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August 14, 2008

How High Tech Must We Go in ICU Today?

Criticalpatient72x731 Reading the latest news (360 Degree Care) about Sloan-Kettering’s newly developed ICU, I have one key question to ask -- how high tech must we go to give efficient care to patients today? Is rubberized flooring necessary? Do Web cams interfere in patient privacy? (Would you want to be seen weeping on a Web cam with your dying family member?) The article on Nurse.com describes how “Rooms have Web cams to let nurses monitor patients and beds that turn 360 degrees, perform respiratory percussion and vibration, turn and weigh patients, and elevate them to a chair position.” What happened to an aide and a nurse physically getting a patient out of bed, letting them dangle by the bedside, and then stand and walk to a chair?    
I have not seen this new ICU although there are constant advertisements, "Come Join Us," in nursing magazines for job positions in the unit. But I do like the idea of more room space; there never seems to be enough in any ICU. And I certainly like the concept that nurses had input in designing the unit architecturally. New beds, no manual chest percussion. My arms can get a rest now!

Has your critical unit been updated recently? What would your optimal ICU look like?

August 14, 2008 | Permalink


I think that technology used in patient care is great as long as it is combined with personal care for a nurse. Having beds that turn 360 degrees to do assessment on respiratory percussion and vibration, or even simply just positioning the patient, cannot substitute direct attention given from healthcare professionals.

Posted by: Thao Nguyen | Sep 19, 2008 1:02:20 AM

The idea of 360 Degree ICU is scary to me. I think that technology is great but it seems like it's replacing human touch with machines. Patients already feel scared enough being attached to so many life supporting machines that they would feel more comfortable with physical contact with nurses. This new ICU is taking away the essence of nursing. What has nursing come to when they don't even have time to turn a patient and provide other therapeutic care? How would this affect the patient when they are being cared for in everyway by machines??

Posted by: Sophanny Ouk | Sep 16, 2008 11:43:40 AM

I believe that technology is definitely a great thing to have in healthcare today and we should take advantage of it. Commodities such as having rubberized floors and webcams promote safety for patients and promote effective healthcare. However, some technological advances may be unnecessary. For example, a bed that can perform respiratory percussion and vibration is not really needed. It may be good to have, but I believe that procedures such as these and also things such as taking vital signs, should be performed hands on by the nurses. Machines are helpful, but actually performing these procedures on patients yourself ensures accuracy. It is inevitable that technology will advance, but hands on nursing should go hand in hand with it.

Posted by: Alison | Sep 14, 2008 10:26:11 PM

I think it is always important to be able to physically touch the patients and be able to provide care for the patients itself. I think it is good in a way to be able to see and weight patient and be able to turn the bed 360 and see if everything is going fine. But for some reason I remember, in order to be able to provide care if we could give a little bit of touch therapy, I mean little be of holding hands and listening to the patients would be more relaxing to them as well. But everything is computerized and we as a nurses didn't get to see patients than will that therapy every work. Will patient be satisfies and on top of that if we are looking patient just through the webcam..and providing care we are also invading the patients privacy...

Technology is good... but it comes to human and their lives I think it should be dealt by human or not by some kinds of technology.

Posted by: Puja | Sep 14, 2008 10:26:08 PM

The integration of "old school" nursing and the use of new technology should be used to take care of patients. Therapeutic communication and actually touching the patient is very important in caring for the patient. Technology can aide in constant monitoring of the patient and help save your back. But we should not rely on technology to do everything.

Posted by: Brian | Sep 13, 2008 1:58:25 PM

You can just let go of that "what happened to the nurse & aid getting a patient out of bed, walking to a chair, etc..." concept! As an RN with nearly 30 yrs of that in the ICU, I can barely walk MYSELF! And "body mechanics" won't save you when your patient is incredibly ill, weak & hasn't been out of bed in months. Made doubley dangerous if you weigh 130 lbs or less yourself!
Those days are over! People are too large, especially sick people! You need machinery, robots, & big strong people to help you!

Posted by: Kathy | Sep 11, 2008 11:56:32 PM

Web cams are the latest in telehealth technologies; yet no different than a performance improvement, quality assurance or JCAHO consultant wataching over nursing. This technology was designed for patient safety because a few bad apples spoiled it for nurisng. It would be great to say that all ICU patients are turned frequently, suctioned and bathed and perhaps had their hand held for awhile, but it's the very nature of these regulatory agencies that drive nurses further and further from the bedside because of all the paperwork. Efficient nursing care does not parallel effective nursing care and that is where our problems begin.

Posted by: sharon | Sep 9, 2008 8:32:01 PM

Optimal ICU :
* Noiseless
* Alarmless
* Spacious
* Webcam free environment
* Safe flooring
* Soothing colors
* Food cart availability
* Stocked rooms at all times
* Minimal walking from room to room- distances
* An ounce or two of compassion and time from the staff

Uhmm- any other ideas ??


Posted by: beka | Sep 2, 2008 2:34:28 PM

Thanks Jen for your comments. I know when I was a patient in ICU 20 years ago, there were no webcams. Instead the nurse sat across the hallway from my room. I too felt that I had absolutely no privacy, and soon began to become paranoid.. Always watched, always listened to... but speaking in Latvian and German lessened that aspectto a certain extent.. but the constant watching made me feel uncomfortable. Unable to even relax or sleep in my bed.

Are WEBCAMS an invasion of HIPPA policies ??? Should they be allowed in use ??


Posted by: beka | Sep 2, 2008 2:30:25 PM

Thanks for posting this. As an ICU patient in a unit with webcams I must say that I absolutely hated it. It was a complete invasion of my privacy and when I was in the throws of the drugs it made me very paranoid and gave me awful nightmares about who might be watching me. My husband thought I was delusional from the drugs when he came in one day and was crying about the "robots" watching me only to find out that it was true. People were required to announce themselves, but I often found myself with an unannounced young student or resident (particularly males) when I was naked and getting dressed or changing my ostomy. This was very upsetting to me and I felt like the staff minimalized my concerns. I understand why they have it and I think it may help save patients lives, but as a patient it was a huge invasion of privacy and source of anxiety.
-Jen http://www.caringbridge.org/visit/jenelle

Posted by: Jenelle | Sep 2, 2008 5:56:34 AM

As an "old school" nurse who thinks that we should be touching our patients and offering therapeutic communication as much as possible, I think that some of this new technology would need to be curtailed to ensure that our newer millennial nurses remember what its like to actually communicate with their patients an not just sit out at the desk.

Posted by: Elizabeth | Aug 22, 2008 10:24:01 PM

The beds described are just adjucts, and will not substitute for mobilization under the pts. own power. I've noticed that fewer & fewer nurses and techs are willing to turn, lift etc out of fear of injury to their backs.

My ideal ICU would have no first year interns, attendings who examine the patients themselves and teach both house staff and the RNs, RNs who take responsibility for educating themselves independently to know what signs/symptoms may mean and the nursin AND medical standards of care for dealing with them, and then put the knowledge into practice--a true collaboration of MD and nurse on the continuum of medical care. This ideal unit would not have the new JCAHO acronym or slogan of the week, new JCAHO-mandated form to be filled out every 2 hours, or JCAHO created obstructions to the rapid delivery of care.

Posted by: Rae | Aug 20, 2008 6:24:57 PM

Good points. Technology can fail, and you have to fall back on your own skills. How often have you looked at your patient "numbers" and they didn't quite match the clinical picture.

Caring hands can do much, and sometimes we do sit and stare at numbers in the ICU while our machinery does the work.

An optimal ICU would appear well staffed, with minimal noise, and naturally well lit. The nurses would all be helping each other (regularly), and physicians would round, with their hands on, inspecting their patients head to toe. The OR staff would never bring a patient in without helping to settle, and upper level management would frequently visit to say "good job everyone, bonuses will be in all of your paychecks". Oh yes, and patient charting would be verbally dictated. lol

Posted by: Kathleen | Aug 17, 2008 10:16:38 AM

Clearly technology improves many of the things we do in our lives on a daily basis. With respect to an intensive care unit being as automated as this I am sure this frees up some time for the nursing staff - to an extent. High tech beds will likely become all the rage especially with the new reimbursement rules that CMS puts into effect in October of this year. Preventing VTEs and pressure sores will be key to higher reimbursement rates.

If healthcare can integrate technology without sacrificing quality than it would seem to be a good fit. However if we as healthcare providers start relying solely on technology and become sloppy in our care than we end up doing a disservice to ourselves and our patients.

Technology is great but some times it is better to do things the "old fashion way". Finally one of my favorite isms that I think fits here is this: The evil of "good" is not always "bad". Sometimes the evil of "good" is "better".

Posted by: Mike | Aug 15, 2008 6:57:11 PM

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