The Digital Revolution

Caring with computers

Data played a crucial role in nursing long before computers. Florence Nightingale was a pioneering data scientist. She used statistics to show the impact of disease on the British Army in the Crimean War and the urgent need to improve hospital conditions. In 1858, she was the first woman elected to the Royal Statistical Society.

There were ethical challenges in data gathering and analysis. Nightingale was not alone in a desire to use statistics to solve social problems. She wrote to numerous scientists, including Francis Galton, for advice. Galton notoriously coined the term ‘eugenics’, a practice which aimed to improve society by deciding who ‘should’ (and ‘should not’) have children.

Early automated data analysis was carried out using punched cards, first introduced for the 1890 US Census. By the 1950s, punched card technology was being used to explore a range of subjects in nursing from psychometric testing to pain responses. 

For decades, digital and paper records continued side by side. When the RCN began computerising membership records in 1967, there were teething problems. In the NHS, the process was much slower, and many hospitals did not begin to go digital until 2002.

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Computer-Assisted Learning

Computer-Assisted Learning (CAL) first emerged in the 1960s. In the early 1980s, Sue Norman became one of the first British nurses to explore the benefits this could bring to nurse training. She conducted a ground-breaking study into the use of computers to teach drug administration and co-founded England’s first national network for computer-based nurse education.

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From the star trek unit to virtual wards

The impact of technological advances on nursing has been starkly visible in intensive care. The earliest units in the 1950s and 60s – with their innovative but imposing ventilators, cardiac monitoring equipment and kidney dialysis machines – were futuristic and alien places in the popular imagination.

Initially, doctors instructed nurses in using this cutting-edge equipment. But specialist nurses soon became experts in operating the machinery required to monitor and care for critically ill patients. At the same time, intensive care nurses were expected to ‘humanise’ these technical environments.

Contemporary critical care nurses cover a wide range of specialisms and are experts in using highly technical and life-saving equipment – from perfusionist nurses operating heart-lung machines to renal nurses in kidney dialysis to transplant coordinators caring for patients before and after organ transplant. Yet today, as in the past, technology can only ever be as good as the caring professionals who are using it – combining high-tech care with human touch.

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Hospitals at home

Advanced technology doesn’t just save lives in hospitals. Many of us use Fitbits or smartphones to monitor our steps, heart rate or sleep. Increasingly, the health care sector has recognised the potential of these remote monitoring devices. Nursing staff can oversee ‘virtual wards’, caring for patients who track their own vital signs via wearables or smartphone apps. However, there is a digital divide in the UK, and not everyone has the necessary tools or support. Nursing staff can play a role in digital inclusion, helping patients to monitor health conditions at home.

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Nursing: An Artificial Future?

In recent years digital changes have accelerated and intensified, with a considerable impact on the range and complexity of tools nurses are expected to use. From the introduction of computer-based Clinical Decision Support Systems in the 1950s, nursing staff in education and practice must now navigate VR simulations, artificial intelligence and even robotics.

In the USA and Japan, it is common to see robots on hospital wards and in care homes. During Covid-19, robots were used to carry out repetitive tasks like disinfection and are still used for deliveries and other purposes. The UK has been slower to incorporate robotics into nursing, which is why investigations like the project undertaken by Heriot-Watt and Edinburgh Napier Universities are key to moving forward.

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Tackling digital anxiety

One challenge has been ensuring that nurses are confident enough to use new equipment to deliver the best patient care. Digital literacy is vital, not only for nurses to do their own jobs, but increasingly to assist patients with managing care plans and preparing their own digital assets after death.

Digital transformation can be an asset to nursing. Yet it is essential to ensure that nurses are comfortable using new technologies whilst maintaining the holistic approach necessary to deliver patient-centred care.

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Conclusion

Information technology has become more and more entwined with nursing over the last seventy years. From everyday aids to lifesaving gadgets, technology has improved efficiency, opened up new communication channels and transformed education, research and critical and community care.

But, of course, this is only part of the story. Bias, exclusion and error have been present from the data gathering of the nineteenth century to artificial intelligence today. Digital nurses of the twenty-first century must be open and critical, understanding how new technology can support their role, but why human knowledge and nuance remain vital to our future health.

Will tomorrow’s nurse be a robot carer or an AI chatbot? This seems no more likely now than it did in 1960s science fiction. Caring is a uniquely human practice and, whatever new aids are added to the nursing toolkit, the nurse remains the interpreter and expert analyst.

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