My Reflection!

For me, this class gave me more confidence as a writer. At the start of this class, I was completely nervous about the final paper that was required at the end of course. Throughout the quarter, I was able to gain the skills to produce a good paper. Learning how to write to your audience was one of the most helpful parts of the class for me. Knowing who you are writing to, helps you know what to write and how to write it. Another thing I found helpful was the day we spent in the library learning how to search for academic articles. I have always been curious to discover a way to find academic, peer reviewed articles. So I know that this is one thing that I will definitely use in the future.

In this class, I also learned why it is important to have all of your claims backed up. It makes since why you need to do it out loud, but actually doing it in my paper was another story. I really enjoyed how to actually write a summary. Everyone says they know how to summarize something and I thought I did too. This class made me realize what components actually go into a summary and why it is so important.

As I reflect upon my research, I am a little disappointed in myself. I had another crazy class this quarter that took up all my free time so I didnt spend as much time as I would have liked on certain parts in this class. I feel as though I did get a lot of research and I was very excited about my topic because I am a nursing major and I thought that maybe this is something that I might have to do in my later career so why not learn about it? I would have liked to spend more time on actually writing my final paper. I was impressed with how many articles I was able to gather for my research. I am usually the person who has the hardest time finding enough research for my papers. I am also very pleased with the quality of each of these resources. When I do normally find stuff, it usually has nothing to do with my actual paper. This is the part of the class that I enjoyed the most.

Overall, I would say that I learned some major writing skills. I learned how to write to my ideal audience and also why that it so important. I also discovered how to locate articles that are peer-reviewed and scholarly and why finding these types of article are important. I also learned how to actually summarize an article or movie and why it is important to summarize the correct way. I feel as though these skills will carry me throughout my life and I am happy that I was able gain these skills in this class this quarter.

My final paper

Taking a Look at Tele-ICUs

Tele-ICU refers to the integration of a critical care team and state-of-the-art two-way, audiovisual communication systems in hospitals. These systems are designed to monitor patients in highly critical conditions, hospitalized in the intensive care unit (ICU). Monitored by nurses themselves, these systems act as a second set of eyes when people need it most. The tele-ICU can provide a better hospital environment by decreasing the length of hospital stay and decreasing mortality rates. Furthermore, the tele-ICU system creates a better working environment for hospital staff by teaching and assisting fellow co-workers. Despite these aspects, the tele-ICU is a controversial system. Many feel as though the tele-ICU interferes with ethical standards in hospitals. In addition, some nurses themselves feel a loss of identity while working with the tele-ICU. The tele-ICU can cause debate over potential problems in the system, however considering the amazing potential of the tele-ICU, I will show you that these concerns can be quickly dispelled.

The tele-ICU is designed to keep a closer eye on patients in critical care in hospitals. They do this by setting up each room with two way audiovisual cameras. Many might ask, how does this work? There is a control “hub” that contains about 5 to 7 computer monitors which display various data. The tele-ICU staff has access to the same information that a bedside team would have. Real time vitals are displayed on one computer screen while the others give access to lab test results, care plan updates, and all other documentation regarding the care of the patient (Goran). This allows for the tele-ICU nurses, doctors, and other members of the critical care team to constantly receive updated information on each patient.

This is where one might ask how the cameras come into play. Each room is equipped with these cameras which many think are constantly on. However that is not the case. The two way audiovisual equipment is off until an alert is given. The nurse monitoring the tele-ICU cameras will then look to see what the cause of this alert was by checking the computer screen to see for a drop in vitals. At this time, the nurse will turn on the camera that is located in the room. The tele-ICU nurse can then see the possible cause of the alert and actually communicate with the patient to make sure they are still coherent. The time it takes for a nurse to analyze a situation like this is cut in half because of the tele-ICU. In a situation where there was no tele-ICU, a nurse would have to run into the patients room and assess the situation to identify the problem. This wastes valuable time and energy. If by chance the alarm turned out to be nothing, no time is wasted by running to the patients room because the tele-ICU only has to turn on a camera . The ability to turn on a camera to check on a patient, rather than having a nurse find time in their already busy schedule to check on them, improves patient safety.

This raises controversy over whether or not this system is completely ethical or if it is an invasion of one's privacy. Privacy is an important element in hospital care. Not only is it mandatory for patient confidentiality, but it also eases the minds patients who are in the ICU. Some may believe that the first thing that is compromised with tele-ICU is privacy. Patients feel that having a camera in their private room is intrusive. However, what many don’t realize is that patients admitted into the tele-ICU are not watched all the time. In reality, the amount of monitoring that happens in the tele-ICU is equal to before. One difference being that a nurse isn’t constantly walking into rooms and waking up the patients. However, patients that are in very high critical conditions are often watched more than others. The fact is, patients have every right to be weary of tele-ICUs, but when you look at the bigger picture, one can see that the purpose is not to interfere with the patients privacy but rather improve a patients safety. When someone is admitted into the ICU, they are going to be watched closely, whether its in a tele-ICU or not. The tele-ICU is just a new way of watching over patients. The only thing that is different is that a nurse is watching you through a lense.

From here another issue arises: What about the nurses themselves? How do they feel about sitting behind a desk for 12 hours straight watching a computer screen? Even though some nurses are drawn to the idea of tele-ICUs because they see the potential it has in easing their workload, some feel differntley about the situation. Many nurses feel that spending so much time behind a computer sitting down is just as stressful as working directly with the pateints. Tele-ICU nurses that are spending eight to tweleve hours behind the computer are at higher risk for eye strains, wrist injury, and neck strain from viewing data on multipule screens. (Goran Making the Move 26). Some hospitals take this into account when putting together such an elobrate computer system that requires a lot of “down time.” Ergonomic specialists are consulted to reduce the number of workplace accidents caused from sitting at a computer for such long periods. Nurses, as well as other tele-ICU staff, are advised to take frequent breaks and to exercise in order to reduce the health risks of this job (Goran Second Set of Eyes 52).

In her article “Making the Move: From Bedside to Camer-side,” Susan Goran says, “Proffesional identity includes the attributes, beliefs, values, motives, and experiences by which indivuals define themselves in their professional lives.” Nurses feel as though they will no longer be viewed as “real” nurses which compromises their ability to openly accept this technology. Tele-ICU nurses are forced to cope with how this new system affects their proffesional identity. If nurses view themselves in such a way, it can lead to an unhealthy work enviroment. Hospitals can give assistance in finding a new identity for tele-ICU nurses by identifying specific roles and providing new, challanging oppertunities in the workplace. By doing this, hospitals can reduce the number of unhappy workers and ultimatley provide a comfortable, pleasant workplace.

Tele-ICUs are new to many nurses and they will have get use to the idea of working so closely with technology. They will have to share their role as caregivers with the tele-ICU staff which many nurses are finding hard to do. Many hospitals allow for shared positions. This means that part of the time, the nurse works in the tele-ICU and the regualr ICU. This can establish trust between the nurse and the new system which can help ease the tension between nurses and the tele-ICU. The most effective type of scheduling is still being researched to identify the best way to collaborate this new technology into hospitals and the already established staff (Goran Making the Move 24).

Even though there may be some controversy over tele-ICU and the different aspects of it, one can see through close examination, the benefits outweigh and possibly eliminate the controversy. The simple fact that mortaility rates have gone down in hospitals that are equipped with tele-ICUs should help ease the minds of patients. From 2006 to 2007, 156 hospitals supported by tele-ICU rooms showed a 29% decline in mortality rates. This means an additonal 7233 lives were saved (Goran Second Set of Eyes 53). Patients may also be concerned with intrusting their lives with this “new” technology. The fact of the matter is, this kind of technology has been around since the 1950's. Early use of this technology was used to transmit the vital signs of astronauts (Reed 176). Many elderly citizens know about the commonly used medical alert system. If an elderly patient falls in their home, they can simply press a button located on a necklace to reach assistance and have medics arrive with help (Swann 516). The same basic principle is applied to the tele-ICU, and elderly citizens fully support this type of technology. With the press of a button inside a tele-ICU room, you immediately contact a readily avaliable nurse who has the ability to provide a quick response.

Furthermore, patients are still going to recive top of the line care while addmitted in the tele-ICU. There is still a bedside team to assist in situations were a computer can't fix the problem. There is nothing in the world that can take the place of the bedside team. If patients are concerned with not getting the the personal care, they need not worry. The purpose of the tele-ICU is not to replace the bedisde team “...they are meant as additional care...” (Goran, Making the Move 21). The tele-ICU computer system is also updated every four hours to maintain accurate documentation of each patient. This ensures the tele-ICU staff has everything they need to provide excellent care. The care they provide benefits the patient by declining the mortaility rate and length of their stay in hospitals (Nowlin 56).

The tele-ICU staff has a very important role in the care of each patient. Tele-ICU nurses have the duty of four basic jobs: virtual rounding, alert response, providing bedside team support, and coaching and collaboration (Goran Making the Move 21). Virtual rounds consist of reviewing documentation of the patient and looking for any “red flags” that indicate the need for for further assesment. The camera located in a patients room may be turned on to validate equipment settings. The tele-ICU nurse is also in charge of alert response. This includes evaluation of alerts to determine the possible cause and notify the proper response team. The tele-ICU staff can support the bedside team by providing fast delivery of patient documentation and/or lab results. Finally, the tele-ICU can help coach and collaborate with other nurses. Most tele-ICUs are watched by nurses with many years of experiece. If a new nurse on a bedside team is faced with a situation that they have never delt with before, they can ask for assistance from an experienced member of the tele-ICU nurses. They can provide their knowledge and skills to aid in the situation via the two way audiovisual cameras.

Now, it is clear to see how the tele-ICU does not take away jobs from nurses and other hospital staff, it actually creates them. Most obviously, a computer can not replace the kind of care administered by a human being. As Goran explains “the purpose of the system is not to replace bedside clinicians or bedside care, but to provide improved safety through redundancy and enhance outcomes through standardization” (A Second Set of Eyes 47). The tele-ICU actually creates jobs for hospitals while at the same time easing the workload of the bedside nurse. The tele-ICUs are watched over by nurses with over 15 years of bedside experience in critical care (Goran Second Set of Eyes 49). As previously mentioned, this system does not eliminate the bedside team, instead it actually creates another team entirely. Someone will have to be hired to monitor the system and fix any problems that arise . The system will need to be updated with new software enhancements whenever possible. These are some examples of how the tele-ICU can create jobs. A system that creates jobs while keeping the ones that are already established is reassuring to hospital staff.

Hospitals benefit from all of these aspects as well as staff and patients. If a hospital can lower mortalilty rates, provide better care, and create more jobs, they can establish a good reputation. Patients will feel at ease when going into a hospital with a reputation such as this and people will want to work for a company with such high regard. Many hospitals are experiencing staffing issues where there are too many patients and not enough nurses. “The virtual ICU was developed in part, because of shortage in physicians specializing in critical care medicine” (Nowlin 54). The tele-ICU can watch over more people at a time, that means that nurses and other ICU staff don't have to watch over as many patients. Now hospitals can employ a seperate team for the tele-ICU and ease the work load for nurses. All hospitals want is the best outcome for all who enter the building, whether it is a patient or an employee, and the tele-ICU has the ablility to improve many different elements inside the hospital.

The concerns that arise from patients, nurses, and hospitals about the tele-ICU are important to address. This system is controversial, for many reasons. However, it is important to take a look at the bigger picture and realize that there are certain aspects of the tele-ICU system that can drastically improve the way hosptials function. Patients are concerned with their privacy and the ethicality of this system. Nurses are weary of people not considering them “real” nurses anymore. These are both important elements that need to be confronted while considering the tele-ICU system. It is ultimatley up to hospitals to ensure the quaility of their care to patients and to establish specific job duties for nurses and the tele-ICU staff.

What many do not realize is that there are bigger problems that need to be addressed as well. There is an expected increase in population as many “baby boomers” age. Many of these people develop chronic health problems. This is going to cause hospitals to become overcrowded and staff is going to be stretched thin. The tele-ICU has the ability to help in this situation because it can monitor more patients at time. This in turn will help hospitals meet the demand of increasing population and the decreasing number of nurses. If more hospitals were to equip their ICU rooms with this technology, the increasing number of future patients can be provided with better health care with less complications.

In this paper I have set out to show that although there are concerns with tele-ICUs, the pros of this system outweigh the cons. Tele-ICUs provide a second set of eyes for monitoring patients that are in critical condition. Tele-ICU provide fast service which saves valuable time. Concernes for patient privacy can be quickly dispelled as the patients are not constantly watched, but rather are able to be monitored from remote in case of emergency. As the duties of the tele-ICU nurse become more clearly defined, it will help establish the role of nurses in this modern age. Just as every other industry has had to adapt to technology, nursing is no exception. Overall, the tele-ICU system provides benefits that can not be overlooked. It is the next wave in the future of nursing and it will provide better care for all patients.

Works Cited

Goran, Susan F. "A Second Set Of Eyes: An Introduction To Tele-ICU." Critical Care Nurse 30.4 (2010): 46-56. Health Source: Nursing/Academic Edition. Web. 14 May 2012

Goran, Susan, F. "Making The Move: From Bedside To Camera-Side." Critical Care Nurse 32.1
(2012): e20-9. CINAHL with Full Text. Web. 7 May 2012.

Nowlin, A. "Get Ready For The Virtual ICU." Rn 67.8 (2004): 52. CINAHL with Full Text. Web. 14 May 2012.

Reed, K. "Telemedicine: Benefits To Advanced Practice Nursing And The Communities They

Serve." Journal Of The American Academy Of Nurse Practitioners 17.5 (2005): 176- 180. CINAHL with Full Text. Web. 7 May 2012

Swann J. Telecare: looking to the future. International Journal Of Therapy & Rehabilitation [serial on the Internet]. (2007, Nov), [cited May 14, 2012]; 14(11): 512-517. Available from: CINAHL with Full Text.

Here is a link to my Multimedia!

Link to Multimedia

Reflection on Extended Analysis

Reflection on Textual Analysis

My textual analysis was an article by Susan Goran called A Second Set of Eyes: An Introduction to Tele-ICU. This article will be very helpful to me while writing my final paper. Goran gives an excellent introduction to this system. Because of this article, I will be able to include the specific duties that a tele-ICU nurse has. This is going to be one of the articles that I use the most for my final paper. This article also included the negative aspects that need to be addressed with this system. Goran talks about the loss of identity that nurses feel because of this new system. It helps to get some more information on both sides of the argument.

Thus far, I am happy with what research I have. Like I said before, it is good to have information on both sides of the argument. This helps me form a more well rounded and informed paper. I want to argue that this system is good! However, I do acknowledge that patients and nurses themselves have some weariness with this idea. I want to address that so that I can provide a solid argument saying despite this hesitation, this system will better our hospitals.

My argument hopefully can be important to patients that are not sure of their stance on the situation is. It should be important to them seeing as how they are the ones that are actually in the ICU. My argument can also be important to nurses too because they are the ones who will be working in this environment and their full understanding is important for the success of this technology.  

Creative anecdote/intro

Creative Anecdote

Say you or someone you know gets admitted into the ICU. In your private room, you see a few things that you have never seen in a hospital room. All of a sudden, a monitor that’s in the corner of your room turns on and there you see your nurse staring back at you. At first you can’t decide if whether or not that is actually her. Then she starts talking and you realize she can hear you too! That’s what the tele-ICU is. It is not designed to scare patients by any means however; the thought of it can be a little intimidating.

This brings me to introduce my argumentative claim. I think this technology is going to better our hospitals around the country. It has amazing potential in many aspects. It has the ability to be a second set of eyes for many patients at a time, always watching and waiting. When an alert of any kind goes off, the tele-ICU nurse looks inside the patients room with the camera and sees what the cause of this alarm is, and from there the tele-ICU can decide what steps to take to fix the problem. This system has a faster response time than regular nurses because they don’t have to run around the hospital to get to the patients room. All they need to do is turn on a camera. Because of this, mortality rates have gone down in hospitals that have the tele-ICU. Furthermore, it is a great teaching tool for new nurses to the field.

            I will also address the problems associated with this technology and its direct effect on nurses themselves. No one single thing can fix EVERYTHING, so I will also be addressing this in my argumentative paper.

Outline

Outline

Introduction

• Thesis
• Pro tele-ICU (support)
• introduce tele-ICU with background info

Paragraph

• Give detailed outline of room
• Review of monitoring system
• Outline of workstation area

Paragraph

• Benefits of tele-ICU
  • cost effective
  • lower mortality rates
  • solve staffing issues
• Cost effective
  • Can cost some money to install but otherwise, very cheap
• Lower mortality rates
  • Rates without tele-ICU vs with
  • Less chance of patient becoming more ill in the hospital
• Solve staffing issues
  • Helps monitor more patients giving nurses a break

Paragraph

• Some argue that tele-ICUs will take away jobs from Nurses
  • It doesn't – back up with facts from articles
  • Actually creates jobs
  • A computer cant do the actual nursing job, which many don't realize. This system is just a second set of eyes, ears, and hands

Paragraph

• Discuss the job of the tele-ICU nurses
  • Virtual rounding
    • Patient information updated every 4 hours
  • Alert response
    • Bedside alerts are still the job of the nurses
    • Tele-ICU has special alerts and whoever is monitoring it can distinguish which alerts need addressed by a nurse and which don't
  • Provide assistance to the bedside team
    • This allows for quick access to information whereas before it might have taken a little longer
  • Coaching/Collaboration
    • Great teaching tool
    • New bedside nurses can ask for help from the tele-ICU nurse without bothering doctors or other busy nurses

Paragraph

• Discuss how some nurses appeal to tele-ICU and why

Paragraph

• Ethics?
  • Privacy is very important to ease peoples minds
  • Discuss how not all patients are watched at all times
  • Actually just as much monitoring as before only you wont be having a nurse walk into your room every hour
  • high priority/risk patients are watched more closely than others
  • Real time vital signs are displayed on the screen, if a problem arises, then the camera is turned on
  • Camera is not on all the time, it becomes activated when a problem or alert arises

Paragraph

• Patient care vs nurse conveniences
  • Better outcomes for patients
  • Any system that lowers the mortality rate for patients is better
  • This puts peoples mind at ease

Paragraph

• This system only successfully works with the collaboration of health care providers

Counterargument

• Even though tele-ICU systems do all of these great things, there is the concern that the physical demands add to the stress that nurses already have and there is also the issue that nurses loose their identity
• Having an identity in the workplace is very important
• Discuss why this is so harmful

Conclusion

• restate my argument and finish with a strong ending about the positive outcomes from having tele-ICUs

I search

Kaitlen Baser

            Instructor Hartley-Smith
            English 201-20
            14 May 2012

I-Search

When I first started debating topics for my research paper, I was slightly overwhelmed with the notion of having to write a paper of this nature about technology. I took into consideration possible topics involving ideas about video games or television. Taking into account the fact that I only occasionally play video games and I hardly ever watch TV, it didn't make much sense to me to write this paper on something that I really don't care about. Instead, I look at this paper as an opportunity to inform myself, and hopefully others, about something that I care about and have a passion for.  That is why I decided to write my paper on Nursing and Technology. My major is nursing and I thought it would be interesting to write a paper on something that I might have to deal with in my future career.

            I started to look at different articles in the library database that were written about nursing and technology. I soon discovered that I needed to narrow down on a more specific topic to improve my results. That is when I came across an article that was about tele-healthcare. I was immediately intrigued and I was able to specify my searches. I began searching for more articles related to this one until I got to an article about monitoring systems that were used to keep a better eye on patients in the ICU which included an introduction into tele-ICU (Goran). I continued to find articles that talked about tele-ICU rooms and how much better they are compared to the traditional ICU room. But with “someone” always watching you, there can be issues that arrive. Something like this might be considered an invasion of privacy and unethical (Swann).  However, the majority of the sources that I have are pro tele-ICU rooms. I originally thought that most of the articles that I would find would be against this type of thing, but to my surprise, I am finding more and more articles that are written by scholars in the field of health care who advocate this new technology.

             A number of the articles specifically talk about the improvements that have been made to the ICU because of technology. They discuss how using technology provides a better service to patients because you are better able to carefully watch over not only one, but many people at a time.  By improving hospital rooms with technology, nurses can ensure the correct medicine for a patient and check administration time by simply scanning a bar code that is located on the wrist band of the patient. I wanted to also include some background on tele-ICU rooms. I knew that my potential audience might be curious with how tele-ICU rooms work and what kind of training would be involved. In an article by Jennifer Mitchell gave an overview of the system and how this technology worked. She also gave a brief description of the training that a nurse might have to go through (Mitchell). I even discovered that pretty soon, this won't be a choice for nurses, every nurse will need to know how to work in an environment with tele-healthcare and I found that to be very interesting (Nowlin).  Overall, I am very pleased with my discoveries in my research thus far because each article has the ability of providing specific details about nursing and technology.

            From here, I see that I have the option of taking different angles on my paper. I can write about the ethical issues that come along with technology being more involved with the care of a patient. Is it better to have conveniences in the work place, or does this interfere with personal care? Yes I could argue that, however, the position that I have decided to take is opposite of that. A rough draft thesis that I have could be, despite the fact that many might have weary thoughts behind tele-ICU rooms, the ability to improve health care with technology while providing even better patient care, will eliminate the hesitation of tele-healthcare. With the research that I have found already, I feel very confident that I will be able to provide an informative, argumentative paper on this topic.

            The next goal that I have in the writing process would be developing a complete analysis of the articles that I have found. From there I feel as though I would be better able to start putting together the important information that would support my argument. I also hope to improve my thesis and the claim that I am making with my paper. After doing all that, I feel as though I will be able to form a counterargument claim that will be included in my paper. The only problem that I think I will face is forming my counterargument and finding evidence to support it that is unbiased. I feel as though I have gotten lucky with my research because I haven't really come across a road block of any kind, and I hope that my streak will continue. As stated previously, I am happy with what research I have. Overall, I have a desired outline for my paper and I have discovered many articles that will continually help me through the writing process. 

Works Cited

Goran, Susan F. "A Second Set Of Eyes: An Introduction To Tele-ICU." Critical Care Nurse 30.4 (2010): 46-56. Health Source: Nursing/Academic Edition. Web. 14 May 2012

Mitchell, Jennifer, K. "Nursing Informatics 101: Using Technology To Improve Patient Care." ONS Connect 26.4 (2011): 8-12. CINAHL with Full Text. Web. 14 May 2012.

Nowlin, A. "Get Ready For The Virtual ICU." Rn 67.8 (2004): 52. CINAHL with Full Text. Web. 14 May 2012.

Swann J. Telecare: looking to the future. International Journal Of Therapy & Rehabilitation [serial on the Internet]. (2007, Nov), [cited May 14, 2012]; 14(11): 512-517. Available from: CINAHL with Full Text.