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Practice comment

Nurse intuition will be restricted if technology dominates care


While technological advances have made patient observations more accurate, care must not become too mechanical as it is patient interaction that enables staff to use intuition, says Eileen Sills


To mark the centenary of Florence Nightingale’s death, Guy’s and St Thomas’ Foundation Trust recently launched the Year of the Nurse and Midwife initiative. This celebrates the progress nursing has made over the last 100 years by focusing on specific themes.

One of these areas is patient observation, as the failure to detect and treat deteriorating patients is an increasing concern in the health service. I was quoted at the launch as saying that increasing reliance on technology in observations may be “stopping or reducing” nurses’ ability to use their intuitive skills (Nursing Times, 2010). The article quoted me as saying: “Some of the technology can be overwhelming and can stop nurses from really seeing the patient.”  

I believe that over reliance on technology may restrict nurses’ ability to develop the refined skills of intuition. How many of us can reflect back on an experience with a patient, when instinct has told us that something was wrong even though the patient’s observations were satisfactory? Even though instinct has often proved right it can be difficult to describe what it was that stood out, since nurses’ intuition develops through years of working, listening and observing patients.

So is there a threat that advancing technology on our wards will erode the art of nursing? I do not believe this is necessarily the case. However, there is a risk of it happening if we do not see technology as playing only a part in patients’ care. If we allow technology to dominate then our care becomes mechanical.

Fortunately, the days when nurses would wander round the ward looking for a sphygmomanometer that worked or an available stethoscope are behind us. How many times would you see a patient with a thermometer half hanging out of their mouth or lost in their bed when it fell from under their arm? How did you really accurately record a rapid, thready, irregular pulse? We must all accept that this was not the most effective way to record an accurate set of observations, and we should be grateful that technology has enabled us to move on from this and provide better quality patient monitoring. On the other hand, we did take time to sit down with patients, hold their hand to take their pulse, and take time to talk to them, look at them and ask how they were really feeling. In this way nurses gained more then just a set of observations, as this kind of interaction helped them to form a rich picture of how patients were feeling.

For most of us now the traditional ways of recording observations have been replaced with new methods such as devices that automatically record temperature, pulse, blood pressure and oxygen saturation levels. These devices are wheeled up to a patient’s bed, where the nurse stands attaches the cuff and finger probe, watches the screen and records the observations, and then moves on to the next patient. While this may be satisfactory for gaining the relevant readings, how much interaction is happening between patient and nurse? Without this interaction, it is impossible for nurses to create a holistic picture of the patient – it is not the machine that will develop nurses’ intuitive skills but patients and nurses working together.

While technology has a vital part to play in patient care and observations, we must remember that so do patients themselves.

EILEEN SILLS is chief nurse, Guy’s and St Thomas’ Foundation Trust, London.


Readers' comments (6)

  • I remember an incident when I was doing my training in the mid 90's, a patient collapsed. As the student, I was ordered to get a BP machine and check the patients BP. The correct BP cuff was duly applied to the patient and a very low reading was promptly displayed. On checking the BP manually the BP was normal; there was a huge difference between the 2 readings. It went to show that we cannot always rely on these machines and must always use our own clinical judgement, something I always remember. As mentioned in the article, too much dependence is placed on these machines and these are replacing traditional hands on assessments of our patients. What would some nurses do if they didn't have these machines to depend on?

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  • I feel that people are viewing this wrongly, the technology and machinery is there to provide additional information about a patient alongside observation. As the article highlights observations on their own do not enhance patient care, but then again neither does just using the machines. Patient care will only be enhanced when the two are combined.

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  • Memories of people panicking over technology in ITU while the patient was happily drinking a cup of tea - very much alive and well!

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  • My husband just had cardiac cath. He was up in the chair and I saw his eyes 'go fuzzy.' Seconds later, we had him Trendelenberg and the new bp reading was quite low. In retrospect, the Q15 minute readings were indicating he was dropping ever so slightly - wish I'd asked his nurse about those rather than waiting for him to turn white and already be in distress.

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  • I remember how difficult it was to find a radial pulse sometimes as a beginning student! I soon got the hang of it with 4 hourly obs daily on a medical ward of 30 patients! However, I often wonder how easy it would be to confidently find a pulse if someone collapsed in the street without having that experience of manual pulse monitoring if you are used to relying on a machine?

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  • “Intuition is like a slow motion machine that captures data instantaneously and hits you like a ton of bricks. Intuition is a knowing, a sensing that is beyond the conscious understanding — a gut feeling.” Abella Arthur
    I like this quotation. Intuition as a slow machine, what a paradox!

    If the systematic and excessive use of machines may alter our judgment and lead to nursing malpractice, the real problem is not the interaction between machines and humans, but the fact that our workload exceeds our human capacities.
    We need technology; we also need to control and use it as a way of liberation toward quality of care.
    The ‘look-touch-feel-listen’ skills remain the primary communication in nursing observation and examination. Human interactions are irreplaceable. Hence, patient safety and quality of care are only possible if the resources are adequate, appropriate and sufficient, as to allow health professionals deliver the best possible care.
    Abel Sidhoum(RN)

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