TECHNOLOGICAL COMPETENCY AS CARING IN NURSING: A 
DESCRIPTION, ANALYSIS AND EVALUATION OF THE THEORY 
Cvetka KREL1*, Dominika VRBNJAK2, Sebastjan BEVC1,3, Gregor ŠTIGLIC2, Majda PAJNKIHAR2
1University Medical Centre Maribor, Clinic for Internal Medicine, Department of 
Nephrology, Ljubljanska ul.5, 2000 Maribor, Slovenia
2University of Maribor, Faculty of Health Sciences, Žitna ul. 15, 2000 Maribor, Slovenia
3University of Maribor, Faculty of Medicine, Taborska ul. 8, 2000 Maribor, Slovenia
Received: Jul 20, 2021
Accepted: Feb 18, 2022
Review
*Corresponding author: Tel. + 386 41 279 491; E-mail: cvetka.krel@gmail.com
10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
115
OPIS, ANALIZA IN EVALVACIJA TEORIJE “TEHNOLOŠKA 
KOMPETENTNOST KOT SKRB V ZDRAVSTVENI NEGI”
© National Institute of Public Health, Slovenia. 
Krel C, Vrbnjak D, Bevc S, Štiglic G, Pajnkihar M. Technological competency as caring in nursing: a description, analysis and evaluation of the theory.  
Zdr Varst. 2022;61(2):115-123. doi: 10.2478/sjph-2022-0016.
ABSTRACT
Keywords: 
Rozzano C. Locsin, 
technology, nursing 
theory, nursing practice
IZVLEČEK
Ključne besede: 
Rozzano C. Locsin, 
tehnologija, 
teorija zdravstvene 
nege, praksa 
zdravstvene nege
Introduction: When introducing and using technology in nursing, there is a danger that too much focus is 
placed on technology over caring for patients. The ‘Technological competency as caring in nursing’ theory 
can facilitate technology in caring, but the theory needs to be described, analysed and evaluated before it is 
used. The purpose of the literature review was to determine the possibility of applying the theory in education, 
research and practice, and whether the theory could be used to guide research into the use of electronic 
nursing record systems. 
Methods: A literature search was conducted in PubMed, CINAHL, ScienceDirect, Google Scholar and Google 
Books, and supplemented with manual searching using the keywords ‘Locsin’, ‘technology’, ‘caring’ and ‘nursing 
theory’. The criteria for inclusion were fully accessible articles and books in English on the relevant topics. 
The review process is shown in a PRISMA diagram. A hierarchy of evidence was used to evaluate the relative 
strength of the results. Pajnkihar’s model was used to describe, analyse and evaluate the theory. 
Results: A total of 26 hits were included in the final analysis. The theory in question meets the criteria of 
clarity, simplicity and complexity, adequacy, importance and significance; it can be tested; and it is useful in 
patient care that employs technology. 
Discussion and conclusion: The theory is useful in nursing education, research and practice. The theory will be 
used to guide research on the perception of technological competency and care of internal medicine patients 
by nurses when using the electronic nursing record system in three Slovenian hospitals.
Uvod: Pri uvajanju in uporabi tehnologije v zdravstveni negi obstaja možnost, da se bolj osredotočamo na 
uporabo tehnologije kot skrb za pacienta. Teorija “tehnološka kompetentnost kot skrb v zdravstveni negi” 
olajša vključitev tehnologije v skrbno obravnavo pacienta, vendar jo je pred uporabo treba opisati, analizirati in 
ovrednotiti. Namen raziskave je bil ugotoviti možnost uporabe teorije na področju izobraževanja, raziskovanja 
in prakse zdravstvene nege ter njeno skladnost s podporo raziskave o uporabi elektronskega zapisa zdravstvene 
nege. 
Metode: Pregled literature je bil izveden v podatkovnih bazah PubMed, CINAHL, ScienceDirect ter tudi Google 
Scholar, Google Books in dopolnjen z ročnim iskanjem s pomočjo ključnih besed “Loscin”, “ technology”, “caring” 
in “nursing theory”. Kriterija za končno analizo sta bila polna dostopnost člankov in knjige v angleškem jeziku z 
ustrezno tematiko. Za prikaz poteka pregleda literature je bil uporabljen diagram PRISMA. Identificirani zadetki 
so bili uvrščeni v nivo glede na hierarhijo dokazov. Za opis, analizo in vrednotenje teorije je bil uporabljen 
model avtorice Pajnkihar. 
Rezultati: V končno analizo je bilo vključenih 26 zadetkov. Izbrana teorija zadosti kriterijem jasnosti, 
enostavnosti in kompleksnosti, ustreznosti, pomembnosti in pomenu. Teorijo je možno testirati in je uporabna 
pri oskrbi pacientov, kjer se uporablja tehnologija.
Zaključki: Teorija je uporabna v izobraževanju, raziskovanju in praksi zdravstvene nege ter bo podpirala 
raziskavo o zaznavanju tehnološke usposobljenosti in skrbne obravnave internističnih pacientov pri medicinskih 
sestrah v treh slovenskih bolnišnicah, kjer se uporablja elektronski zapis zdravstvene nege.
1 INTRODUCTION
The use of technology is becoming increasingly common in 
nursing (1, 2). It can be classified as a completer of human 
beings (prosthetic devices for missing body parts or non-
functional ones), instruments, and gadgets that facilitate 
human care of persons (computers) and mimic human beings 
(robots) (3). Advances in technology can impact human 
health and enable nurses to perform their work efficiently 
and safely (4). Technology can bring the patient closer to 
the nurse by enhancing the nurse’s ability to know more 
about the person. However, there is also the possibility 
that the focus of treatment moves from the patient and 
patient care to the technology itself. The use of technology 
can also increase the gap in the interpersonal relationship 
between the nurse and the patient, as exhibited by the 
conscious disregard of the patient as a ‘person’ (2) and 
ignorance of the nursing imperative to know the patient 
as a ‘person’ (2, 5). The latter affects patient and nurse 
satisfaction, and the quality and safety of patient care (1, 
6). Focus should be placed on nurse-caring behaviours that 
contribute to patient satisfaction and well-being (7). Caring 
is a fundamental concept of nursing that manifests itself as 
the genuine, intentional presence of a nurse with the person 
cared for. Holistic care is needed, and the competent use 
of technology could support patient care (2, 5). Nursing 
theories can help nurses focus on caring for patients 
and their families. Locsin’s ‘Technological Competency 
as Caring in Nursing’ (TCCN) theory is one of the nursing 
theories that refers to care and the use of technologies 
in nursing (5, 6). In caring for patients, this theory gives 
significance to knowing people, a continuous process in 
which the nurse and the nursed can affirm, celebrate and 
support each other (1). The empirical, personal, ethical 
and aesthetic ways of knowing that are fundamental to 
understanding patients as a whole increase the likelihood 
of being able to know patients (5). The use of technologies 
in nursing is consequent to the contemporary demands 
for nursing actions that require technological knowing. 
Technological knowing is a way of knowing in nursing, 
engaging the competent use of technologies of care to 
get to know patients as a whole. Through technological 
knowing, both nurse and nursed are appreciated as a 
whole, as people whose hopes, dreams and aspirations 
matter most in living their lives fully as whole persons (5). 
Locsin’s theory represents the theoretical starting points 
for using technology and caring as a coordinated interaction 
in the nursing environment. Theory-based nursing practice 
is essential to high-quality nursing and healthcare (3). 
The e-health project in Slovenia was launched in 2005; 
however, we still do not have a comprehensive health 
information system, which hinders the development of the 
healthcare system and affects the quality of healthcare 
services (8, 9). Important areas for further e-health 
development are the accessibility and completeness of 
personal e-health data (10). 
10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
116
The implementation of Locsin’s theory can further 
develop the electronic nursing record system (ENRS), 
which is a part of the health information system. Theory-
based ENRS could utilise the language of caring human 
dimensions of nursing practice, and not only physical 
needs and medical conditions. ENRS can provide patient 
information to multiple healthcare providers and allow 
better-coordinated care (4). ENRS development can 
improve the quality of healthcare services (9). However, 
the theory needs to be described, analysed and evaluated 
to determine its applicability to clinical settings, research 
and education (11). 
This paper therefore sets out to describe, analyse and 
evaluate Locsin’s ‘Technological Competency as Caring in 
Nursing’ theory. 
The goals are to identify the usefulness of theory in 
nursing and to determine whether the theory can be used 
to guide research on using the ENRS.
2 METHODS
A systematic literature review was conducted. 
2.1 Search and eligibility criteria
A search was conducted in November 2021 using PubMed, 
CINAHL, ScienceDirect, Google Scholar and Google Books. 
It was supplemented by a manual search.  The search was 
performed using keywords in English with the following 
search combination: (“technology” OR “technological 
competency”) AND (“caring”) AND (“nursing theory”). 
Full-text articles, books and book chapters published in 
English by November 2021 were considered for review. The 
exclusion criteria were letters to the editor, editorials and 
literature in other foreign languages, as well as literature 
unrelated to the research topic.
2.2 Study identification and selection
Figure 1 contains a Preferred Reporting Items for Systematic 
Reviews and Meta-Analyses (PRISMA) (12) flow diagram 
of study selection. Two independent investigators were 
included in the study identification. Any disagreement 
was resolved by discussion or by the involvement of a third 
investigator.
2.3 Quality appraisal and data analysis
To assess the quality of the review, we classified the 
results into a hierarchy of evidence. A seven-level 
hierarchy of evidence was used: Level I (randomised 
clinical trials (RCTs) and systematic review of non-
randomised trials), Level II (individual RCT studies, 
single non-randomised trial), Level III (systematic review 
of correlational/observational studies), Level IV (single 
10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
117
correlational/observational study), Level V (systematic 
review of descriptive/qualitative studies), Level VI (single 
descriptive/qualitative study), and Level VII (opinions of 
authorities, expert committees) (13).
To describe and analyse the theory’s context, content 
and scope, and to evaluate the theory in terms of its 
clarity, simplicity/complexity, importance/significance, 
adequacy, testability, acceptance, the model developed 
by Pajnkihar was used (11, 14). 
Figure 1. PRISMA diagram.
3 RESULTS
The search yielded a total of 765 records in electronic 
databases and 86 from other sources. Using the EndNote 
program reference manager software, we identified 
and removed duplicates (n=17) and then reviewed the 
remaining records by title and abstract to ascertain their 
eligibility (n=207). A total of 759 records were excluded. 
After the full texts were retrieved (n=75), 49 full texts 
were excluded because their content was not relevant to 
the study. A total of 26 records were included in the final 
analysis (Figure 1).
Table 1 shows the characteristics of the studies included 
and their classification in the hierarchy of evidence. The 
literature included was ranked with the fourth (15–22), 
fifth (2, 23), sixth (1, 6, 24–25) and seventh (3–5, 26–34) 
hierarchy of evidence levels. 
(15)
(16)
(17)
(18)
(19)
Reference Research design 
or typology
Sample Key findingsAim of study Hierarchy of 
evidence
Quantitative, 
descriptive 
survey
Quantitative
descriptive 
survey
Quantitative, 
psychometric 
evaluation
Quantitative, 
descriptive 
survey
Quantitative,
psychometric 
evaluation
Nursing  
students  
(n=9)
Nurses
(n=421)
Nurses
(n=299)
Nurses
(n=421)
Nurses
(n=590)
Researchers have shown 
that caring behaviour 
can be developed using 
simulation technologies.
The criterion-related validity 
of PITCCN could be confirmed.
The survey showed that the 
PITCCN questionnaire was valid 
and reliable for measuring TCCN.
Continuous education is needed 
regarding the practice of nursing 
based on the TCCN theory.
Content validity and reliability 
of the TCCN-R was confirmed.
To identify the impact of nursing 
education on nurses’ behaviour 
using the simulation technology 
supported by TCCN theory.
To confirm the criterion-
related validity of PITCCN. 
Validation of the PITCCN 
questionnaire and performance 
of factor analysis.
To identify managers’ and 
staff nurses’ perceptions 
regarding the TCCN theory at 11 
general hospitals in Japan.
To assess the psychometric 
properties and establish the 
reliability and validity of the 
Japanese version of the TCCNI-R.
Level 4
Level 4
Level 4
Level 4
Level 4
Table 1. Summary of studies included.
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10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
(20)
(21)
(22)
(23)
(2)
(24)
(25)
(3)
(4)
(6)
(1)
Reference Research design 
or typology
Sample Key findingsAim of study Hierarchy of 
evidence
Descriptive, 
psychometric 
evaluation
Quantitative,
descriptive 
survey
Quantitative, 
pre-test/
post-test
Descriptive, 
literature review
Describe the 
development of 
TCCN theory.
Qualitative, 
hermeneutic 
phenomenological 
study
Qualitative, 
hermeneutic 
phenomenology
Professional 
article
Professional 
article
Qualitative 
research, 
hermeneutic 
phenomenological 
study
Qualitative, 
phenomenological 
study
Experts in 
theory and 
practice
(n=13)
Nurses
(n=426)
Nursing  
students
(n=27)
/
/
Family  
members  
(n=10)
Nursing  
students  
(n=61)
/
/
Patients
(n=10)
Nurses
(n=10)
The experts confirmed the 
substantive validity. 
Ratings for TCCN were 
significantly higher in the group 
that conducted the training, 
which included caring behaviour.
Students’ confidence in 
using the theory in practice 
was significantly higher 
after the simulation.
TCCN is a medium-range 
theory in nursing that provides 
a theoretical framework for 
research and is applicable in 
practice and education.
A theoretical framework 
for using the theory in both 
research and practice.
Family caregivers described 
their experiences (nurses 
should support family carers 
and share care experiences, 
and should teach family carers 
to use technologies, alarms).
Caring in nursing focused 
on whole-person relating, 
practice competency and 
reciprocal relationships.
With timely development, the 
integration of technological 
competence into nursing 
practice for the professional 
use of advanced technology 
can be imbued with 
artificial intelligence.
Technology can perform 
routine tasks so that nurses can 
spend more time interacting 
with the patient. There is a 
need to transform nursing 
education that incorporates 
technology, and increase the 
focus on nursing research that 
explores the effects of using 
technology in practice.
In practice, nurses should 
know the importance of their 
patient’s experiences. This 
would allow them to anticipate 
the patients’ needs and improve 
their experience by providing 
appropriate interventions 
involving the use of technology.
The application of the theory 
is to assist nurses in achieving 
high-quality care for patients 
in the intensive care unit.
Validity of the instrument 
for measuring TCCN.
To explore how nurses 
working in intensive care units 
implement nursing practice 
based on the TCCN theory.
Pre-test – post-test self-evaluations 
to rate students’ confidence 
in using Locsin’s theory.
Describe TCCN theory and 
its contribution to science 
and the nursing process.
Descriptive, literature review.
Describe the importance of the 
experience of family caregivers.
To describe caring in nursing by 
Japanese nursing students.
Clarify the impact of advanced 
technology on healthcare.
Answer the research question ‘How 
can nurses remain relevant in the 
technologically advanced future?’
Describe the importance 
of technology-dependent 
patient experiences in the 
intensive care unit.
Describe the importance of the 
experience of nurses caring 
for patients who are vitally 
dependent on technologies 
in the intensive care unit.
Level 4
Level 4
Level 4
Level 5
Level 5
Level 6
Level 6
Level 7
Level 7
Level 6
Level 6
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10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
(26)
(27)
(28)
(29)
(30)
(31)
(32)
(33)
(5)
(34)
Reference Research design 
or typology
Sample Key findingsAim of study Hierarchy of 
evidence
Professional 
article
Professional 
article
Professional 
article
Professional 
article
Professional 
article
Professional 
article
Professional 
article
Author’s opinion 
Author’s opinion 
Author’s opinion 
/
/
/
/
/
/
/
/
/
/
The use of simulation in the 
use of technology in patient 
care should be introduced 
in education at colleges.
Technological competency 
as an expression of caring 
in nursing that maintains, 
supports and values caring 
people through mutually 
satisfying representations of 
co-creation moments in nursing.
With the increased use of 
technologies and the consequent 
technological dependence 
of care recipients, the TCCN 
theory must be used.
Maintaining the impact of 
technological competency 
as caring in the complex 
world of nursing is critical 
to the mutual interaction 
between nurse and patient.
The TCCN theory could 
encourage more opportunities 
for the growth of philosophical 
and practical values.
The use of nursing robots 
will redefine conceptual 
frameworks of comfort 
and safety in particular.
An organised education 
plan could improve the 
quality of nursing care.
Origin of the theory, clarity, 
simplicity, further theory 
generation, credibility, 
and the contribution of 
the theory to nursing.
In the nursing process, 
technologies are used to 
know the person as a whole 
at a given moment.
Frameworks for advanced 
nursing and research practice. 
Basic knowledge to improve 
understanding of the theory.
Describe the approach to student 
learning through the simulation of 
the use of technology and caring.
Development of the idea of co-
creation of moments as caring 
that arises in knowing people 
within the technological domain.
Describe the application of the 
TCCN theory in nursing.
Explain the process of nursing 
within the context of knowing 
persons within the TCCN theory.
Describe the development 
of the TCCN theory.
To describe the disciplinary 
recommendations of developing 
humanoid nursing robots.
To describe education programme 
for nursing administrators   
focused on the TCCN theory.  
Analysis of the TCCN theory. 
Presentation of the author and 
the TCCN theory, the process of 
knowing persons as a whole.
Understanding philosophies, theories, 
models and taxonomies in nursing.
Level 7
Level 7
Level 7
Level 7
Level 7
Level 7
Level 7
Level 7
Level 7
Level 7
Legend: TCCN – Technological Competency as Caring in Nursing, PITCCN – Perceived Inventory of Technological Competency as Caring in 
Nursing, TCCN-R – Technological Competency as Caring in Nursing Instrument-Revised.
3.1 Description and analysis of the theory
3.1.1 Author, origins, development of the theory and 
the philosophy of science
Locsin developed the theory based on Boykin and 
Schoenhofer’s ‘Nursing as caring’ theory: a model for 
transforming practice based on caring as the primary 
nursing role (35). It also feels the influence of theorist Ray 
and her ‘Technological caring: a new model in critical care’, 
in which she stressed the importance of technological care 
in intensive care (2, 36). The development of the theory 
was greatly influenced by hermeneutic phenomenology and 
the philosopher Heidegger. He expressed concern about 
the adoption of technology without critical evaluation. 
He stressed that technology would be accepted insofar 
3.1.5 Concepts and propositions
The following concepts are defined: technologies 
in nursing, caring in nursing, and human beings as 
persons (2). The focus of nursing is to know persons (2). 
Empirical, ethical, aesthetic and personal knowing are 
ways of knowing persons (38) and are fundamental to 
understanding a person as a whole (2). Technologies in 
nursing are tools that nurses use in practice. The use of 
technologies in nursing is consequent to the contemporary 
demands for nursing actions that require technological 
knowing. Technological knowing is a way of knowing in 
nursing that engages the competent use of technologies 
to enable a nurse to get to know a person as a whole (5). 
The use of technology in nursing can be complementary to 
human beings through technology (prostheses), the use of 
technology in the form of various machines (computers), 
and technologies that mimic man and his activities, such 
as cyborgs, anthropomorphic machines and robots (2, 27). 
Caring actions are perceived as compassion, conscience, 
trust and commitment (2). Locsin explains the view of a 
person as a person he sees as a whole, who is unique (with 
dreams, hopes, and desires), whole (body, mind, soul) 
and perfect (regardless of illness). He cited propositions 
as the continuous acquisition of information obtained 
through technologies in nursing – about human beings who 
are dynamic and unpredictable as a holistic person. The 
expansion of technology in nursing is an ever-changing 
and demanding process, while caring in nursing is the 
substantive body of knowledge that drives the practice of 
knowing persons (2, 5).
3.2 Theory evaluation
3.2.1 Clarity
The concepts and propositions of the theory are clear, 
described and presented in the schemes. Locsin is consistent 
in structure, but often cites the use of technology to know 
the patient as a whole while stating that technology, by its 
nature, reduces relationships with people, who can only 
become an object made up of parts (28).
3.2.2 Simplicity and complexity
The theory is simple, as it contains some concepts and 
propositions (11, 33). The concepts are logically connected, 
and the propositions clearly explain the connections 
between them, making the theory complex (11). Because 
of its simplicity and complexity, the theory can be applied 
in nursing environments in which technology is used (33).
3.2.3 Adequacy
The theory is adequate for practice, education, and 
research (33). The author cites a narrow field of 
application, which is mainly reflected in the use of 
technology, caring in nursing and knowing the person (2, 
5, 33). Due to the increasing development of technology 
120
10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
as we do not become too dependent on it in the future 
(34). Locsin’s perspective of caring for and understanding 
human beings refers to Parse’s simultaneous paradigm 
(simultaneity) and the recognition that the whole person 
is more important than the sum of its parts (37). Locsin 
also included four ways of knowing (empirical, personal, 
ethical and aesthetic), which he summarised after the 
theorist Carper (2, 38), adding that technologies in 
nursing required technological knowing (5). We can 
speak of historicism and retroductive judgment in theory 
development, which led to the development of a new 
specific theory. 
3.1.2 Scope, level of abstraction and metaparadigm
The selected theory is a middle-range explanatory theory, 
as it clearly describes phenomena and concepts, and 
provides relationships between them (5, 23, 27). Locsin 
explains the metaparadigm through a person, nursing, 
health and the environment. He defines a person as a 
whole, in a given moment, and one who is constantly 
growing, changes according to personal conditions and 
experiences, and is a union of mind, body and spirit. 
Technologies of care support the expectations of persons 
that they will be known as participants in their care rather 
than as objects of care (2, 5). Locsin’s definition of nursing 
is the concept of caring and intentionality (33). Each 
person is unique and individual, so the definition of health 
varies from person to person, depending on their hopes 
and desires. The environment in Locsin’s theory is narrow 
and tied to the technological environment (2, 5, 29).
3.1.3 Assumptions
Locsin grounded his theory in several key assumptions, 
the first two of which are derived from Boykin and 
Schoenhofer’s theory:
• Persons are caring by virtue of their humanness (35).
• Nursing is a discipline and a professional practice (35).
• The ideal of wholeness is a perspective of unity (2, 3).
• Knowing persons is a multidimensional process (2, 3).
• Technologies of health and nursing are elements for 
caring (2, 3).
3.1.4 Phenomena
The theory focuses on recognising human beings as complete 
in their being without reference to composing a part. The 
nurses should focus on nursing as a shared lived experience 
between the nurse and the person cared for, rather than 
fixing the person or completing the person’s missing parts. 
Three phenomena are addressed in theory: ‘being cared 
for’, ‘caring for’, and ‘technology’. ‘Being cared for’ refers 
to the patient’s experience. ‘Caring for’ is based on the 
nurse’s experience. ‘Technology’ can bring the patient 
closer to the nurse, which allows the nurse to know the 
patient more fully as whole and complete (1, 6, 24). 
in our environment, Locsin’s theory could be applied to 
all areas of nursing. Technology is increasingly present in 
education, so it is necessary to also educate and develop 
technological competence in this field (4, 22, 25, 26, 32). 
3.2.4 Testability
The theory can be tested because the instrument is 
developed and contains empirical indicators by which we 
measure concepts (20). The Technological Competency as 
Caring in Nursing Instrument (TCCNI) was developed by 
Parcells and Locsin (20). A survey of nurses in intensive 
care units in Japan was conducted to detect technological 
competency, using the developed Perceived Inventory of 
Technological Competency as Caring and Nursing (PITCCN). 
The PITCCN focused on nurses’ technological caring 
behaviours in acute care settings (21). The PITCCN has 
been further upgraded and psychometrically tested (16, 
17). The PITCCN constituted of four factors: (1) Training of 
nurses to provide optimal care, (2) Intentional and ethical 
nursing of a person, (3) Utilisation of information obtained 
from technology and continuous knowing, and (4) Empirical 
knowledge and whole human knowing. The results of the 
studies showed that the PITCCN questionnaire is valid 
and reliable for measuring TCCN (17). Technological 
Competency as Caring in Nursing Instrument–Revised 
(TCCNI-R) was also developed to measure technological 
competency as an expression of caring in nursing. TCCNI-R 
was constructed as a four-factor: (1) Nursing expression 
as caring, (2) Technological competency as caring, (3) 
Technology and caring, (4) Technological knowing (19). 
The TCCNI-R was also used in the survey to determine 
managers’ and staff nurses’ perceptions regarding the 
TCCN theory in general hospitals in Japan. (18). 
3.2.5 Acceptance
Because the theory was only recently developed, there 
has not yet been a great deal of research (17, 21). 
Nevertheless, the theory can serve as a theoretical 
framework for nursing practice, as it coincides with the 
rapid development of technology. The research found 
that education related to caring behaviour and the use of 
technology was needed (25). There is a need to increase 
the focus on research in nursing that explores the effects 
of using technology in the profession and the ways in 
which the use of technology can be mastered in practice 
(4). Content related to the use of technologies and clinical 
simulation should be included in nursing education (15, 
22, 25, 26).
3.2.6 Importance and significance
The importance of the theory in nursing relates to 
its clinical value, which is reflected in nursing areas, 
especially in highly developed technological environments 
such as intensive care units (5, 21, 23). The theory can 
also be applied in environments where technology is used 
as a complement to man through technology that mimics 
man and his activities, and in the use of computers (2, 
27). Its importance for the discipline of nursing is seen 
with the development of theory that contributes to the 
development of knowledge (2, 30). 
4 DISCUSSION
Technology is becoming increasingly more integrated 
into nursing practice and increasingly complex. Locsin 
developed the TCCN theory as a way of solving problems 
using technologies in nursing (27, 29), and described the 
nurses’ technological competency as expressing caring 
in nursing (19). The theory is useful in nursing research, 
education and practice. Despite certain limitations of the 
literature review, such as exclusively English texts and the 
inclusion of hits belonging to the fourth to seventh levels 
of the hierarchy of evidence, knowledge development is 
essential. The studies show that nursing education related 
to caring and technology is needed. The introduction of 
simulations in student education and the application of 
the theory are appropriate in the educational environment 
(4, 15, 32). The TCCN theory has been used in several 
studies of nursing practice (6, 16–19, 21, 24, 39). Nurses 
should involve family members in patient care and share 
experiences (24). The importance of patient experience 
was confirmed and can allow nurses to anticipate 
patient needs and improve their experience by providing 
appropriate nursing interventions involving technology 
(6). Several instruments were developed from the TCCN 
theory to measure nurses’ behaviour of technological 
competency as expressing caring in nursing and tested 
in clinical settings. The TCCNI was developed by Parcells 
and Locsin (20), and the PITCCN was developed and tested 
in intensive care units (21) and acute care settings in 
hospitals in Japan (17). The TCCNI-R was tested in general 
hospitals in Japan (18, 19). The studies showed that the 
TCCN theory could be applied in high-tech developed 
settings (21) and all environments in which technology is 
used (18, 19). The theory has not been tested in various 
demographic areas, such as Europe. Most studies have 
been conducted in Asian countries. Nurses’ professional 
practice environments are different, and are also related 
to demographic, cultural, health-system and technological 
development (17). The theory should therefore be 
tested in various countries (17, 19), including Slovenia. 
The TCCN theory can contribute to the development of 
an ENRS (40) and will guide our study in implementing 
the ENRS. Technology – ENRS will be used to know the 
patients as ever-changing from moment to moment (27). 
Technological knowing will be a way of understanding 
patients. We will include knowing as understanding the 
patients’ needs, including physical and emotional needs 
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10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
and health conditions, which will be documented in the 
ENRS. While using ENRS, it is necessary to understand the 
patients as unique in their wholeness (2, 19, 27). There 
are essential caring activities, such as carefully listening 
to patients, showing compassion, meeting the patients’ 
needs and thoughtful consideration of patients’ lifestyles 
(2, 18), that should be implemented and not focus on the 
use of technology, in our case the ENRS.
5 CONCLUSION
The theory provides important theoretical starting points 
in the competent use of technology, emphasising caring 
for the patient as a whole and not focusing only on 
the patient’s medical condition. It also provides nurses 
with important guidelines for preventing technological 
dependence on technology, and places the patient at 
the centre of care. In our study on nurses’ perceptions 
of technological competency and caring for internal 
medicine patients when using the electronic nursing 
record system, the TCCN theory will be included in three 
Slovenian hospitals. The theoretical starting points of 
TCCN theory will help us identify and propose strategies 
to include the language of caring and caring behaviours in 
the ENRS. The survey findings can also impact the further 
development of the ENRS and the health information 
system in Slovenia. 
FUNDING
This work was not funded.
CONFLICT OF INTEREST
The authors declare that no conflicts of interest exist.
ETHICAL APPROVAL
As this paper does not report on any study, ethical 
approval was not acquired.
REFERENCES
1. Kongsuwan W, Locsin RC. Thai nurses’ experience of caring for 
persons with life-sustaining technologies in intensive care settings: a 
phenomenological study. Intensive Crit Care Nurs. 2011;27:102-10. doi: 
10.1016/j.iccn.2010.12.002.
2. Locsin RC. Technological competency as caring in nursing: a model for 
practice. Indianapolis: Sigma Theta Tau International Honor Society 
of Nursing, 2005.
3. Locsin RC. The co-existence of technology and caring in the theory 
of technological competency as caring in nursing. J Med Invest. 
2017;64:160-4. doi: 10.2252/jmi.64.160.
4. Pepito JA, Locsin RC. Can nurses remain relevant in a technologically 
advanced future? Int J Nurs Sci. 2019;6:106-10. doi: 10.1016/j.
ijnss.2018.09.013.
5. Locsin RC. Technological competency as caring. Knowing as process 
and tecnological knowing as practice. In: Smith MC, Parker ME, 
editors. Nursing theories and nursing practice. 4th ed. Philadelphia: 
F.A. Davis Company, 2015:449-59.
6. Locsin RC, Kongsuwan W. Lived experience of patients being cared 
for in ICUs in Southern Thailand. Nurs Crit Care. 2013;18:200-11. doi: 
10.1111/nicc.12025.
7. Pajnkihar M, Štiglic G, Vrbnjak D. The concept of Watson’s carative 
factors in nursing and their (dis)harmony with patient satisfaction. 
Peer J. 2017;5:e2940. doi: 10.7717/peerj.2940.
8. Stanimirović D. Development of eHealth in Slovenia - critical issues 
and future directions. CEPAR. 2015;12(4):9-38. doi: 10.17573/
ipar.2014.4.a01.
9. Ćwiklicki M, Schiavone F, Klich J, Pilch K. Antecedents of use of 
e-health services in central eastern Europe: a qualitative comparative 
analysis. BMC Health Serv Res. 2020;20(1):171. doi: 10.1186/s12913-
020-5034-9.
10. Iljaz R, Meglič M, Petek D, Kolšek M, Susič TP. Adherence factors 
to paperless primary healthcare: a focus group study. Zdr Varst. 
2013;53(1):42-54. doi: 10.2478/sjph-2014-0006.
11. McKenna H, Pajnkihar M, Murphy F. Fundamentals of nursing models, 
theories and practice. Hoboken: John Wiley & Sons, 2014.
12. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, 
et al. Preferred reporting items for systematic review and meta-
analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. doi: 
10.1186/2046-4053-4-1.
13. Polit DF, Beck CT. Nursing research: generating and assessing evidence 
for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott 
Williams & Wilkins, 2012.
14. Pajnkihar M. Modeli in kriteriji za analizo in vrednotenje teorij 
zdravstvene nege. In: 5th International Scientific Conference on 
Nursing Research. Jesenice: Visoka šola za zdravstveno nego, 2012:77-
84.
15. Blum CA, Hickman C, Parcells DA, Locsin R. Teaching caring nursing 
to RN-BSN students using simulation technology. Int J for Hum Caring. 
2010;14:41-50. doi: 10.20467/1091-5710.14.2.40.
16. Miyamoto M, Ito H, Miyagawa M, Yasuhara Y, Tanioka T, Locsin R. 
Criterion-related validity of the perceived inventory of technological 
competency as caring in nursing (PITCCN) in acute care settings. J Med 
Invest. 2019;66(1.2):42-5. doi: 10.2152/jmi.66.42.
17. Ito H, Tanioka T, Miyamoto M, Miyagawa M, Yasuhara Y, Locsin R. 
Perceived inventory of technological competency as caring in nursing 
(PITCCN): psychometric evaluation. Int J Nurs Stud. 2019;4:1. doi: 
10.20849/ijsn.v4i2.562.
18. Nakano Y, Yokotani T, Betriana F, Kawai C, Ito H, Yasuhara Y, et al. 
Perceptions of nurse managers and staff nurses regarding technological 
competency as caring in nursing theory in general hospitals in Japan. 
Belitung Nurs J. 2021. doi: 10.33546/bnj.1767.
19. Yokotani T, Tanioka T, Yasuhara Y, Ito H, Nakano Y, Miyagawa M, 
et al. Assessing the psychometric properties of the technological 
competency as caring in nursing instrument-revised. Int J Hum Caring. 
(1):30-44. doi:10.20467/humancaring-d-20-00015.
20. Parcells DA, Locsin R. Development and psychometric testing of the 
technological competency as caring in nursing instrument. Int J Hum 
Caring. 2011;15:8-13. doi: 10.20467/1091-5710.15.4.8.
21. Kato K, Miyagawa M, Yasuhara Y, Osaka K, Kataoka M, Ito H, et al. 
Recognition and status of practicing technological competency as 
caring in nursing by nurses in ICU. Int J Nur Clin Pract. 2017;4:1-8. doi: 
10.15344/2394-4978/2017/264.
22. Singleterry L. Intentional application of nursing theory in 
simulated practice. Nurs Educ Perspect. 2020;41:41-2. doi: 10.1097/ 
01.NEP.0000000000000446.
122
10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123
23. Lim-Saco F. Philosophical and contextual issues in nursing theory 
development concerning technological competency as caring in 
nursing. J Med Invest. 2019;66:8-11. doi: 10.2152/jmi.66.8.
24. Kongsuwan W, Borvornluck P, Locsin RC. The lived experience 
of family caregivers caring for patients dependent on life-
sustaining technologies. Int J Nurs Sci. 2018;5:365-9. doi: 10.1016/j.
ijnss.2018.09.011.
25. Kongsuwan W, Yasuhara Y, Tanioka T, Locsin R, Osaka K. Aesthetic 
expression of caring in nursing among Japanese undergraduate 
nursing students. Nurse Educ Today. 2021;105:105031. doi: 10.1016/j.
nedt.2021.105031.
26. Locsin RC. Caring scholar response to: Grounding nursing simulations 
in caring: an innovative approach. Int J Hum Caring. 2008;12:47-9. doi: 
10.20467/1091-5710.12.2.47.
27. Locsin RC. Technological competency as caring in nursing: co-creating 
moments in nursing occurring within the universal technological 
domain. J Theory Constr Test. 2016;10:5-11.
28. Locsin RC, Purnell M. Rapture and suffering with technology in nursing. 
Int J Hum Caring. 2007;11:38-43. doi: 10.20467/1091-5710.11.1.38.
29. Locsin RC, Purnell M. Advancing the theory of technological 
competency as caring in nursing: the universal technological domain. 
Int J Hum Caring. 2015;1:50-4. doi: 10.20467/1091-5710-19.2.50.
30. Locsin RC, Tanioka T, Kondo K. Advancing the theory of technological 
competency as caring within nursing and the health sciences: from 
philosophical and theoretical to praxis. J Med Invest. 2019;66:1. doi: 
10.2252/jmi.66.1.
31. Tanioka T, Osaka K, Locsin R, Yasuhara Y, Ito H. Recommended design 
and direction of development for humanoid nursing robots perspective 
from nursing researchers. Intelligent Control Automation. 2017;8:96-
110. doi: 10.4236/ica.2017.82008.
32. Nakano Y, Tanioka T, Locsin RC, Miyagawa M, Yokotani T, Yasuhara 
Y, et al. A novel in-service nursing education optimizing theory 
of technological competency as caring in nursing. J Nurs Manag. 
2019;9:85. doi: 10.1111/jonm.13215.
33. DeJonge K, Vankampen N, Cambier E, Kelley Ferris N. Technological 
competency as an expression of caring. Theory Critique. Michigan: 
Ferris State University, 2011. Accessed December 9th, 2020 at: 
https://kristindejonge.weebly.com/uploads/5/0/2/2/50228145/ 
locsin_group_theory_critique_.pdf.
34. Utley R, Henry K, Smith L. Frameworks for advanced nursing practice 
and research: philosophies, theories, models, and taxonomies. New 
York: Springer Publishing Company, 2017.
35. Boykin A, Schoenhofer O’Bryan S. Nursing as caring: a model for 
transforming practice. Boston: Jones and Bartlett Publishers, 2001.
36. Ray MA. Technological Caring: a new model in critical care. Dimens 
Crit Care Nurs. 1987;6(3). 
37. Parse RR. The human becoming theory: the was, is, and will be. Nurs 
Sci Q. 1997;10(1):32-8. doi: 10.1177/089431849701000111.
38. Carper BA. Fundamental patterns of knowing in nursing. Adv Nurs Sci. 
1978;1(1):13-24. doi: 10.1097/00012272-197810000-00004.
39. Kongsuwan W, Matchim Y, Nilmanat K, Locsin RC, Tanioka T, Yasuhara 
Y. Lived experience of caring for dying patients in emergency room. 
Int Nurs Rev. 2016;63(1):132-8. doi: 10.1111/inr.12234.
40. Pepito JAT, Locsin RC. Can nursing drive technological advances in 
healthcare in the Asia-Pacific? Asian Pac Isl Nurs J. 2018;3(4):190–8. 
doi: 10.31372/20180304.1022.
123
10.2478/sjph-2022-0016 Zdr Varst. 2022;61(2):115-123