PATIENT CARE TECHNOLOGY: WHERE THE PATIENT MEETS THE NURSE BELINDA M. TOOLE, PHD, RN, CCRN, CCNS SHARP MEMORIAL HOSPITAL JULY 30, 2017

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1 PATIENT CARE TECHNOLOGY: WHERE THE PATIENT MEETS THE NURSE BELINDA M. TOOLE, PHD, RN, CCRN, CCNS SHARP MEMORIAL HOSPITAL JULY 30, 2017

2 DISCLOSURE AND LEARNING OBJECTIVES Disclosure The author has no conflict of interest to declare. Learner Objectives The learner will be able to describe how perceptions of caring and nurse presence vary by patient demographics. The learner will be able to discuss how technological device use connotes a sense of safety, learning, and balance for the nurse and patient. Acknowledgements Sharp HealthCare for their presentation support and University of San Diego for their research support.

3 BACKGROUND & SIGNIFICANCE Nursing s historical focus Holistic, humanistic relationship Current state: Explosion of technological device use More connected to devices than each other (Rosen, 2012; Turkle, 2011) Technological imperative (Weitz, 2013, p. 252) Care delivery focus: patientcentered care (Kitson, Marshall, Bassett & Zeitz, 2013) Challenge: Integration of technology into care delivery process Allure and presence (Barnard & Sandelowski, 2001) Paradoxical view: Safety and reassurance vs dependency and distraction (Kongsuwan & Locsin, 2011; Locsin & Kongsuwan, 2013; Price, 2013; Stayt, Seers, & Tutton, 2015; Tunlind, Granström, & Engström, 2015)

4 STUDY PURPOSE Explore how patient care technology influences the interpersonal relationship between the patient and the nurse during care delivery in the acute care setting.

5 CONCEPTUAL MODEL STUDY VARIABLES Locsin * Technological Competency as Caring Technological Competency Caring Swanson ** The Structure of Caring Kostovich *** Model of Nursing Presence Presence *Locsin (2005) Technological Competency as Caring in Nursing; **Swanson (1993) The Structure of Caring; ***Kostovich (2012) Model of Nursing Presence

6 RESEARCH AIMS To quantitatively describe the levels of nurse technological competency as caring, patient perceptions of caring, and patient perceptions of nurse presence. To examine the relationships among demographic variables and study variables. To qualitatively explore the perceptions of the nurse and patient of technological device use in care delivery.

7 METHODOLOGY Research Design Mixed methods Setting Sample Quantitative convenience sample 112 nurses 115 patients Qualitative purposive sample 23 nurses 15 patients

8 INSTRUMENTS Variable Instrument Description Reliability Technological Competency as Caring Caring Presence Technological Competency as Caring in Nursing (TCCNI) 1 Caring Behaviors Inventory (CBI - 24) 2 Presence of Nursing Scale (PONS) 3 25 items 0-100mm dichotomous visual analogue scale 24 items 6 point Likert scale 4 subscales 25 items 5 point Likert scale α =.081 α =.096 α = Locsin, 1999; Parcells & Locsin, 2011; 2 Wu, Larrabee, & Putman, 2006; 3 Kostovich, 2012

9 INTERVIEWS

10 DATA ANALYSIS Quantitative SPSS, Version 22 Qualitative Thematic coding

11 NURSE: DEMOGRAPHICS & QUANTITATIVE RESULTS Demographic Variable n=112 (%) Age in years Gender Race Highest Nursing Degree Years of Nursing Experience Mean Median SD Female Male White Asian Two or more Races Black/African American Native Hawaiian/Pacific Islander Other Associate Degree Bachelor s Degree Master s Degree Mean Median SD (83.9) 18 (16.1) 63 (56.3) 33 (29.5) 4 (3.6) 4 (3.6) 3 (2.7) 5 (4.5) 17 (15.3) 89 (80.2) 5 (4.5) Nurses rated their technological competency as caring as high M = 82.72, SD = 7.56 Race: ANOVA indicated significant differences among groups F [2,109] = 6.600, p =.004 Post hoc: scores higher in the Asian group relative to the white group, p =.002 Asian: M = 86.04, SD = 5.41 White: M = 80.57, SD = 7.84

12 PATIENT: DEMOGRAPHICS & QUANTITATIVE RESULTS Demographic Variable n=87 (%) Age in years Gender Race Education Admission Reason Length of Stay (days) Mean Median SD Female Male White Asian Two or more Races Black/African American Native Hawaiian/Pacific Islander American Indian/Native Alaskan Other High School or Less College Post Graduate Medical Surgical Mean Median SD (46.0) 47 (54.0) 58 (66.7) 5 (5.7) 2 (2.3) 9 (10.3) 1 (1.1) 2 (2.3) 10 (11.5) 30 (34.5) 41 (47.1) 16 (18.4) 48 (55.2) 39 (44.8) Patients rated overall caring behaviors high, between almost always to always: M = 5.44, SD =.58 Subscales: Highest: Professional knowledge and skill Lowest: Positive connectedness Patient perceptions of nurse presence were high, scoring these behaviors as occurring frequently to always: M = , SD = 10.55

13 PATIENT: DEMOGRAPHICS & QUANTITATIVE RESULTS (CON T) Demographic Variable n=87 (%) Age in years Gender Experiencing Pain If yes, current pain level Mean Median SD Female Male Yes No Mean Median SD (46.0) 47 (54.0) 34 (39.1) 53 (60.9) Presence: Age: r s (85) =.280, p =.006 Caring: Gender: Male patients rated overall caring higher than females M = 5.56 (SD =.47) vs M = 5.29 (SD =.66), p =.040 Pain: Patients in pain rated positive connectedness lower than those not in pain M = 4.94 (SD =.92) vs M = 5.30 (SD =.74), p =.047

14 QUALITATIVE RESULTS Patient: Safety net Devices care efficiencies easier faster Connected to device Safety Balance Learning Nurse: Safety net Devices malfunctioning troubleshooting learning Utilized device

15 STUDY IMPLICATIONS Nursing Education Need for relevant training and support in live setting Teaching integration of caring and presence attributes with technology in academic setting Nursing Practice Pain relief positive connectedness Noise Inherent in operating system Timely response to alarms alarm fatigue alarm burden patient response/intercession with alarm

16 LIMITATION AND STRENGTHS Limitations Single site Convenience sampling Self selection for qualitative interviews Non-response bias? Strengths Mixed methods Comparison of two constructs from patient perspective

17 CONCLUSIONS Attributes of technological competency as caring, caring, and nurse presence rated high Demographic factors influenced scores Race Gender, age, pain Safety, learning, and balance were qualitative themes

18 The increasing use of technology in healthcare imbues an interaction with a presence. That presence can be perceived as positive or negative; what is key is how the technology is explained, operationalized, and integrated into patient care. Technologies, in every generation, present opportunities to reflect on our values and direction. Turkle (2011, p. 19)

19 REFERENCES Barnard, A., & Sandelowski, M. (2001). Technology and humane nursing care: (ir) reconcilable or invented difference? Journal of Advanced Nursing 34(3), doi: /j x Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient-centered care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing, 69(1), doi: /j x Kongsuwan, W., & Locsin, R. C. (2011). Thai nurses' experience of caring for persons with life-sustaining technologies in intensive care settings: a phenomenological study. Intensive and Critical Care Nursing, 27(2), doi: /j.iccn Kostovich, C. T. (2012). Development and psychometric assessment of the presence of nursing scale. Nursing Science Quarterly, 25(2), doi: / Locsin, R. C. (2005). Technological competency as caring in nursing: A model for practice. Indianapolis, IN: Sigma Theta Tau International. Locsin, R. C., & Kongsuwan, W. (2013). Lived experience of patients being cared for in ICUs in Southern Thailand. Nursing In Critical Care, 18(4), doi: /nicc Papastavrou, E., Efstathiou, G., Tsangari, H., Suhonen, R., Leino-Kilpi, H., Patiraki, E.,... Merkouris, A. (2012). Patients and nurses perceptions of respect and human presence through caring behaviours: A comparative study. Nursing Ethics, 19(3), doi: / Parcells, D. A., & Locsin, R. (2011). Development and psychometric testing of the Technological Competency as Caring in Nursing Instrument. International Journal For Human Caring, 15(4), 8-13.

20 REFERENCES Patiraki, E., Karlou, C., Efstathiou, G., Tsangari, H., Merkouris, A., Jarosova, D., Papastavrou, E. (2014). The relationship between surgical patients and nurses characteristics with their perceptions of caring behaviors: A European survey. Clinical Nursing Research, 23(2), doi: / Price, A. M. (2013). Caring and technology in an intensive care unit: an ethnographic study. Nursing in Critical Care, 18(6), doi: /nicc Rosen, L. (2012). idisorder. New York: Palgrave Macmillan. Sossong, A., & Poirier, P. (2013). Patient and Nurse Perceptions of Caring in Rural United States. International Journal for Human Caring, 17(1), Stayt, L. C., Seers, K., & Tutton, E. (2015). Patients' experiences of technology and care in adult intensive care. Journal of Advanced Nursing, 71(9), doi: /jan Swanson, K. M. (1993). Nursing as informed caring for the well-being of others. Image: Journal of Nursing Scholarship, 25(4), Toole, B. M. (2014). Patient Care Technology and the Nurse-Patient Relationship. (Doctoral Dissertation). Retrieved from ProQuest Dissertations and Theses database ( ). Tunlind, A., Granström, J., & Engström, Å. (2015). Nursing care in a high-technological environment: Experiences of critical care nurses. Intensive & Critical Care Nursing, 31(2), doi: /j.iccn Turkle, S. (2011). Alone together: Why we expect more from technology and less from each other. New York: Basic Books.

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