Technology is increasingly becoming a crucial part of the day-to-day practice of a community nurse. Although the implementation of electronic systems in the UK is not standardised, so every practitioner has the same opportunities, there is a push to develop and use technology to support community nurses. Anecdotally, technology, especially mobile technology, is being used by community nurses for various purposes, including knowledge sharing, reporting and caseload planning.
Role of technology in community nursing
The Queen's Nursing Institute’ (QNI)'s (2018) publication ‘Nursing in the digital age’ presented a picture of the ways in which information and communication technology is being used in the provision of nursing care in the community. The report highlighted that there was significant diversity around the country, as well as a range of approaches to the implementation of information technology. Systems were not fit for purpose, as the financial cost of implementing information technology services was a significant barrier. This was due to potential IT savings being realised in the medium, or even long term, rather than in the short term or being immediate. Additionally, some community nurses expressed reluctance in embracing information technology when it was deemed inefficient and not fit-for-purpose (QNI, 2018). The different systems being used were incompatible; while many information-sharing protocols were being used, the systems could not be used to their full potential due to inter-operability issues, such as out-of-date hardware and software as well as operating systems that were not able to communicate with each other. Moreover, electronic systems were not always tailored to community nurses, with unsuitable and ineffective systems from other parts of the heath service used inappropriately. Systems were found to be prone to crashing and were often very slow, leading to frustration and compelling community nurses to work with paper. Finally, connectivity was reported to be a significant barrier, and systems failed to update and/or synchronise, and programmes used for recording information failed to load (QNI, 2018).
Nonetheless, it is apparent that technology has clear benefits, and, if used correctly and appropriately, it can yield a more personalised service to patients and ensure that patient concerns are addressed in a more timely manner, often without the patient needing to leave their residence. Overall, the digitalisation of the systems has tended to focus around the following areas, each of which is introduced and discussed in the present article:
Electronic patient records
Digital tools potentially offer opportunities to ensure that patients are directed to the most appropriate care for their needs within an optimised timeframe. This can happen in four ways (Castle-Clarke, 2016:18):
The ability to access the electronic patient record is potentially a considerable time saver, as it enables community nurses to avoid carrying hardcopy patient files with them. For the same reason, it also allows for increased security and a reduced risk of loss of personal data. A further advantage is that the records can be updated directly while the nurse is with the patient. This ensures accuracy and the ability to verify facts.
Telephone triage
Telephone triage saves time and money. Telephone calls allow the community nurse to determine the seriousness of the patient's problems and either advise, signpost, refer or visit the person as a result. A simple telephone call can enable a nurse to contact many patients in the time it might take to see just one. Furthermore, it enables the nurse to prioritise those most in need of assistance, which is especially important for end-of-life care.
Mays-Scott (2018) suggested that implementing a telephone triage system is an opportunity to educate and empower patients so they can manage their own healthcare by signposting them to the appropriate level of care. When triage calls are answered immediately, greater patient satisfaction is higher and the quality of care improves. However, Pinnock et al (2005) suggested that technology creates distance and de-personifies the users, as the telephone imposes a psychological distance, and both patients and clinicians may be concerned that they lack the verbal and auditory skills to explain and understand a complex clinical situation in the absence of non-verbal clues. On the other hand, Sands et al (2013) suggested that telephone triage can play a significant role in preventing coercive treatment outcomes through the early identification of the signs of crisis and psychiatric emergency, and it allows timely interventions to stabilise the immediate crisis.
Telehealth and telecare
Supporting people with technology, for example, with the use of telehealth and telecare, provides reassurance for the patient's family and friends, and can also enable the person to be more independent and monitor their own conditions. Some systems can generate alerts that can be transferred straight to the health professional, so immediate action can be taken. Dewsbury and Ballard (2012) stated that, with the appropriate use of technology, people have the opportunity to live independently. Further, telecare can also support measures to ensure the safety of a person. Telehealth and telecare enable alerts to be generated in case a non-normal state develops. For telecare, this can be, for example, when a person experiences a fall, whereas for telehealth, it can be instances such as blood glucose monitors showing very high or very low readings, or heart rate monitors recording states of exertion. Blood-pressure monitors are also useful for patents with chronic obstructive pulmonary disease, as are peak flow metres that send the data directly to the clinician. The readings obtained by the devices and the alerts sent to community nurses can guide future treatment and also inform the nurse of the effectiveness of ongoing treatment.
A common concern with all such technology is that of the accuracy of measurement. Several studies have focused on the accuracy of telehealth and telemedicine devices, but the findings have been inconclusive (Brewster et al, 2014; Gogia et al, 2016; Smith et al, 2017). Fitness devices demonstrate the issue well, as wrist-worn devices can determine the rise and fall in heart rate relatively accurately but are not as accurate at determining heart rate as chest strap-based systems. Thus, technology must be used judiciously and appropriately, and any results and outputs should be viewed relatively not absolutely. When an alert is triggered because a person's heart rate is out of the normal range, nurses should bear in mind that this might be for a number of practical reasons and not necessarily because the patient is in danger. If the device also provides feedback to the patient, then the patient can take control of their own health at this point, but if the abnormal findings persist, clinical interventions might be required.
Online consultations
The ability to use technology to hold secure online consultations in a triage where the patient can see community nurses as well as other professionals is time saving and an efficient use of resources that enables community nurses to determine the seriousness of the patient's condition without the need to visit the patient. This can be useful for caseload management and scheduling. In addition, some systems allow multidisciplinary team consultations, whereby other professionals can also remotely assist the patient.
Electronic reservation and appointment systems
Booking appointments, be they outpatient or community based, is time consuming. Using technology can enable patients to book appointments remotely at a time that is convenient, and they can do this from the comfort of their own home. This also reassures the patient that the appointment is actually booked and removes the wait for postal confirmation from the hospital. Electronic appointment booking can be undertaken as part of a normal visit or while doing a telephone triage, saving time and money (Castle-Clarke, 2018).
Technology and nursing practice
In 2011, While and Dewsbury proposed that technology would change the practice of the nurse. Nurses can use technology to support and explain complex issues to patients. Long-term conditions, such as diabetes and high blood pressure, can be effectively monitored using telehealth and telecare devices. The ability to record patient information in real time can improve the accuracy and allows community nurses to verify facts immediately. The effective use of information and communication technology can inform and simplify decision-making regarding changes in treatments, and virtual consultations can save time and money. Care navigation within the health system is also simplified with the use of technology. Lastly, technology can be used to help nurses provide essential and good-quality information to their patients.
Evidently, these changes have come to pass, and the community nurse is more engaged as a result of technology. What is a potential cause for concern is the digital divide. As the NHS digitalises itself and staff adopt technology to a greater extent, there is an assumption that the patient will be as knowledgeable about technology, which is clearly a fallacy. Although a virtual meeting with a community nurse might allow the patient to express health concerns, the meeting is remote and does not allow for personal interaction.
Conclusion
The use of technology can be beneficial in triage, enabling the community nurse to be more productive and to provide a better nursing experience to the patient. It has changed the triage process and has the potential to increasingly improve care but can be hindered by legacy technology systems and inter-operability issues, in addition to issues of the digital divide, which means that some patients might access care easily, while others might have difficulties.