Digital working is changing nursing.

Abstract

Digital working that is personand family/carercentred in nursing cannot be implemented without the information infrastructure set out in the Informing Healthcare Strategy (Mann, 2005). In fact, all four UK countries’ strategies for health offer nursing the means to demonstrate its contribution to ‘Substantial and detailed evidence... to illustrate what nurses, midwives and health visitors are able to achieve’ (Clark, 2006). But is nursing prepared for digital working and are we going to embrace this opportunity to push forward nursing informatics? While there are immediate practical challenges, such as the lack of accessibility to appropriate hardware and lack of training in basic computer skills (Royal College of Nursing (RCN), 2006), the much more important challenge lies in how we, as nurses, redesign the way we work and think about nursing and digital working in 21st century healthcare. All healthcare delivery involves the use of information. In the 21st century, digital working is the means by which information is accessed, used and shared. The NHS has been much slower than other organisations to integrate the use of digital working, and UK nursing has been much slower than nursing in some other countries in recognising the significance of information management and clinical decision-making in nursing practice (Clark, 2003; Casey, 2006). However, in all four UK countries, ‘ehealth and care’ is seen as the primary means of achieving ‘modernisation’. It is already affecting all aspects of health and social care delivery, and is rapidly accelerating. Although the Electronic Health Record (EHR) is the core of all the ehealth and care strategies, digital working in health and care includes much more—the term ‘ehealth’ refers to the whole scope of digital working, which must become a core competency for nursing practice in all fields and at all levels, and is a significant element of all ‘new nursing roles’. The eHealth and Care Strategies across the four UK countries offer patients, nurses and nurse leaders a fantastic opportunity. If properly implemented, the nursing-related aspects of the programme will enable frontline nurses to provide more consistent, evidencebased and well-communicated care. All the ehealth and care strategies set out a principle that the secondary analysis of data will also improve clinical governance and will enable nurse leaders, educators and researchers to evaluate care and plan for the future. However, the evidence (RCN, 2006) shows that, although nurses see the potential benefits for both service users and service providers, they are not yet able to integrate digital working into their routine practice. Many nurses still see digital working as a technical ‘addon’ to their practice, rather than as an integral part of it, and as a matter of concern primarily for informatics specialists rather than nurses. Rory Farrelly Director of Nursing & Patient Experience, Abertawe Bro Morgannwg University Health Board, Swansea The implementation of a health and care information system has the potential to improve clinical practice and both personand family/carer-centred care. Some parts of the system, however, have had extremely negative consequences on nursing practice and therefore on nursing care, at least in the short term. From a clinical perspective, poorly planned and under-led systems can reduce nursing to a list of tasks generated by a care pathway, which diminishes nursing and gives rise to unsafe, unthinking nursing practice, creating a major clinical-governance issue. A major risk of introducing digital working without understanding the significance of the underlying knowledge structure is what has been called ‘tick-box nursing’—the tendency of nurses simply to complete the screens with which they are presented without using the core skill of clinical judgement. This can already be seen in the trend to delegate computerassisted recording of vital signs to health care support workers (HCSWs). If, as the RCN (2003) definition suggests, the core of nursing practice is clinical decision-making, it follows that skills in critical thinking and decisionmaking are essential, especially in the ‘Designed for life’ vision (RCN, 2003) of a ‘workforce required to support the changes’ and which ‘requires a new culture in which to work’. These skills are critical to information management as well as to the development of ‘new roles’, but decision-making in particular is rarely explicitly taught in pre-registration nursing programmes. This is a particular challenge to nurse educators, but even their best efforts will fail unless ward-based practice changes in parallel. Across the four UK countries, nurses’ involvement in the planning and implementation of the relevant eHealth and Care Strategies is essential for us to ensure that digital working is appropriate for personand family/carer-centred care. As nurses, we must continue to deliver digital working. This means keeping up to speed with new or recent developments and research in nursing informatics, clinical decision-making, standardised terminology for nursing, nursing diagnosis, and the standardised assessment tools that are already being incorporated into the EHR system throughout the UK. BJN