Contributor: Samantha Juan
EdD candidate, Teachers College Columbia University
This is the fourth in a series of posts about a nursology study conducted by a student-faculty group from the Online Nursing Education (ONE) program at Teachers College Columbia University. The study, “Use of Foundational Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States,” looked at the use of four nursing concepts, context, holism, health, and caring, in program descriptions and the first three nursing course descriptions of 300 BSN program websites.
A variety of factors might impact patient experience and outcomes in healthcare, such as communication and staffing. Technology, especially artificial intelligence (AI), has become a trend in identifying and addressing the gaps and deficiencies of those quality contributing factors. For instance, electronic health records (EHRs) are evident to improve patient safety by significantly decreasing near-miss medication errors due to communication(1,2). In addition, Moxi, a hospital robot, is being gradually deployed in hospitals to assist nurses in some simple tasks, such as ferrying medications and supplies.
If nursing practice is a series of tasks, with evolving advanced technology, robots will replace nurses. However, is nursing only a series of tasks?
During the data collection and analysis of the published research project, Use of Nursing Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States, we were surprised that only 30% of the accredited entry-level BSN programs included all four disciplinary concepts of nursing, including holism, context, health, and caring, in the program description. In addition, less than 5% of the programs included all 4 nursing concepts in the description of the first three nursing courses. As holism, context, health, and caring are the common concepts of nursing and reflect the disciplinary focus, what message are we delivering to our prospective nursing clinicians and leaders in the nursing programs?
The competencies of safe medication administration and task prioritization are important to promote patient experience and outcomes. But, is it all nursing is about? Or, are medication administration and task prioritization who and what we are in the nursing profession? As core values define the meanings and purposes of the nursing profession to our society, a clear understanding of who and what we are is critical in entry-level nursing education. Without a clear understanding of what nursing is, the relevant knowledge learned in nursing education, such as pathophysiology and pharmacology, and skills performed in practice are simply used to support and promote the practice of other disciplines, like medicine or pharmacy, not nursing.
Will robots replace nurses? I’d like to say no. Nursing for me is promoting the balance of health across the lifespan with caring, and the balance is determined by multiple levels of factors. The series of tasks are a small portion of nursing practice, which is only one part of maintaining that balance. Although both EHRs and Moxi can help to promote the balance of health by performing tasks, no AI can take the leadership role and implement the four foundational concepts of context, holism, health, and caring. However, if we only teach and emphasize the skills needed to complete tasks in nursing education, yes, robots will replace nurses.
References
1. Agrawal, A. (2009). Medication errors: prevention using information technology systems. British journal of clinical pharmacology, 67(6), 681.
2. Classen, D. C., Holmgren, A. J., Newmark, L. P., Seger, D., Danforth, M., & Bates, D. W. (2020). National trends in the safety performance of electronic health record systems from 2009 to 2018. JAMA network open, 3(5), e205547-e205547.
About Samantha Juan
Samantha is a nurse and nurse educator, who is interested in simulation, nursing curriculum, online learning, and nursing students’ well-being. She has practiced in critical care settings for almost 15 years and believes caring (for patients, families, and all the providers in the healthcare team) is equally important to ventilators and inotropes.
I would be interested in some direction on how nurse educators are supposed to deal with the two completely separate agendas going on in this discipline. We are essentially forced to “teach to the test” because NCLEX and NP board pass rates drive much of what we do in academia. This agenda has led to test preparation companies, like ATI, making millions of dollars.
These exams require students to give untrue, racist answers to questions based on the historical scientific racism embedded in nursing and our current clinical guidelines. Hypertension in African Americans is not “genetic”, it is the physiological outcome of racism, yet I have to explain to students that they must pretend this is true in order to correctly answer these questions on their board exams. They also have to pretend that eGFR needs to be racially “corrected” because black bodies have more muscle mass than white bodies (they do not), PFTs also need to be racially “corrected” because black bodies have less lung capacity than white bodies (they do not), and that race is a risk factor for disease and somehow black bodies are so genetically unlucky that they have all of the genes that predispose them to every disease (they are not).
How is teaching racist, non-evidenced based information contextual, holistic, or caring?
I am trying to understand what “context” and “holistic” means in a nursing understanding of those concepts in a discipline that appears to be ahistorical, apolitical, and thoroughly wedded to the neoliberal economic agenda. Is knowledge from other disciplines, such as pathophysiology, pharmacology, philosophy, the social sciences, indigenous science, “simply used to support and promote the practice of other disciplines” or is it fundamentally important to understanding what it means to be human which is critical to being a well-educated nurse capable of deep, contextual analysis utilizing theories from both within and outside of nursing?
You raise vitally important issues in your comment here! Thank you! I am confident that there are many responses and ideas — let’s keep this conversation alive!!
I would love robots. No hand holding, fluffing, chatting. Do obs and meds and get out. I find all the empathy condescending and it makes me look weak and vulnerable.