by Katlin Dubravetz

Recall your last doctor appointment, whether it was for an annual check-up or a scheduled visit because you came down with the flu. You walk into the room with a nurse who is carrying a laptop. The nurse asks you how you are and what you are there for as he or she sits down in front of you, eyes focused on the computer screen. After some small talk, the nurse throws a series of questions at you, and speedily types away after every answer. You are no longer making eye contact with each other as you try to explain your symptoms and ask questions about them. The nurse will occasionally look away from the computer screen, but you still wonder if he or she truly cares about what you are saying. You notice that the nurse is in a hurry as he or she quickly closes the laptop and exits the room while reassuring you that the doctor will be in to see you soon. Is this all starting to sound familiar? Not every appointment is like this, but it may have a similar structure because just about every healthcare professional carries a laptop around with them today. Technology like this is extremely helpful in many ways if it is used correctly, but it can also give way to a dangerous future for healthcare. Technology has created a barrier in face-to-face communication and this poorly affects the medical field because it changes how patient care is administered and approached.

The decreased desire for face-to-face communication all began with the outbreak of innovative devices and new ways of interaction, such as texting on cell phones and communicating through social media websites. This redefined way of human connection has made everything more convenient, from online shopping to scheduling doctor appointments, but what comes along with this convenience is a new way of life. Overusing social media websites and text messages leads to a world where privacy is destroyed and we lose our sense of self. We forget the importance of face-to-face communication and lose the desire to do anything that technology can accomplish in a much smaller amount of time.

Sherry Turkle, a psychologist, spoke about this dilemma during a TED (Technology, Entertainment, and Design) conference. In her speech titled “Connected, but Alone,” Turkle explains that texting is replacing real time human interaction and redefining communication between humans. Turkle argues, “What I’m seeing is that people get so used to getting shortchanged out of real conversation, so used to getting by with less, that they’ve become almost willing to dispense with people all together” (Turkle, 2012). This decline in the desire for face-to-face communication takes a serious toll on relationships between people. We all want to stay in touch with old friends, but we are afraid to actually see them and have to communicate with them in person. We have lost trust that we can be there for one another. Turkle explains, “Across the generations I see that people can’t get enough of each other, if and only if they can have each other at a distance. In amounts they can control. I call it the Goldilocks effect. Not to close, not too far, but just right” (Turkle, 2012). We demonstrate Turkle’s “Goldilocks effect” through our text messages and posts on social media websites. We mediate what we want people to see and how we want people to hear us. We give up real friendships for virtual ones because they are more convenient and easier to control. We let technology take over, and lose our sense of self in the process.

As strange as it sounds, solitude is actually crucial for human connection. In his essay, “The End of Solitude,” William Deresiewicz, an author, essayist, and book critic, explains that it is important for each of us to make time to be alone. He believes that we must have time alone to understand who we really are, before we can understand others. Deresiewicz argues, “Today’s young people seem to feel that they can make themselves fully known to one another. They seem to lack a sense of their own depth, and of the value of keeping them hidden” (Deresiewicz, 2009, p.315). If we are constantly sharing every aspect of our lives online, we are helping technology destroy human communication. We are revealing every mediated detail about us online. We are not allowing our selves to become comfortable in our skins, so how can we be comfortable to communicate in person with others?

So what does all of this have to do with nurse and patient relationships? As it may seem obvious, communication plays a huge role in the medical field for physicians, nurses, pharmacists, technicians, therapists, administrators, and patients. Without communication, which involves speaking, listening, questioning, observing, and analyzing others, all consistency and helpfulness of the healthcare field would be lost. But there is a difference between communication and face-to-face communication. When we engage in direct interaction, we feel a sense a security and fulfillment. As we communicate face-to-face, we can express importance, strengthen our relationships, interpret facial reactions, and develop trust between one another. We cannot get these same feelings through reading text. Just as viewing a speech online is much less powerful and effective than it is to attend the speech in person, talking with healthcare professionals over the phone is much less understanding and empathetic than it is to talk with them in person. If there were any relationship that could not exist without face-to-face communication, it would be between nurses and their patients.

When we think about nurses, we think about trustworthy, compassionate, and understanding people. To obtain all of these qualities, a nurse must attend to each patient’s needs individually. Patients need to feel comfortable around their nurse because they are sharing personal information with them. People, in general, have to learn to like themselves before they can get into relationships with others. This is where the necessity for solitude comes into play. Emotional baggage is part of a person’s health, so everyone must be emotionally stable and comfortable in his or her own skin to be able to talk to others about personal, sensitive subjects. This is not only essential for patients, but it is especially important for nurses. Nurses have to put themself in the patient’s situation. They have to be confident about themself before a patient can trust them. Patients must also be able to trust and rely on their nurse to relay their personal information to other professionals, such as physicians, to improve and maintain their health. All of this proficient care is difficult without face-to-face communication between patients and nurses. How can we trust our nurses if they do not spend enough time to talk with us in person and make meaningful eye contact and sympathetic expressions? It is uncomfortable to be alone in a room with someone who we have never met before, let alone being in a room with someone who acts uninterested in our needs.

Nurses and patients may view healthcare technology differently, and this makes perfect sense. Nurses are becoming accustomed to the technological advances that help speed up their performance, while patients may have a hard time understanding this side of healthcare. A patient and a caregiver of her parents, Suzanna Dubravetz, explains her parent’s and her own doctor appointments as she sees them: unsympathetic. She suggests, “Technology is only as good as the people using it. Older people have a hard time understanding how everything works today. My parents want to have real conversations with their nurses and don’t know what the nurse is typing on the computer for” (S. Dubravetz, personal communication, March 30, 2013). While nurses may value the laptop they are using, their patients may not understand its importance. Patients rate their experience at the doctor’s office or hospital on how they were treated, not by the accuracy of their care. They do not understand if a nurse is performing their tests correctly, but they will recognize being treated correctly. Dubravetz explains, “I tell my nurses and my parent’s nurses when they do a good job because I have learned to appreciate it. When nurses are helping the people I care about, I expect them to do their best and pay attention to the patient’s needs. I wish I could say that was true for every case” (personal communication, March 30, 2013). It is unfortunate that patients feel lucky when they get a nurse that acts like they actually care about them. Patients should always be able to feel this way.

So, it is understandable why patients are only seeing a rushed nurse who stares at a laptop screen, just as it is easy to understand how much less stressful and more convenient technology has made a nurse’s career. Some nurses even believe that technology leads to more time with their patients. For example, in her academic journal article, Remote Access to Closer Care, Daloni Carlisle, a health journalist with a Bachelor’s of Science honors degree in chemistry, discusses how technology in the healthcare field give nurses more time to have face-to-face conversations with their patients, and explains that nurses want to continue using and improving technology for the benefit of nurses. Carlisle claims, “There are community nurses who have seen patients’ lives transformed by telehealth systems that allow them to monitor their own condition and send the results electronically for review by a health professional” (Carlisle, 2012). This means that telehealth systems remarkably innovates healthcare and eases a nurses’ jobs, so much that it is not required to see a nurse anymore because patients can assess themselves. What Carlisle fails to realize though, is that never meeting with a nurse in person is not the most effective presentation of care and may even be dangerous for the patient. A nurse cannot determine a patient’s emotional health through electronic results, and assessing a patient’s emotional state is crucial in determining their overall health.

There is no doubt that technology helps the healthcare field in many ways. With technology, patients are able to view their test and exam results online, machines can maintain and improve patient health, and electronic documentation makes it easier to access patient information and speeds up a nurse’s job. While all of these technological advances improve the healthcare field, they can also destroy nurse and patient interaction and face-to-face communication. The increase in electronic documentation is one technological advance that threatens nurse and patient relationships. A review of the many studies of quality in health care and medical outcomes research by Avedis Donabedian, a physician, was made. This review states, “As part of the American Recovery and Reinvestment Act (ARRA) of 2009, hospitals across the United States are expected to become meaningful users of electronic health records by 2014” (Kelley, Brandon, & Docherty, 2011, p. 154). Electronic documentation is becoming more popular for plenty of reasons, including saving time and money, but this is not always a good thing. The review also reports, “While these features of electronic nursing documentation are seen as time savers for nurses, they may alter the processes by which nurses assess and critically think about the patient status and care (Kelley, Brandon, & Docherty, 2011, p. 155). Electronic documentation may allow a nurse to dismiss their patient more quickly than usual since it speeds up a nurse’s process of acquiring and recording information. This is why nurses must learn to adapt to this new technology and prevent it from limiting their time with patients. They must be careful when using technology like this so that it does not get in the way of efficient care.

Technology in healthcare does not have to continue destroying communication. There are a few things that nurses can do to maintain effective relationships with their patients. As proposed in the academic article, Connected: Communication Skills for Nurses Using The Electronic Medical Record, there are a group of steps for nurses to take to obtain good communication with their patients, while also taking advantage of the Electronic Medical Record’s (EMR) benefits. The authors of this article, Laurence Baker, Sandra Reifsteck, and Ward Mann, are all former healthcare administrators, who name these steps, “connect, collaborate, and close.” Baker, Reifsteck, and Mann explain, “The connect step involves (a) greeting the patient, person-to-person, before turning to the EMR; (b) acknowledging patient’s companions, if present, and discussing confidentiality; (c) introducing the EMR/ERC to the patient; and (d) arranging the computer screen for patient viewing” (2003, p. 86). This step is critical in establishing a patient’s trust. If a patient was made aware of the EMR before the nurse uses it, the patient will feel more comfortable, rather than overlooked. The collaborative step is performing procedures that make the patient feel involved. The authors go on to explain, “The techniques of collaborate include making bridging statements that describe what one is doing on the computer, asking the patient’s permission to write notes during the visit, and referring to information in the EMR to let the patient know the nurse is aware of what is going on with his/her health care” (Baker, Reifsteck, & Mann, 2003, p. 87). This step helps the patient understand what the computer is there for and why the nurse is so concerned with it. If the nurse explains that he or she will be typing information into the EMR before they begin, the patient will know exactly what they are typing, and why. Lastly, the close step is where the nurse leaves the patient feeling like they have received effective and sympathetic care. The authors explain, “The steps for close are (a) telling the patient you are securing his/her EMR for his/her privacy, (b) reviewing the visit with the patient after you have finished with the computer, (c) informing the patient of the next steps at the end of the visit, and (d) saying goodbye, person-to-person” (Baker, Reifsteck, & Mann, 2003, p. 88). This final close between the nurse and patient will end the appointment on a good note. The patient can then feel that they have not only been accessed correctly, but also treated with compassionate care.

Technology has come a far way and has drastically changed the healthcare field for the better, while also creating many challenges for nurses and patients. Nurses must understand these challenges to provide efficient care in the future. Technology should be used as a helpful service instead of a way to speed everything up. Nurses are meant to take care of their patients, who should be considered a number one priority. Technology that helps nurses get things done more quickly is less important than a patient receiving compassionate and understanding care. It may be difficult for nurses to slow down and reconsider the way they use technology, but they could start by recognizing a patient’s needs as top priority. If nurses do not begin participating in methods like the “connect, collaborate, and close” steps, technology will continue to destroy face-to-face communication, and the future of healthcare will be very different. Personal relationships between people would not exist. Robots could begin replacing nurses, resulting in less healthcare positions and impersonal patient care. Now, recall your last doctor appointment again. Imagine being questioned about your health by a robot. Do we really want this?

References

Baker, L. H., Reifsteck, S. W., & Mann, W. R. (2003). Connected: Communication skills for nurses using the electronic medical record. Nursing Economic$, 21(2), 85.

Carlisle, D. (2012). Remote access to closer care. Nursing Standard, 26(29), 20-22.

Deresiewicz, W. (2009). The end of solitude. In M. Baurelin (Ed.) The digital divide: Arguments for and against Facebook, Google, texting, and the age of social networking. (pp. 307-317). New York, NY: The Penguin Group.

Dubravetz, S. Personal communication, March 30, 2013.

Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011). Electronic nursing documentation as a strategy to improve quality of patient care. Journal of nursing scholarship, 43(2), 154-162. doi:10.1111/j.1547-5069.2011.01397.x

Turkle, S. (2012). Connected, but alone? TED Talk. Retrieved March 4, 2013 from http://www.ted.com/talks/sherry_turkle_alone_together.html