Nursing Advancements

An apple a day might keep the doctor away, but an Apple brings the nurse closer. Those Apples are iPhones that use Voalte, a secure software program that enables ER nurses at Nemours/A.I. duPont Hospital for Children to communicate quickly and easily. “Before iPhones, we used desk phones to call or page someone, or we would go find the person we needed,” says nurse Jean Gallagher. “Now, I don’t have to leave the patient’s side because we can talk and text directly to each other.” Apple products enhance communication with patients, too. Using iPads, A.I. nurses and doctors use a secure video link to contact interpreters who translate medical information to patients and their parents, and vice versa. “It’s helpful for everyone to see each other, and I believe it helps the children feel more cared for,” Gallagher says.

Enhanced communication is only one of the ways in which technology is improving nursing in Delaware, and it is part of a nationwide movement. In “The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead,” published by the American Nursing Association, author Carol Huston wrote, “While myriad forces are changing the face of contemporary health care, one could argue that nothing will change the way nursing is practiced more than current advances in technology.” Huston identified seven technologies that will change the practice of nursing by 2023: genetic testing, less invasive and more accurate tools for diagnosis and treatment, 3-D printing, robotics, biometrics, electronic health records and computerized physician/provider order entry, also known as CPOE. Biometrics could improve security by replacing computer passwords and ID badges with fingerprints or retinal scans, and 3-D printing might be used to replicate human tissue. If that sounds more futuristic than realistic, consider the technology currently used in Delaware. Genetic screening is available at most hospitals, and almost all health-care providers have traded pen-on-paper charting for electronic medical records and CPOE. But, robots? Yes. Meet SimMan.

Fully computerized yet alarmingly human, SimMan is a patient simulator used by nursing students to practice everything from inserting IVs to responding to heart attacks. SimMan has a family: adult man, woman, a 6-year old boy and an infant. Hearts beat, lungs breathe and pupils dilate, plus the baby cries and the woman screams when she’s in labor. Those reactions are controlled via computers run by nursing educators positioned behind a one-way mirror. All of this high-tech nursing education takes place at the $238,000-plus simulation lab at Delaware Technical Community College’s Terry Campus in Dover. Fully operational defibrillators, ventilators, bladder scanners and other equipment are used by nursing students to “treat” the Sims, says Jo Ann Baker, an instructional director of nursing at DelTech’s Terry Campus. “It is labor intensive to have nurses learn how to use those things in a hospital setting, so they learn it here,” Baker says. “We also have a regular skills lab with 11 patient beds and 11 mannequins. That’s where nurses learn how to insert Foley catheters, NG tubes and other things.”

Bayhealth Medical Center’s nurses often use DelTech’s Sim lab for their fellowships; they also work at Delaware State University and Wesley College’s high-tech facilities, says Bayhealth’s director of education Catherine Salvato. It’s a reciprocal relationship; nursing students at those schools often go to Bayhealth to do their clinical work. Bayhealth nurses use a different kind of simulator to educate people about shaken baby syndrome (SBS), in which brain injuries are caused by whiplash-like movements of an infant’s head. Even the most loving adult can be exhausted by an infant’s crying, and that’s when frustration can result in shaking, Salvato says. To educate parents, babysitters and other caretakers about SBS, Bayhealth nurses use a 10-pound doll that is life-like except for a skull composed of sensors and LED lights. “The baby cries, and when it is shaken to the appropriate degree, its head lights up to show what part of the brain is being affected,” Salvato explains. “People are surprised at how little it takes to cause a traumatic brain injury to an infant. The doll delivers a huge message.”

Treating real infants’ injuries and illnesses is the job of Nancy Forsyth, a neonatal nurse practitioner at Beebe Healthcare in Lewes. Technology has made huge improvements to neonatology, Forsyth says, not the least of which is creating infant-sized medical equipment used in life-saving procedures. Beebe extracorporeal membrane oxygenation (ECMO) machine is an example, as is a new therapy that induces hypothermia in infants. “It’s called therapeutic hypothermia, and we use it to cool the baby’s brain—and sometimes the whole body—to below normal temperatures to guard against brain damage, Forsyth says. We use it in cases where babies may be deprived of oxygen, like birth asphyxia, placenta separation and if there is an umbilical cord around its neck.” A.I. uses a lot of technologically enhanced pediatric medical equipment, and Gallagher favors those that make diagnostics and treatment easier for children to tolerate. One example is a hand-held ultrasound that nurses use to determine whether a child’s bladder is full. “In the past, we may have catheterized the child,” Gallagher says. “Now, we just roll the gadget over his belly.” 

Cancer treatment has benefited greatly from technological advances, says Jennifer Cormier, a nurse practitioner at Christiana Care Health System’s Helen F. Graham Cancer Center & Research Institute. Physicians now get enhanced images that allow them to deliver high target radiation to tumors while sparing surrounding tissue from exposure. That reduces the side effects of radiation, making treatment a little easier to tolerate for patients. Helping people cope with their treatments is part of Cormier’s job, as is educating patients. Gone are the “because I said so” days of medicine; most patients now want their illness and treatments explained. “Digital images are a wonderful teaching tool for our patients,” she says. “To show a scan helps patients understand what the cancer is, where it is and what our treatment will be. I can pull up the image and say, ‘This is your anatomy, and this is what we are focusing on.’”

That builds respect and trust between patients and their care providers. “It’s marrying good old-fashioned TLC in this very technology-driven field,” Cormier says. “Technology enhances but does not replace the nurse-patient relationship.” Bayhealth’s Salvato agrees. “We have all sorts of gizmos to work with, but we need to remember that we can’t take our sights off the patient,” she says. “You have to nurse the patients, not the computers. Years ago, I couldn’t rely on any machines, so I would take a patient’s pulse by hand. I would look at the color of their lips, the activity in their eyes and feel the temperature of their skin. No technology can tell you as much about a patient as a nurse can.”

TOP NURSES LIST 2015