I would like to put out a question to my ED colleagues. Has anyone noticed the ethical problems created by computerized charting? Before I pursue some of the problems I see, allow me to say that I am not suggesting that computerized charting is all bad, merely that it is a mixed blessing.
Here are some of the problems I see:
•It teaches cookbook medicine. As we were all taught in nursing school, look at the patient NOT at the textbook or your machines. Patients are rarely if ever classic textbook cases. I am finding some new young nurses a couple of years out of nursing school with no assessment skills, but who can walk circles around me on the computer. If you cannot assess your way out of a paper bag, you are not a real nurse in my mind, so what good is your computer?
•It teaches nurses to be technicians, not professional care givers. Like a lot of our modern technology, we are driven to learn more and more about how to operate machines, and have less and less time to really look at our patients.
•It takes the nurse away from direct patient care.
•It can depersonalize the patient.
•It encourages the caregiver to work with the computer, not with the patient.
•It makes it look like all charting is in real time, so a constant lie is perpetrated. Of course, who really charts in real time, except perhaps during critical incidents and codes?
•It is all about billing for services and protecting from legal attacks, not about taking real care of real patients.
•It may actually increase our legal risk in some ways. Just from my own experience with computerized charting, I suspect that I could take any nurse or doctor apart on the stand who uses it. It encourages dishonesty in charting even more than paper charting does, because it asks you to fill in all sorts of boxes (to encourage thorough charting), things you can check off in a second, which can tempt people to check that they looked, but never did. There is the constant temptation to be more thorough in your charting then you really were in your assessments. It makes it too easy to fill in more than you really did. (To be honest, check-off boxes on flow sheets have similar risks, but they don't put words in your mouth as some computerized charting programs do.)
Again, let me reiterate. I am not against computers. I think they bring us many wonderful opportunities, but if we are not aware of the potential problems or address them, then we are in danger of perpetuating them to the point they become dangerously acceptable.
I would love to see the issue of the interaction of ethics and the use of modern technology, and how this drives our care in good and not so good ways, reviewed in depth in JEN.
in collaboration with other Emanuel ED RNs, Legacy Emanuel Hospital, 2801 N. Gantenbein Ave., Portland, Ore
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