A Fundamental Role in Caring for the Sick - Essay Example

Table of Contents Table of Contents 1 Introduction 2 2 Overview of the Research Article 2 2 Rationale 3 2.2 Methodology 5 3 Critique 6 3 Problem definition 6 3.2 Literature review 7 3.3 Research design 11 3.4 Sampling 11 3.5 Data collection strategies 12 3.6 Data analysis strategies 12 4 Findings, conclusions, recommendations 12 5 Bibliography 14 1 Introduction From the inception of nursing practice, simple and complex technologies have played a fundamental role ion caring for the sick. From the poultices of the 1900’s to the intravenous balloon pumps of the 1970s, nurses have incorporated technology as an integral part of nursing care. As Sandelowski (1996) points out, however, although the nursing profession has relied on technology and incorporated technological advances into its practice since inception, very little has been written about the impact of these technologies on nursing practitioners. In direct relation to the research gap outline in the above introductory paragraph, Sawyer and Penman (2007) address the impact of computer use on nursing practitioners. More specifically, they address the physical consequences of usage and whether or not nurses receive the required ergonomics training and implement it in their practice. This study will critique offer a comprehensive critique of Sawey and Penman’s (2007) article. 2 Overview of the Research Article The critique will commence with an overview of Sawyer and Penman’s (2007) article. Within the context of this overview, the rationale for the article will be explicated, a brief review of its selected methodology presented and, importantly, the importance of the article and its relevance to contemporary nursing practices will be fully articulated. 2.1 Rationale Computers are becoming increasingly prevalent in the healthcare setting, and their potential applications and value are extensive. Computers store and process information that can be interconnected to various sources to transfer information from one source to another within the hospital and outside to the world at large. Within the field of nursing, computers can be used by nurses for the purposes of education and seeking information, facilitating communication, and patient documentation. While much of the literature focuses on factors contributing to computer utilization, few studies describe the actual computer utilization by nurses. The available literature identifies uses and benefits of computer access that are often anecdotal and assumptive. Computer technology is rapidly evolving, and research is not keeping up with examining and documenting its impact on the profession of nursing. In a profession focused on providing evidence based practice, current and relevant evidence is needed regarding, not just the actual application of computers by nurses, but the health-related impact of usage on nurses. The implication here is that the rationale for this article stems from the role which computers play in the nursing profession and the delivery of healthcare services. Thus, as an appreciation for the rationale is contingent upon understanding nurses’ uses of computers, the next paragraphs will be devoted to explaining this point. The movement towards advancing nursing through the use of computers began in the early 1970s at a national and international level through the creation of nursing informatics (Saba, 2001). Nursing informatics has been described as the blending of information science, computer science, and nursing science into one entity (Saba, 2001; Saba, Pocklington, & Miller, 1998). The goal of nursing informatics is to use computer technology to improve clinical nursing practice and increase the quality of patient care (Saba, 2001). In 1992, the American Nurses Association recognized nursing informatics as a nursing specialty (Farrell & Conner, 2003). Today, nursing informatics and computer technology are incorporated into all facets of nursing care, facilitating the transfer of nursing information into knowledge to support nursing practice and the delivery of patient care (Farrell & Conner, 2003; Saba, 2001; Zytkowski, 2003). The literature surrounding computer use in nursing reveals that a number of different perspectives have been studied. Much of the focus of research has been on the individual nurse, such as personal traits, demographics, and social factors (Axford & Carter, 1996; Barr, 2002; Ngin & Sirnrns, 1996). Few studies have focused on the use of computers in practice clinical setting (Axford & Carter, 1996; Estabrooks, OLeary, Ricker, and Humphrey, 2003). Nurses attitudes about computers have been studied extensively (Axford & Carter, 1996; Lee, 2005; Lee, Lee, Lin, & Chang, 2005; Ngin & Simrns, 1996). Research studies on nurses attitudes towards computers often reveal contradictory findings. A study done in the United Kingdom in the late 1980s showed that nurses attitudes towards computers were more unfavorable than favorable. Nearly 213 of the nurses in that study felt that the computer did not improve patient care (Sultana, 1990). Axford and Carter (1996) found that nurses did not expect computer technology to have a negative impact on patient care. A significant amount of the available research is older than 10 years, but Lee (2005) noted a shift from negative to positive attitudes among nurses towards computer use. Ngin and Simrns (1 996) revealed in their literature review that nurses tend to be skeptical, resistant, and anxious about computers. Axford and Carter (1996) found that only 113 of nurses used computers in their clinical practice. More recently, Estabrooks, et al. (2003) noted that nurses, as a group, are generally not educated in computer technology. Proceeding from the above stated, one may surmises two things. In the first place, computers have been integrated into the nursing profession and, in the second place, nurses have not received the requisite computer training. Indeed, as indicated in the preceding paragraphs, nurses have expressed frustration at the integration of computers into their work environment and do not appear to fully appreciate just how much computers can facilitate their work. Despite this, however, there really is no way to circumvent the use of computers in the nursing profession. Therefore, the most obvious solution lies in training nurses in computer use and ergonomics training is a very important element of the said training process. Nurses should be given the tools requisite for the constructive exploitation of the benefits of computer use and for the minimization of the health-related risks of doing so. This is precisely the issue which Sawey and Penman’s (2007) article addresses and it is from here that the rationale for the article emanates. 2.2 Methodology Sawyer and Penman (2007) quite evidently proceed with an awareness of the issues raised in the preceding section. They acknowledge the importance of computers within the nursing profession and emphasize the beneficial aspects of integrating computer technology into the healthcare delivery paradigm. At the same time, however, they express complete awareness of the extent to which use can detrimentally impact the health of users and that the only possible precaution against this is ergonomic awareness and training. This is the article’s primary concern and purpose: the degree of ergonomics awareness among nurses and the extent to which ergonomics principles are implemented in nurses’ use of computers. In addressing this concern and in an effort to satisfy their articulated purpose, the authors apply a “descriptive and empirical approach” (12). The choice of methodology allowed the researchers to fulfil the research’s purpose through the collection of primary data designed to evaluate nurses’ awareness of computer ergonomics and the extent of their implementation of ergonomics principles in their use of computers. It is within the context of the stated that the methodology is well-suited to the research’s approach. 3 Critique Having outlined the article’s rationale and presented its methodology, this section of the critique will critically analyze the research from multiple perspectives. 3.1 Problem definition Sawyer and Penman (2007) quite clearly define their study’s problems and clarify its importance. As they explain, the nursing profession is a stressful one and has the potential to exert a physical as well as psychological toll on practitioners. The introduction of computers into the profession has significantly contributed to the facilitation of an entire array of complex nursing tasks and, more importantly, to greater efficiency. Nevertheless, constructive exploitation of this technology is dependant upon proper training. More importantly, if computers are not to emerge as another source of physical stress, nurses must receive the requisite ergonomics training and, at the very least, have ergonomics=awareness. Indeed, the avoidance of physical injuries related to computer use is predicated on the receipt of ergonomics training. The problem lies in that there is a tendency to ignore this particular imperative. 3.2 Literature review Sawyer and Penman (2007) do not include a literature review section in their article. The closest they come to any semblance of a literature review is in their “Background” section where they analyze a handful of scholarly research on ergonomics, ergonomics awareness in Australia and the importance of ergonomics to nursing practitioners within the parameters of a computerised work environment. While the literature on computer-ergonomics within the nursing profession is sparse, a review of academic databases such as CINHAL, Emerald Insight and EBSCOhost indicates that some articles have been published on the topic. Furthermore, were one to break down the topic to computer use in nursing and computer ergonomic principles, one uncovers a wealth of literature on the topic. Sawyer and Penman (2007) largely ignore this literature. This oversight somewhat detracts from the value of their article as understanding the importance of ergonomics training in relation to nurses’ computer use is predicated on an appreciation of the proliferation of computerization across the profession. Indeed, the integration of computer technology into the profession is precisely that which places nurses at the risk of musculoskeletal injures and physiological and psychological stress and makes ergonomics training very important. The following paragraphs will review the literature on computer use in the profession for the purposes of fortifying the argument pertaining to the imperatives of ergonomics training for nurses. Nurses are morally and ethically obliged to practice and provide nursing care based on current and up-to-date information (Pravikoff, Tanner, & Pierce, 2005; Richards, 2001; Seifert, 2002). Information is a critical resource which is essential to support nursing practice, patient care, and clinical decision making (Barr, 2002), and is also essential for nurses professional development (Morris-Docker, Tod, Harrison, Wolstenholme, & Black, 2004). Evidence-based nursing practice is the integration of the best clinical information and evidence currently available into nursing practice (Gosling, Westbrook, & Spencer, 2004; Pravikoff & Donaldson, 2001; Pravikoff et al., 2005). Bakken, Cimino, and Hripcsak (2004) noted that computers can serve to improve information access. The Internet provides an opportunity for all nurses to have access to a wide range of research evidence, and is recognized as a potentially beneficial way of accessing evidence (Gosling et al., 2004; Morris-Docker et al., 2004). The Internet is used as a tool for the dissemination of information (Estabrooks et al., 2003). Saba (2001) observed that the Internet has progressed to be a powerful medium for sharing information. The Internet can support the delivery of high quality, clinically effective, and evidence-based nursing care (Harrison, Morris-Docker, & Tod, 2000). One research study revealed that 72% of nurses that gathered information online integrated the retrieved information into their practice (Estabrooks et al., 2003). Estabrooks, et al. noted that the Internet, while only one source of practical knowledge, is becoming an increasingly important one. Gosling, et al. (2004) found that when nurses seek out computer information systems, they most frequently use it to fill a knowledge gap and for personal education. Pravikoff, et al. (2005) found that 61% of nurses in their study seek out information for patient care at least once a day or several times per week. Estabrooks, et al. (2003) noted that the nurse is twice as likely to use the Internet for general information as for practice-related information. Estabrooks, et al. (2003) revealed that there is a delay in acceptance of computers by nurses. As a group, nurses are not well educated in computer technology. Estabrooks, et al. (2003) reviewed literature and found that most nurses practice what they learned in nursing school, and through practice experiences. Pravikoff, et al. (2005) found in their large study that 79% of nurses were over 40 years of age and 70% of nurses graduated before 1990 when computers and Internet were not well integrated into practice. Nurses access to the Internet is limited. Estabrooks, et al. (2003) study found that 58% of nurses had access to the Internet at work, but only 45% used it. Only 5.1% of nurses used it for practice information while at work. Literature reviewed by Estabrooks, et al. claimed that having Internet on site encourages practitioners to seek information as it is needed. However, Estabrooks, et al. found that just having the Internet resource available was not sufficient for nurses to seek out information. Bakken, et al. (2004) noted that errors have been associated with impaired access to information, suggesting that increasing access to information could increase patient safety and increase the quality of patient care. Richards (2001) noted that computers can speed up the flow of information, as well as the ease and availability of information access. Beyea (2004) also acknowledged that computers can facilitate access to health information and improve patient care. Considering that nurses are obliged to provide nursing care based on current information, it is surprising that the Pravikoff, et al. (2005) study showed that 58% of nurses are not using research to support practice. Forty-six percent of nurses surveyed were not familiar with the term evidence-based practice, and 72% of the nurses said they had never evaluated research reports. Most nurses felt that one of the biggest barriers to accessing evidence, besides time constraints, was difficulty finding and understanding material (Pravikoff et al., 2005). The magnitude of information can create problems in determining the credibility, relevance, and accuracy of the information accessed. Harrison, et al. (2000) revealed that barriers to accessing information pose a threat to evidence-based clinical practice. The information explosion presents a significant challenge for nurses as they seek to integrate research evidence into practice (Gosling et al., 2004). Hall and Walton (2004) discussed information overload, noting that over 7 million pages of information is added to the Internet web daily. Estabrooks, et al. (2003) revealed that in order for information sources to be seen as valuable by nurses in the clinical setting, contextually relevant information needs to be accessed quickly and efficiently. The intranet is a network of interconnected computers that can operate within a hospital organization. The intranet is an internal use of the Internet, and can be tailored to the needs of the organization. The intranet can provide direct links to contextually relevant information for use by nurses in the clinical setting (Bakken et al., 2004). Brunges (2002) discussed the creation and use of an intranet website which can be created to have relevant information available for staff nurses. The website creates easy and timely access to clinically pertinent information in a continually changing health care system. It provides consistent information for all staff nurses, improves work flow, and the quality of patient care (Brunges, 2002). Most hospital settings have an intranet in place, thereby facilitating nurses’ access to updated patient information. As may have been deduced from the literature reviewed in the foregoing, computers are an integral part of the nursing profession and their utilization positively contributes to patient well-being and improved healthcare services. Nurses, therefore, use computers as part of their current job descriptions and, indeed, arguably rely upon them for information. It is, thus, that the imperatives of ergonomics training and the implementation of ergonomics principles in nurses’ use of computers cannot be overstated. 3.3 Research design Sawyer and Penman (2007) adhered to a quantitative data analysis approach and utilised a close-ended questionnaire strategy for data collection. Theirs was, as earlier noted, a descriptive and empirical research design. 3.4 Sampling The authors used purposive sampling. The sample was derived from registered nurses at several healthcare facilities in a single regional city. The authors compiled a list of the registered nurses in this facilities, and found that there were 174 nurses. The authors approach the facilities regarding participation in the study and following the receipt of approval, 140 questionnaires were distributed. The response rate, however, was very low, standing at 37%. This means that of the 174 registered nurses in the city, only 52 participated in the study. This calls the conclusions arrived at by the authors into question and, at the very least limit their applicability and possibilities of generalization. 3.5 Data collection strategies The authors utilised a questionnaire approach to data collection. The instrument utilised for this study was based on one which had been earlier developed by sawyer and refined and validated through prior use. Apart from demographic data, the questionnaire collected information on ergonomics awareness, the extent of computer training received by nurses, if any, organisational policies on ergonomics and perceptions of the importance of ergonomics principles and their implementation. The questionnaire is appropriate to the purposes of the study and examines awareness and implementation of ergonomics principles from both organisational and individual employee perspectives. 3.6 Data analysis strategies As Sawyer and Penman (2007) employed a quantitative data collection strategy, they employed a quantitative data analysis approach. Questionnaire responses were coded and entered into SPSS. As the authors state, “descriptive and frequency analyses were performed for all variables. Data analysis consisted of physically sorting the data into files and tables, coding and analysing the organised data” (13). This strategy is well-suited to the purposes of the research which are limited to uncovering and evaluating nurses’ awareness of ergonomics principles and the extent to which they implement these principles in their on-the-job computer use. 4 Findings, conclusions, recommendations The authors found that, despite the proliferation of computers in the nursing profession and in spite of participants’ admission of reliance upon computers in their execution of their professional responsibilities, almost 80% had received no computer training and had very little, if any, awareness of ergonomic principles. The majority of participants quite clearly stated that their organization did not offer ergonomics education and training and, indeed, that they believed that it did not have an ergonomics policy in place. These findings lead to the conclusion that there is very little ergonomics awareness among nursing practitioners and, therefore, no implementation of ergonomics principles. Given that, as Sawyer and Penman (2007) emphasise, computers are here to stay and their importance to the profession is only likely to increase, they recommend the adoption of ergonomics policies and the introduction of ergonomics training and awareness sessions. These conclusions and recommendations are well informed but their generalizability is questionable considering the size of the sample upon which they are based. 5 Bibliography Axford, R., & Carter, B. (1996). Impact of clinical information systems on nursing practice: Nurses perspective. Computers in Nursing, 14(3), 156-163. Bakken, S., Cimino, J., & Hripcsak, G. (2004). Promoting patient safety and enabling evidence-based practice through informatics. Medical Care, 42(2), 1149-1156. Barr, B. (2002). Managing change during an information systems transition. AORN, 75(6), 1085-1088, 1090-1092. Beyea, S. (2004). Internet use in the OR- Is it safe? AORN, 80(5), 935-938. Brunges, M. (2002). 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