TCCN and the RN in NZ
In my professional practice as an aged-care nurse, I am currently encountering several scenarios wherein the assumptions of the theory Technological Competency as Caring in Nursing and the Practice of Knowing Persons as a Whole are highly evident. I am quite happy to say that in my facility, assumptions of this theory are palpable in our day-to-day operations.
Working in a rest home, the daily clinical practice of nurses and health care assistants can be highly routine-based. The day would usually start with the handover which lasts for thirty minutes. Then, the nurses do the medication rounds, follow through with wound care and all other important nursing interventions such as ringing families and liaising cases with the GP. Yes, the usual care in the rest home seems to be repetitive, however, at the very core of how care is delivered, this is not always the case. It is good to note that New Zealand, being sensitive to the needs of its Maori population, have adopted the “Te Whare Tapa Wha'' model by Durie (1994) (Richford, 2004) of the Maori healthcare culture in delivering care to the consumers. This model teaches healthcare professionals to view patients as a complete person and thus nurses should tend to their patient's whole physical, mental, spiritual and family or cultural wellbeing.
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For the benefit of this testimony, I’d like to give a brief background of New Zealand’s cultural terrain. Although not literally relevant as of today, New Zealand is primarily a bicultural country. Taking from its rich history, it has been composed of two peoples: the NZ Europeans and the Maori’s. The Maori people are indigenous in New Zealand (they have been here before the land was re-discovered by the British Crown). They are known to have ways, knowledge and culture that are highly kin-centred. These beliefs and traditions are then deeply embedded in the rules and policy of NZ by the power of its founding document which is the Treaty of Waitangi. The Treaty of Waitangi (1840) states that both the British Crown and the Maori people should work under the principles of protection, partnership and participation. These three principles are evident in all the rules, policies and laws of NZ. Consequently, these principles did not apply only to Maori’s and NZ Europeans but also to everyone living in NZ regardless of background or nationalities and thus, this has given birth to the concept of cultural safety. Working in this country (even as an immigrant), everyone is expected to be sensitive to the culture of other people. Healthcare professionals are trained and encouraged to practice in ways that cater to the diverse cultural background of NZ.
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In view of the Te Whare Tapa Wha model and cultural safety, I am already applying one of the assumptions of this theory which is viewing persons as whole or complete at the moment by recognizing their cultural characteristics and preferred ways of doing things. Culture is perceived as a concept that is not only limited to one’s ethnic identity e.g. Indian, Kiwi, Filipino, Chinese, etc. but it is regarded as the whole identity of a person: it encompasses what they eat, what they prefer to watch, what activities they do, and if they like to socialize or not. Thus, residents are not forced to do a certain task just because it is part of the carers’ normal routine but rather, the nurses or carers adjust the care plan to suit the lifestyle and preferences of the resident. In this way, we cater to the culture of that person without sacrificing essential nursing procedures or tasks such as personal care, wound dressings, etc. For instance, if Mr X prefers to wake up late in the morning, say --- at 11 am, health care professionals should recognize and respect this. Thus, his care plan is adjusted and his care is done after he wakes up or rather, it is rescheduled in the afternoon even if this is usually out of the normal time for showering residents (8 am-10 am).
Another good example is during medication rounds. Some residents dislike taking too many pills in the morning, or some of them sleep early at night. As a response, nurses liaise with the GP to adjust the timing of the residents’ medications to suit their sleep-wake schedules or their personal bedtime preferences. In this way, care is delivered with recognition of the person as a complete being (not just someone to be cared for) without compromising the standard care management due to that resident in relation to his/her condition.
For another assumption of the theory which is “technology is used to know persons as whole moment to moment,” I can testify that a nurse’s capability to use technological advances such as computers and tablets “CAN” actually affect the perception of patients towards the nurse in terms of whether he/she is caring. For instance, we are using a medication administration application known as Medi-map to administer medications to the residents with the goal of minimizing errors. The medications are pre-packed by a machine and delivered to the facility: each blister pack reflects the medications that each resident should take on a specified date and time e.g. breakfast, lunch, dinner, and bedtime. Other than these regular medications, PRN medications are also listed on the application and each time a nurse administers this PRN medication, it should be entered into the system. This application is installed on a tablet and is being used during medication rounds. If a nurse does not have basic knowledge of using a tablet and the application, then it would be hard for him/her to correctly use the device and adhere to the 8 Rights of Medication Administration --- whereas, medication errors might happen. As a result, residents “may” view this incident as non-caring because the healthcare professional wasn’t prudent enough to give the correct medications. Furthermore, each resident’s Medimap interface shows not only the medications they receive but as well as other relevant clinical information such as any known drug allergies, preference in taking medications, monitorings (blood sugar levels, vital signs) and communications between health professionals across facilities. This technology then is highly helpful in making the nurse know more about the resident with just a glance into the application.
Technological competency is also essential in this time of the COVID pandemic. In NZ, during alert levels 3 and 4 lockdowns, families are not allowed to visit the care facility to see their loved ones. As a result, some residents feel isolated and get depressed. One of the facility’s solutions to this is through video calls between the resident and their families. In our rest home, we try our best to give residents the time to connect to their sons, daughters and grandchildren by using a tablet with WhatsApp installed. Some of these mature people do not know how to use a tablet, thus, it is then the nurses’ task to facilitate the call process. After each video call, our residents feel much better and their moods bounce back from being low and the family members are all in gratitude for making these video calls happen. In my viewpoint, this simple gesture of using a tablet to connect a resident to his/her whanau (Maori word for family) is in itself an act of caring for the social (not just physical) wellbeing of the person.
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