Check out how nurses use social media and technology in their nursing practice. I got the chance to sit down and chat with our distinguished nursing panel including Pamela Cipriano, Research Associate Professor at the University of Virginia School of Nursing and Meredith Rowe, nursing professor and endowed chair at the University of South Florida College of Nursing. Here’s that segment.
MP3 Audio Podcast
Jamie Davis: Pam and Meredith, welcome to Nursing Notes Live. It’s great to have you both on the program this month. I always ask the first question of my nurse panelists to share a little bit about their backgrounds in nursing – why they wanted to become a nurse and their career to date in a brief synopsis. So, Pam, why don’t you go first and just tell us a little bit about what directed you into the nursing field.
Pamela Cipriano: Thank you, Jamie. When I was first going to college, I was pursuing a degree in Medical Technology but then quickly realized that that was really not going to give me the opportunity to be very interactive with people. So I quickly turned my interest to nursing and have never looked back since and have always appreciated the times that I was able to care for patients both as a staff nurse and as a clinical nurse specialist. And then relatively early in my career, because of my experiences, I served as president of the National Student Nurses Association and then quickly became involved in the American Nursing Association. So I did leverage those leadership opportunities and moved into management. So I have been doing that for many, many years both as a chief nurse and chief operating officer in a number of academic medical centers. But probably some of my favorite days were really as I spent as a manager of a Shock Trauma Intensive Care Unit as well as working as an adult ICU clinical specialist where you really felt like you are on the frontline and can influence care. My responsibility in management, obviously, is really to be an advocate for nurses so that they can deliver the best care. So I have really also enjoyed being in management for many years now.
Jamie: Great. I’m looking forward to hearing your input on technology later on in the segment. Meredith, how about you? Why did you become a nurse?
Meredith Rowe: I primarily became a nurse because I was very interested in science and research as well as the healthcare field. And nursing was a very nice balance between those three and I originally started out in the Army Nurse Corps, the Army Student Nurse Program and then, after, I went to practice primarily in critical care, my master’s degree and then I went into the Academic route. After getting my PhD, I started in nursing research. I’ve been in nursing research for about 15 to 20 years now.
Jamie: And you’re involved actually in development of technologies. So we’re going to be looking at both the management side of nursing involving technology as well as looking at some of the aspects of developing new technology for use in the patient care setting. So I’m really looking forward to that.
Meredith: Yes, that’s correct.
Jamie: Fantastic. Pam, let’s start with you because I know you got a background and done some work with the Institute of Medicine which is a big proponent of utilizing nurses to the fullest extent of their educational potential and training and that includes the use of technology to facilitate better patient care.
Pamela: And, Jamie, one of the most exciting experiences I had when I was a nurse scholar and resident at the Institute of Medicine was not only being there at the time that the Initiative on the Future of Nursing was launched but then being able to spend the year that I was there helping staff there, the work that was done to look at the safety of using electronic health records and other health information technology. So it is a really nice combination, as you pointed out, that as we look at the fact that technology is an amazing enabler of care, nurses are very concerned not only with being able to provide more efficient care to patients but looking at how technology is helping them provide safer care. And we see that consistently with systems like barcode medication administration. We see that with the advantages of electronic health records. We also see that from the standpoint that we have accuracy in using wireless technologies to upload data to our electronic health records from devices such as wireless blood pressure monitoring, pulse oximetry, those kinds of things. But there’s also a number of other ways that we can use technology to really transform care that, again, nurses are very interested in looking at. Those include ways that we can automate data collection. Also we have the ability to use devices that monitor patient movement that might be predictive for falls. Outside of the hospital, there’s a very large movement where we’re looking at the use of mobile technologies that can help keep patients safe in their house. It can also, again, transmit vital signs such as weight for patients that are managing congestive heart failure in the home. So nurses in all venues are really taking advantage of using technology not only to improve their direct care but keep patients safe and make care more efficient.
Jamie: And it’s really helping to connect everyone together. We think about the connected world in which we live. But really my experience talking to home care nurses and my own experience caring for a parent who needed home care, I really was impressed by the ways that telehealth technologies connected that patient with a healthcare professional like a nurse and other people who are monitoring them directly and really made a huge difference and made them feel like there was someone there even when there wasn’t able to be someone physically there.
Pamela: Yes, absolutely. There are also health monitoring centers that are now being created that are the connection with usually a nurse as the health coach or the nurse as the individual that responds to the patient and the family and helps monitor them that they can do exactly what you’re saying which is they’re helping the patient and the family adhere to a plan of care to make sure that if a patient has questions, that they have that contact of a professional nurse to ask about medications, to ask about treatment regimens, to be sure that they are connected to the services that they need in a community. This really didn’t exist that long ago. So nurses are really on the forefront. Some of our nurse researchers are creating an app to help patients do everything from de-escalate concerns they have about potential child abuse to really look at adhering to well-baby care and to also helping individuals understand the importance of doing health screenings. Also helping young people quit smoking. So nurses are involved on the research forefront really looking at how technology can be deployed so that they can help people live wherever they are and improve their health. Meredith probably has some examples too because she spent a fair amount of time looking at research and the use of technologies.
Meredith: Yes, I just like to follow on a comment that both of you made which is the nursing care of the people who are chronically ill and remaining in their own home because I think telehealth has been a big advantage in connecting the informal caregiver, the relative caregiver to formal healthcare services. But for the huge majority of the day, those caregivers are left on their own and the only technology that they probably have to assist in the care of these chronically ill individuals are borrowed technologies from the hospital. For instance, things like that which oftentimes don’t translate very well to a home environment. There are people end up putting hospital beds in living rooms and all kinds of adaptations they need to make to try and improve their ability to care for their relative at home. So I think a very large market for nurse entrepreneurs currently is to develop novel technologies to help informal caregivers to take care of chronically ill individuals at home and really facilitate their ability to do that and remain at home particularly those who are aging. So most of us want to age in place, we don’t want to move to a formal care setting to age. As you become frailer and frailer, it becomes more difficult for a relative caregiver to take care of you. The area that I got involved in had to do with excessive vigilance that was required for persons of dementia and their caregivers. So many caregivers report that they have to be vigilant for the care recipient 24/7 and usually they’re doing this by themselves. And, in fact, 30% of caregivers say they actually have to be in the same room with the person with dementia in order to provide safe care for that individual. So through research grants from the National Institutes of Nursing Research at NIH, I developed a product to help the caregiver with vigilance particularly during the night time so that the caregiver can sleep soundly knowing that they’ll be reliably alerted when the individual got out of bed and there’s been so many opportunities to develop products and the nurse is in a really ideal position to be the go-between between the people developing the technology and the needs of the patients whether it’s in a hospital setting or at the home. Because, oftentimes, engineers don’t quite understand the exact use of technologies that are developed or the needs of the interface for the user and the nurses are really in a very qualified and expert position to inform that whole product development process.
Pamela: I think that’s a really excellent point. I think the other thing that I would add just listening to Meredith, again, whether it’s the caregiver at home, whether it’s a nurse in the school setting, whether it’s the parent that has an active child with a chronic condition, all of these areas are places where nurses are actually intersecting with patients and families to look at particularly mobile applications now to really help individuals monitor their care, get help when they need it and figure out how can they best follow the course of therapy or the home plan to keep somebody well. And some of the vigilance I think Meredith is talking about also, we see with some of the advances that have been done with medication monitoring. We know that that’s one of the primary reasons that people get readmitted at the hospital is that they don’t understand how to take their medications or don’t take them correctly. There are now electronic pillboxes that families can acquire and use in the house that have multiple levels of reminders. Similarly, there are passive monitoring systems that older individuals will use at home to be able to pick up on any kind of gate problems. They actually can provide some sensors that connect. They can look at dehydration, which again can really affect whether a patient is at risk for falling. So nurses are on the other end of these monitoring systems in many cases and are really helping individuals figure out how to age in place and how to be able to get care in their home or wherever they are in their community.
Jamie: Yes. It seems interesting because there’s a discussion I’ve had recently with several nurses that nurses are somewhat technophobic. That they are afraid of new technologies but you two are clearly not in that group and maybe belie the truth of that statement because, like you said, there are nurses in the forefront of all of these types of initiatives and it’s ultimately the nurse that explains the use of these tools to patients and their caregivers and makes it so that they can be able to care for someone in the home setting so that that person can, as you said, Meredith, age in place.
Pamela: Yes, I think the other thing that we’re seeing is as the cellphone has really become part of many, many people’s everyday paraphernalia. That that coupled would have been a great equalizer for nurses as well because we look at a platform for communication, like a cellphone, and that now is your gateway to extra information, to electronic health record, to communication inside and outside the facilities, both with telephone and text messaging and it really – for many years, we’ve been able to send monitoring alerts to cellphones and things like that. So I think nurses – I truly don’t believe nurses are technophobic but for those who they are, again, the difference is that now we are seeing everyday applications of all kinds of technology and nurses accept that and really are using that to the full extent that they can in order to again sort of shorten any kind of additional steps that they would need to take so that they can spend more time at the bedside or patient side and really take advantage of the fact that now we’ve got tools that are portable and easily used by everyone.
Meredith: Yes, I would say that some of that, that term “technophobia” comes, I don’t think from the initial use or the desire to use that equipment to make their job easier but it becomes from the problems of troubleshooting equipment that doesn’t work as advertised. And that really is not an issue about somebody’s ability or not ability to use technology. It’s usually more about how much education you have on a particular technology and an understanding about how to troubleshoot that technology. And I think for nurses today, they just see so many new technologies. So in a single institution, you can have 15 or 20 different varieties of IV administration pumps, for instance, and each one of those have different troubleshooting procedures that you might do. So I think one of the things about the plethora of technology, it’s not being technology used more difficult but it has made the need for education on these devices in terms of troubleshooting these devices more important to provide.
Pamela: The other point that you’re raising, which is really an excellent one is one of, how is that technology designed? What is with the input of nurses and how was it tested so that people who are really using this equipment have input into the original formation of what it looked like, how it worked, the size of it, the ease of use. That’s one thing that we found in the American Academy of Nursing when we studied the use of technology to improve care and efficiency on medical-surgical units was that one of our key recommendations is that technology really needs to be designed in a partnership from the very beginning between the technology developer and the frontline users. Because nurses are masterful of figuring how to solve the problems but it could be so much more effective and user-friendly if nurses were involved upfront. Similarly, in their organizations, they should be involved in testing and selecting equipment. And then, as Meredith was saying also, nurses can really push for standardization because you don’t want multiple brands of the same kind of equipment which calls for additional education particularly for things that have high risk associated with them. So you want to be able to standardize and keep your education as streamlined as possible.
Jamie: What about the interconnectivity of these devices? As these devices become aware of their surroundings in some way because of the wireless capabilities that we can build into them, there are tools out there that are connecting IV pumps directly to the pharmacy computer. So when you identify a patient and barcode a medication, the pump sets itself up which reduces the risk of errors. Meredith, how far away are we, do you think, from having all of the devices talk to each other in this way?
Meredith: I think Pam is probably better suited to answer that question but I will say the more integrated you get technology, the more likely it is that you’re going to have problems as you put the pieces together. The point about having nurses involved in the beginning, I think this is really an important point because what needs to integrate with what is a really important question. Once you integrate – have mass integration then you also have mass failures. I’ll turn it over to Pam.
Pamela: Yes. I think we’re actually very close. There are some companies who actually provide the kind of integration, equipment that you’re mentioning, Jamie. Throughout all of our use of electronic health records and, as you’re mentioning, all of the mobile equipment that connects with wireless. The key thing that we’ve been looking for and sort of the Holy Grail is true interoperability. Whether it’s interoperability of equipment assistance or whether it’s different information systems connecting and integrating with the master electronic health record, that’s really been one of the key areas that some of the federal government programs have been focused on as well as our technology vendors really wanting to improve the ability to bring as much information together in the hands of the users. So I think not only are we seeing more and more, I think, as you were mentioning, there is very active effort to make sure that if we can automate something safely, and it’s going to improve the efficiency of the professional that’s providing the care. Then that’s really a key component of the next phase of redesign of any of our equipment and systems.
Jamie: So what lies out there for the future for us? This seems like it’s such an exciting time for nurses and technology and healthcare settings. Where are we looking forward to in the future? What are some of the things that you’re most excited about on the horizon?
Pamela: Well, let me jump in there. For hospital nurses, I think there are so many opportunities, again, to sort of create more time for the nurse to be with the patient. And that’s everything from having wireless communication devices to having wireless transmission of vital signs for patients. We also know that the real-time location and tracking systems are making a huge difference not only in making sure that supplies and pumps and things are better available but we now have the opportunity to retrieve data about our staff and our patients, where they are. We’ve been doing a lot of manual collection, about when people are going in rooms. We can do surveillance about handwashing. All with the addition of technology that is becoming more and more affordable for institutions. So we’re saving time hunting and gathering for supplies or saving time not having to do paper and pencil monitoring of different events and the transit of staff in essential places such as trying to monitor on time and presence in our operating room. So we have lots of applications for technology in the hospital. Including there are now high-end smart beds that have a translation option where you can get certain phrases in a number of languages that help you communicate with patients, so lots of great technology there. But I think the biggest promise is really part of what Meredith was talking about earlier, which is we know we have more and more care moving into the home setting. We also have much more affordable personal devices. So as we really advantage the use of smartphone technology, that’s really becoming a consistent platform. As we now have smart television sets that people can connect to. That’s a two-way gateway between the patient and the provider, the patient and the monitoring center, a patient and their pharmacy. It really becomes sort of a command central for people to be able to better manage their care in the personal setting of their own home. Again, nurses are interconnected to many of those activities.
Jamie: Meredith, what about you?
Meredith: I’ll address it from the community side because I think that’s where I have more experience. One of the interesting things is that in somebody in the home, they’re very interested in having technology that fits in to their home environment and doesn’t make their home environment looked medical. And they’re also very interested in understanding what is being gathered as far as the data, where that data is going, and who’s utilizing that data and having some control over that. So I think one of the exciting things in the community is that the ability to monitor personal health needs, the technology for that is becoming very miniaturized, wearable. As well, consumers are becoming smarter about how having ongoing monitoring of different physiologic functions can be helpful to their overall health. The healthcare community is becoming smarter about how to safely use that information, how to safeguard it and also to protect the individual’s privacy with regards to what’s happening in their home be it walking or physiologic monitoring. So I think the miniaturization of the monitoring technologies as well as individual’s better understanding about how health monitoring can overall improve their health and a greater acceptance at doing the different platforms that are being made available for the home setting.
Pamela: The other thing I would add is that there are additional inventions, if you will, that are coming out all the time. Two of the ones that I think are pretty amazing are there will be full body sensors, another technology built into clothing. And so before long, we’re going to have the ability to passively monitor a lot of different signs and symptoms in patients. Similarly, the Ford Motor Company is committed to create a car that cares and be able to have patients – well, we wouldn’t call them “patients” then, they would be every day consumers – be able to monitor things like their glucose levels, be able to use the GPS to get alerts about a pollen count and different allergens in the community. Also be able to connect with systems like OnStar for emergency healthcare services. So what we’re going to find is that, as I think you mentioned, nurses not only teach people how to use technology but nurses are going to be in the position of being able to make sure that citizens are really aware of all of these connectivity. So it’s not just when you’re sick but it’s really all of the things that you want to do when you’re well in any setting where you’re traveling or you’re going to school or you’re at work or you’re at leisure or you’re trying to exercise. So nurses are going to be really important to help translate all the opportunities that people have in order to use technology.
MP3 Audio Podcast
Make sure you check out the entire February, 2014 issue of Nursing Notes, where we look at how nurses use social media and technology in their nursing practice. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I bring you special interview on nursing and social media with Pamela Ressler, MS, RN, HN-BC, founder of Stress Resources and lecturer in the pain research, education and policy program at Tufts University School of Medicine in Boston. She researched how social media can be a tool to help combat isolation and build communities for chronic disease patients. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.