High tech, low touch.

[Cateran]

I am a respiratory patient for the most part when I make use of the NHS, be it with my GP surgery or through various clinics at my local hospital, I freely confess to being a fan of health care technology. To my way of thinking medical machinery and devices enhance my health, be they inhalers or be they scanners.

Now for the provocative bit. Many of you may disagree strongly with me when I say that nurses and what they do take second place to the medical machine. The nursing contact in a hospital, or even in a clinic or GP surgery, the low touch so to speak of my binary title above, is more and more being overtaken and edged aside by technology.

Pharmaceutical solutions to poor health are the norm. It is the research scientist in hospitals and laboratories who are our saviours, by developing the better drugs which can make the difference. When we think about it, even the care which we provide to ourselves or a loved one are for the most part personal work of the home and house patient, ensuring the necessary delivery of the pill regime or the monitoring of minor low tech instruments such as oxygen machines.

Controversially perhaps I would say that patient-centred care is effectively attending to the efficient delivery of medical machinery, that is, that the technology is kept working. The function of a nurse is to nurse the machine more than the patient. Have I said enough?

[Hidden]

We had this discussion a couple of days ago didn’t we. Started by yourself. Some interesting responses.

[skischool]

I take it you have never nursed somebody at home with crippling disabilities and or cognitive deficiencies,Carers are not pill disposing machines adding a personal touch and smiling whilst doing the housework?

Family carers need to constantly judge and try to respond to both the physical and mental needs of their loved ones and charges,often having to research their conditions to gain knowledge to ensure they are being given the correct treatment in a timely manner in a very challenging environment and with little or no support.No amount of machinery is ever going to replace that human touch.

Yes i champion the use of technology in overcoming health problems and without it and the use of artificial intelligence in diagnostics in the future we will most definitely struggle and hopefully its introduction will free up time for our precious Nhs resource to have a more humane and personal approach to our needs rather than just watch what will hopefully be self maintaining machines.

We have probably both said enough.

[Hidden in reply to skischool]

It’s a combination of the two which should improve patient diagnosis, treatment and outcomes isn’t it. For instance I love my new hi tech nebuliser which has made a dramatic difference to the delivery of drugs deep into my lungs and I am so thankful for the scanner which aided a physiologist in removing fluid from an empyema by needle rather than inserting the dreaded tubing.

However, it is when these tecnologies are used to form a barrier between the patient and the nurse or doctor who do not wish to relate on a personal basis to the patient that I become concerned and angry.

Family carers are a whole different topic. They are probably the only true source of continuous, personal and attentive care available to the very sick at home. Yet they are left with almost no support, practically or financially and precious little acknowledgment of how much they contribute.

[mikeadams51]

Whilst medication and technology is vital without nurses and doctors our lives would be cut short. There is not a machine yet that can tell you have a problem just by looking at you. Doctors and nurses can

[Cateran in reply to mikeadams51]

Well Mike, perhaps not quite by simply looking at the patient but by gauging a diagnosis and then conferring with a screen to validate that diagnosis. As littlepom and skischool both seem to acknowledge there is a shared space between nursing in its many forms and health care technology.

I did preface my remarks by a guess that what I had to say would be provocative but all three of you have been very kind to me and stated the obvious especially about personal nursing. I have been an attender to palliative care with my mother-in-law but within the cocoon of a nursing home, which rather brings out the comment that skischool makes about different important aspects of nursing when supervised and regulated. Little pom also touches upon the domestic situation of nursing care in a sensitive insight into its particular value.

I am grateful for these comments from you three, as you each have given me more to think about.

[mikeadams51 in reply to Cateran]

Whilst I am fully supportive of the nursing profession I cannot see why we went from State Registered Nurses and State Enrolled Nurse to just SRN. In my opinion degrees do not equate to more knowledge or common sense and many of the nurses jobs are really just personal care for the lot of the time. More ways for universities to make money. My views might be controversial as well

[skischool]

With regard to technology in a medical environment i have often observed nursing staff totally unable to grasp the concept of gravity,positioning bedside equipment in such a fashion as to make the delivery of medications impossible,that is those that have been fortunate enough to find a doctor trained in inserting a Cannula without the destruction of the patients veins in the process.

On the subject of I.T given the millions the Nhs or more likely government imposed contracts have squandered on systems not fit for purpose i rest my case.

Mind you i did enjoy that little rant.

[judes]

MikeAdams51 oh how much I agree with you, nursing is not a degree level qualification and students only seem to be at uni part time and placements don’t seem to last that long.

Having been in hosp a lot over the past year some nurses knowledge and practise is really poor.

I may be old fashioned but I feel the training I went through in the 70’s was much better. Many of my friends agree with me.

J

[Cateran]

It seems to me that these further observations about nursing and professional competence and regulatory standards, as well as the piecemeal introduction of HCT underline the pragmatic approach to the topic I raised. Technology in itself is a process of trial and error and some clumsy applications in real time. Many errors and expensive waste of machine development in the hospital as well as harmful adaptations to patient care. But surely the lessons to be learned are that HCT can make us less dependent on professional incompetence and lack of training of doctors and nurses. Medical science has a decisive impact on our well-being as a species. We look to gain from technology per se in the ward and the GP surgery; machines ought to be idiot proof and enhance our experience as illness and ageing affect us. HCT and its continuous application is the goal of better medicine . It might be that the human element is a variable factor in this paradigm.

[Ribbon2079]

Sadly, my experiences in the hospital have found that to be true. The caring of SOME nurses these days is robotic and non specific. You can tell in 2 minutes which nurses are only there to keep the equipment working and which ones will care how you are feeling and adjust the equipment accordingly to help. The sad part is when you have to argue with a nurse during a breathing crisis (at the beginning of your stay because you are still in emergency mode with whatever is happening to you therefore the reason why you are there) because the books she has read say one thing...while you feel you could be taking your last breath!!! I've been told it was too early to give me another breathing treatment as my throat was closing and that if I past out they had the equipment to resuscitate me. Just what I hope to hear in my panic with an asthma/COPD episode and instead of having a second breathing treatment an hour too soon....I'm comforted to know that I will need to try to stay calm for the next hour until my official time while it becomes harder and harder to breathe....but take comfort in the fact that the nurse said they are ready to beat on my chest and intubate me if necessary. Sorry....I had a bad experience with a nurse and hope I never run into her on a hospital stay again. This time I will have a meeting to have her removed immediately or I will pack my things and take a cab home. Unfortunately, I now wait at home until the last minute when in crisis to go because I actually feel safer home with my own nebulizer where I can have a second treatment if need be. Sorry....this is not typical and I certainly don't want to scare anyone or have anyone follow my madness!!! I did have a really bad experience and it has left a bad impression upon me but certainly is not the norm and the next time I will insist on speaking to someone until I get help or I will pack my bags and leave right after I finally have the treatment and can breathe again. (Then I will write to the Board of Directors!) Be proactive for yourself as soon as your emergency is over. If you don't fight for yourself...no one else will. That one episode in the hospital was the only one I had like that. I was able to follow their protocol after as the steroids and antibiotics got into my system. I don't know why I was made to suffer that way as I have had respiratory therapists give me two treatments back to back as well. There was no reason other than the nurse was enjoying her power.

[Cateran]

What you describe Ribbon is appalling. "robotic and non-specific" is the phrase which sticks in my memory. I too have experienced such inhumane and definitely not person-centred nursing. I share your wish to escape from any repetition of this kind of unthinking rigidity in the application of HCT, to flee the hospital asap. The trouble is that hospitals serve to make patients that are timid and subservient to the institution and do not complain. The health managers and their minions are skilled at making you feel guilty if you do complain or criticise. This kind of process in unhealthy for the patient, perhaps a feature of institutional behaviour, perhaps also a denial of human rights (and dignity).

We can only hope that hospitals evolve into a better form of care that mergers HCT with the humanistic approach, not a hoministic model wherein the patient is nothing but an object merged with a machine monitoring the body. Nurses become technicians little interested in the living, breathing body ( ironic when you described that you could not "breathe" easily during the episode that you describe). Generic care seems to be what you experienced.