The gaze of nursing has shifted over the past several decades. Where once nurses would have their eyes, ears, nose, and hands-on a patient, a transformation has occurred in which the attention is increasingly directed towards what is known as the digital twin. The person, once flesh and blood and imbued with life energy, personality, and unique human qualities, has been moving more and more into what we can think of as a representation of the human self.  No longer does the nurse enter a room to see a patient. Rather, the patient’s condition is now better represented by a series of numbers and data points, assembled in the amorphous digital realm. This new virtual space, the in-between space that is filled with 0s and 1s, is the new post-Nightingale domain of the nurse.

A digital twin (DT) is a digital representation of an actual (or intended) real-world physical thing (VanDerHorn & Mahadevan, 2021). The digital twin serves as an indistinguishable practical counterpart. Within technological realms, a digital twin serves several model roles including testing, implementation, monitoring, integration, and simulation. Within healthcare settings, the digital twin is the representation of the human patient and is expressed through the electronic medical record (EMR) as well as within the clinical trial environment. Many will recognize their DT as represented by lab work, or vital signs, or an ECG tracing.

The vision of the nurse on the digital twin is different than the person. With background training in healthcare as well as within an organization, the nurse sees the DT as the representation of the patient in a holistic way that captures the notion of person. When healthcare providers are talking about a patient, especially in a hospital setting, they are speaking generally of the DT rather than the patient-as-real. Therefore, rounds will include data and metrics about tests, what was eaten, vital sign charts, and other representation of the person. In many cases, the actual status of the person is irrelevant because they are only as well or unwell as the DT.

Barbara Carper’s contribution to nursing theory on the patterns of knowing has stood as fundamental for the profession since the 1970’s. Carper highlighted the importance of nursing experience in the process of gathering information (knowledge) in a clinical setting (Chinn, 2018). The patterns of knowing include empirical knowledge (data and scientific competence), aesthetic knowledge (meaning and transformative acts), ethical knowledge (morality and ethics), personal knowledge (therapeutic use of self) (Carper, 1978). Carper’s work was expanded on by Chinn and Kramer in 2008 with the introduction of “emancipatory knowing,” a pattern of knowing which acknowledged social and political factors leadings to inequity and injustice.

The DT symbolizes a type of knowledge in the clinical setting, and Carper might conclude that the data constructing the body of the DT represent data arising from technologies built to inform the scientific method. It seems that within an increasingly technological healthcare system, knowledge is increasingly biased towards objective metrics. Is the DT the true patient then, and the person is the representation of the DT?

As a long-time nurse working in acute and critical care oncology, I can recount countless examples of episodes when a nurse would enter the room and look at the equipment. The nurse gaze was on IV pumps, monitors, foley catheter bags, ventilation equipment, and output sheets. In a lessening number of cases would the nurse actually look at the patient, the human lying in the bed. This gaze to the data is accentuated at times when a patient is clearly deteriorating but the numbers look good. In these instances, the predominance of empirical knowledge and therefore the DT leads a nurse to believe that things are OK when, in fact, co-application of other ways of knowing would reveal that things weren’t going so well. 

Many patients have told me that they appreciated when a nurse would come into a room and “see” them. While the DT is an important aspect of a new, postmodern, technological reality, there is a danger for nurses to lose the person in the process.

References

Carper, B. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004

Chinn, P. (2018). Fundamental patterns of knowing in nursing. Nursology Blog Post. https://nursology.net/nurse-theories/fundamental-patterns-of-knowing-in-nursing/

Chinn, Peggy L., Kramer, Maeona K., & Sitzman, Kathleen. (2022). Knowledge Development in Nursing: Theory and Process (11th ed.). Elsevier.

VanDerHorn, E., & Mahadevan, S. (2021). Digital Twin: Generalization, characterization and implementation. Decision Support Systems, 145, 113524-. https://doi.org/10.1016/j.dss.2021.113524

About Jennifer Stephens

Jennifer Stephens is an Assistant Professor at the University of Wyoming Fay W. Whitney School of Nursing. Long ago before she was a nurse, Jennifer was a professional historian with focuses on Early Modern philosophy and public history. Fast-forward a few decades and she is now a long-time oncology nurse with extensive nursing experience in both the US and Canada. Jennifer’s overwhelming passion is nursing philosophy and theory, and she is an avid reader of transhumanist and posthumanist literature.

We are delighted that Jennifer is now working with the web management team, in charge of the preparation and posting of blog posts on Nursology.net!