From anxiety to creativity

9 MINUTE READ

From Luke’s Journal 2022 | Technology | Vol.27 No.2

Introduction

The moon was setting on Easter morning as the sun was rising. The earth’s shadow was visible in the light of the dawn. Technology was not needed to embrace this scene. Turn 180 degrees, and four planets were observable with the naked eye.  As the sun peeked from behind the hills, the glow of radiance was reflected off the gliding blades of the windmills perched proudly on the horizon. The sun had risen – no technology required.

The Bible has a lot to say about God’s gift of tools with which we can work.  He created us with abilities comprising music, art and design – this includes the development of technology, which in turn is a part of His own creation. It has enabled us to reach many more hundreds, thousands and millions of people with The Word. God commanded our ancestors to exercise dominion over the creation (Genesis 1:28), therefore it is our place to exercise dominion over computers.  For His glory we are to use our intelligence and the technological advances that derive from it, with discernment.

Technology in a nursing context

There is an ethical expectation that all nurses and other healthcare workers meet  their  professional standards with the appropriate use of technology. However, within the context of patient care, in which screens and devices are used so widely, this technology may interfere with the building of trust through digital relationships and create anxiety.^1-4

Social media is another technology that has led to the downfall of some nurses in Australia through incorrect use⁵.  However, if used wisely  it can lead to relationship building instead of destruction.  Meeting a Bruderhof Twitter user introduced me to this wise community (near Inverell, NSW) that makes full use of technology with a measured approach; wherein they leave all digital technology at the work site, enabling them to spend their free time serving, sharing and relationship building.  As John Rhodes⁶ says (p.243) “It’s vital to become technology’s master and not its slave”.  He goes on to say that, “If a form of technology is proving deleterious to your relationships with others, you have to have the guts to drop it. Don’t be afraid to walk away.”

We can apply this principle to nurses and other healthcare personnel who, if they work with all the faculties of their being,  can work well with each other.  I reflect back on the time of my new-grad year (2006): On a busy morning shift I found myself being reported for “spending too much time with the patients” and not enough time looking up and reading notes, blood results and other  tasks that kept me away from the bedside. Although I was spending time listening to the patients’  concerns and feelings (observing their position and movement in bed  to better assess their source and level of pain), I quickly learnt that I needed to hone my  time management skills to accomplish both tasks – the bedside care AND digital documentation –  with competency.

Digital advancements and nurses’ anxiety

In 2005, Eley et al¹  conducted a national survey on the status of training and education in information and computer technology of Australian nurses.  In2007, the Australian Nursing and Midwifery Federation Australia² produced a 127-page report  on the use of technology in nursing.   Over recent decades it has become evident that  digital advancements in nursing (and now the COVID-19 pandemic) have seen the escalation of the use of information technology (IT) in hospitals and aged care facilities all over the world.  Much of this progress is needs-based, but new trends, such as the use of artificial intelligence (AI) and predictive analytics in nursing, are emerging.^3,4

But what if nurses are no longer able to keep up with, or are non-accepting of, technology – especially in healthcare settings where paperless bedside care and consultations are the norm, and nearly all documentation is digital?  Although nurses have been cited as using technology to enhance patient-centred care (learning so much more about the patient from the immediate feedback that technology allows), many fear that computers will dehumanise patient care.^1,3  This was evident at a demonstration in Taiwan (2^nd Asian Conference on Nurse Education, 2016) of a Japanese prototype robotic nurse who could deliver medications to a bed-bound patient.  That same robot was programmed to tilt/turn the patient’s bed every two hours for pressure area care.  The robot was, however, non-verbal. This begs the following questions: Was the patient receiving care despite the lack of communication?  What was their quality of life? 

Back then, I had something to say about removing ‘care’ from our Australian Nursing Standards for Practice⁷ and what that meant for hospital-trained nurses like myself. Had ‘care’ become a ‘four-letter word’?  Growing up in Sydney and attending St Luke’s Hospital Nursing Training School in the 1960s, no one dared to use vocabulary designated as ‘four-letter words’. These were considered vulgar, forbidden and certainly not heard on streets, television or radio as they are today. Has ‘care’ become a ‘four-letter word’ in modern-day health services? Currently, a nurse draws up a nursing ‘plan of practice’, no longer a nursing ‘care plan’, which (more often than not) is now a digital document.

“Currently, a nurse draws up a nursing ‘plan of practice’, no longer a nursing ‘care plan’, which (more often than not) is now a digital document.”

Gough et al⁸ (2014) studied the many interconnections between new technologies, nurses’ professionalism and practice as well as upskilling and adaptive processes contributing to patient care.  It is important that nurses are involved in system design, which will then improve post-implementation satisfaction and thus create a positive, supportive atmosphere which is instrumental to sustainability.^1-4

More recently, researchers at the University of Lausanne have demonstrated that nurses and midwives are being subjected to waves of pressure to perform and practise well, albeit with signs and symptoms of “psychological distress: insomnia, alcohol and/or drug misuse and symptoms of post-traumatic stress disorder (PTSD) such as feelings of anxiety, depression, burnout and even anger.”⁹ This, in part, is due to nursing through a pandemic, something very few nurses have been trained to do.  We have had to rely on technology for so many aspects of care, along with meetings, training and patient communication.

Nurses have also had to forfeit breaks due to pressure to practice under more demanding conditions such as mask fit-testing and donning and doffing personal protective equipment (PPE).

The SafeWork Code of Practice¹⁰ has been developed by a working group that included the NSW Nurses and Midwives Association. It outlines the need for nurse and practice managers to provide adequate breaks for their workers.  There is a growing  concern that nurses are subjected to even further harm from nursing in COVID-driven technological times.  The revised International Council of Nurses (ICN) Code of Ethics¹¹ (2021) has responded with a call to protect nurses from psychosocial hazards which include moral distress.  The long shifts and heavy workloads have been undermining the previous ICN Code of Ethics¹² (2012) [See insert-[2]].

People’s fears need to be listened to, addressed and ameliorated before they cause harm, especially as nurses, midwives and other healthcare workers become distressed at not being equipped to provide adequate care for those they support.  Value placed on nurses’ and midwives’ ethical stances can help direct their moral compass, supported by staff through pre- or post-shift briefings on how they are managing and feeling, along with any changes that can be made to improve their situation.

Spiritual well-being is another concept to be considered when dealing with stress related to a variety of issues, including the appropriate use of technology in the care of patients.^13,14  Nurses’ Christian  Fellowship Australia have responded to this need with the development of a new face-to-face course that invites all colleagues to share their real-world experiences  in a safe forum – Spiritual Care for Australian Nurses (SCAN),¹⁵ endorsed by the Australian College of Nursing in 2021.  The discussions that ensue could contribute to shaping what politicians and public servants understand and then use to write legislation and supporting documentation, eg, Worksafe Australia Code of Practice.  These are all steps in the right direction.

RESET

The question to address now is how Australian nurses can adjust and reset their hearts and minds to form an understanding of the governance of  mobile technology use for continuing professional development in our nursing  contexts¹⁶. We can learn from  Agnew⁴, who brings to our attention the work of the British National Health Service (NHS) which recommends getting the basics right by explaining that “nurses will not embrace digital technology if they are struggling with outdated hardware and poor connectivity. Inadequate technology drives nurses back to using paper and duplicates work.” (Queen’s Nursing Institute [QNI], 2018; Clever Together, 2018, from Agnew)

Patients should also be involved in technological innovations and be part of risk assessment initiatives to ensure new services, such as video consultations, are suitable for them.  Nurses may resist new ways of working if they suspect patients are unhappy, or there are adverse consequences. (QNI, 2018)

As Mather et al¹⁴ (2019) stated, where feasible, new technologies for continuing professional development will enable staff to find more time to care  with a person-centred model, thus enhancing therapeutic relationships  with patients instead of creating barriers. `This could be achieved by appointing nurse leaders, such as chief nursing information officers, and digital champions who can work collaboratively with system developers and speak the same language as those of their nursing colleagues who may be less confident in the digital world (QNI, 2018).

Reasonable rest from digital screens leads to the
Expectation that nurses and other healthcare professionals can meet their
Standards for practice and provide for
excellent patient care and
Therapeutic relationships that build Trust

Conclusion

It was not until I spent Easter with a Bruderhof community that I was able to finish this article. There, resting with the Risen Lord, I was reading from “Another Life is Possible”⁶  that “any use of technology that undermines the richness of human relationships must be presumed suspect, especially if it encourages passivity rather than creativity.” (p.242).  That is why the use of social media is minimised in Bruderhof communities. Thankfully, I was able to reset my head, heart and spirit in one such community, and accept retirement as a new phase in my life – full of hope and with a desire to revive my creative skills.

Two of the nurses there have turned to producing graphic design. One of those explained how God led her away from nursing (where she was hands-on in the local hospital and nursing home communities) to redevelop her talents through technology. I found it ironic that I was able to reconcile ceasing my nursing work in an environment that saw me spending time with minimal use of technology. I felt free and able to build relationships by sharing meals and stories together with words and presence.  

We have been blessed in these COVID times to be able to use digital technology for prayer and fellowship, but we know God has the ultimate code for life, that is love and His Word.

Click for anecdotes from Georgie’s nursing experience. Technology: Changes & Challenges

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References

1. Eley, R et al The status of training and education in information and computer technology of Australian nurses: A national survey (2008) https//eprints.usq.edu.au/3633/1/Eley_Fallon_soar_Builstra_Hegney_AV.pdf. accessed 19 May 2022
2.  Australian Nursing and Midwifery Council Australia Nursing and Technology: Report, p1-127 (2007) https://anmf.org.au/documents/reports/it-project.pdf accessed 22 May 2022
3. Huryk, LA (2010) Factors influencing nurses’ attitudes towards healthcare information technology. J Nursing Management. https://doi.org/10/.1111/j.1365-2834.2010.01084.x accessed 9 March 2022
4. Agnew, T. Digital engagement in nursing: the benefits and barriers. Nursing Times, 118:2 Online February 2022
5. Bickhoff, L . Smart nurses thoughtless posts on social media. (2018) ANM J 22(4):31
6. Rhodes, J.  A CEO with a unique set of challenges and opportunities – and no paycheck (2020) Another Life Is Possible: Insights from 100 Years of Life Together. Stober, C (Author) . Plough Publishers, New York.
7. Hoddle, G & Macaulay, G: Competency: What’s in a word?  Personal presentation at the 2^nd Asian Conference on Nursing Education, 2016, Tainan, Taiwan.
8. Gough, R, Ballardie, R & Brewer, P (2014) New technology and nurses. Labour and Industry https://doi.org/10.1080/10301763.2013.877118 accessed 9 March 2022
9. University of Lausanne, BMC Public Health, Aug.2020
10. SafeWork Australia: Code of Practice: Managing psychosocial hazards as work (2021) https://www.safework.nsw.gov.au/resource-library/list-of-all-codes-of-practice/code-of-practice/managing-psychosocial-hawards-at-work accessed 30 October 2021
11. International Council of Nurses Code of Ethics (2021) https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf   Accessed 30 October 2021
12. International Council of Nurses Code of Ethics (2012, retired) Geneva.  Accessed 30 October 2021

ICN Code of Ethics (2012, retired) – Glossary: Personal health: Mental, physical, social and spiritual wellbeing of the nurse.

Footnote: DISSEMINATION of the ICN Code of Ethics for Nurses (2021)
To be effective the ICN Code of Ethics for Nurses must be familiar to nurses. We encourage its dissemination to schools of nursing, nurses in their workplace, the nursing press and other mass media. The Code should also be disseminated to other health professions, the general public, consumer and policy-making groups, human rights organisations and employers of nurses. National Nursing Associations are encouraged to adopt this Code, translating it into local language(s), or use it as a framework to support their own codes of nursing ethics.

13. Soleimani Sharif, SP, Yaghoobzadeh, A, Sheikhi, MR,  Panarello, B, Win, MTM  Spiritual well-being and moral distress among Iranian nurses. Nursing Ethics, 1-13 2016
14. Mather, CA, Gale, F, & Cummings, EA . Governing mobile technology use for continuing professional development in the Australian nursing profession. BMC Nursing 16 (2017) https://cbmcnurs.biomedcentrals
15. Spiritual Care of Australian Nurses information can be accessed at https://lukesjournalcmdfa.com/scan
16. Australian College of Nursing. Position Statement on Person-Centred Care.