Exploring the evolution of digital nursing: from paper documentation to digital optimisation
Nursing documentation has come a long way from paper to different kinds of digital tools. Where are we now and where are we going next? Join us on the journey from pre-digital to the future.
Pre-digital: paper-based processes
In the past, nursing processes were based on paper documentation, which entailed numerous challenges. In addition to being time-consuming, paper documentation is prone to errors and misinterpretations. Handwritten notes can be difficult to read. Paper records are also difficult to store and retrieve, as well as replicate.
Nurses may remember the times when there was only a single set of paper notes available. Yet a lot of people, including nurses, doctors, and anaesthetists, would have needed the notes, often at the same time. To address these problems, nursing informatics became to evolve in the second half of the 20th century1. Over time, small pockets of nurses started to consider digital processes, although the movement towards ‘digital nursing’ was not yet starting.
Digital adoption and the emergence of digital nursing
In the UK, the NHS has launched many initiatives, programmes, and funding streams towards digitalisation since the early 2000s. In many places, the focus has first and foremost been on doctors’ digital tools, whereas the digitalisation projects in nursing have followed afterwards. At a broader level, the digitalisation processes in healthcare and nursing have been slower than perhaps expected.
Nevertheless, electronic documentation was introduced to address the challenges of paper documentation, and in many cases, it did so successfully. Benefits of electronic documentation include improved efficiency, accessibility, and storage, as well as reduced errors and misinterpretation.
Looking at the landscape of digital nursing, The CNIO, or Chief Nursing Information Officer role was introduced with the onset of digital implementation. The CNIO role was highlighted as important in a number of NHS England’s digital strategy including the Topol review2 with the aim of improving the use of technology and data in health and care services. The CNIO is responsible for leading the nursing, midwifery, and care staff in developing and implementing digital solutions that enhance patient safety, quality, and outcomes. The CNIO also acts as a bridge between clinical and technical teams, ensuring that the needs and perspectives of the frontline staff are represented and addressed in digital transformation projects.
The first national CNIO for England was appointed in April 2020. This role is to oversee the development of the CNIO network across the country, which consists of local and regional CNIOs who work in different health and care settings, such as acute hospitals, mental health trusts, community services and primary care. The CNIO network aims to share best practices, collaborate on common challenges and support the adoption of digital innovations that benefit patients and staff.
Towards digital optimisation
While some organisations have already taken steps towards digital optimisation, many are still at the digital adoption stage. Since the advent of digital adoption, a lot of systems continue to be ‘electrifying paper’ or creating electronic versions of paper charts. As regards the devices, big computer carts are still in use in many places.
Yet, the future of digital nursing is exciting. More and more hand-held mobile devices are likely be used to improve efficiency. AI and machine learning provide possibilities for improved diagnosis and treatment. Advanced clinical decision support will be available.
We are also moving towards a stage of digital nursing being fully recognised as a speciality – in the UK, the Royal College of Nursing have already taken steps to this direction. We are moving significantly towards proper education processes for digital nursing. With hand-held mobile devices the hope is that efficiency will be improved, as data collection and communication will be faster and easier. AI and machine learning will improve diagnosis and treatment through predictive analytics and personalized care. The hope is that all of this will speed up workflows and move away from the clunky entry of data, freeing up time to carry out patient care.
In practice, digital optimisation is often a wide range of small but significant changes. For this, user feedback is essential. The whole point of digital optimisation in nursing is to implement innovative changes to improve the users’ experience, and ultimately, enhance the patients’ care and hospital experience.
How will the future look?
While new technology can bring significant benefits to nursing, there are also some potential disadvantages. One major concern is that AI cannot replace human intuition and empathy, which are critical aspects of nursing care. Additionally, the use of AI may lead to reduced direct patient care, as nurses may rely too heavily on technology. Finally, there is a risk of increased dependence on technology, which could have negative consequences if systems fail or are unavailable.
While hand-held technology may be more convenient and efficient, it also presents several challenges for nurses. One of the biggest disadvantages of hand-held technology in nursing is the increased risk of distraction and errors. With so much information at their fingertips, nurses may be more likely to miss important details or make mistakes. Additionally, hand-held technology can decrease communication between nurses and patients, as nurses may be more focused on their device than on the patient in front of them. Finally, hand-held technology can be expensive to maintain and upgrade, making it difficult for healthcare organizations to keep up with the latest advancements.
It’s critical that we are mindful of these challenges and address them by education and in the digital optimisation work. In the end, the benefits will dwarf the disadvantages;
Nursing is a progressive art such that
Florence Nightingale
to stand still is to go backwards.
Sources:
This article is based on the presentation given by Fiona Mills, Deputy Chief Nurse Informatics Officer from Oxford University Hospitals NHS Foundation Trust, at the Medanets User Days 2024. In addition, the following sources were cited:
- Ozbolt & Saba (2008): A brief history of nursing informatics in the United States of America. Nursing Outlook 56 (5): 199-205.
- Health Education England (2019): The Topol Review: Preparing the healthcare workforce to deliver the digital future. Health Education England.
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