used by nurses in nursing care delivery (Table 1). There are numerous classifications for patient care technologies. Direct nursing care delivery technology, indirect nursing care delivery technology, communication technology, patient and nurse protective devices, nurse protective devices, patient assessment, monitoring and surveillance, patient assistive devices, remote monitoring, continued learning, and pattern identification are the categories for these technologies. Well-designed technology allows nurses to focus on caregiving and patient health promotion.
Table 1 Technology Frequently Used by Nurses
Workplaces have four dimensions, according to Stone and Wiener9:
Organizational arrangements, such as goals, structure, policies, and rewards.
Social factors include organizational philosophy and values, management style, and interactions with employees and patients.
The physical setting/environment includes character, material design, and ergonomics.
According to our proposed model, these workplace dimensions influence nurses’ initial and ongoing use of technology.
Nurse-use technologies prevent errors and adverse events (for example, medication errors, miscommunications, treatment delays, and adverse events such as failure to rescue, nosocomial infections, pressure ulcers, falls, and immobility complications). However, technology introduces unintended consequences and opportunities for failure. 6 In a chart review, Samore and colleagues10 discovered that foley catheters (57 per cent of adverse events involving devices), arterial catheters (17 per cent of such events), central venous catheters (17 per cent of such events), and peripherally inserted central catheters (7 per cent of such events) were the devices most commonly associated with adverse events. Implementation of a computerized provider order entry system intended to reduce handwriting and transcription errors at one pediatric hospital was unexpectedly associated with increased mortality, presumably due to nursing personnel’s reduced ability to anticipate patients’ needs before their arrival. 11 Other research found that while most nursing personnel believed that barcoding medication administration would reduce medication errors, it would also limit physicians’ ability to review medication administration accuracy and deviate from routine medication administration sequences. 12 In another case, a few years ago, some nursing homes used non-adjustable low beds to prevent hip fractures from falls from the bed. On the other hand, this solution for preventing hip fractures in residents forced nursing staff to provide care on their knees or bent over, increasing staff risk for back and knee injuries. Green13 noted that all damages and unintended consequences of technology are impossible to predict in advance and are an unavoidable aspect of technology development. In other words, there can be no technological advancement without technological failures.
Nurses may respond to unintended consequences of technology by devising “workarounds,” or temporary solutions to technological problems or malfunctions. While workarounds solve the immediate problem at hand, they can be dangerous because they do not address the underlying problem in a system,14 increasing opportunities for error over time. Due to infection control restrictions, scanning devices attached to the medication cart with a cord, for example, made it difficult for nurses to monitor the patients’ identification arm during the early implementation of barcode administration. As a result, nurses made duplicate armbands and kept them near the medication cart. The duplicate bands made scanning easier, but they circumvented a safety feature that required positive patient identification (by checking the bar on the arm) before administering medication, increasing the likelihood of “wrong patient” errors. When an independent evaluator discovered this workaround, nursing collaborated with the vendor and infection control experts to scan infectious patients using disposable plastic covers. 15, 16
Policies, resources, culture, social norms, management commitment, training programs, and employee empowerment are all organizational factors that influence technology use. It has been observed that the effects of implementing technology, such as information technology, can vary greatly depending on the setting,17 owing to differences in the social-organizational environment, such as workflow, work tasks and processes, and the people in the background. The policy is frequently regarded as an effective means of bringing about change. For example, before mandating mechanical lifting through policy, it is beneficial to have firmly established leadership and management support, equipment, training, and coordination with other departments. 18 Policy implemented hastily without considering the impact of technology may result in staff avoiding the policy and risking the consequences, or the team appears to comply when they are not. Both of these scenarios can harm employee morale and satisfaction.
Factors of Society
Since the establishment of nursing as a profession in the latter part of the nineteenth century, Sandelowski19 has noted the complex and often troubled relationship between technology and nursing. Nurses have been both users of technology and facilitators of patient acceptance of technology. Still, it has been difficult for them to define the role of technology in their profession at times. In explaining the role of nursing in health care, technology has played a role in the debates of caring versus curing and high-touch versus high-tech. In the 1970s, mastery of technology frequently came second to the knowledge of psychosocial skills such as communication and therapeutic relationship development. This relatively new nursing and healthcare culture have often worked against the systematic incorporation of technology into nursing practice to improve patient outcomes. Using a Heideggerian analysis of technology, Zitzelsberger20 proposed that the usual ways in which we perceive technology in terms of function, utility, and positive effects overshadow other “modes of revealing,” such that nurses and other health care personnel are more likely to accept and incorporate technology into practice without critically evaluating its benefits and problems. For example, why is it that nursing that requires more technology, such as critical care, is valued more (i.e., paid more) than nursing that requires little technology, such as personal care of nursing home residents?
Certainly, nurse characteristics will influence technology adoption, but little empirical evidence has supported this claim. Nurses are willing to adopt safe patient handling and other technologies if they are convenient, easy to use, target a high-risk, high-cost, and high-prevalence problem (such as falls), are consistent with the unit and organizational goals, and are either compatible with existing work patterns or have the potential to improve efficiency and time spent with patients. The nurse characteristics that influence technology use are likely technology-specific. In one study of the implementation of a nursing documentation information technology system, the researchers discovered that some nurse characteristics influenced adoption, including the commitment to nursing care planning and written documentation, acceptance of computers in nursing, computer and typing skills, professional experience, level of motivation, and climate of trust and support within the nursing team. 17
The Physical Setting
The physical environment, especially in older buildings that were never designed to accommodate newer technologies, is frequently a limiting factor in the use of many types of nursing equipment. According to research, an ergonomic approach that relies on equipment to promote safe patient handling reduces musculoskeletal injuries in nurses. 21 The environment is essential in using this equipment by nurses because if the equipment is not easily accessible, the nurse is less likely to use it. The nurse is less likely to use patient handling equipment if it is stored at the end of a hallway in a room behind other equipment than if it is stored in an open nook in the hallway where it can be easily retrieved. 22
Factors Mediating and Moderating
Ergonomics and human factors engineering provide valuable frameworks for investigating many mediating and moderating factors (for example, the user/technology interface) that will influence equipment use and outcomes. The International Ergonomics Association23 claims that.
Ergonomics (or human factors) is a scientific discipline concerned with understanding interactions between humans and other system elements, as well as a profession that applies theory, principles, data, and methods to design to optimize human well-being and overall system performance.
Ergonomists help design and evaluate tasks, jobs, products, environments, and systems to ensure they are compatible with people’s needs, abilities, and limitations.
“Human factors engineering is the discipline concerned with understanding human characteristics and how humans interact with the world around them, and the application of that knowledge to the design of safe, efficient, and comfortable systems,” according to Gosbee24 (p. 3). Without a comprehensive understanding of human factors, the tendency is to focus on human failures as the primary source of error and to prioritize task automation to prevent mistakes. This approach has several apparent flaws: 4
Automation can make the challenging aspects of the job more difficult by removing the accessible parts of the job.
While humans are known to be fallible, we leave staff to handle tasks that the designers could not automate, most notably restoring the system to a safe state following a failure.
Humans are expected to “monitor” automated processes, although we know vigilance is unlikely when abnormal events are rare.
Skills must be practised continuously to be preserved, but the occasional system failure denies staff the opportunity to practice the skills required in an emergency.
Engineers, biomedical engineers, industrial designers, and ergonomists, the designers of the equipment used in providing care, are generally kept from nurses during educational programs or on the job.
Because nurses work on the front lines of health care, where nurses, patients, and technologies collide and actions are obvious, there is a tendency to blame them for human error caused by technological failures. These are referred to as “human operator problems” by Reason4 and can be classified at the individual or system level. Individual-focused issues include inadequate procedures or documentation, a lack of knowledge or training, a failure to follow guidelines, and inadequate planning or scheduling. Miscommunication, inadequate supervision, and policy issues are examples of system-oriented issues. Instead of blaming the individual nurse, technology failure should be viewed in the complex health care system context.
Technology Use Outcomes
As Fuhrer and colleagues8 pointed out, a need for outcome measures is a significant barrier to conducting technology-related outcomes research. In addition, there needs to be more conceptualization of outcomes in the context of the type of technology and its context of use. The device’s effectiveness, efficiency, and user (i.e., nurse) and patient satisfaction are the primary initial outcomes of technology. Verza and colleagues25 focused on “equipment abandonment,” or the disuse of a previously obtained device, in the context of assistive devices for people with multiple sclerosis. They discovered that an interdisciplinary prescribing approach could reduce abandonment.
Longer-term goals include adverse events, injuries, satisfaction, competency, errors, goal attainment, and organizational outcomes like efficiency, cost (including cost avoidance, return on investment, margins, and working capital),26 healthcare quality, and nursing retention and recruitment. Karwowski27 distinguished positive outcomes (e.g., increased work productivity, shorter performance times, improved product quality, and desirable psychological and behavioural effects) from adverse outcomes when developing an ergonomics model (e.g., loss of productivity, low quality, accidents, injuries, and undesirable physiological and psychological consequences).
Ideally, technology is designed to:
Eliminate errors and adverse events.
Reduce the occurrence of errors/adverse events.
Detect errors early, before injury occurs.
Mitigate the effects of errors after they occur to minimize injury.
3 In this “ideal” scenario, patient care technology would result in positive outcomes for nurses, patients, and organizations. Consider all of the alarms and warning systems used in nursing care delivery to detect errors before they cause harm. Bed exit alarms, warnings on IV pumps that signal occlusions, patient-initiated call bells, staff-initiated code alarms, wandering and elopement alarms, cardiac monitor alarms, and ventilator alarms are just a few examples. All of these warning systems rely on the nurse’s ability to notice the warning, process the alarm, understand what is going on, and then take the appropriate action to reduce risk to the patient. 28 According to one recent study, medical/surgical nurses desired “smart monitoring devices” that communicate with electronic medical records and wireless communication devices. 29 However, the use of automated alarms is hampered by “alarm fatigue” caused by the sheer volume of alarms. Furthermore, alarm fatigue is exacerbated by the well-intentioned but erroneous decision to deliberately set alarms with a high false alarm rate; the effectiveness of an alerting signal plummets with just a small number of false alarms. 30
The model presented here differs significantly from Fuher’s8 in that it includes both nurse and patient outcomes. In addition to the potential physical harm from technology, Monk and colleagues31 proposed that psychological injuries are as crucial as physical harm for older adults living with disabilities in their homes. For systematically evaluating technology used to promote independent living, these researchers argued for including three types of physical harm (injury, untreated medical condition, and physical deterioration), four types of psychological and social damage (dependency, loneliness, fear, and debt or poverty), and four generic consequences (distress, loss of confidence in ability to live independently, costly medical treatment, and death).
While patient care technology provides numerous opportunities to improve nurse productivity and satisfaction, operational efficiency, patient satisfaction, safety, and quality, little research has been conducted to evaluate the outcomes of specific patient care technologies. Barcoding, scanning, and robotics have all been shown to increase efficiency while lowering costs. 32 Barcode medication administration software has been successfully implemented by the Veterans Health Administration (VHA). This cutting-edge automated system employs wireless point-of-care technology with an integrated barcode scanner. The system can significantly reduce medication administration errors by allowing clinicians to verify a patient’s identity and validate medications against active orders. The VHA estimated that the software saved 549,000 errors while dispensing 8 million doses after being implemented at the Kansas VA hospital. 32 Bahlman and colleagues33 discovered in a quality improvement project that implementing an integrated communication system in an operating room had a positive effect by reducing staff time for phone calls to relay messages; reducing time nurses had to spend hunting for pieces of equipment; enabling more timely administration of antibiotics for total joint procedures; and improving communication with family members about the patient’s progress through preoperative, operative, and anesthesia communication.
There is moderate evidence supporting the use of electronic medical records and automated drug-dispensing machines, with reports of increased nurse satisfaction, retention, and productivity and decreased errors.
32 Despite the scarcity of research to back up technology’s benefits, a recent Institute of Medicine report identified the use of information technologies to automate clinical information as one of the keys to safer, higher-quality healthcare systems.
Home>Homework Answsers>Nursing homework help
Kindly help me respond to the following questions in 100 words each:
1. How do the EBP models promote quality care in the clinical practice setting?
2. Do you think nursing has embraced information technologies?
3. How do you currently utilize information technologies in your nursing practice?