Continued from Page 1

Beyond the device

Advances in CCU equipment provide great benefits, everyone agreed, but they also emphasized that nurses can’t get too comfortable in relying on it.

Matute says that it’s not good if “nurses walk up to the bedside and look at the monitors first, the patient second. At Good Samaritan, we’ve trained them to look at the patient first.” That’s because there are some things monitors and equipment can’t tell you. How pale is the patient? Is his or her skin flaccid or sweaty? Electronic urinometers may be great for listing urine output, Matute says, but nurses also have to check the urine’s color and look for sedimentation.

Every nurse interviewed has developed or gone through training designed to prevent too much reliance on the equipment. Matute says his facility regularly holds mock codes, just to make sure the nurses are prepared for that big earthquake (or other disaster).

What happens if you just don’t have enough of each device on a floor? Bader notes that her unit once managed to get a $15,000 monitor on a trial basis, but the unit actually needed three monitors. A generous donor supported the other two, but what if it hadn’t happened?

Carlson recalls finding a less-experienced nurse waiting for the BP spot-check machine.

“I pointed to the old-fashioned sphygmomanometer hanging on the wall and said, ‘Why not use that?’ ” It had never occurred to the younger colleague. Some newer nurses are willing to admit that while they’re a whiz at newer technology, some of the old methods can stump them. Prior’s nemesis, he admits, is “IV starts. Every patient gets a central line,” so he doesn’t get much practice with the former.

Dahlberg says, “Computers are a mixed blessing. In critical care, you check on the patient so often that if the data don’t automatically download, you can’t keep up with data entry. It’s also difficult to see what’s going on with patient trends.” One reason may be a too-small monitor; many nurses find even 17-inch screens hard on the eyes.

That’s a rare complaint about computer technology in CCU or even hospitals in general. Sandra Lombardi and Johanna Van Dijk are both RNs in the pulmonary vascular program at the University of California, San Diego. Their patients come from around the world, but need constant check-ins once home (using a “slow CAD pump” to deliver their drug). Both nurses use e-mail to answer questions; Van Dijk uses an Excel spreadsheet to keep track of patients’ lab tests and her Palm Pilot to juggle thousands of other details, such as patient appointments and call reminders.

The devil’s in the details

Matute says top-notch devices are great, but notes that sometimes it’s simple solutions that nurses need — easier-to-read fonts and screens or urinometers with longer-lived batteries, for example. When the hospital first brought in computer charting, he says, it started the nurses (on average in their 40s and not computer techies) with checkboxes on paper forms; when they transferred to a screen, it already seemed familiar.

Carlson points to the pros — and possible cons — of some new wireless communications that have been approved for installation at UC Davis. Like handheld communicators, it could end the frustration in the 36-bed unit of not getting to a phone quickly, but “confidentiality might be a problem if you don’t remember to step away from people or simply say, ‘Now’s not a good time.’ ”

Bader cites the “small” expense of regularly supplying Mission’s brain oxygen monitors with $500 catheters that can strain budgets. Matute adds, “Sure, I can bring in the technology. Where you make the case to the administration is proving that you can support all the costs,” like those $500 catheters, training, and the additional infrastructure that supports the equipment.

So it’s vital to talk to people who’ve used the equipment. Find out how well it really works and make sure you know all the details (including expenses) for maximizing the equipment’s viability. Ultimately, our experts agreed that all the technology in the world doesn’t substitute for a nurse at the bedside. Carlson says, “Technology gives you lots of data, but it won’t do the thinking, to plan the care.”

Matute emphasizes, “In a CCU, we can’t forget that we’re taking care of people and their families.” These are not just numbers and digital readouts, they’re people, he said.

And if — despite all the planning — that disaster does occur and the technology’s useless, you can still count on well-trained CCU nurses. As Carlson says, “When the chips are down, nurses go the extra mile. That’s the awesome thing about nurses.”

To comment on this story, send e-mail to editorca@nurseweek.com.