1. Nolan, Judy RN


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When I graduated from nursing school, I was given a pen, a stethoscope, tape, and scissors. In my current practice as a pediatric nurse in acute care, I've found that it's all too easy to let technology with all its conveniences and safety measures take center stage. I have a bedside computer, cell phone, and cardiac monitor, among many other technical tools.


Yet the importance of creating a therapeutic milieu for patients and families has remained unchanged. Now the challenge I have is how best to use technology as a prop and a backdrop and not as the main event, how to prevent data collection from creating a barrier between me and my patient.


Of course, technology has many advantages. In the past, I had to spend long stretches of time away from the bedside, creating written medications sheets and care plans. I remember spending hours looking up each medication dose and side effects in reference books. Transcribing written doctor's orders and medication information was an art form. Now we obtain the most current doctor's order and medication information in seconds with a click of a button.


Making technology an asset, not an obstacle. While these conveniences have given me more time to teach, answer questions, and involve patients and family members in their plan of care, my experience as a family member of a hospitalized patient suggests that it is all too easy for nurses to walk into a room like a robot with a computer front and center. The challenge is to make technology an asset to my nursing practice, to not "turn my back on my audience."


If I now bring a computer along with my stethoscope, tape, and scissors, I also bring a sense of humor. A touch of comedy can distract patients from too much awareness of my nonhuman coworker. For example, when I walk into a patient room, I introduce myself, log on the computer, grab the medication scanner, and make a comment like, "I'm just checking to see if you have earned any coupons." This breaks the ice and turns an impersonal transaction into a familiar friendly exchange.


From 'charting by exception' to real-time documentation. In the 1980s, we were taught to chart by exception and document only changes or abnormal findings. Our assessment was documented with a few checks and notes on the back of a flow sheet. This type of charting was quick, but it often took place at the end of a shift. In 2005, central monitoring was introduced. Each patient's room was equipped with a bedside monitor and a computer on wheels.


Now documentation happens in real time. Vital signs and assessments can be completed and charted with a click of a button. Any member of the health care team can obtain the most current information from anywhere in the hospital at any time. We log on and off the computer in minutes.


But this convenience can create a barrier between us and our patients. It's difficult to maintain eye contact while we constantly feed the computer information. That bright electronic screen shouldn't be more compelling than the human face. I've learned to place the computer to one side, enabling me to use open body language and to maintain eye contact at the same time.


Forgetting more direct modes of assessment. Most patients have an order for continuous cardiac and oxygen saturation monitoring these days. We adorn our patients with electrode wires, oxygen saturation probes, and bar-coded identification bands. I used to walk into a room and immediately make eye contact with my patient or a family member. With just a quick glance I could assess the child's general appearance, skin color, and respiratory effort.


Now, I find myself walking into a patient room consciously reminding myself to look at the patient first, the monitor second. Like many nurses, I find my eyes drawn to that bright screen and colorful tracings. I must keep reminding myself that monitors and other equipment are tools I use to enhance my head-to-toe assessment, not replace it. I keep sharing with my younger coworkers that before central monitoring we were fully dependent upon our nursing assessment skills.


As I stand at the bedside, with distracting alarms ringing in the background, it would be easy for me to allow my patient to be upstaged by all the sounds and bright lights. I try not to forget that the patient is the real star. Recently, I received a compliment from my patient's grandmother, an experienced nurse. She said she had just been hospitalized for major surgery and the technology around her had made her feel disconnected and isolated. She wanted me to know that although her grandchild's bedside was surrounded by just as much equipment, she did not feel the same sense of disconnection. She praised me and my colleagues for our "human touch."


When I reflected back on her comments, I realized that I had learned my lessons well. I didn't turn my back. My patient had remained the main event. I was merely playing a supporting role in the production of promoting my patients' best outcomes.