Can digitalisation improve a profession that primarily relies on human contact? One thing is certain: robots cannot replace the empathy that nursing staff provide. But how can digital technologies nonetheless help to provide improved care and a better working environment?
Whenever the care sector has been in the news recently, the focus has tended to be on problems: too few staff for too many patients, too little money, too much stress, too much bureaucracy and administrative work. Digitalisation will not be able to solve all these problems, but it can at least help to minimise two of them: administrative work and mental and physical stress. A well-thought-out digital strategy can give nursing staff more time and energy to spend with patients. My article sets out to discuss the objectives that digitalised and, at the same time, more human care can bring about.
Nursing is regarded as lagging behind in terms of digitalisation. In the not too distant future, it will also benefit from electronic medical records and a telematics infrastructure but, at the moment, many things are still more likely to be done by fax. Patient data still needs to be manually entered into the local databases – work that costs time and is prone to errors.
At the same time, there are some facilities that already have assistance systems enabling patients to be independent and take pressure off the nursing staff. Sensors in rooms that send messages directly to the nursing staff, hygiene robots and autonomous transport systems are no longer just in the realms of science fiction. And administration has also moved on somewhat from the fax era: many processes are already digital within companies patient care information systems. The fact that doctor's prescriptions still need to be faxed is not due to a lack of willingness to digitalise things, but due to the legal situation. Fortunately, this is gradually changing.
In actual fact, digitalisation in nursing care has already advanced significantly further than the reports on faxed prescriptions might suggest. In its "Care 4.0" study, the Employers' Association for Health and Welfare Services (BGW) stated that 74 percent of the employees surveyed in the nursing sector used electronic documentation, while technical assistance systems were only used by 32 percent.
Patient data needs to be treated sensitively and care should not lose its human dimension – these are the two key basic conditions of digitalisation in nursing care, formulated by the German Nursing Council, among other bodies.
The fact that these basic conditions are taken very seriously by nursing staff is reflected in a study by the New Quality of Work Initiative. The study reveals that nursing staff judge the benefits of digitalisation in different areas of their profession in very different ways. In principle, an overwhelming 87 percent of the respondents are open-minded about the use of modern technology. They regard the greatest benefits as being electronic documentation and technical assistance systems. The individuals surveyed tend to be more opposed to robotics, especially in the social sector. They also reject further consolidation of work and strict monitoring of their work.
The most prominent representative of digitalisation in nursing care, Pepper the care robot, does not fit quite into this picture. Pepper can talk to patients, make jokes, play games and more – but he is unable to relieve pressure on nursing staff and improve their work, as they wished for.
What is called for is not digital technologies that take over care work, but technologies that relieve pressure on nursing staff in their day-to-day work. There is a particular need for technology to reduce red tape. Administration and communication with other medical institutions requires unnecessary time and effort. Several large-scale projects are currently being developed to rectify this situation, including the German electronic medical record (ePA) and the associated communication infrastructures, such as Communication in Medicine (KIM) and the Telematics Infrastructure (TI).
A further challenge that needs to be addressed in networking of the healthcare sector: while there are many digital technologies that are already very powerful in some sectors, they are often isolated solutions. They are also a major problem in the care sector. A person in need of care may have a detailed digital file with their family doctor, but it may have to be printed out and sent to the care centre by post, to then be manually entered into a care information system. At the care centre, the patient's health condition can be monitored by assistance systems, but the messages can only be transmitted to the patient's general practitioner by an analogue method.
A report by the German 'Healthy Care Offensive' network on transport robots in the University Hospital Hamburg-Eppendorf reveals that networking can significantly relieve pressure on nursing staff. Hospital logistics is handled by autonomous robots in the University Hospital. They transport laundry, medicine and food, among other things, across the campus. The app reports to the ward personnel when a delivery is arriving. This saves the nursing staff additional work, such as transporting dirty laundry. Drug orders for the ward are also placed via the system – and then arrive there autonomously.
Telemedicine can also take considerable work away from nursing staff in care facilities and outpatient care. Specialist medical practitioners can clarify issues quickly in many situations by video call, saving themselves the need for a time-consuming visit to the patient. Vital signs, such as pulse and oxygen saturation, and other diagnostic data can also be transmitted to physicians by telemonitoring. They, in turn, can better monitor the well-being of their patients with less travel and a lower workload.
Assistance robots provide even more 'science fiction', for instance helping to lift patients and protecting the backs of nursing staff. Some of these systems are already in use and are being intensively researched. Exoskeletons are already being tested, which enable care personnel to carry more weight, although it will take a few more years for this to be used across the board.
Assistance systems can also bring about improvements for patients. What is known as Ambient Assisted Living (AAL) plays a key role in this. AAL comprises systems in patients' home environments, which provide caregivers, relatives or physicians with data and notifications about the condition of the people they look after. Care beds fitted with sensors can notify nursing staff as soon as patients get out of bed, smart floors can detect falls, and emergency call systems can contact an emergency call centre at the touch of a button.
The aim of these technologies is to enable patients to live as independently as possible. The sensors in the patient's room and the emergency call button enable people in need of care to live with fewer restrictions. They do not need to be monitored directly as often by other people to protect themselves.
Other technologies protect the privacy of patients. Hygiene robots, as well as fully automated toilets with wet cleaning and drying function, prevent patients having to call for assistance to go to the toilet.
Two of the objectives of digitalisation in the care sector can therefore be realistically achieved in the near future and are welcomed by nursing staff: the reduction of administrative and additional work, and the promotion of self-determination among patients so that the nursing staff have more time for personal interactions with patients.
Text: Nils Bühler
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