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.
Nursing Times (2010) The week in nursing. Lean less on technology. Nursing Times; 106: 3, 4.