Technological competency as caring in nursing: A description, analysis and evaluation of the theory

The use of technology is becoming increasingly common in nursing (1, 2). It can be classified as a completer of human beings (prosthetic devices for missing body parts or non-functional ones), instruments, and gadgets that facilitate human care of persons (computers) and mimic human beings (robots) (3). Advances in technology can impact human health and enable nurses to perform their work efficiently and safely (4). Technology can bring the patient closer to the nurse by enhancing the nurse’s ability to know more about the person. However, there is also the possibility that the focus of treatment moves from the patient and patient care to the technology itself. The use of technology can also increase the gap in the interpersonal relationship between the nurse and the patient, as exhibited by the conscious disregard of the patient as a ‘person’ (2) and ignorance of the nursing imperative to know the patient as a ‘person’ (2, 5). The latter affects patient and nurse satisfaction, and the quality and safety of patient care (1, 6). Focus should be placed on nurse-caring behaviours that contribute to patient satisfaction and well-being (7). Caring is a fundamental concept of nursing that manifests itself as the genuine, intentional presence of a nurse with the person cared for. Holistic care is needed, and the competent use of technology could support patient care (2, 5). Nursing theories can help nurses focus on caring for patients and their families. Locsin’s ‘Technological Competency as Caring in Nursing’ (TCCN) theory is one of the nursing theories that refers to care and the use of technologies in nursing (5, 6). In caring for patients, this theory gives significance to knowing people, a continuous process in which the nurse and the nursed can affirm, celebrate and support each other (1). The empirical, personal, ethical and aesthetic ways of knowing that are fundamental to understanding patients as a whole increase the likelihood of being able to know patients (5). The use of technologies in nursing is consequent to the contemporary demands for nursing actions that require technological knowing. Technological knowing is a way of knowing in nursing, engaging the competent use of technologies of care to get to know patients as a whole. Through technological knowing, both nurse and nursed are appreciated as a whole, as people whose hopes, dreams and aspirations matter most in living their lives fully as whole persons (5). Locsin’s theory represents the theoretical starting points for using technology and caring as a coordinated interaction in the nursing environment. Theory-based nursing practice is essential to high-quality nursing and healthcare (3).

The e-health project in Slovenia was launched in 2005; however, we still do not have a comprehensive health information system, which hinders the development of the healthcare system and affects the quality of healthcare services (8, 9). Important areas for further e-health development are the accessibility and completeness of personal e-health data (10).

The implementation of Locsin’s theory can further develop the electronic nursing record system (ENRS), which is a part of the health information system. Theory-based ENRS could utilise the language of caring human dimensions of nursing practice, and not only physical needs and medical conditions. ENRS can provide patient information to multiple healthcare providers and allow better-coordinated care (4). ENRS development can improve the quality of healthcare services (9). However, the theory needs to be described, analysed and evaluated to determine its applicability to clinical settings, research and education (11).

This paper therefore sets out to describe, analyse and evaluate Locsin’s ‘Technological Competency as Caring in Nursing’ theory.

The goals are to identify the usefulness of theory in nursing and to determine whether the theory can be used to guide research on using the ENRS.

A systematic literature review was conducted.

2.2

Study identification and selection

Figure 1 contains a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (12) flow diagram of study selection. Two independent investigators were included in the study identification. Any disagreement was resolved by discussion or by the involvement of a third investigator.

Figure 1

The search yielded a total of 765 records in electronic databases and 86 from other sources. Using the EndNote program reference manager software, we identified and removed duplicates (n=17) and then reviewed the remaining records by title and abstract to ascertain their eligibility (n=207). A total of 759 records were excluded. After the full texts were retrieved (n=75), 49 full texts were excluded because their content was not relevant to the study. A total of 26 records were included in the final analysis (Figure 1).

Table 1 shows the characteristics of the studies included and their classification in the hierarchy of evidence. The literature included was ranked with the fourth (15, 16, 17, 18, 19, 20, 21, 22), fifth (2, 23), sixth (1, 6, 24–25) and seventh (3, 4, 5, 26, 27, 28, 29, 30, 31, 32, 33, 34) hierarchy of evidence levels.

Technology is becoming increasingly more integrated into nursing practice and increasingly complex. Locsin developed the TCCN theory as a way of solving problems using technologies in nursing (27, 29), and described the nurses’ technological competency as expressing caring in nursing (19). The theory is useful in nursing research, education and practice. Despite certain limitations of the literature review, such as exclusively English texts and the inclusion of hits belonging to the fourth to seventh levels of the hierarchy of evidence, knowledge development is essential. The studies show that nursing education related to caring and technology is needed. The introduction of simulations in student education and the application of the theory are appropriate in the educational environment (4, 15, 32). The TCCN theory has been used in several studies of nursing practice (6, 16, 17, 18, 19, 21, 24, 39). Nurses should involve family members in patient care and share experiences (24). The importance of patient experience was confirmed and can allow nurses to anticipate patient needs and improve their experience by providing appropriate nursing interventions involving technology (6). Several instruments were developed from the TCCN theory to measure nurses’ behaviour of technological competency as expressing caring in nursing and tested in clinical settings. The TCCNI was developed by Parcells and Locsin (20), and the PITCCN was developed and tested in intensive care units (21) and acute care settings in hospitals in Japan (17). The TCCNI-R was tested in general hospitals in Japan (18, 19). The studies showed that the TCCN theory could be applied in high-tech developed settings (21) and all environments in which technology is used (18, 19). The theory has not been tested in various demographic areas, such as Europe. Most studies have been conducted in Asian countries. Nurses’ professional practice environments are different, and are also related to demographic, cultural, health-system and technological development (17). The theory should therefore be tested in various countries (17, 19), including Slovenia. The TCCN theory can contribute to the development of an ENRS (40) and will guide our study in implementing the ENRS. Technology – ENRS will be used to know the patients as ever-changing from moment to moment (27). Technological knowing will be a way of understanding patients. We will include knowing as understanding the patients’ needs, including physical and emotional needs and health conditions, which will be documented in the ENRS. While using ENRS, it is necessary to understand the patients as unique in their wholeness (2, 19, 27). There are essential caring activities, such as carefully listening to patients, showing compassion, meeting the patients’ needs and thoughtful consideration of patients’ lifestyles (2, 18), that should be implemented and not focus on the use of technology, in our case the ENRS.

The theory provides important theoretical starting points in the competent use of technology, emphasising caring for the patient as a whole and not focusing only on the patient’s medical condition. It also provides nurses with important guidelines for preventing technological dependence on technology, and places the patient at the centre of care. In our study on nurses’ perceptions of technological competency and caring for internal medicine patients when using the electronic nursing record system, the TCCN theory will be included in three Slovenian hospitals. The theoretical starting points of TCCN theory will help us identify and propose strategies to include the language of caring and caring behaviours in the ENRS. The survey findings can also impact the further development of the ENRS and the health information system in Slovenia.