The meaning of technology in an intensive care unit—an interview study

doi:10.1016/j.iccn.2007.03.003

Intensive and Critical Care Nursing

Volume 23, Issue 4, August 2007, Pages 187-195

https://doi.org/10.1016/j.iccn.2007.03.003 Get rights and content

Summary

Background

Previous research has suggested technology may dehumanise patient care and also that technology may restrict nurses’ freedom of action. This raises questions about the relationship between technology, care and medicine in units where the patient's need for treatment is often an emergency.

Aim

The aim of the study was to explore how staff members in an intensive care unit (ICU) make sense of technology in their everyday practice.

Method

Twelve staff members from one ICU were interviewed about their understanding of technology in their everyday practice.

Result

Three main findings emerged from the analysis: Technology seems to be considered decisive as it directs and controls medical treatment and results in the patients’ well being; technology is seen as facilitating everyday practice because it makes treatment more secure and decreases workload; however technology can complicate the staff members’ everyday practice as it is not completely trustworthy, is not easy to handle and can cause ethical dilemmas.

Conclusion

Contrary to previous findings this study shows that technology seems to be embedded in care and medical treatment. Furthermore, the meaning of technology appears to be dependent on the different staff members’ accounting practices.

Introduction

When entering an intensive care unit (ICU), it is obvious that seriously ill patients and their relatives are surrounded by technical tools in a high-technology environment. Most intensive care patients are unconscious and unaware of what is happening to them in the ICU. Their lives are in the hands of the ICU staff.

The ICU developed in the early 1960s intending to treat and take care of seriously ill patients by specially trained staff members, using advanced technical tools. Technological development has evolved at a rapid pace during the last century. The handling of technical tools such as ventilators, infusion pumps and monitors makes care giving more specialised and complex to manage. In addition, the division of labour between staff members and technical tools continuously has to be shaped and reshaped as new instruments are introduced in to the arena (Hutchins, 1990).

The ICU involves different staff members such as enrolled nurses, registered nurses and anaesthetists. Söderberg (1999) has studied such team members’ experiences of ethical dilemmas in connection to technology in the ICU. She found that the different professionals emphasised varying dilemmas when narrating their experiences. Söderberg's conclusion was that these differences could be explained by the fact that the professionals thought about different cases when describing their experiences with technology.

Other previous studies (Barnard, 2000, Gjengedal, 1994, Granberg et al., 1999, Norrie, 1995) about the influences of technology in care giving have focused on registered nurses’ and patients’ experiences of technology within the ICU. The conclusions were that technology may dehumanise the patient care in that technology restricts the nurses’ focus on the patients’ social needs (Gjengedal, 1994, Granberg et al., 1999) and that technology restricts the registered nurses’ freedom of action (Barnard, 2000, Norrie, 1995). Barnard and Sandelowski (2001) questioned this dualistic approach to nursing and technology and Barnard (2002) suggested a re-examination of this dichotomy between nursing and technology.

The present study can be seen as a re-examination of nurses’ understanding of technology but it also explores how anaesthetists and enrolled nurses construct the meaning of these tools. To our knowledge no previous study has addressed the question of how different professionals in the same ICU perceive technology. The aim of this study is therefore to explore how these staff members make sense of technology in their everyday practice.

The research questions were:

1.
How do the different staff members talk about technology in their everyday work?
2.
Are there any differences and/or similarities in their statements?

Section snippets

Theoretical background

From a socio-cultural perspective our perception of the environment is connected to our socio-cultural experiences (Wertsch, 1998). When two people look at the same situation they often “see” different things (Säljö and Bergqvist, 1997). The understanding of what we see is thus, from this perspective, connected to knowing in practice, or to put it differently, their ‘accounting practices’ (Johanson, 1994, Shotter, 2000). In this sense, accounting practices set limits for our vision, but they

Method

The data in the present study was drawn from a larger project Communication and Technology—a study in a technological environment in health care (Sätterlund Larsson and Wikström, 1998). The project was conducted as a field study drawing on ethnography in a general intensive care unit in a medium-sized hospital in the west of Sweden. The overall research question for the project was “How is intensive care produced?”.

Within the ethnographic field informants’ accounts are important elements in the

Result

When analysing how the professionals construct meaning of technology three main themes emerged from the analysis; technology is decisive, technology is facilitating and technology complicates. Each theme is presented with its sub themes.

Discussion

The present study has been conducted in an ICU setting heavily equipped with technical tools which different staff members are supposed to manage when giving treatment to severely ill patients. The results should be seen as tentative because the sample was small and the findings originated from interviews. The main finding supported, however, the critics of the previous understanding of technology as separated from nursing and medicine (Barnard, 2002, Barnard and Sandelowski, 2001). Instead it

Study limitations

The present study is included as part of a field study drawing on ethnography and could be seen as a complement to participant observation. The interviews gave the informants the opportunity to express their meaning of technology to the researcher (author one) (Hammersly and Atkinson, 1983). It could also be seen as a way for the researcher (author one) to test the credibility of the interpretation of the field notes. However, one limitation of the present study could be that the first author,

Conclusion

In spite of its limitations it has been demonstrated that the construction of meaning is dependent on education and experiences, and also on the professionals’ position in the network of technology in the ICU.

However, the construction of meaning seems to be mutually dependent. The accounting practice is produced and developed through the professionals’ actions and communication at the same time as their understanding is based on the prerequisites they are given from the institutional context

Acknowledgements

The research reported here was financed by the Swedish Council for Working Life now VINNOVA and University West. We would also like to thank the intensive care staff: it is their participation that made this study possible.

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Original articleThe meaning of technology in an intensive care unit—an interview study

Summary

Background

Aim

Method

Result

Conclusion

Introduction

Section snippets

Theoretical background

Method

Result

Discussion

Study limitations

Conclusion

Acknowledgements

Intens Crit Care Nurs

Intens Crit Care Nurs

Intens Crit Care Nurs

Alteration to will as an experience of technology and nursing

J Adv Nurs

Philosophy of technology and nursing

Nurs Phil

Technology and human nursing care: (IR)reconcilable or

J Adv Nurs

On distribution, drift and electronic medical record. Some tools for a sociology of the formal

The construction of credibility in court judgment of child sexual abuse

Acta Sociol

Forms of talk

Professional vision

Am Anthropol

Seeing as situated activity: formulating planes

Ethnography

Principles in practice

Original article
The meaning of technology in an intensive care unit—an interview study