Technology and nursing: an anatomy of definition

Inr. J. Nun. Srud., Vol. 33, No. 4, pp. 433441, 1996 Copyright ‘Q 1996 Elsemer Science Ltd. All rights reserved Printed in Great Britam 002C-7489/96$1500+0.00

Pergamon

0020-7489(95)00069-o

Technology and nursing: an anatomy of definition ALAN

BARNARD,

Queensland Australia

Uniwrsity

R.N., B.A., M.A.

of’ Technology,

Locked

Bag No 2, Victoria

Park

Road, Kelvin

Grove.

Queensland

4059,

Abstract-This paper discussestechnology in relation to nursing practice development in order to demonstrate the need to apprehend nursing within the context of technological advancement. Issuespertinent to formulating an understanding of technology are reviewed and four common approaches to the definition of technology within the domain of nursing are critiqued. The purpose of the paper is to analyse issuesrelevant to defining technology, and to make obvious the limitations of current nursing literature. Copyright 0 1996 Elsevier Science Ltd.

Introduction

Understanding the influence and meaning of technology is of extraordinary importance to nursing. It is important because of the influence technology has upon nursing practice and education, and has significant implications for interpreting history, contemporary practice, and the future of nursing. Technology is an evolving phenomenon which continues to influence our actions, conceptions, and social arrangements. Whether nurses use technology to enhance or control their environment, our conceptions of the phenomena are subject to, and directed by, technological development, political bias, assumptions, thought and experience. This paper does not specifically define technology as a phenomenon but addressesissuespertinent to the formulation of a definition, and is a critique of the way many nurses have sought to understand technology within the context of their practice. Technology and nursing history

Nurses have always used tools and techniques in valued ways in order to achieve valued ends. Prior to this century, nursing was essentially as it had been throughout history, a 433

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craft practised by individuals, of whom the vast majority were women. Most women had gained experience in care giving through religious and secular orders or through families. Knowledge and skill developed by trial and error, and was passed down through generations. Nursing practice mainly relied upon rule of thumb, experience, and faith, and was isolated to groups of individuals and geographic areas. Skills included magical and aesthetic components, which equated with moral and psychic life. Nursing care was carried out by appropriately trusted and pure hearted individuals, who effected treatment which was less able to be translated into scientific language or rationale. Nurses relied less on scientific knowledge than on a personal and intuitive understanding, developed and refined through practice (Dock and Stewart, 1925; Reverby, 1982; Reverby, 1987). Additionally, technology did not present nursing, medicine, or society, with many challenges associated with social adaptation, morality or ethics prior to the beginning of the industrial revolution. The evolution of technology was slow, and was based on the knowhow of a person who used an expert eye and was distinguishable for his/her particular style and precision. The slow evolution meant that technical advance rarely threatened social equilibrium, and was assimilated into society (Ellul, 1964; Kranzberg and Pursell, 1967; Mumford, 1934). The rapid growth of scientific and technical knowledge since the eighteenth century, and in particular this century, has generated enormous changes for nursing, health care, and society. Technology and science have developed at a rate which is affecting every facet of our awareness and experience. Although the rapid growth of science and technology presents us with many challenges, particularly associated with adapting precepts to a rapidly changing social milieu, the exploitation of people, the further division of classes, and poverty, society has maintained an adoration for technological advance. Like society, nurses both welcome and encourage technological development. Their belief in the efficacy of technology has not however, led to an interest in interpreting technology within the context of nursing practice, developing an historical awareness of the influence of technology, or understanding the significance of the emergence of technology (Foha, 1973; Harding, 1980; Reverby, 1987; Sandelowski, 1988; Walker, 1970). Historical texts, nursing literature, and manuals of nursing practice, fail to reflect upon or adequately critique the social and professional impact of technological development. This fact is, according to Kranzberg and Purse11 (1967), not restricted to nursing. There is a propensity amongst many groups to ignore the social outcomes of technological development, and to restrict the analysis of technology to internal history (machinery, periods of technological advance, industrial revolutions, etc.). Outcomes from the emergence of technology, such as the evolution of morai or ethical debate, the experience of technology within nursing practice, and the impact of technology upon nursing as a discipline are infrequent. Texts which purport to analyse trends in nursing history, particularly those written during the second half of this century, are at times inadequate when the pervasive influence of technology upon society and nursing is fully understood. Technology is generally incIuded within a discussion on science and is avoided as an important determining factor on the evolution of nursing practice and the experience of nursing. Harding (1980) asserts that inadequate insight into the experience of technology, and simplistic conceptions of the phenomena, are restricting the development of nursing as a discipline. It is suggested that adequate conceptions of technology will emerge, when nursing defines technology as influential in the organisation of human labour, and fundamental to its moral and political goals. A better informed understanding of technology is needed,

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because current conceptions contribute to “ineffective and destructive interactions with nature and also support privileged accessto the social benefits of technological change” (p. 56). Brinkman (1971) claimed more than two decades ago, that many professions were attempting to understand better the experience of technology, with specific reference to how technology influences employment and decision making: “Today technology penetrates the whole realm of human life to an extent and depth never before attained. Thus it is understandable that even engineers are beginning to think about technology, in order to make sure of the presuppositions and consequences of their actions” (p. 122).

Unfortunately, a trend towards better understanding presuppositions and consequences has not developed in the field of nursing and the profession has largely avoided technology as a phenomenon in need of understanding and critique. Nurses are today responsible for an increasingly machine orientated health care system, dominated by administrative and bureaucratic structures. Nurses in all specialties of practice, are required to care for their patients and have the technical knowledge, to not only manipulate machinery and interpret the world around them, but to take on increasingly varied and complex roles and responsibilities associatedwith the emergenceof technology.

Technology:

issues of definition

It is a historical truism that people have always used technology in the form of tools and techniques. The history of human development is dominated by accounts of technological achievement, periods of discovery, invention, and the dominance of people over their world. The mraning of technology In recent years the meaning of the word technology [technokogy], has been lost under a weight of varied usagesand interpretation. Technology has become a catchword which engendersa large amount of confusion and meaning, and is often used to engender an aura of superiority, specialisation and professionalism. Technology is commonly used as a descriptor for knowledge and skills such as, food technology, medical technology, or information technology. The word attempts to denote a socially impressive body of knowledge and know-how, and the activity of a group (technologist). An intuited understanding of technology, transcends this cloud of phraseology, and vague notions of practice in order to better understand what is meant by the term. It is important to recognise that technology, has at least three layers of meaning. Firstly, technology at its most basic and obvious level refers to physical objects such as tools, machinery, and matter. These physical objects are manipulated to obtain particular ends. Secondly. technology is a form of knowledge in which, meaning is awarded to an object (e.g. a cardiac oscilloscope) through our knowledge of, how to use, repair, design, and make it. Thirdly, technology forms part of a complex set of human activities. Ellul (1964) emphasisesthat technology must be understood as the creation of a technical phenomena (technique). in which all that has been, tentative, unconscious and spontaneous, is transformed into the realm of clear, voluntary, and rational concepts and actions. Technique is the foundation of technology, and is directed by rationality and consciousnessin an unending attempt to reduce means, whether they be machines, tools, activities, thoughts, people. to that which is most efficient. The third layer of meaning is more holistic in its

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portrayal of technology and transcends simple notions of machinery and tools, to include politics, economics, organisational behaviour and human activity which are all interlinked within our total environment. The way in which our world is organised for, as well as by, machinery and tools, etc., is as much technology as is the first and second level of meaning.

Limitation

of definition

Definitions of technology are subject to historical and cultural gender bias towards men. Definitions tend to be socially stereotypical, and emphasisephysical objects. Explanations trivialise technology associatedwith activities such as horticulture, childcare or cooking, in order to stereotype women (who are commonly associated with these roles) as technologically incapable and ignorant (Wajcman, 1991). The fostering of these beliefs has led to an emphasis on impressive machinery, industrial objects, and socially sanctified technology. The emphasisneglects a more complex and complete conception. The development of superior insight acknowledges that which is obvious about technology, but transcends gender bias, and is cognisant of the entire technological environment in which we live. Superior insight into technology also distinguishes between scienceand technology, and rejects the reduction of technology to a finite set of neutral objects such as tools and machinery (Cotgrove, 1982; Ellul, 1968; Harding, 1980; Pacey, 1983; Wajcman, 1991). There has, in recent years, been a reorientation of thinking about the relationship between technology and science. There has been a move away from a hierarchical model which treated technology as merely applied science, towards an understanding which recognises that scienceand technology, are distinguishable as two separate bodies of knowledge and skills. The belief that science discovers and technology applies is in steep decline (Ellul, 1964;Mumford, 1934; Ortego Y Gasset, 1972; Pacey, 1983; Wajcman, 1991). Technologists often build upon, create, and modify technology, using specific knowledge and skills separate to science.In fact technology has for much of its history had limited relationship to science. Many technological advances have originated from little or no understanding of science,and technological advance has often proceeded far beyond scientific knowledge and rationale. The development of the first aircraft and the steamengine, are two commonly cited instancesof technology developing separateto scientific explanation (Brickman, 1971; Ellul, 1964; Mumford, 1934). Technology is more apt to develop empirical laws in practice than theoretical laws, i.e. laws which are generalisations from practice rather then laws which are intuited and then applied to practice. Although sciencehas provided technology with knowledge and means for development, science should not be conceived as essential for technological advancement, from either an historical or a preconditional perspective. Technology is therefore, more than applied science. The trend this century towards a technical ideal in which efficient practicality is achieved asa general character of technology, reinforces this fact. Technology is required to fit with economic and material purposes. Technology is often judged in relation to status symbols, the supply of expertise, the development of advertisement, and materialism, rather than a relationship to science.There are clear patterns of life style, socio-cultural activities and values, associatedwith technology which identify it as distinct. Technology is obvious in a physical sense,as evidenced in the development of cities, the alteration of work practices, and the array of gadgets which dominate our existence. But

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for many who have thought about the historical, philosophical and social consequences of technological development, technology can no longer be understood merely from the perspective of technical advancement or science. Technological development must also be understood from the perspective of how we each experience technology in our daily lives, and what implication technology has to human existence. Social considerations such as, what are the effects of technological development on work?; what effect does efficiency have upon clinical practice?; and how does technology influence the practice of a profession?; are amongst a number of many important and unresolved questions which must be considered when seeking to define and understand the evolution and experience of technology.

Defining technology in nursing

Machinery, tools and instrumentation

It is rare for nurses to define technology. Nurses often disregard the need to provide a definition, even when technology is the focus of a literary discussion. They often display an indifference to technology as a concept, and fail to transcend that which is socially impressive. The lack of perspicacity to issues of definition and conceptualisation, has led nurses to define technology in an insufficient manner, and to assume a synergy of understanding between the author and reader, based on a belief that technology is machinery and tools (Abbey, 1978; Ashworth, 1987; Bailey, 1969; Carnevali, 1985; Farmer, 1978; Golonka, 1986; Handy, 1989; Henderson, 1985; Kristensen, 1989; Jacox et al., 1990; Lenihan and Abbey, 1978; Miaskowski, 1990; Pillar and Jacox, 1990; Quivey, 1990; Reed-Ash, 1983; Wilkinson, 1992; Wilson, 1981). Carnevali (1985) is typical of authors who conceptualise technology at its most simple, and defines technology as: “the mechanical equipment and associated patients’ health care” (p. 11).

knowledge

and procedures

or activities

involved

in

This definition emphasises the way in which nurses apply technology to clinical practice and is similar to Given and Given (1969), who define technology as: “the

substitution

of machine

labour

in the performance

of a given task”

(p. 74)

Technology is conceptualised as standardising and regulating the function of a nurse and is regarded as activities associated with the performance of nursing functions. Technology is noted to be a collection of discrete technological moments which are created in order to maximise health care and the practice of nurses. The understanding leads authors to define technology from the perspective of machinery and tools (Anello, 1970; Birckhead, 1978; Braun et al., 1984; Chustman, 1978; Handy, 1989; Fagerhaugh et al., 1980; Farmer, 1978; Fitter, 1987; Lenihan and Abbey, 1978; Mathew, 1976; Mayberry, 1985; McClure, 1991; McConnell, 1990; Pillar and Jacox, 1991). Technology is defined as a collection of technological acts within the technological environment. Rather than conceiving of technology as a system of numerous and interrelated techniques, technology is reduced to a collection of moments of action. Despite the inadequacies of conceiving of technology as only machines and tools, most authors continue to fail to transcend the limitations of their deliberations. For instance, Mayberry (1985) refers to technology as machines which record variations in temperature, blood pressure, chemical analysis, and written communication, and McClure (1991) defines technology as:

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A. BARNARD “any means of delivering care using objects that are not a part of the patient’s own body. This means that it includes not only the vast array of machinery we have come to take for granted, but also the pharmaceuticals that are prescribed and administered” (p. 144).

Farmer (1978) in a research project undertaken to study the impact of medical technology on nursing, defines technology as: “the non-passive (P. 18).

things

of economic

value

which

stimulate

a function

or facilitate

an action”

In this definition the human element is removed, as technology is assumed to be machines and tools of economic value. The research undertaken by Farmer (1978) is widely cited, and the authors definition of technology has served to reinforce an interpretation of technology which focuses on instruments, machines, and a power source other than human effort. Farmer (1978) does however, make note of the functional interchange between nursing and medicine which has led to alterations in nursing practice, as a result of increases in technology. In particular the author emphasises that technology has led to role erosion and an increase in technical aspects of nursing practice. Despite Farmer’s (1978) assertion that it is unrealistic to expect nurses to appreciate the demands technology places upon nurses and patients without understanding the technological environment to which patients must adapt, the author has only apprehended and researched technology from the context of machines and procedures. For example, Farmer (1978) never conceives of technology from a perspective of practices, procedures, policies, society and values. It must be stated, that if the author truly sought to reach the goal of “learning about the prospects and pitfalls of technology in health care” (p. 20), then more was needed to understand and research technology in a more holistic manner. These definitions emphasise the machinery of technology. The authors conceive of nursing and technology from the perspective of action. Nursing is a series of activities, and technology is the phenomenon which facilitates the process. The way in which machines and tools assist nurses to be more accurate and efficient is not only a measure of the success of technology, but a conceptual framework in which technology is viewed as a response to the needs and goals of nurses and patients. Technology is technological advancement

A second approach to defining technology is through a compendium of technological discovery. Rather than proposing a formal definition, authors present the reader with a list of technological achievements. The compendiums are always a list of technology which is judged to be both socially impressive, and commonly known to have impacted upon disease and treatment (Anello, 1970; Baumgart and Larsen, 1988; Bennett, 1970; Laing, 1982; Lenihan and Abbey, 1978; Miaskowski, 1990). Anello (1970) is typical of authors who define technology from this perspective. The author states that: “the past 20 years has brought tremendous changes both in medical knowledge, and in medical practice and professional nursing. The use of new techniques and instruments, many highly sophisticated, have provided us with insight into the mysteries of the cell structure, molecular biology, genetic studies, and a host of the other biological phenomena. We are beginning to know more about disease, the control of infection, and the propitious use of synthetic drugs. Most dramatic are the variety of transplantations and biomedical engineering achievements that have taken place in medical science” (p. 4).

It is important

to note that nurses commonly

do not list technological

invention and/or

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achievements which are specific to nursing. In fact the compendiums are significant for their absence of technology commonly associated with nursing practice. Compendiums of technology are always advances of other professions. Even though nurses have had input into the development of significant technology, such as sanitation and aseptic techniques, these technologies are not listed. It is interesting to contemplate reasons for this fact, and it is fair to suggest that nurses either do not know what technology is specific to their discipline, or conversely do not rate it as suitably impressive. Definition, explanation, and lists of technological achievement, always focus on techniques and instruments which are sophisticated, and have provided advances in domains outside of nursing. Lists of technological development tend to include science and technology associated with: molecular biology, genetic studies, biological phenomena, surgical intervention, and pharmacology. These fields of technological and scientific development have been important to health care and society, and although the developments noted by these authors have often impacted upon the practice of nurses, it can not be substantiated that nurses and nursing practice have been highly responsible for the development of these bodies of knowledge. As such it is difficult to apprehend why nurses include technological development of the kind noted above, as their definition of technology. At another level, the current inclusion of technological advances which are dubiously attributable to nursing as a discipline, may not only reflect a fascination by nurses for that which is socially impressive, but also the fact that there has been little attempt to investigate and document, the many technological developments directly attributable to the expertise, insight, and practice of nurses. Technology

is science

A third approach to defining technology is to assume that technology is science. It is assumed that technology is a response to the development of science. Therefore nurses refrain from defining technology, assuming technology to be science. Technology is defined and conceived as the application of scientific principles and knowledge to domains of practice (Anello, 1970; Battistello, 1976; Brown, 1985; Carnevali, 1985; Chustman, 1978; Farmer, 1978; Joachim, 1988; Orem, 1991; Salmon, 1977; Zwolski, 1989). Salmon (1977) is typical of authors who understand technology in this manner. The author asserts that: “In the final analysis (P. 19).

science which is the basis of technology,

is just one more

of the human

gifts”

Yet another nurse defines technology in a similar manner: “A technology is defined as an application achieved in a field” (Orem, 1991, p. 92).

of scientific

knowledge

to the practical

purposes

to be

This approach to defining technology, misrepresents the development of technology by confusing science with technology, and fails to recognise specific knowledge, skills, and activities associated with technological practices. These definitions inadequately identify the specific influence of technology upon the practice and experience of nurses, and ignore the evolution of technology as discrete domains of knowledge and skills. Technology

andpopular

literature

Lastly, technology is defined through reference to popular literature such as Alvin Toffler’s Future Shock (Toffler, 1971) or Aldous Huxley’s Brave New World (Huxley, 1932).

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The literature would appear to assist nurses to conceptualise the experience of technology, and is cited often as evidence of the future development of technological nursing and society (Ashworth, 1987; Henderson, 1985; Kelly, 1984; Paulen, 1984; Phillips, 1988; Quivey, 1990; Reed-Ash, 1983). Novels such as those cited above are influential in the formulation of beliefs, and are noted by D’A Slevin (1993), on p. 241, to be ‘bibles’ used by many nurses to interpret the interrelationship of nursing and technology in a changing world. The possible evolution of technology is taken seriously, and advice such as: “not wanting to live in a man made stratljied society” (Quivey, 1990, p. 329), is extolled as a significant conceptual issue and forms part of the experience and definition of technology.

Conclusion

This paper has examined the development of technology within nursing, and presented issues pertinent to an appropriate understanding and critique of the phenomena. It is clear from the literature that nurses inadequately define technology and most often understand technology to be machinery and tools. Nurses frequently confuse science with technology and frequently rely upon popular literature and the formulation of lists of achievement when seeking to understand technology within the domain of nursing. The various ways in which nurses define technology have been presented, as has a discussion of the limitations of literature. It has been argued that nurses have continued to inadequately understand technology, and have failed to place technology within the wider context of its emergence. Definitions are often simplistic and inadequately portray the experience of technology within the domain of nursing and rarely transcend a most simple conception of the phenomena. It is important to emphasise that this paper is a plea for technology to be better considered within nursing. The literature has revealed serious deficiencies in both the frequency to which nurses define technology, and the conceptual maturity of attempts to understand and explain the phenomenon. It is suggested that inadequate conceptualisation of technology and an ignorance to fundamental issues, is severely limiting our understanding of the experience of technology and our ability to advance nursing as a discipline.

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22 August

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