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.