Advancing the Theory of Technological Competency as Caring in Nursing: The UniversalTechnological DomainRozzano C. Locsin, RN, PhD, FAAN, Florida Atlantic University and Tokushima University;Marguerite Purnell, RN, PhD, AHN-BC, Florida Atlantic UniversityAbstractSophisticated technologies are accepted as integral with contemporary life, occupying auniversal technological domain that is coextensive with humans and their environment.In human healthcare, the risk for depersonalization of persons receiving care renders thepreservation of humanness as essential, particularly in technology-dense arenas. Nursesare challenged to sustain their caring nursing practice while responding to the complextechnological demands of modern healthcare. This paper explicates a further developmentof the theory of technological competency as caring in nursing (TCCN) that embraces theuniversal domain of technology. Within the theoretic lens of the TCCN, 3 key elementsdemonstrate the fundamental process of knowing persons within the universal technologicaldomain: technological knowing, designing, and participative engaging. Underpinning thisprocess of nursing are concepts of human naturalness, human wholeness, and nursingtechnology connoisseurship. From the perspective of the TCCN, the nurse appreciates andknows persons more fully as active participants in their care rather than as passive recipientsof care, and thereby advances the preservation of humanness.Keywords: technological knowing, humannaturalness, technological connoisseurship,universal technological domain, humannaturalness, human wholenessIntroductionSophisticated technologies are now acceptedas integral with contemporary life, occupying auniversal technological domain (Figure 1) that iscoextensive with humans and their environment.This paper explicates further development of thetheory of technological competency as caring innursing (TCCN) that embraces the universaldomain of technology, a contemporary reality. Inhealthcare, specialized technologies areubiquitous and routinely infiltrate all environmentsof care. The risk for depersonalization of personsreceiving care is great and renders thepreservation of humanness as essential intechnology dense healthcare arenas. Nurses arechallenged to sustain their caring nursingpractice while attempting to respond to thecomplex and competing technological demandsof modern day healthcare. A theory of nursingthat is focused on knowing persons across theuniversal technological domain is crucial to aidnurses in their practice and help preserve thehumanness of the persons in their care.Within this domain, expert nurses areinformed through the process of technologicalknowing in nursing. The view of competentnurses as technological connoisseurs, especiallyin “high tech” arenas, is celebrated with theirexpertise grounded in technological knowing.This enables them to fully know their patients aspersons and to realize the value of their skillednursing practice. The TCCN (Locsin, 2005) is theonly middle-range nursing theory that specificallyaddresses technological knowing within theharmonious coexistence of nursing, technology,50and caring. This practice theory is focusedon “knowing persons,” with key elements oftechnological knowing, designing, andparticipative engaging.Nurse satisfaction with enacting theory-basednursing through technological knowing isenvisioned to contribute to improved nurseretention in high tech environments. Through thetheory of TCCN, nurses can more easily bridgethe advancing world of technology whilepreserving the humanness of their patients.Patient satisfaction as an outcome of enhancedpractice grounded in the theory affirms nursingas a professional practice that fosters idealpatient well-being.BackgroundThe issue of preserving humanness may wellbe an increasing concern in modern society. Inhealthcare, particularly, the need is critical topreserve humanness amid the saturation ofroutinely invasive technologies of care. Nowhereis this felt more keenly than in nursing practice,where nurses are faced with enacting caring asfoundational to their practice within a “high tech”milieu stretching from hospitals and other primarycare institutions, to the home.For nurses practicing in high-technologicalenvironments, the tension is palpable betweenthe need to preserve humanness through caringnurturance and the demands of the technologyfor attention, interpretation, and action.Polkinghorne (2004) notes that “technification”(p. 25) occurs when the technological worldviewhas thoroughly permeated culture where thescientific method serves as a basis for thinking.Nurses operate under the tension-filled dictumsof improving cost effective outcomes based onprescriptive, measurable strategies, and reducinghospital stays for patients according to diagnosticInternational Journal for Human Caringrelated groups (DRGs), instead of their expert,nursing appraisals for human care. The threat topreserving humanness is constant. Nurses oftenlose the view of the person as natural and whole.Practicing within the theoretic lens of the TCCNin Nursing allows nurses to reclaim thisfundamental value: Nurses are able to see theperson as whole again.Against the backdrop of technologicaldominance and dependency in healthcare andthe imperative in nursing education to advancetheory-based practice, the following question iscogent: Can a theory-based practice of nursingpreserve humanness in an overwhelminglytechnological world of human healthcare?Preservation of humanness in contemporary andfuture nursing practice is essential to maintainthe critical value, meaning, and practice ofhuman healthcare.PurposesThe purposes of this theoretical paper are,(a) to explicate the nursing practice process ofknowing persons within the theoretic lens of theTCCN (Locsin, 2001, 2005, 2009, 2010; Locsin& Barnard, 2007), and (b) to describe thepractice implications of maintaining humannessin a technological healthcare environment, inwhich the technological environments of personsare coextensive, coexisting, and cocreated(Purnell, 2005) within the universal technologicaldomain (Figure 1).The concept of humanness that is oftenreflected in healthcare is an essential ingredientin the practice of nursing grounded in caring.Critical to preserving humanness in nursingpractice is the theoretic lens of the nurse. Ashuman healthcare technologies facilitate therealization of efficient and quality nursing, it befitsnurses to practice their nursing caring, rootedand grounded in an explicit theory of nursing.Persons are living human beings who havehopes, dreams, and aspirations (Boykin &Schoenhofer, 2001). Human beings have thecapacity to think, imagine, innovate, and create,and are unpredictable. Within the high-technursing situation, the liminal, dynamic space ofthe technological environment (Figure 1) in whichopportunities for human caring become manifestand evolve, the question of how technologyfacilitates the nurse’s knowing of the personchallenges understandings of how persons,in their humanness, come to know each othernaturally, without technological artifice or tool.These philosophical and disciplinary questionsare bound up in the realities of practice: Astechnological connoisseurs, expert nurses are
Advancing the Theory of Technological Competency as Caring in Nursing: The Universal Technological Domainso skilled as to make the technology seeminvisible and almost natural. They are at onewith their technological environment.The Theory of Technological Competencyas Caring in NursingTechnology, wherever and in whateverenvironment it is embedded, can result inmediating and transforming the dimensionsand quality of care for the nurse and the personbeing nursed. A realistic practice model forcontemporary nursing is one in whichtechnological competency is expressed as caringin nursing (Locsin, 2005, 2009, 2010). Accordingto the TCCN (2005), being technologicallycompetent is being caring. Clearly, it matterswhether or not the expert nurse is competentin the use of care technologies.The following five assumptions describethe elements that guide the understanding ofthe theoretical process of technological knowingof persons in order to preserve and maintaintheir humanness.Assumptions of the Theory: Persons are caring by virtue of theirhumanness (Boykin & Schoenhofer,2001). In nursing, caring is understood asthe substantive focus of the discipline. Itis not simply the act or emotion one mayportray toward another person but also thesubstance of the domain that directs theintegral nature of nursing as a disciplineof knowledge. In the assumption, “personsare caring” is studied as fundamental tothe practice of nursing. The ideal of wholeness is a perspectiveof unity (Locsin, 2005) derived from theideal that persons are known as wholesin ways shaped by philosophical truthsand realities. The conceptualization ofwholeness allows for the recognition ofhuman beings as complete in their beingwithout reference to composition of parts.This ideal allows the nurse to focus onnursing as a shared lived experiencebetween the nurse and the person beingnursed (Boykin & Schoenhofer, 2001),rather than focusing on fixing the personor completing the person’s lack ormissing “parts.” Knowing persons is a multidimensionalprocess (Locsin, 2005) in which thenurse and nursed focus on appreciating,celebrating, supporting, and affirming eachother, while allowing for mutual recognitionas dynamic participants in human caring. Technologies of health and nursingare elements for caring (Locsin, 2005)through which nurses in practice are ableto know human beings more fully aspersons who are active contributors intheir care, rather than simply as objectsof care. Nursing as a discipline and aprofessional practice (Boykin &Schoenhofer, 2001) provides the essentialopportunity for engagement in thescholarship of practice grounded in caringwithin the universal technological domain.These assumptions provide essentialelements of the theory of TCCN that guide thenurse in the practice of nursing as knowingpersons as wholes through the proficient useof technologies for human care. Technologicalknowing (Locsin, 2009) is a way of understandingpersons through the use of technologies ofhealth and human care and provides nursesan “other” way of knowing persons.demonstration of intentional, deliberate, andauthentic encounters of knowing persons intechnologically demanding nursing practicesettings, particularly those in environmentsrequiring specialized and substantialtechnological expertise. From the perspectiveof the theory, three multidimensional elementsserve to guide nurses in their practice. Theseelements inform each other as aspects of awhole, and are described as technologicalknowing, designing, and participative engaging.Technological KnowingTechnological knowing is the shaping ofdeliberate understanding of persons guided bythe revelations of technology. In this process,the understanding of the person is magnifiedFigure 1. Knowing of Persons: A Practice Process of NursingSince Carper’s (1978) germinal research waspublished, nurse scholars have critiqued,extended, and sought to reconcile with practicethe fundamental patterns of knowing that sheand later scholars articulated. The range anddimensions of these patterns were insufficient toembrace other ways of knowing (Purnell, 2009),especially the knowing of persons in intimaterelationship with highly technologicalenvironments. Technologies that nurses usein proficient human caring provide opportunitiesfor furthering the knowing of persons in theirwholeness. Nurses are challenged in theirauthentic intentions and desires to engage inquality nursing practice.Knowing persons as a practice processof nursing is revealed in the knowledgeablethrough the realities of the data obtained fromthe technology. In comprehending these realities,the nurse enters the world of the other, knowingthem as participants in their care rather than asimpersonal objects of care. Although the person’sstatus may change from moment to moment, theperson is realized by the nurse as a dynamic andunpredictable human being (Locsin, 2010).DesigningDesigning is a multidimensional process ofknowing persons in which both the nurse andthe one nursed cocreate a mutually fulfillingcare process from which the nurse can designresponses to the patient’s desire for qualityhuman care (Locsin, 2010).2015, Vol. 19, No. 251
Advancing the Theory of Technological Competency as Caring in Nursing: The Universal Technological DomainParticipative EngagingParticipative engaging promotes theopportunity for simultaneous practice of sharedactivities that are crucial to knowing persons.In this engagement, the alternating rhythm ofimplementation and evaluation occurs duringwhich the nurse enters the world of the other andengages in continuous knowing (Locsin, 2010).Discovery and Advancing Knowing Withinthe Universal Technological DomainDiscovery of further knowledge about theperson that is derived from the process ofknowing, designing, and participative engaginginforms the nurse and the one nursed in anintegrated and seamless practice, illuminatingthe generative nature of technological knowingin nursing. Both the nurse and the person beingnursed cocreate and mutually experience nursingfor the purpose of realizing each other’s hopes,dreams, and aspirations. The ongoing cognitiveengagement and plenary practice of knowingpersons using technologies of human careillustrate advancing discovery of knowledge.As a conceptualization of themultidimensional nature of technology embeddedwithin nursing in contemporary practice, theuniversal technological domain is boundary-lessas signified by the mobius-like wave in Figure 1,and coextensive with the nurse and nursed.The notion of complexity and complex dynamicswithin the universal technological domaintherefore open the realm to discovery andadvancing knowing.Theoretical Concepts DevelopmentNurses as Technological ConnoisseursContemporary nursing stresses knowingpersons as a process of nursing in which humanbeings are appreciated through practicetechnologies that provide acknowledgementsof their humanness (Locsin & Purnell, 2009).The expert nurse as a connoisseur of practicetechnologies demonstrates seamless skills, withconnoisseurship being “as much of an art ofdoing as an art of knowing” (Polanyi, 1962,p. 54). In situations of critical care, nurses astechnological connoisseurs choose delicatelyhoned complex responses to human needs inorder to maintain or to titrate life in their actions.This profound way of knowing underpins theprocess in which nursing technologies are usedto engage persons more fully as participants intheir care, and to know them as not needing tobe “fixed,” or to be made whole again (Boykin &Schoenhofer, 2001): They are already whole. Inthis process of knowing through technologicalcompetence grounded in caring, the practice ofnursing is made meaningful and valuable, and itsoutcomes made visibly clear.Nevertheless, while technology has greatpotential to bring the nurse closer to the patient52by enhancing the nurse’s ability to know theperson more fully (Locsin & Purnell, 2007), it isconversely possible that technology can increasethe gap between the nurse and the personnursed. Such situations may occur through thenurse’s conscious disregard of the patient asperson, and ignorance of the nursing imperativeto know the patient who has hopes, dreams, andaspirations for living. Sadly, nurses are often tornbetween the medical dictum of a focus on humanparts, and their nursing stance of caring for thewhole person.In many situations, nurses contemplate thenotion that advanced technology may distancethem from patients because they need to paysuch close and extensive attention to themachine technologies (Locsin, 1999). However,one can understand and appreciate that it isthrough these technologies that criticalinformation about the person can be moreaccurately obtained, thereby allowing nursesto focus more on being with the person who isbeing nursed, rather than simply illustratingproficiency with the technology. When the latteroccurs, such situations can lead nurses todemonstrate technological proficiency as a skillor technique rather than as the artful andknowledgeable expression of nursing as caring.With these conceptual tensions of beinghuman, of nursing, and of technological knowing,varying expectations of purpose and focus areconstrued within the descriptions of humanwholeness and human completeness. It is herethat we return to our original question: Can atheory-based practice of nursing preservehumanness in an overwhelmingly technologicalworld of human healthcare? If a theory of nursinganswers to the contemporary practice need tobe grounded in an affirmation of the realities oftechnology as both internal and external humanenvironments, and to the necessity for a practiceprocess of knowing persons as wholes groundedin caring, the answer is clearly in the affirmative.Human Naturalness and Human WholenessThe notion of persons as wholes and naturalregardless of artificial parts is fundamental to theunderstanding of knowing a person as a humanbeing, and not an object. Within this perspectivethat is consonant with the unitary transformativeparadigm (Newman, Sime, & Corcoran-Perry,1991), the lack of a human part or parts doesnot render the human being as less of a person.From a human science viewpoint, human beingsare understood as more than and different fromthe sum of their parts, therefore, the personremains whole at all times.Another view of the meaning of being humanencompasses the idea of completeness. Thisperspective is grounded in the totality paradigm(Parse, 1987). Human completeness implies thathuman beings have a sufficiency of requisite andInternational Journal for Human Caringexpected parts. Completeness is held to be theideal illustration of a human person, in which aperson as object is known from a studiedanatomical and physiological human perspective:With a totality or completeness of parts view, theperson is regarded as “normal” when all parts arecomplete. The implication of this perspective isthat with a part missing, the person may beappreciated as less human and at riskfor objectification.The objectification of persons occurs andbecomes conventional when nurses practicenursing as merely the achievement andcompletion of tasks. Situations such as these canexist when persons are viewed as objects of careand therefore only as recipients of care, whopassively and “patiently” await the “nursing” to berendered by the nurse. However, when personsare recognized as participants in their care, agestalt opens up into a process of knowing inwhich caring can be expressed in complex ways.A feature of this practice process of nursing isthe expectation of commitment to know the onenursed. Committed knowing is expressed bythe nurse in the appreciation, design, andengagement of practice to facilitate thepreservation of humanness. Instead of doingfor the patient, the nurse is now able to be withthe patient in mutual knowing.Implications for Nursing and Its PracticeThe mandate is clear for a nursing practicethat is based on the intention to know personsmore fully as human beings, transcending thenotion of persons as objects of care. The nurseis challenged to know persons as whole usingevery possible creative, imaginative, andinnovative way to appreciate and celebrate theirintentions. Nurses need to return to an overridingimperative of practice to know persons more fullyas whole in order to maintain and sustain theirhumanness.Communicating Nursing PracticeWith technological knowing in nursing,communicating the cocreated moment betweenthe nurse and the one nursed is essential, ifnursing is to preserve the humanness of personsin a nursing practice grounded in environmentsof nursing caring. As perceptive as the nursecan be of the nursing situation (Boykin &Schoenhofer, 2001), the technological knowingof
are challenged to sustain their caring nursing practice while responding to the complex technological demands of modern healthcare . This paper explicates a further development of the theory of technological competency as caring in nursing (TCCN) that embraces the universal domain of technology .
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Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
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