By Debra Wood, RN, contributor
Technological advances and new devices are helping nurses to better care for older patients and allowing those elders to potentially live independently longer. And from noninvasive scanning devices to smarter homes, the field is growing rapidly ― impacting nurses specializing in geriatrics, rehabilitation, home health and many other areas.
Mary Brennan, MS, ACNP-BC, reports that technologies, such as ultrasound, allow nurses to cut down on the number of invasive procedures needed to care for patients.
“Technology and innovation have helped to improve patient care,” said Mary Brennan, MS, ACNP-BC, a clinical assistant professor at New York University College of Nursing and the coordinator of the college’s Acute Care Nurse Practitioner Program. “Anytime we can reduce invasive procedures patients have to go through, it’s so much better for the patients.”
Barbara Bates-Jensen, Ph.D., RN, associate professor at the University of California, Los Angeles School of Nursing and David Geffen School of Medicine, division of geriatrics, whose research is focused on improving the quality of care in nursing homes, reported a movement toward using technology in her specialty.
Barbara Bates-Jensen, PhD, RN, is researching the use of a dermal phase meter to pick up the inflammatory changes associated with pressure and shearing at the cellular tissue level before redness begins.
Avoiding pressure ulcers
Bates-Jensen has spent the past three years researching ways to detect skin damage before it becomes visible, using biophysical measures looking at what is happening under the skin. By using a dermal phase meter to measure surface electrical capacitance, which reflects the amount of water in the dermis and epidermis, Bates-Jensen can detect early inflammatory changes associated with pressure and shearing.
“If we can pick up the inflammatory changes at the cellular tissue level, before it’s visible on the surface of skin, then we might intervene,” Bates-Jensen said. “We might catch the damage at its earliest stage, before visible, and prevent these horrible wounds.”
In early pilot studies of the dermal phase meter, Bates-Jensen found an association with early signs of skin damage, and the device had the ability to predict when damage would occur. She has received a $4.25 million grant from the National Institute of Nursing Research to test the device, with particular attention to patients with darkly pigmented skin which makes early signs harder to detect. The device fits into a pocket and requires simply a light skin touch with a small wand over the bony prominence.
Bates-Jensen also uses movement monitors to determine horizontal and vertical movement, so she knows if the person is being turned sufficiently to relieve pressure, and whether the person gets up and ambulates.
Laurie DeLaney, an occupational therapist and assistive technology practitioner with the NIH Clinical Center Rehabilitation Medicine Department, demonstrates the department's pressure mapping system. It evaluates pressure distribution in wheelchairs and beds and shows patients and nurses areas at risk for pressure ulceration. Photo credit National Institutes of Health.
Electronic mapping of pressure between a patient and the bed or wheelchair can assist nurses in preventing bedsores by alerting them to high-pressure areas before the skin reddens. Sensors in a mat placed under the patient detect pressure areas and produce a color-coded image on a computer. It’s up to the nurse to take the appropriate action to relieve the pressure with redistribution support surfaces.
Bates-Jensen has found pressure mapping devices are more commonly used for patients in wheelchairs, especially those with spinal cord injuries, than for bed patients.
“Pressure mapping is a tremendous technological advantage for looking at wheelchair cushions,” Bates-Jensen said.
Motion detectors have proven helpful in preventing falls, but their success depends on the setting, availability of caregivers and response protocols, according to the State of Technology in Aging Services report from the Center for Aging Services Technologies (CAST), a program of the American Association of Homes and Services for the Aging.
Devices range from wearable tilt-sensing accelerometers to chair or bed alarms that alert caregivers when the person stands.
“The fall bells or fall alarms in many cases have significantly decreased the number of falls in nursing homes and hospitals,” Brennan said. “They are not used alone. They are an adjunct to fall prevention programs.”
Nurses often note the difficulty of finding older adults’ veins to start an intravenous line or draw blood. Devices, including the newly approved AccuVein AV300, allow nurses to zero in on a vein, decreasing the risks associated with multiple sticks. The AV300 scans up to 8 mm below the skin surface, highlights the hemoglobin, and projects a light pattern on the skin. The device weighs less than one pound, fits in the palm of the hand, can go from hand-held to hands-free in seconds, and displays vein location quickly with no image processing, calibration or focusing.
“This technology can be extremely helpful to the clinician and, primarily, the patient to reduce injury and increase comfort,” Brennan said.
Avoiding catheterization with ultrasound
Nurses in acute-care and long-term care settings are quickly, accurately and noninvasively measuring urinary bladder volume and post-void residuals using BladderScan portable ultrasound devices. A 1997 nursing study showed an overall 50 percent decrease in urinary tract infections on two units at a Maryland hospital after they began using BladderScan.
“Instead of subjecting the individual to an uncomfortable procedure, such as a Foley catheterization, this technology employs ultrasound, or sound waves, to visualize how much urine the person has in the bladder,” Brennan said. “It’s wonderful technology for preventing discomfort and reducing the intervention where you could introduce infection.”
Brennan reports that in intensive care units, nurses are also using ultrasound in place of a Swan-Ganz catheter to estimate the amount of volume in the right atrium and left ventrical.
The LifeBed monitors patients’ heart and respirator rates.
Sensors in LifeBeds, found in acute-care hospitals, continuously track patients’ heart and respiratory rates and alert nurses to changes outside the requested parameters. The device helped nurses at Queen’s Medical Center in Honolulu, Hawaii, pick up a patient going into atrial fibrillation and others suffering from opioid related respiratory depression. LifeBeds include a bed exit alarm to prevent falls.
Wander management systems, such as HomeFree, track residents’ locations and will alert facility staff if anyone wearing the wrist device leaves or enters a pre-defined area. Systems, such as the Atlas Rx, generally use radio frequency, global positioning systems (GPSs) or both.
Several home medication monitoring and reminding systems are also available, such as Med-eMonitor which sounds a musical chime when medication is due and alerts loved ones when the person misses a dose.
Various telehealth systems, such as the Health Buddy and HomMed, remotely check patients’ vital signs and have decreased the frequency of home nursing visits, focusing attention when a patient most needs professional intervention. Many of these systems operate through telephone lines and require the patient to step on the scale, put a blood pressure cuff on the arm, and communicate with the nurse through a keypad or other means. Some of the systems allow nurses in the home to send images of wounds to a wound expert to obtain a second opinion about the proper care to begin.
AFrame Digital recently received U.S. Food and Drug Administration approval to market its MobileCare™ Monitor and myPHD™ personal help device, worn on the wrist. The device detects impacts from falls, uses a GPS system to locate the wearer, and observes health and habits over time to pick up aberrations.
QuietCare, from Living Independently Group, is another home behavioral remote monitoring system that uses wireless sensors to track seniors’ daily patterns of activity and notifies caregivers about changes that might signal a health problem or emergency, such as a fall or not getting out of bed at the normal time.
Computer software, such as that used by the U.S. Department of Veterans Affairs health care system, can prompt providers to contact patients to come in for an influenza vaccination or when it’s time to check cholesterol or blood sugar levels. The software allows the provider to decline the recommendation but, typically, that must include a reason.
“Clinical reminders come up and help remind physicians about key aspects of care that needs to be done,” Bates-Jensen said. “The VA has an extraordinary rate of administering flu shots to elders during the fall, and part of it relates to their using clinical reminder systems.”
Investigators at the University of Southern California Viterbi School of Engineering in Los Angeles, are researching the use of robots with human qualities to guide stroke patients during rehabilitation and interact and move with elderly patients with dementia to prompt or remind them to take specific action and to help them safely navigate. The socially assistive robotic system can report back to caregivers about the person’s progress.
Building smarter homes
Stove Guard monitors activity around the stove and shuts the power off to the appliance one minute after the last sensing motion in the cooking area and will automatically reset when a person returns.
Universities and aging services providers are investigating the benefits of “smart homes,” residences with monitoring systems, tracking sensors and universal design that are expected to help elders live independently longer. Eskaton, a multisite, full-continuum provider, recently built the Eskaton National Demonstration Home in Roseville, California. It includes a cognitive fitness system, wireless sensors to track motion and the door opening, an air purification system to decrease lung irritation, and telehealth technologies to check blood pressure, weight and blood sugar levels.
The University of Florida Gator-Tech Smart House features an ultrasonic location tracking system, tiles embedded with pressure sensors to detect falls, overhead cameras, a bathtub that regulates the water temperature to prevent scalding, a bathroom mirror that displays reminder messages, and a toilet the measures weight and temperature
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