This page provides links to the findings of a research study undertaken by Richard Lakeman in June-July 1996.
These findings were
presented at:
Lakeman, R. (1996). The
internet: Facilitating and international nursing culture. (Conference
Proceedings). (pp. 261-282). Auckland: ANZCMHN
and published in:
Lakeman, R. (1996). Psychiatric nursing. The Internet: facilitating an
international nursing culture for psychiatric nurses. Computers in Nursing,
16(2), 87-9.
5.0 How psychiatric nurses see the internet affecting
nursing culture.
Most respondents perceived that the internet will have a positive
influence on psychiatric nursing culture. Some questioned whether
there was an international psychiatric nursing culture at present
but suggested that the internet could play a major role in forming
or shaping one. A number of existing constraints were acknowledged
which need to be overcome if the potential of the internet as
a positive influence is to be realised. Respondents viewed the
internet as having the potential to affect nursing culture in
a psitive way in three main areas.
5.1.0 Building an international community of psychiatric nurses
The internet was seen as a tool which could assist in building
a truly international community of psychiatric nurses. The characteristics
of this community would be:
5.1.1 Universality and a sense of belonging. The internet
has the potential to reduce the sense of isolation felt by those
who may be geographically isolated from colleagues. One respondent
described the "tyranny of distance" as one factor which
has led to the "failure to achieve or maintain a 'critical
mass'" of experience psychiatric nurses in his home country.
Communication with colleagues from around the world was seen as
able to engender a sense of belonging to a wider international
community of people with a shared vision and interests.
For other nurses a sense of isolation may be related to holding
beliefs which run counter to those which dominate in the institutions
in which they work. These individuals may feel isolated in their
places of work despite being surrounded by colleagues. The internet
was seen as able to provide access to peers who share similar
beliefs as well as assisting in maintaining optimism and shaping
ideas.
One respondent commented that "Psych nurses have always been
set apart from other types of nurses (at least in the U.S.) and
the internet gives me a sense of belonging and of the power of
psych nurses". The internet was viewed as having the potential
to foster a sense of belonging and cohesion with in the profession.
"We can support and encourage each other personally through
email. This brings us truly together as a profession instead of
the fragmentation that is happening now."
5.1.2 Acceptance of diversity. It was apparent to a number
of respondents that the internet had increased their awareness
of other cultures and the diversity of beliefs and values held
by others. One spoke of "being enriched" by the contact
with "other cultures". The internet provides a means
of celebrating the diversity of beliefs held by the community.
5.1.3 Egalitarian participation. The internet is essentially
egalitarian in nature. While the infrastructure may be owned by
commercial interests, there is no controlling body which can at
this time determine and enforce what can and cannot be shared.
Anyone can participate in discussion, or access information without
necessarily having advanced qualifications. Unlike the television
media which is selective in its choice of who will comment on
issues, the internet allows for anyone to have their say. The
value of peoples' contributions may be judged on content and style
rather than on the gender, race or class of the person (as these
may not be known). The persuasiveness of peoples arguments and
the insight that they show may provide more credibility than an
impressive array of qualifications. Thus a new graduate nurse
may have access to the same information resources as a doctoral
candidate and may enter into discourse that they may be excluded
from in other forums:
The egalitarian nature of the internet allows clinicians, researchers
and educators to dialogue with each other instead of only within
those specialised fields of nursing practice. Greater access to
information allows the 'doorkeeping' function of professionalism
to be dispensed with and this will make a huge difference to new
graduates who will not have to 'depend' on those in senior positions
for knowledge. I also believe it will have an effect of 'demystifying'
the profession, that is it is able to communicate on levels where
local tradition and professional norms do not exist.
The internet may also provide a means by which those with qualifications
and experience can share their knowledge with others. "There
are a lot of people with loads of education out there - and they
answer questions and let you participate in discussion although
you are not so experienced."
5.1.4 Collaboration. The internet may increase the ease
with which nurses around the world can collaborate on projects.
Respondents identified curriculum development and research in
which collaboration would be enhance through the internet.
5.1.5 Enhanced Practice A result of the sharing of observations and ideas ought to be enhanced practice informed by sound theory. "By instantaneous sharing of info with colleagues around the world we can all keep our scientific knowledge base up to scratch(so to speak). New ideas and theories can be debated and reflected on." The internet was seen as able to assist psychiatric nurses gaining "… a more global view of our practice". The speed of communication and "wider network of opinions and professional input" was seen by one respondent as helping to "inform and 'spread' new practices…"
5.1.6 Shared Language. A number of respondents described
the need for and the potential of the internet to assist in the
development of a shared language to describe the phenomena of
concern to psychiatric nurses.
To some extent communication on the internet both requires and
assists people to develop a shared language. With the advent of
e-mail, a form of shorthand has evolved to assist in communicating
the nuances or shades of meaning that are more readily communicated
by face to face or verbal communication (see table 1). What respondents
alluded to however, was the need for a way to describe peoples
experience and the activities which psychiatric nurses engage
in which better captures the essence of nursing than the present
lexicon of psychiatric diagnosis.
5.2.0 Enhancing interdisciplinary and intradisciplinary
communication.
5.2.1 Speed and efficiency. The internet was understood
to have the potential to increase the speed and efficiency of
global communication with colleagues from within and outside the
discipline of psychiatric nursing.
5.2.2 Online journals. Journals are the established means
by which new knowledge is shared, debated and developed in any
discipline. The development of online journals was seen as an
exciting potential that the internet has to offer. Even if these
do not supersede their written counterparts the process of refereeing
articles and providing feedback to authors can be substantially
speeded up through the use of internet communication.
A number of journals already publish on the world wide web for
example the American Journal of Nursing (AJN) and The Australian
Electronic Journal of Nursing Education. The world wide web as
a publishing medium provides opportunities which cannot be realised
with conventional journals. For example an article might include
a sound commentary, a video clip or animation, or direct links
to references or other sources of information. The AJN already
provides the opportunity to complete and submit questionnaires
for continuing education credits online. The world wide web allows
for feedback and comments to be provided to the author or editors
directly upon reading an article. Thus the delays between submission,
publication and feedback are minimal.
5.3.0 Facilitating Educational Opportunities
Distance education was an area where many though that the internet
had huge potential to shape nursing culture. Some respondents
had already had experience of using email to keep in touch with
lecturers and students during courses in which they were enrolled.
Extra-mural students are able to collaborate with other students
via email. Most also spoke of the informal learning that arose
through their exploration of the internet and communication with
colleagues. Others saw the potential for developing distance education
packages.
Clinical supervision for nurses in remote areas was another potential
that respondents saw for the internet: "Could be used for
clinical supervision, for rural areas such as the one I live in.
I do home health psychiatric nursing, and if I weren't in school,
clinical supervision would be impossible."
5.4.0 Constraints on the realisation of the potential of the internet
Respondents identified a number of constraints which need to be
overcome before the internet will have a major impact on nursing
culture.
5.4.1 Financial. The cost of internet access varies around
the world. While in some areas of the United States full access
may be obtained for a small fixed monthly fee in other parts of
the world monthly accounts can cost hundreds of dollars. In addition
the hardware requirement needed for many internet applications,
for example a fast computer, modem and lots of memory, make cost
a prohibitive factor for many people.
5.4.2 Involvement. A number of respondents felt that a
"critical mass" was required, that is a substantial
number of nurses needed to have access to the internet and use
it before the internet would have any major impact on nursing
culture. One respondent suggested that "It will only have
a significantly effect if large numbers of nurses join up, which
presumably depends on resources and facilities". Clearly
cost will be a barrier to many individuals. Perhaps an even greater
barrier, as some respondents pointed out, is discomfort using
the technology and the present level of computer literacy amongst
nurses. It was suggested that the impact of the internet "depends
on how many nurses get computer literate". One respondent
said his colleagues viewed the internet as an "eccentric
hobby".
5.4.3 Superficiality of information. It was suggested that
finding useful information on the internet involves wading through
a "lot of rubbish". Information is not always accessible
and some described it as "superficial". Clearly nurses
who use the internet must learn how to find the information they
are looking for and they must be involved in creating and sharing
information if this constraint is to be overcome.
5.4.4 Education not valued highly. One person suggested
that "Psychiatric Nurses, in general, from my experience,
don't see learning in their specialty as a priority. They limit
themselves to on-the-job training and the minimum continuing education
units required by their licensing agency". If this assertion
is indeed true then the internet will have limited scope for affecting
nursing culture except within the academic community in which
its use is already established.
5.4.5 Ethical and legal. It was evident to respondents that most internet communication at the present time is not secure. Any of the potentially millions of computers between the sender and receiver of information may intercept, read and distribute messages. Some respondents suggested that international protocols need to be developed relating to the discussion of clinical information and the identification of patients / clients.