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1-Page Feature_FNL CX 5/8/10 3:17 PM Page 17 Are You Listening? By Helen Greenspan, RN M y mother taught me to be on time, to send thank you cards for gifts, and to always help those less fortunate than I am. Most importantly, she taught me about kindness, and the importance of human connection. My career in nursing has allowed me a perfect playing field to nurture these qualities. Throughout my 21 years of nursing, nothing has been more meaningful to me than the times I have been able to step outside of the flurry of tasks, data, and time constraints and enter into a space of quiet intimacy with my patients, simply by bringing my attention to our shared moment without distraction and without agenda. While so many other parts of my job as a hospice nurse are demanding, draining, and stressful, this type of connection is the nectar that sustains me as a nurse. But as nursing gets more regulated, even hospice is being forced to move to a more corporate model for care. Enter the laptop. What were we thinking? For many of us, it sounded like a good idea at the time. More ease and efficiency, access to patient information at our fingertips, a quick click of the mouse rather than all that writing. The days of suffering from numb hands and stiff necks as we sat charting in our cars, limbs twisted in ergonomically nightmarish positions, would be over. The ease of not having to return to the APRIL 2010 office every day to drop off charts, or not having to spend hours in the office searching for paper charts only to find that a nurse had taken them home and forgotten to bring them back. All of this sounded pretty good, even to me, a kind of minimaltechno type. However, now four years into it, I can honestly say I don't think any of us really understood what real-time use of computers in home care would look like. The use of laptops in hospice has presented many unexpected challenges. Security and confidentiality of private health information is a top one. Suddenly, the "Oh cool, I've got all my patients' information right here in my laptop!" became "Uh-oh, I've got all my patients' information here on my laptop!" No one, not even the managers, was prepared for this. Who knew that it would be a federal issue when a laptop was stolen or lost? Field staff have been scolded, disciplined, and even terminated for lapses in judgment which might allow for private health information, or PHI, to be, well, not so P. Should you find yourself in the unfortunate position of being held at gunpoint with someone demanding "Your computer or your life," you'd best give up your life so you can hang onto your job. And there'd better be signs of a struggle! Apart from all the security issues surrounding the use of laptops in hospice, my W W W. N A T I O N A L N U R S E S U N I T E D . O R G biggest objection to it is this: While I see the immense benefit from having my patients' records literally at my fingertips (and I imagine would fight like heck if they ever tried to take our computers away from us for that reason alone), I cannot reconcile the use of laptop computers in patients' homes, especially in hospice, for one reason alone—it interferes with the capacity to connect fully with our patients. Call me a holdover from the past, but I still believe in the kind of nursing where we hold someone's hand when they are frightened, versus documenting "anxiety" on a scale from 1-10. Or listening deeply as a dying person searches our eyes for connection, which, by the way, they can't find if our eyes are glued to a monitor. Most of all, I value the practice of deep listening and full presence, which requires a minimum of two people and no electronic devices. When my 16-year-old daughter tells me "I'm listening!" while her iPod is blaring in her ears and her fingers are manipulating buttons to find the perfect song, well, call me overly sensitive, but I don't feel like I'm being heard. Likewise, when I am sitting in my patient's home plunking in information on my computer, my attention is not fully with my patient. It's true, I can look up every minute or so and give a reassuring nod to let them know I'm really listening, but we all know the quality of attention is different when a third, electronic party is present. There are nurses who will defend their ability to handle both patient and computer in the home setting, claiming that they can maintain connection with their patients despite their fingers and their brain doing two separate things at the same time. There are other nurses, and we all know them, who have literally left the profession scratching their heads wondering what happened. Me, I'm somewhere in the middle. I value the use of computers at home or in the office, but I struggle with laptop use in patients' homes and am outraged at the haphazard PHI protocols and the fear that the PHI gods have implanted in home care nurses. Mostly, though, I am saddened by what looks like the replacement of heart-based listening and attention for those who are physically vulnerable by speed and efficiency which, ultimately, don't heal a damn thing. I know one thing for sure, though. My mother was right when she told me years ago, "It's nice to listen, when you're being talked to." N AT I O N A L N U R S E 17