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BACKGROUND
Although computers often are associated with
the business functions of health care delivery (B&rend,
1994) and decision support for professionals (Papemy,
Aono, Lehman, Hamar, & Risser, 1990), their use to
deliver patient care has progressed slowly. More
recently, however, common nursing functions,
previously accomplished in face-to-face interactions,
are beginning to be done using computer
communications. Integrating the high touch values
commonly associated with nursing care into the design
of computerized nursing care deliveT systems is
essential if the widespread use of technology-mediated
care is to be realized. This paper describes
characteristics of nurses and the work of nurses that are
important to consider when designing computerized
nursing care delivery systems. These characteristics are
nurses attitudes towards technology, values central to
nursmg practice and nursing functional roles.
Experiences from several projects in which electronic
nursing care delivery systems were developed and
evaluated are described.
Nurses Attitudes toward Technology
Over the past 50 years nurses have increasingly
used technology to support the care they provide.
Widespread use of technology by nurses began
following the development of monitors, ventilators and
other machines for use in intensive care units by critical
care nurses. The use of technology in healthcare has
progressed to the point where machines, such as
ventilators are frequently used by home care nurses in
peoples homes. It has been proposed that modem
nursing is deeply connected to technology development
(Barnard, 1999). However, nurses attitudes toward
computers tend to indicate that they are undecided
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watchfulness of nurses in assessing, screening, and
monitoring patient clinical status and patient responses
to the application of interventions.
Basic to nursing values is the helping
relationships in which nurses engagewith their patients
(Morse, 1990). This relationship progresses over time
as the nurse interacts with patients to manage health
problems by building trust through genuine caring and
encouraging patients to share thoughts and feelings.
Through intimate interpersonal relationships, nurses
conduct activities aimed at restoring physical,
emotional, spiritual and social well being. Additionally,
nurses historically have fostered patient autonomy by
supporting patients rights to make decisions about their
health. Nurses also value collaboration with other
healthcare professionals to plan care.
Nursing Functional Roles
Common roles and functions of nurses are
caregiver, client advocate, case manager, rehabilitator,
comforter, communicator, and teacher. While
caregiving will always require some face-to-face
interaction
(i.e.
bathing
patients,
physical
examinations), many nursing caregiver functions are
amenable to computer mediation, such as symptom
monitoring, the provision of information, assistance
with decision-making, and providing emotional
support. As patient advocates, nurses support and
uphold patients values and assist them to navigate the
health care system to get their needs addressed.Nurses
also act to protect the human and legal rights of those in
their care. As case managers,nurses assess,coordinate
and organize the healthcare resources needed by
patients throughout their illnesses. As rehabilitators,
nurses direct and engagein activities aimed at restoring
physical and psychological functioning. As comforters,
nurses direct care of the whole person, giving the
physical and emotional support needed for coping with
illness or preparing for death.
The role of
communicator is central to nurses in their interactions
with patients, families and other healthcare
professionals. As teachers, nurses offer explanations
about the patients condition, necessary treatments, and
demonstrate procedures to facilitate the persons selfcare abilities.
Nurses work in several types of environments.
Hospitals, a major work environment of nurses, are
complex orgamzatmns in which nurses have
traditionally had a large responsibility for system
maintenance. Nurses also provide care in clinics,
homes, schools, industrial companies, and health
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included: (1) the lack of physical presence of clients,
(2) diffuse time referents, (3) asynchronous
communication, and (4) the necessity to teach clients to
use the technology. The absence of face-to-face visual
cues required the nurse to rely on a new set of cues,
many of which differ from those of clinical encounters
involving face-to-face or voice communication.
Developing and maintaining relationships is a goal in
any therapeutic clinical encounter. Rapport and trust
were developed between the nurse and clients though
the use of standard protocols for comptiter
introductions
participating
among
parties,
encouragement of the use of a conversational tone in
messagesposted on the system, and nurse modeling of
emotional expressionsin messages.
Changing Cardiac Risk Factors
In another project, interdisciplinary teams of
health professions students (medical, nursing, nutrition,
and epidemiology) worked with an electronic
community of individuals to change cardiac risk
factors, such as increasing physical activity and
following a low fat, reduced calorie diet (Moore, in
press). Using on-line methods without face-to-face
interactions, the students: (1) developed a therapeutic
relationship with clients over a computer network (2)
assessedclients current health patterns regarding diet
and exercise compliance with heart-healthy lifestyle
guidelines, (3) employed a series of behavior change
strategies while electronically coaching clients to
make these lifestyle behavior changes, and (4) tracked
trend data related to diet and exercise behavior over the
project period. The interdisciplinary teams held virtual
team meetings for case discussion of their client load.
This virtual approach to team care solved some of the
challenges normally associated with interdisciplinary
collaboration in the health professions, such as finding
convenient times to meet and creating efficient records
of team discussions and decisions.
He&Care
In a recent project, HeartCare (Brennan, et al.,
1998), customized teaching and home management
support are provided by nurses to patients for six
months following cardiac surgery using home-based
WebTV. In this project, several hundred pages of
cardiac recovery information on the Internet were
evaluated for accuracy, appropriateness,reading level,
and gender focus. Additionally, nearly 200 pages of
cardiac information not available on the Internet were
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