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Nursing; knobs; and know-how: The impact of hospital automation
ht. 1. A’UU. ~lU,f. vol. 2, pp. 145-148, Per~man
plar8,196S.
Printed ia Great Britain
Nursing; Knobs; and Know-How:* The Impact of Hospital Automation ALEX RICHMAN,
M.D., M.P.H
Associate Professor, Dep. of P&&y, Head, Section qf Social Psych&v, Unixersi~ of British Columbia, Canada
IN recent years major medical
advances have drastically altered the nature and role of hospital care. These changes have also affected nursing. Even more drastic changes are envisaged for hospital care of the near future. The purpose of this article is to outline the import of some aspects of automation for nursing education today. Nursing has undergone many transitions in its historical tri-partite evolution from religion, war, and science.(‘) The development of automation and decisionmaking mechanisms portends new areas of nursing functions and responsibilities and concomitant needs for new patterns of adaptation. Nursing education today has many problems in the discrepancies between student expectations and experiences ; studentship and apprenticeship ; servant, technician, and healer ; individual These discrepancies care and team performance ; training and responsibilities. are beyond the scope of this article ; however, it is hoped to highlight the increasing significance of the machine in hospital care and some aspects of the nurse-machinepatient relationship. In the popular press, headlines of “Electronic Nurse Watches Patients” precede descriptions of existing electronic systems which simultaneously measure temperature, pulse and respiration rates, and blood pressure of several hospital patients, and sound warnings if any function goes outside of the limits desired by the physician. “It is not too fantastic to imagine the day when hospitalization and medical care may well he provided within the hospital to patients some of which are in a state of suspended animation. fa)
To regard
these devices as remote
and unpractical
is unrealistic
“ . . . the modern hospital cannot continue in an isolated world of its own following procedures used for the last quarter century.“(*) It is difficult to educate nurses for the patterns of nursing care which exist today, and preparation for the possible forms of care which will develop in the future is * Canada’s Mental Health, Vol. XII, No. 6, 1-4 (1964). 145
ALEX RICHMAN
146
Although the nature of the devices in hospital-use 10 yr from even more complex. now is not reliably known today, it is necessary to provide for the future adaptation of the nurse to such devices. Fifty years ago the nature and requirements of nursing were described as: “Many candidates approach the calling with a very imperfect appreciation of its exacting character. The work is not easy or to be taken up lightly. It demands physical strength, sound health, scrupulous cleanliness, good temper, self-control, intelligence and a strong sense of duty. It embraces many duties-some of them menial and disagreeable-beside the purely medical and surgical functions.“(i)
More recently, diffuse :
the definition
of nursing
has become
even more diverse and
“In reply to the question, “What is nursing?“, 27 different definitions were reported and as many statements of beliefs about nursing. In general, however, it seemed to break down into five or so areas . . . personal service; the administration of physical comfort, as well as social and spiritual; the requirement of nursing that one assess, decide and take action; concern over levels of health; and finally, the experience of se&resurrcction of the nurse herself as she performs her task.” ts)
Along with increasing specialization, shortages in personnel, problems in training, it has become progressively difficult for the nurse to provide bedside nursing care. “The mass service being given today cannot include personal service and lacks continuity. Progressive patient care was not thought to be conducive to the mental health of the patient, where the ambulatory case is placed under a registered nursing assistant.“(s) “Admonishment by ourselves and others to give comprehensive care to the patient as a whole, admirable though it might be, provides us with no patterns of procedure, no way, even to check on ourselves.“(4)
Nursing education difficulties :
itself, has major
difficulties
in adapting
to these current
“The result has been the superficial presentation of subject matter through a multiplicity of courses that often bear little relation to what the student is doing in the wards.“(s) “What point is there in delegating much or most of the humane art of nursing to scantily trained nursing assistants and then giving nurSes a basic course in the psychology of patients whom it seems they will not nurse, only annotate?“(@) ,. “The present educational structure for the training of nurses lacks system, order, and coherence . . . The situation is aggravated further by the fact that almost all kinds of nurses must carry responsibilities for which they are not adequately prepared.“(‘)
To an increasing degree attempts are being made to “train” nurses in various aspects of the nurse-patient relationship through exposure to some of the behavioural sciences. The nature of this relationship has changed considerably with the development of newer methods and patterns of care. It is inevitable that nursing of the future Will have to deal with the problems associated with the interposition of automatic mechanisms in the nurse-patient relationship. This will inevitably increase the existing problems and produce new difficulties until suitable adaptations are made (more in nursing rather than in the machinery). The usual problems involved in the introduction of machinery and the relinquishment of some of the human’s functions will occur. Although the recurrence of the Luddite riots of 181 I-1816 is unlikely, other forms of conflict may ensue.
NLJRSIJ?G; KNOBS; AND KNOW-HOW:
IMPACT
OF HOSPITAL AUTOMATION
147
‘6 . . . A nurse may continually check on the monitoring system, never really trusting it. trying to outdo it, and ending up in confusion. In some instances, nurses actually have become concerned about the future of their jobs, fearing that these instruments would do away with the necessity for the nurse.“(s)
Another major problem lies in the attitudes and expectations of nursing students. Among current students there are major discrepancies between attitudes and achievement. L‘. . . Those students who had the highest attitude scores i.e., who liked nursing best, also had the lowest achievement scores, i.e., were rated as being the poorest in practical aspects of nursing; conversely, those students who disliked nursing most were rated as being best in practical aspects of nursing.“(s)
The introduction of automatic devices will produce even greater discrepancies for students with stereotypes of nursing care based on the present, let alone the past. It is also quite likely that the types of skills and abilities involved in effective utilization and collaboration with such devices are quite different from those usually imputed to nurses. As described in an Ontario survey: “There was also the belief that the nurse finds it difficult to amalgamate and to act concertedly with others because of the intensely personal nature of her vocation.“(s)
On the other hand some of the difficulties attributed to insufficient, poorly motivated or poorly trained personnel may be reduced by the assumption of suitable types of “routine” and “specialized” care, supervision, and decision making by machinery. This reduction of function, would rather increase the responsibility of the human, but must be supplemented by appropriate training. “ . . . Although automatic methods may reduce the immediate part played by human operators, they leave human beings in certain key positions in which the mental load upon them may be heavy and the effects of their actions far-reaching. The human link in the system thus becomes more and not less important than it was before.“(s)
Major conflicts will arise in the selection and training of nurses who can personally cope with the changes in nursing which must accompany increasing automation; who can utilize and collaborate with machines ; and who can nurse the patient within the nurse-machine-patient trial. “The patient cannot be allowed to become too automated because of the part direct human care plays in his treatment and recovery. Somewhere between an extreme degree of automation and today’s treatment patterns lies the probable answer and we will have to find the right point of compromise.“(*)
Reference6 1. EncyclojmcdiaBrittunicn, Article on Nursing, Eleventh edition (1910-l 1). 2. DETWXLLER,L. F. Automation in the hospital, Chad. Hosp., 41(5), 54-55 et passim (1964).
3. 4. 5. 6. 7.
Registered Nurses Association of Ontario, Canad. Hosp., 41, 51 (1964). SMITH, DOROTHY M., Myth and method in nursing practice, Amer. 3, Nurs., 64, 68-72 (1964. CHITTICK, RAE and ALLAN, MOYRA, In defence ofnuning,Caaad. Med. Assoc. J., 76,228-229( 1957).
ZERNY,J. and OSMOND, H., In defence of nursing, Caaad. Med. Assoc. J., 75,752-756 (1956). U.S. Department of Health, Education and Welfare, Report of the Surgeon General’s Consultant Group on Nursing, Toward Qualip in Jvursing: Jveedrand Goals, Washington, U.S.G.P.O. (1963). 8. VAN, G., Nursing attitudes: Cause for administrative concern, Canad. Ho@., 40(7), 41-43 (1963). 9. WELPORD,A. T., Ergonomics of Automation, London, H.M.S.O. (1960).
ALEX RICHMAN
148
R&sum&Lcs progr&s rkcents ont incroyablement changC la nature et le r61e de l’hbpital et des soins que l’on y donne. L’extcnsion de l’automation g l’hbpital produira dea transformations encore plus grandes en cc qui conceme le soin da malades et l’education dcs infirmitres. I1 est ntcessaire de prendre db maintenant des mcsurcs pour r&sir l’adaptation dea infirmitrcs aux situations crtes par l’interposition de mtcanismes automatiqucs dam la relation entre Ies m&des et les infirmiks. L’introduction de syst*mes automatiques pour le traitemcnt dcs malades aggravera encore les d&accords habituels cntre I’attitude des infirmitres et la pratique m&Scale. Le genre d’habilett et de compttance requis pour une collaboration effective avec de telles machines est tout B fait diffbrent de celui habituellement exigt des infirm&es. Avant tout, l’tducation des infirm&es doit affkonter le probltme de leur s&ction et de leur prCparation pour que ces machines soient utilistes avec comp&ence et que les relations malades-infirmitres aient quelque chance de s’amtliorer. Le conflit entre les aspects personnels et techniques des soins aux malades continuera P s’aggraver si l’automation cst introduite B l’hbpital sans que des changements majeun soient apportks dans le type actuel d’kducation des infirmitres. Reaumen-La naturaleza y funci6n de1 hospital y de1 cuidado de la enfermera se han alterado sustancialmente en virtud de avarices recientes. La extensi6n de la automacidn dentro de1 hospital producirA alin mayoress cambios en la funci6n y educaci6n de la enfermera. En la actualidad es necesario prever la futura adaptaci6n de las enfermeras a 10s problemas derivados de la interferencia de 10s sistemas autom&icos en las relacioncs entre ellas y 10s enfermos. La introducci6n de procederes automlticos en la labor de las enfermeras incrementari ias actuales discrepancias sobre la conducta y prktica de las enfermeras. El tipo de preparacibn y habilidad necesario para el debido manejo de 10s nuevos aparatos, son distintos de 10s actualmente poseidos por las enfermeras. Por encima de todo, la formaci6n de las enfermeras deberi tender hacia la seleccidn y preparaci6n de enfermeras capaccs de utilizar adecuadamente tales aparatos, dentro de las habitual= normas de excelentes relaciones enfermera-paciente. El conflict0 entre 10s aspectos tknicos y personales de la profeskjn, continua+ incremendndose si la automaci6n de1 hospital se realiza sin estar acompaiiada de las suficientes modificaciones en el actual modelo de la educacibn de la enfermera. Awiofauufl-
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plar8,196S.
Printed ia Great Britain
Nursing; Knobs; and Know-How:* The Impact of Hospital Automation ALEX RICHMAN,
M.D., M.P.H
Associate Professor, Dep. of P&&y, Head, Section qf Social Psych&v, Unixersi~ of British Columbia, Canada
IN recent years major medical
advances have drastically altered the nature and role of hospital care. These changes have also affected nursing. Even more drastic changes are envisaged for hospital care of the near future. The purpose of this article is to outline the import of some aspects of automation for nursing education today. Nursing has undergone many transitions in its historical tri-partite evolution from religion, war, and science.(‘) The development of automation and decisionmaking mechanisms portends new areas of nursing functions and responsibilities and concomitant needs for new patterns of adaptation. Nursing education today has many problems in the discrepancies between student expectations and experiences ; studentship and apprenticeship ; servant, technician, and healer ; individual These discrepancies care and team performance ; training and responsibilities. are beyond the scope of this article ; however, it is hoped to highlight the increasing significance of the machine in hospital care and some aspects of the nurse-machinepatient relationship. In the popular press, headlines of “Electronic Nurse Watches Patients” precede descriptions of existing electronic systems which simultaneously measure temperature, pulse and respiration rates, and blood pressure of several hospital patients, and sound warnings if any function goes outside of the limits desired by the physician. “It is not too fantastic to imagine the day when hospitalization and medical care may well he provided within the hospital to patients some of which are in a state of suspended animation. fa)
To regard
these devices as remote
and unpractical
is unrealistic
“ . . . the modern hospital cannot continue in an isolated world of its own following procedures used for the last quarter century.“(*) It is difficult to educate nurses for the patterns of nursing care which exist today, and preparation for the possible forms of care which will develop in the future is * Canada’s Mental Health, Vol. XII, No. 6, 1-4 (1964). 145
ALEX RICHMAN
146
Although the nature of the devices in hospital-use 10 yr from even more complex. now is not reliably known today, it is necessary to provide for the future adaptation of the nurse to such devices. Fifty years ago the nature and requirements of nursing were described as: “Many candidates approach the calling with a very imperfect appreciation of its exacting character. The work is not easy or to be taken up lightly. It demands physical strength, sound health, scrupulous cleanliness, good temper, self-control, intelligence and a strong sense of duty. It embraces many duties-some of them menial and disagreeable-beside the purely medical and surgical functions.“(i)
More recently, diffuse :
the definition
of nursing
has become
even more diverse and
“In reply to the question, “What is nursing?“, 27 different definitions were reported and as many statements of beliefs about nursing. In general, however, it seemed to break down into five or so areas . . . personal service; the administration of physical comfort, as well as social and spiritual; the requirement of nursing that one assess, decide and take action; concern over levels of health; and finally, the experience of se&resurrcction of the nurse herself as she performs her task.” ts)
Along with increasing specialization, shortages in personnel, problems in training, it has become progressively difficult for the nurse to provide bedside nursing care. “The mass service being given today cannot include personal service and lacks continuity. Progressive patient care was not thought to be conducive to the mental health of the patient, where the ambulatory case is placed under a registered nursing assistant.“(s) “Admonishment by ourselves and others to give comprehensive care to the patient as a whole, admirable though it might be, provides us with no patterns of procedure, no way, even to check on ourselves.“(4)
Nursing education difficulties :
itself, has major
difficulties
in adapting
to these current
“The result has been the superficial presentation of subject matter through a multiplicity of courses that often bear little relation to what the student is doing in the wards.“(s) “What point is there in delegating much or most of the humane art of nursing to scantily trained nursing assistants and then giving nurSes a basic course in the psychology of patients whom it seems they will not nurse, only annotate?“(@) ,. “The present educational structure for the training of nurses lacks system, order, and coherence . . . The situation is aggravated further by the fact that almost all kinds of nurses must carry responsibilities for which they are not adequately prepared.“(‘)
To an increasing degree attempts are being made to “train” nurses in various aspects of the nurse-patient relationship through exposure to some of the behavioural sciences. The nature of this relationship has changed considerably with the development of newer methods and patterns of care. It is inevitable that nursing of the future Will have to deal with the problems associated with the interposition of automatic mechanisms in the nurse-patient relationship. This will inevitably increase the existing problems and produce new difficulties until suitable adaptations are made (more in nursing rather than in the machinery). The usual problems involved in the introduction of machinery and the relinquishment of some of the human’s functions will occur. Although the recurrence of the Luddite riots of 181 I-1816 is unlikely, other forms of conflict may ensue.
NLJRSIJ?G; KNOBS; AND KNOW-HOW:
IMPACT
OF HOSPITAL AUTOMATION
147
‘6 . . . A nurse may continually check on the monitoring system, never really trusting it. trying to outdo it, and ending up in confusion. In some instances, nurses actually have become concerned about the future of their jobs, fearing that these instruments would do away with the necessity for the nurse.“(s)
Another major problem lies in the attitudes and expectations of nursing students. Among current students there are major discrepancies between attitudes and achievement. L‘. . . Those students who had the highest attitude scores i.e., who liked nursing best, also had the lowest achievement scores, i.e., were rated as being the poorest in practical aspects of nursing; conversely, those students who disliked nursing most were rated as being best in practical aspects of nursing.“(s)
The introduction of automatic devices will produce even greater discrepancies for students with stereotypes of nursing care based on the present, let alone the past. It is also quite likely that the types of skills and abilities involved in effective utilization and collaboration with such devices are quite different from those usually imputed to nurses. As described in an Ontario survey: “There was also the belief that the nurse finds it difficult to amalgamate and to act concertedly with others because of the intensely personal nature of her vocation.“(s)
On the other hand some of the difficulties attributed to insufficient, poorly motivated or poorly trained personnel may be reduced by the assumption of suitable types of “routine” and “specialized” care, supervision, and decision making by machinery. This reduction of function, would rather increase the responsibility of the human, but must be supplemented by appropriate training. “ . . . Although automatic methods may reduce the immediate part played by human operators, they leave human beings in certain key positions in which the mental load upon them may be heavy and the effects of their actions far-reaching. The human link in the system thus becomes more and not less important than it was before.“(s)
Major conflicts will arise in the selection and training of nurses who can personally cope with the changes in nursing which must accompany increasing automation; who can utilize and collaborate with machines ; and who can nurse the patient within the nurse-machine-patient trial. “The patient cannot be allowed to become too automated because of the part direct human care plays in his treatment and recovery. Somewhere between an extreme degree of automation and today’s treatment patterns lies the probable answer and we will have to find the right point of compromise.“(*)
Reference6 1. EncyclojmcdiaBrittunicn, Article on Nursing, Eleventh edition (1910-l 1). 2. DETWXLLER,L. F. Automation in the hospital, Chad. Hosp., 41(5), 54-55 et passim (1964).
3. 4. 5. 6. 7.
Registered Nurses Association of Ontario, Canad. Hosp., 41, 51 (1964). SMITH, DOROTHY M., Myth and method in nursing practice, Amer. 3, Nurs., 64, 68-72 (1964. CHITTICK, RAE and ALLAN, MOYRA, In defence ofnuning,Caaad. Med. Assoc. J., 76,228-229( 1957).
ZERNY,J. and OSMOND, H., In defence of nursing, Caaad. Med. Assoc. J., 75,752-756 (1956). U.S. Department of Health, Education and Welfare, Report of the Surgeon General’s Consultant Group on Nursing, Toward Qualip in Jvursing: Jveedrand Goals, Washington, U.S.G.P.O. (1963). 8. VAN, G., Nursing attitudes: Cause for administrative concern, Canad. Ho@., 40(7), 41-43 (1963). 9. WELPORD,A. T., Ergonomics of Automation, London, H.M.S.O. (1960).
ALEX RICHMAN
148
R&sum&Lcs progr&s rkcents ont incroyablement changC la nature et le r61e de l’hbpital et des soins que l’on y donne. L’extcnsion de l’automation g l’hbpital produira dea transformations encore plus grandes en cc qui conceme le soin da malades et l’education dcs infirmitres. I1 est ntcessaire de prendre db maintenant des mcsurcs pour r&sir l’adaptation dea infirmitrcs aux situations crtes par l’interposition de mtcanismes automatiqucs dam la relation entre Ies m&des et les infirmiks. L’introduction de syst*mes automatiques pour le traitemcnt dcs malades aggravera encore les d&accords habituels cntre I’attitude des infirmitres et la pratique m&Scale. Le genre d’habilett et de compttance requis pour une collaboration effective avec de telles machines est tout B fait diffbrent de celui habituellement exigt des infirm&es. Avant tout, l’tducation des infirm&es doit affkonter le probltme de leur s&ction et de leur prCparation pour que ces machines soient utilistes avec comp&ence et que les relations malades-infirmitres aient quelque chance de s’amtliorer. Le conflit entre les aspects personnels et techniques des soins aux malades continuera P s’aggraver si l’automation cst introduite B l’hbpital sans que des changements majeun soient apportks dans le type actuel d’kducation des infirmitres. Reaumen-La naturaleza y funci6n de1 hospital y de1 cuidado de la enfermera se han alterado sustancialmente en virtud de avarices recientes. La extensi6n de la automacidn dentro de1 hospital producirA alin mayoress cambios en la funci6n y educaci6n de la enfermera. En la actualidad es necesario prever la futura adaptaci6n de las enfermeras a 10s problemas derivados de la interferencia de 10s sistemas autom&icos en las relacioncs entre ellas y 10s enfermos. La introducci6n de procederes automlticos en la labor de las enfermeras incrementari ias actuales discrepancias sobre la conducta y prktica de las enfermeras. El tipo de preparacibn y habilidad necesario para el debido manejo de 10s nuevos aparatos, son distintos de 10s actualmente poseidos por las enfermeras. Por encima de todo, la formaci6n de las enfermeras deberi tender hacia la seleccidn y preparaci6n de enfermeras capaccs de utilizar adecuadamente tales aparatos, dentro de las habitual= normas de excelentes relaciones enfermera-paciente. El conflict0 entre 10s aspectos tknicos y personales de la profeskjn, continua+ incremendndose si la automaci6n de1 hospital se realiza sin estar acompaiiada de las suficientes modificaciones en el actual modelo de la educacibn de la enfermera. Awiofauufl-
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