Impact of Technology on Nurse-Patient Interactions: A Skill-Based Method for Improvement

A challenge in nursing practice today includes finding a balance between the demands of technology use and the art of nursing which is caring and the human connection. Since implementation of the electronic health record (EHR), nurses and other clinicians are required to be technically proficient with computer skills for required documentation. Effective use of computer skills while providing high quality patient care is a missing element in that proficiency. Interviews with nurse administrators of a 346-bed community hospital in northeast Alabama revealed concerns over low patient satisfaction in the ‘communication with nurses’ section of the Research and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey over the past year. Upon review of data where there was a 28% survey response rate, it was determined that the facility’s top box score was 76% while scores for regional and national facilities were 81% and 80%, respectively. Patient comments revealed negative perceptions of nurses as being too busy, being short-staffed, not caring, and paying more attention to computers. Research shows that effective communication skills are endorsed as an essential component of high quality health care. Barriers to communication between clinicians and patients, such as technology use at the bedside, can have a major impact on patient health outcomes and patient satisfaction. The increased prevalence of technology in practice environments is actually increasing the risk of nurses and other clinicians working with more focus on the computer than on the patient.

The purpose of this project was development and presentation of a skill-based approach called Caring with Tech that will assist nurses to optimize interactions with patients during use of bedside technology. The project’s main parts were adapted from a skill-based approach developed to encourage physicians to remain patient-centered during exam room use of the electronic health record (EHR), as well as relational elements of the Fundamentals of Caring Framework used in strategies to develop therapeutic relationships with patients in clinical practice. Jean Watson’s Theory of Human Caring supported this project since it advocates that a caring consciousness is the core of true nursing. Caring and the human connection must not be lost when using technology at the bedside. After consultation with hospital nurse administrators, the project was developed as an awareness campaign called Caring with Tech. It was intended to increase nurses’ awareness of how their interactions with patients can be impacted during use of workstations on wheels (WOWs) at the bedside.

Caring with Tech was presented to a target group of registered nurses and unlicensed multi-skilled technicians employed on the 30-bed orthopedic/medical unit that operates within the community hospital. A pre-test was administered prior to the session, and a post-test was administered after each session. A total of seven 1-hour educational sessions were held with 28 registered nurses and 5 unlicensed multi-skill technicians in attendance. Participants were 85% female, 15% male, mean age of 34.8 years with 79% being 25 years of age or older, and the number of years in the profession ranged from 3 months to 40 years. Each participant was awarded a laminated card of the Caring with Tech logo to attach to his or her hospital ID badge upon completion of the session. Caring with Tech informational cards were also placed as reminders on the WOWs used by nurses on the unit upon completion of all sessions.

A pre- and post-test design was utilized at the beginning and end of each session that revealed a pre-test score mean of 88.48 and a post-test score mean of 96.66. Using SPSS, a paired t-test statistical analysis determined that the p value was <.05 therefore showing statistical significance of learning between pre-test and post-test administration. This finding provides evidence that the educational content of Caring with Tech increased knowledge and awareness of the impact that technology can have on patient interactions, as well as methods for improvement. It was also determined via demographic questions on the pre-test that only 30% of participants were extremely comfortable using computers, and 61% of participants felt that taking time for empathy is extremely important during patient care. The hospital adopted Caring with Tech to use in orientation of new nursing staff to coincide with computer training sessions.

A skill-based approach, Caring with Tech, provided to nurses and other clinicians can assist in optimizing interactions with patients while using technology at the bedside. Learning about and being mindful of how caring behaviors can impact patient perceptions of nurses using bedside technology, patient health outcomes, and patient satisfaction with their hospital experience can enable nurses to balance technology with the art of nursing. A long-term goal considered during the development of Caring with Tech was improvement of facility HCAHPS scores in the area of communication with nurses. With increased knowledge and awareness of this clinical problem being evidenced in the project results data, Caring with Tech may prove to be a beneficial program to implement in health care facilities striving to improve patient satisfaction with the hospital experience.