A Place for Everything and Everything in Its Place- Technology and Nursing in the 21st Century

Jo Ann Walton, Professor of Nursing, Faculty of Health Studies, Auckland University of Technology, opened by drawing attention to the variety of kinds of information in which those in the health sector are interested and to the need to be mindful of both the message itself and its mode of delivery if the best possible patient care is to be achieved within the New Zealand health system.

She proposed that technology presents, represents, or in post-modern terms (re)presents, both crisis and opportunity. It signifies advancement and it signals both terror and hope, the latter based on an idea from Robert Romanyshyn, an American academic, who also said "Technology is awe-ful. And what is awe-ful, what fills us with awe, invites us to wonder and dream" ^{[ 1 ]}.

Technology offers, and indeed has delivered, speed of communication and a vast increase in knowledge and human skills. Through technological advances in health care humankind is learning to overcome many human frailties and problems, to understand fundamental facts about life and how to sustain, preserve and replicate it. In doing so, some people fear we risk abandoning nature, or attempting so successfully to overcome its forces that we sometimes act as if we might overcome the natural order of life and death altogether.

There is also a sense that technology has brought us close to what some believe are the limits of human skills. While inability to programme a video recorder may be a standard joke, the inability of a nurse to read a cardiac monitor is not so.

In addition, some people are in information overload. There is just too much information to keep up with.

There can also be a problem with undersupply of technology. It is not uncommon for nurses to be required to, or to want to, use computer-based systems, yet have a ridiculously long wait for access. Walton cited the example of a British nurse having to share a computer in her community-based practice with 30 colleagues.

Walton noted that equipment is necessary to the art of nursing but those involved need to know how to use it and it does not work by itself.

With respect to the place of technology in nursing, Walton acknowledged its role in education, research, communication and patient care but noted that technology advancement brings both excitement and fear.

She briefly presented the history of technology and nursing, reviewing the numerous technologies that are commonplace in today’s nursing environment.

Referring to nursing in the digital age, Walton noted features identified by Richards ^{[ 2 ]} including nurses from the Internet generation who willingly use electronic technology, collaborative practice that links geographically distant groups and the use of digital resources.

There is a concern that technical change may result in de-skilling. Some people are resigned to, rather than enthusiastic about, change. There is a fear that nursing may be replaced by technology. Many concerns are more about change than they are about technology.

Walton went on to discuss the danger in losing the distinction between the real world and the "pseudo-world". She noted that a view of the world has developed with the body as machine and others as spectators viewing the body from without. However, all experiences are "experienced by the lived body". A mechanistic description does little to capture the experience of illness. There is a need for more than technical help for illness; there is a need for care along with the cure. There is a problem with the view of the body as a "thing", to be fixed in parts.

The perception of the body is historically and culturally defined. The view of body as machine derives from the anatomised corpse, the view of heart as pump and of movement as depending to a large extent on reflex.

The medical view of the body depends on objectification, seeing the body as specimen and "the distant gaze". It has been useful but is only one view and has its own difficulties.

Walton put forward the possibilities of the nurse as cyborg or the patient as cyborg, the latter where the machine becomes part of the patient not the nurse. In either case, the nurse must be translator and mediator, explaining technology’s meaning and function.

Walton reviewed the required attitude that she referred to as the "listening gaze", an approach brought to the modern day through the practice of nursing. Technological and caring interventions are both equally essential to patient well-being. She concluded by highlighting the need to embrace change and the challenges of technology.
[View Jo Ann Walton’s presentation A Place for Everything and Everything in Its Place: Technology and Nursing in the 21st Century]

Footnote
1. Romanyshyn RD. Technology as symptom and dream. London: Routledge; 1989. p1-2.
2. Richards JA. Nursing in a digital age. Nursing Economics 2001; 19 (1):6