|Year : 2020 | Volume
| Issue : 2 | Page : 127-131
Nurses' perception on technology advancement in intensive care
Sudha Regmi, John Varghese Thekkekara
Department of Masters in Hospital Administration (MHA), St John's Medical College, Rajiv Gandhi University, Bengaluru, Karnataka, India
|Date of Submission||18-Oct-2019|
|Date of Decision||05-Nov-2019|
|Date of Acceptance||28-Dec-2019|
|Date of Web Publication||9-Apr-2020|
Department of Hospital Administration, St Johns Medical College, Sarjapur Road, Bengaluru . 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: Fast changing technology applications in intensive care units (ICUs) are believed to enhance the result of nursing care. We expect the nurses to work with constantly updated technology and presume that they are receptive to any revised version of medical devices. The nurse's perception on technology is infrequently discussed in hospitals or among medical device manufacturers.
AIMS: The aim of this study was to assess the nurses' perception about the advancement of technology in ICUs.
SETTINGS: The study was conducted among the nurses working in different ICUs in a selected tertiary care hospital in Bengaluru, India.
MATERIALS AND METHODS: An exploratory study was done using a hybrid method of qualitative and quantitative techniques. Semi-structured interviews were conducted with nurses having ≥5 years of experience in ICUs, and thematic analysis was applied. Quantitative data were collected from the population of nurses with 1 year or more experience using survey questionnaire.
STATISTIACAL ANALYSIS USED: ANOVA test and sample t-test were conducted on the applicable parameter.
RESULTS: Most of the nurses found that high-tech equipment in ICUs is easy to operate, reduce their effort, prevent errors, and increase the comfort of the patient. The study found that nurses' perception about the advancement of technology does not vary according to age, experience, qualification, and whether they have attended any continued nursing education on technology applications. Statistically significant relationship was found between total perception and the nature of ICU in which the nurses work.
CONCLUSIONS: The study found that nurses perceive advanced technology in ICU as beneficial. Nurses expressed their satisfaction about the advancement of technology, and they perceive it as a good learning opportunity for them. The participants expressed their need for more training when equipment with advanced technology or a revised version is brought in.
Keywords: Health-care technology, intensive care unit, nurses' perception
|How to cite this article:|
Regmi S, Thekkekara JV. Nurses' perception on technology advancement in intensive care. Int J Health Allied Sci 2020;9:127-31
|How to cite this URL:|
Regmi S, Thekkekara JV. Nurses' perception on technology advancement in intensive care. Int J Health Allied Sci [serial online] 2020 [cited 2020 May 30];9:127-31. Available from: http://www.ijhas.in/text.asp?2020/9/2/127/282144
| Introduction|| |
The beginning of intensive care medicine may be traced back to 1950s when polio epidemic broke out, and specialized intensive care was required to treat and care for affected people. Since then huge improvements have been made in terms of technological advances in the area of intensive care. Simple or hand ventilation saved the life of many in those days. We have at present mechanical ventilators which are much smaller, portable, and very user-friendly.
Intensive care medicine as a specialty has developed very slowly and emerged as a highly significant one very recently in India as compared to most other developing nations.
The first coronary care unit in India was started in 1968 at the King Edward VII Memorial Hospital, Mumbai. This unit was followed by another private hospital in the same metropolis, and later in different large private hospitals and further across many cities in the nation. Critical care units in the early 1970s were designed and equipped chiefly to offer intensive care to patients with acute myocardial infarction and other manifestations of ischemic heart disease. The care in Indian intensive care units (ICUs) at present has evolved from cardiac to multisystem diseases.
The modus operandi of critical care has also shifted somewhat, with patient management becoming less invasive, less interventional, and more comfortable for patients. Although the implementation of new technology in ICUs directly affects the work performance of the nurses, quality of patient care, patient satisfaction, and health-care outcome, no evidence suggests that studies have been conducted to understand nurses' perception toward advanced technology usage in ICU. This study is an attempt to fill this void as it would be useful for the management to appropriately plan for technology adoption and updating.
| Materials and Methods|| |
Exploratory research design was used for this study with a hybrid method of both qualitative interviews and quantitative survey techniques. Triangulation of the findings of both the methods was done postanalysis.
Setting of the study
The study was conducted among the nurses working in different ICUs, namely pediatric, medical, surgical, neurological, CTV, and coronary ICU in a selected tertiary level hospital located in Bengaluru, India.
Duration of the study
The study period was from November 2018 to March 2019. The advanced equipment in the present year was considered for the study.
Selection of participants
All 65 individuals forming the population of nurses with ≥1 year of experience was selected for the quantitative study. For the qualitative study, 12 nurses from the population, with ≥5 years of ICU experience in the same hospital were selected by stratified random sampling.
Methods of measurement
Quantitative data include demographic details; experience in the selected hospital; participation in continued nursing education (CNE); and questions on three types of devices such as monitoring (monitors, digital thermometer, electrocardiogram machine, and central monitoring system), therapeutic (ventilators, infusion pump, syringe pump, Bipap machine, defibrillator, Bair Hugger, and high-flow nasal cannula), and comfort devices (automatic beds), which were installed at least 3 years before the data collection. The parameters for the assessment of quantitative study were done using a 5-point Likert rating scale: ease to operate, reduction of effort, time consumption, reduction of errors, ensuring safety and comfort, and training requirement. The above variables are considered as the parameters contributing to “total perception” and the sum of the scores of those variables is considered as the score for total perception in the present study.
The interviews for the qualitative data were structured on the key variables consisting of five structured questions such as nurses' experiences about advancement in medical technology, differences between the equipment used at the beginning of their career and now, benefits of technology advancement, difficulties faced when new equipment are brought in, views regarding the loss of human touch in caregiving, and suggestions to increase nurse's efficiency. Interview themes were formulated based on manual coding.
Data collection and processing
Quantitative data were collected from a sample of 65 nurses using survey questionnaire. The questionnaires were distributed among the nurses with ≥1 year of experience and collected back at the end of every shift. The data were recorded and processed using Microsoft Excel. The qualitative data were collected by interviewing 12 nurses with ≥5 years of ICU experience. Consent was taken first from the nurses for the interview. The spoken words were recorded in an article with permission and at the end of the interview; the written reports were shared with the nurses and got signed. The interviews were conducted until the data saturation was achieved and was coded using manual coding followed by thematic analysis.
To reduce the bias in the study, the data were presented to a panel of experts for verification and content examination. Opinion was recorded based on structured questionnaire to reduce interviewer bias. Misclassification bias was reduced by taking samples from well-delineated strata.
Statistical methods used
The quantitative study was statistically analyzed using the ANOVA test and sample t-test.
Ethical guidelines followed by the investigators
Ethical clearance for the study was obtained from the institutional ethical committee.
| Results|| |
The demographic characteristics of the participants taken for the quantitative study (which includes the interviewees of qualitative study) are shown in [Table 1]. About 92.3% of the nurses were in the age <33 years. About 73.9% of them were graduate nurses, including postbasic B. Sc. About 72.3% of them had ≥1 year of experience in the present hospital, and 78% of them had ≥1-year experience with their previous employer. 55.4% of the nurses had attended training as a part of CNE for equipment handling.
The significance of the relationship of “total perception” (dependent variable) was statistically tested with five independent variables, namely the nature of ICUs where the nurses work at present, age of the respondents, their educational qualification, experience, and CNE attended (independent variables). ANOVA test was conducted on total perception and the nature of ICU in which the staff nurses work. The value of P = 0.002 is statistically significant at 5% level. It indicates that the nature of ICU, in which the nurses work, has a relationship with the nurses' total perception regarding technology advancement. The nurses from PICU and SICU have more positive perceptions, whereas the nurse from NICU has a weak positive perception.
ANOVA conducted on total perception and age revealed that there exists no relationship between total perception and age (P = 0.469). ANOVA conducted on total perception and experience showed no significant relationship between total perception and experience (P = 0.955). ANOVA test conducted on total perception, and educational qualification revealed that no relationship exists between total perception and qualification (P = 0.306).
Two-sample t-test was conducted on total perception, and CNE attended shows that there exists no significant relationship between total perception and CNE attended (P = 0.291).
It was found that advanced technology used in the ICU is easy to operate, reduces the effort of nurses, consumes less time, and increases the safety of patients; but requires more training for the nurses to handle them.
The qualitative interviews were transcribed, and the thematic analysis of the transcripts showed six emerging themes. They are explained below:
The nurses found advancement in technology as more beneficial than the old equipment and described it as a good experience in general. The frequent response was “technology advancement helps to upgrade knowledge and skills with the change,” “enhances learning for us,” and “makes aware of the new trends and advancement while working with advanced technology.”
The response was “it saves a lot of time,” or “the procedure time is shortened with the advanced technology, so I could provide more time to the patient and immediate care for the patient.” The responses showed that through advancement nurses can save a lot of time since the procedures can be done in a short period.
Reduction of effort
The use of advanced equipment in nursing services reduces the workload of nursing staff, according to the interviewees of this study. Most of them said that “portability of the advanced equipment as well as the comfort devices like automatic beds reduces physical stress as well as mental stress of nurses” and “reduces our physical exertion in patient care.”
Benefit to patient
According to the nurses interviewed in ICUs, the use of new technology is beneficial to patients too. Advancement in technology helps in improving patient safety. One of the senior nurses who had worked with manually operated beds opined that automatic beds help the patient to be a participant in assuring his/her safety through controls of beds operated by themselves.
Ease of handling
“Ease” was another theme most repeatedly found in the responses. Their perceptions of advanced medical technology were expressed in synonymous forms such as “easy to use,” “easy to move,” “easy to monitor,” and “easy to train” the staff.
Nurses found that technology advancement is not leading to difficulty in handling the equipment. In the words of one of the participants, the little difficulty in using advanced equipment in the initial phase can be overcome with orientation training and quick clarification from biomedical engineers, making advanced equipment easy to handle. Nurses also suggested that whenever a new equipment is installed or a revised version of the existing one is brought to the workplace, adequate training by skilled biomedical engineers would be beneficial for them.
No loss of human touch
The responses provided by many of the participants inferred that there is “no loss of human touch by the application of advanced technology.” Staff involved in bedside care requires little time with the equipment and hence have more time available to provide the patient care ensuring “no loss of human touch” in patient care.”
| Discussion|| |
A study done on the South West of Iran revealed younger, less qualified nurses had a more negative attitude regarding the influence of technology. Most of the negative attitudes toward the influence of technology on nursing care could be attributed to a lack of knowledge. According to Alasad, nurses with higher experience focused their attention more on the patient rather than the machines. However, our study in the Indian context found that age, educational background, and experience do not impact the perception of nurses about advancement in technology used in ICUs.
In concurrence with another Iranian study, the participants of our study also strongly believed that advanced technology facilitates and enhances patient care and helps nurses to control their work environment. The nurses were comfortable with technology and perceived technology as a useful aid for their nursing care.
In the study that was done by Noh et al. in Korea, nurses believed that handling technology requires considerable skill, so researchers concluded that the nurses in their study were uncomfortable with technology. In our study as well, the nurses believed that high technology needs high skills to handle.
A study done in critical care units of Main University Hospital in Alexandria concludes that technology ensures safety because it provides them with accurate information about patients and helps in controlling treatment. These results are supported by Kiekkas et al. and Wikström et al., where nurses who are working in critical care areas of Greece identified the equipment to have positive influence such as effectiveness, safer patient care, and direct attention on the patient care. Advanced technology saves the time of the nurses. Our study in the Indian context also is full agreement with these studies.
| Conclusions|| |
Based on the findings of the current study, it can be concluded that nurses perceive advanced technology in ICU as beneficial. Statistical analysis showed that there exists a significant relation between “total perception” and “the nature of ICU,” in which the participants worked and nurses from PICU and SICU have a more positive perceptions. Nurses expressed their satisfaction about the advancement of technology, and they perceive it as a good learning opportunity for them. The participants also expressed their need for more training when equipment with advanced technology or a revised version is brought in.
From this study, it was found that the nurses require adequate training when a new technology is introduced, or a revised version of the existing equipment is brought into. Skill training in the form of coaching or simulation on the operations of advanced ICU equipment can be helpful for new employees. Job instructional training may also be helpful for nurses to increase their efficiency in the workplace. Training analysis and evaluation program can be conducted periodically, and nurses can be encouraged to go for CNE. Future research studies can be done to understand the nursing perception of technology advancement.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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