High-tech, High-touch Nursing

November 6, 2008

How do we balance the need for technology with the need for the high touch aspect of nursing?

With all of the technological advances that medicine and nursing have afforded us in the care of our patients how do we balance the need for technology with the need for the high touch aspect of nursing? When I first heard of this term “high-tech/high-touch” I thought of the ICU areas. How many times have I talked to my colleagues in the intensive care areas who tell me that often times they are so focused on the technology, the ventilators, the monitors, the alarms, that it’s easy to forget the simple power of touch. I can understand in such a high tech area where you are taught to be focused on what the numbers are saying that you get caught up in that and miss the fact that there is someone’s daughter, son, brother, sister, mother, father, aunt or uncle there and all the implications that are included with that. Not to say that the ICU nurses don’t have the ability and often do address the personal side of patient care. I have just found there to be a different focus.

Being an oncology nurse, I think that we are almost expected to be focused on the personal side of nursing. Being able to see the whole picture; encompass the journey that the patient and family have travelled before arriving with you at their bedside is crucial. I had a patient yesterday that was getting his first round of adelsleukin for metastatic renal cell carcinoma. This is not an easy treatment. The patients get really ill during the treatment and it’s imperative that the nurse stay on top of impending side effects. The nurse that cared for him during the night was a newer nurse and the patient questioned me as to how long she had been a nurse. He told me he thought she was newer only because she looked so young. But he was quick to point out that “she knows how to talk to the patients and that’s something that many nurses never learn.”

What great insight. We all get tied up in the technology, the administration issues, the higher tech and sometimes forget the low tech or high touch areas are what really touches patients the most.

Recently the nurses on my unit have had to deal head-on with a different aspect of high-tech/high-touch. We have had several patients who were at the end of life and being treated by our palliative care team. Despite all that we were doing, pain was still indescribable for these patients. We did everything we were used to doing and began having to step out of the comfort of what we knew. We had to stretch the ability of the machines we had. We had one young woman on so many pain medications that we had to have four infusion pumps in use for one medication. The continuous infusion of opioids had to be divided among two infusion pumps since the amount we were giving was above the limit of the machine. The remaining two pumps were used to give bolus doses divided among the two.

Needless to say it was a frightening thing for nurses to do; taking extra care that when they needed to administer medications in this method that they had another nurse to verify that the dosages and settings were correct. It was trying for everyone, because no matter how much more opioids we continued to give, it didn’t seem to be helping. We were all very clear that even in the face of the our nervousness in using high tech solutions, we still needed to be able to go into the room, talk to the patient, hold her hand, find out her needs or what was frightening her and address those as best we could also. It seems like our time was often focused on the technical aspects, did we have enough medication, were the infusion pumps programmed right, was this the safest method of administration and was I doing it correctly. But what caused the majority of stress for the staff was that we knew the importance of the high touch aspect of her care as we were trying to help the end of her life be comfortable… and often we felt we were falling short. It took an entire team of nursing, physicians, social workers, pastoral care, pharmacist, patient and family to finally understand and feel comfortable that we were/did do everything we could for this young woman.

We took the technology that we had and pushed it to the limits without every forgetting that one of the most important pieces was that we knew this young girl, we knew her family, she was one of our family now and we would never give up the ability to touch that part of her care.