Clarion Health Partners in Indianapolis uses software for the management of patient records. Nurses and physicians interact with software extensively to get their jobs done. The integration of technology for hospitals and patient care is continuing to be used in more integral ways with the hope that it will assist in alleviating the high costs and demands in the health care industry today.
The average age of nurses in the United States is about their mid-40s, and having worked in the health care industry, I noticed that one of the greatest challenges has been in training computer illiterate nurses to use technology. A specific example is the use of electronic patient charts by nurses. Electronic charts have numerous institutional benefits over paper: quick access, integrity of information, automatic conflict checking, not getting lost, the ability to transfer information across institutions easily witihout the need for it to travel, integrity of information, the ability for statistical analysis and the ability to access the chart in multiple locations at the same time. Despite these and other benefits, nurses are not always enthusiastic about the use of such systems because it does not always enhance their work experience.
As technology progresses and the demand for health care increases, we are also increasing in our dependence on technology. We have surpassed both enthusiast and professional stages for many technologies for hospitals, but we have yet to arrive at a “consumer” stage for most applications of technology in the health care industry. The use of “implicit” meaning is lacking and nurses often require special training to use technology effectively. Emotional satisfaction, communication, intuitive interaction and sociability in healthcare IT are all areas that interaction design has not effectively addressed for managing patient charts, as is evident in the challenges nurses face today. Phenomenologically, we need to consider the horizons of nurses and have an understanding of their lifeworlds so that the aforementioned areas can be adequately addressed. With technology, the nursing “role” has been changed. As actors, nurses presently need to acquire rules of participation together with props, and many times, as designers, we lack the understanding of the actor’s definitions of the situation.
In a famous quote by Isabel Maitland Stewart, she explains “The real essence of nursing, as of any fine art, lies not in the mechanical details of execution, nor yet in the dexterity of the performer, but in the creative imagination, the sensitive spirit, and the intelligent understanding lying back of these techniques and skills”. This quote is supportive of approaching design for nurses beginning at the micro level. A micro level approach would include the assumption that “people are creative, intelligent and knowledgeable” and it would include using “interpretative methodologies which try to capture the actor’s definitions of the situation”. This is also very realistic because now more elaborate “movement” than a new page loading or progress bars can be implemented easily with web 2.0 technologies, making their technological experiences more lively.
Trusting technology is also a common issue at hospitals, which is suggestive that a level of realism should be expressed through digital medium. This obviously could not replace a formative approach, which could be creatively used to enhance the patient-nurse relationship. Those issues that nurses do not care about could be designed to be as ready-to-hand as possible. One goal of nurses is often to reach a level of accomplishment and satisfaction through care for a patient, so the things that nurses care about, such as aspects of the patient-nurse relationship, should probably remain as present-to-hand as possible and could be enhanced instead of abstracted through the use of electronic patient charts.