Breakthrough Busts

By Cathryn Domrose
March 13, 2002

Years ago, said Julie Fairman, Ph.D., RN, FAAN, hospitals introduced a rotator bed. Nurses strapped patients in and the bed tilted from side to side. The object of this state-of-the-art technology was to prevent bedsores, said Fairman, an associate professor at the school of nursing at the University of Pennsylvania, and associated scholar at the Center for the Study of the History of Nursing.

But it was impossible to tell whether the bed actually worked because after a few tries, no one wanted to use it.

"People would get seasick on them, and they would get claustrophobic, too, because they couldn't move," Fairman said. For all the heralded advances in health care technology, no one has yet invented a usable bed that prevents bedsores, she said.

The story of technologies like the rotator bed, the fetal monitor and, most recently, computerized patient information systems, seem to have two morals: not all technology is useful for nurses, and nurses need to help design and test the devices they will be using.

"Nurses have to be more involved in product development," Fairman said. The rotator bed has fallen out of favor, but nurses continue to use other technologies even though they create more work and have not been proven to affect patient outcomes, she said.

Sometimes, untested technologies can do even more harm than creating extra work for no visible gain.

Fetal monitors rolled into labor and delivery rooms without much testing and when no one knew much about fetal heart rates, said Madge Buus-Frank, MS, NP, RN, a neonatal nurse practitioner at Children's Hospital at Dartmouth and Southern New Hampshire Medical Center and principal consultant for Dynamic Neonatal Solutions. As a result, cesarean section rates skyrocketed, doubling in some hospitals. That rate went down as caregivers learned more about fetal heart rates, but fetal monitors still are considered the standard of care even though their benefit has never been proven, she said.

"Once the technology comes in, it becomes difficult to evaluate it," she said. "Just because we have the technology, we don't have the mandate to use it."

The question of using technology just because it's available will become more important as health care providers debate the merits of technologies on the horizon, such as genetic engineering and cloning, said Leah Curtin, DSc(h), MS, MA, RN, FAAN, editor of CurtinCalls, an "irreverent, fact-filled scan of nursing and health care" based in Cincinnati, and contributor to Health Management Technology magazine.

"We're a long way from using cloning as a therapeutic tool," she said. "We may never come to it, or the payoff may be so horrible, we don't want to do it."

Sex-change operations, first applauded as a way to help people who felt trapped in the wrong gender, "are almost never done anymore" because the psychological problems that often followed them were enormous, Curtin said. "Technology can create as many problems as it solves. A lot of it has to be evaluated. It should be used therapeutically."

Diane Skiba, Ph.D., FAAN, associate professor and option coordinator for health care informatics at University of Colorado Health Sciences Center School of Nursing, listed computerized clinical information systems as an example of technology that hasn't come to fruition for nurses.

The technology, which was supposed to make charting and retrieving patient information easier, hasn't really served its purpose, she said. "The nurses see the documentation system as more work, but they haven't seen the value of it."

But it's not the fault of the technology that nurses don't have a useful system, she added. "The problem lies in the lack of a structured nursing language that allows us to retrieve, manipulate and make decisions based on structured data."

Constance Berg, MBA, RN, principal of CMB Consulting in San Francisco, said few patient information systems have the integration and speed that nurses and physicians require. Berg consults with nursing departments and hospitals in selecting new or troubleshooting current information systems, and she also works with vendors who target the health care industry.

"We need people who understand the workload of the nurse and the physician," she said. "And we need people who understand the process of the workflow." As problems like protecting privacy and accepting a standard language are worked out, she predicts the systems will become more useful to caregivers.

Some hospitals still buy systems with little or no recognized input from their clinical staff, she said. "I urge nursing and the physicians to be actively involved in the selection process" of clinical information systems, Berg said.

Unfortunately, Fairman said, she sees no technological innovation in the future that will solve nursing's greatest woes. "A device to make people appreciate nurses and give them more pay, that would be wonderful," she said, laughing. "But I think the best technology is having enough people to do what is needed for patients. That's a technology we haven't devised."