Consider the thermometer-one of health care's most basic technologies. Is it a useful clinical tool, a symbol of nursing as a science or, at least in the days before microchip technology, an annoying device that took up much of a nurse's time and that patients hated holding under their tongues? Depends on whom you ask.

"You can't just say a technology is good or bad," said Margarete Sandelowski, Ph.D., RN, FAAN, professor at the University of North Carolina at Chapel Hill School of Nursing. "You really need to look at the context. A thermometer is something different in every context."

What nurses consider the most important technologies of the last 20 years also depends on which nurses you ask.

The nurse caring for premature infants in the neonatal intensive care unit might say it's the shrinking of existing technologies that enables her to treat tiny patients. Community health nurses in rural areas might talk about devices such as videophones and computers that let them check on patients who live a hundred miles away. Nurses on a medical/surgical unit might mention dose units that save them from having to carefully measure medications, or timed medications that mean they no longer have to wake sleeping patients.

Or they might list the state-of-the art, microchip-operated, digital readout thermometer that lets them take a temperature in a matter of seconds, without squinting, shaking or worrying that a patient might spit it out.

When NurseWeek asked nurses who study, work with or write about nursing technologies to list what they considered most useful, as well as what might be the most useful in the next 20 years, their answers displayed as much variation as their areas of expertise.

Some listed global technologies only recently adopted by health care, such as online education, mobile technology and the Internet. Others mentioned improvements on existing health care technologies, such as electronic beds or increasingly sophisticated ventilators. Some expressed excitement about new-horizon possibilities such as genome mapping and organ cloning; others found these fraught with ethical problems or a long ways off.

Almost all talked about technology as a double-edged sword that creates new problems and questions as it solves and answers others.

Based on their answers, we offer a by-no-means-inclusive list of technologies that have been important for nurses in the last 20 years, and some future nursing tools for the next two decades.

••Improvements on existing technology••

"Sometimes it's the simplest things that make things so much better," said Leah Curtin, DSc(h), MS, MA, RN, FAAN, editor of CurtinCalls, an online scan of nursing and health care in Cincinnati, and a contributor to Health Management Technology magazine. In her opinion, the electronic bed and the IV pump have eased the lives of countless hospital nurses who no longer have to strain their backs moving patients or spend time manually pumping fluids into patients.

"I'm talking about wear and tear on the nurses and easing the physical work they do," Curtin said.

Julie Fairman, Ph.D., RN, FAAN, 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, disagrees with Curtin about infusion pumps-in her opinion, nurses must spend too much time fussing with them and making sure they work. But like Curtin, she believes the greatest technological improvements for nurses have often been simple things like disposable, sterilized items, digital-readout thermometers and glucose meters, even pens that hang around nurses' necks.

"If you look through history, it's actually been the smallest things that make the biggest difference," Fairman said.

For nurses on the neonatal intensive care unit, perhaps the greatest advance is the miniaturization of existing technology, said Madge Buus-Frank, MS, NP, RN, a neonatal nurse practitioner at Children's Hospital at Dartmouth and Southern New Hampshire Medical Center. Buus-Frank is also principal consultant for Dynamic Neonatal Solutions, a company specializing in technology for the neonatal unit.

Many standard technologies have been shrunk "to make them applicable to a patient who weighs 350 to 500 grams, or about a pound," she said. "That's really allowed us to treat patients who we could not treat before. We didn't have a tube that would fit into their airways or a vascular catheter that was small enough to thread into their blood vessels. It simply didn't exist 20 years ago."

••Mobile technology••

More nurses are carrying handheld computers, mobile laptops and cell phones, said Diane Skiba, Ph.D., FAAN, associate professor and option coordinator for health care informatics at the University of Colorado Health Sciences Center School of Nursing.

Instead of having to return to a switchboard to call a patient's physician, order supplies or check in with a family member, nurses can step into the hall and use a cell phone. They can also use these devices to receive information.

"Nurses are using them to look up drugs, to look up medical histories," Skiba said.

Eventually, as information systems improve, nurses might be able to get everything from X-rays to blood test results to pictures showing the progress of a healing wound, all from a device not much bigger than a deck of cards.

••Cybermedicine or telehealth••

Within the last five years, small groups of nurses, mostly in rural areas, have been visiting their patients by computer, telephone or videophone, Skiba said.

Various projects focus on telephone triage, nurse-mediated electronic support groups for patients and "cybervisits."

In Georgia, Skiba said, nurses make regular cybervisits to paraplegics at home, using videophones and cameras.

As the nurses talk to their patients, they observe how they sit, if they are slouching and how much they move around. The nurses use this information to prevent the patients from getting bedsores.

"They save a ton of money," Skiba said. "When you don't have to travel the distance, you can do [an assessment] in 15 minutes."

••The Internet and Web-based technologies••

Whether they're looking up a journal article, taking an online education course or earning a degree through an Internet class, "nurses really do have lifelong learning at their fingertips," Skiba said.

Nurse leaders in different states are using e-mail and the Internet to exchange information about education and retention programs. Internet and Web-based technologies are advancing so quickly that they are outpacing many clinical information systems, said Constance Berg, MBA, RN, principal at CMB Consulting in San Francisco.

"When clinical information systems do not provide easy-to-use applications with the necessary speed to do the job, health care workers, especially physicians, just go around the system and use the Internet," she said.

••Ultrasound and imaging technology••

When ultrasound was in its early stages, Buus-Frank remembers lugging a huge machine to clinics around South Dakota. The image on the screen "looked like a very bad TV reception," she said.

At first, she though her patients were pretending to be able to see their babies "because the picture was that bad." Now, pregnant mothers can see that the baby has hair. They pick out family resemblances.

"It's excellent for nurses," Buus-Frank said, because if the baby has problems or an illness, nurses have time to educate and prepare the families and themselves.

She sees nurses eventually using ultrasound at the bedside for guided interventions, such as inserting a peripheral artery line in an infant.

In the future, nurses may be dancing with these new technological partners:

••Robotic surgery••

At some point, Skiba said, a surgeon at an Army medical hospital may operate on a soldier in the field of a far-off country. Right now, robotic surgery is still in its infancy, although it is more often used in Europe than in the United States, Berg said.

For nurses, follow-up care for robotic surgery will likely mean fewer incisions, less wound care, less chance of infection and easier and faster recovery for the patient, Skiba said. That means nurses can focus more on recovery, rehabilitation and education-if the hospital or clinic isn't sending the patient home in an hour.

"That's the potential danger of it," she said.

••Nano technology••

As technology shrinks to microscopic size, nurses will read information from tiny computer chips embedded in the patient's body. They'll follow the progress of smart pills to see if they are going after the tumors they were meant to attack and see, from the look of the patient's insides, what side effects the pills might cause, then treat those side effects before they happen.

It also means helping patients deal with this tremendous amount of information coming out of their bodies, Curtin said.

"This means taking care of patients who have microscopic-sized robots eating plaque out of their arteries or detecting tumors that were previously inoperable and working to educate the patient about what that technology means."

••Wearable computers••

The Massachusetts Institute of Technology has developed a heart brooch that sends heart sounds back to the health care provider, Skiba said. "They've made it into this beautiful piece of jewelry that someone can wear."

The military has developed vests that can read and send back a soldier's vital signs, she said. In Japan, smart toilets can collect and send out data based on their contents.

As these smart devices improve, along with data integration systems, nurses will have access to far more non-text data. They'll have heart sounds that they can compare from day to day, pictures of a wound as it heals. They'll also have to think about privacy and health care access issues in a different way, Skiba said.

"Does letting someone's heart sounds out into the ether have other consequences besides providing caregivers with important information?"

••Voice-activated information systems••

"I envision a day when nurses will all be wearing a voice-activated headset," Buus-Frank said. "They can dictate their documentation as they work."

Someone sitting at a desk designed most current computer charting systems, she said. "The work of nurses is on the go, on the run. It takes place in a lot of different places, in the hallway."

Curtin knows of at least one hospital in New Jersey that started using voice-activated computers 10 years ago. "It's around the corner," she said. "That will be a boon for physicians and nurses alike."

••Tomorrow's tech••

The possibilities for future uses of the Internet, telehealth, clinical information systems, new drugs and other health care technologies now in their infancy are endless, Berg said. "Biotechnology is one of the areas where nurses are just getting started," she said.

Those who choose to go into the field have a good 500 years of work ahead of them, she predicted. Nurses are needed to help design and test new systems, new devices and new drugs to ensure the new technologies will actually be useful for other nurses. "If a nurse has a science background and a bent for this kind of work," Berg said, "the opportunities are there."

Nurses may also find themselves returning to technologies even more basic than the thermometer.

"I think they're going to have to go back to the olden days and learn nutrition again," said Curtin, referring to studies showing that specific foods may prevent certain disorders. "Some of our technologies won't involve machines at all. They'll involve foods."

Contact Cathryn Domrose at kaguilar@well.com