Health Technologies and Reflections in Nursing Practices

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Original Article

Yasemin Aydin Kartal, PhD Assistant Professor, Department of Midwifery, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey Saadet Yazici, PhD Associate Professor, Department of Midwifery, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey Correspondence: Yasemin Aydin Kartal, Assist. Prof. Department of Midwifery, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey e-mail: [email protected]

Abstract Modern healthcare system uses many advantages of information and communication systems, in order to increase the quantity and quality of medical healthcare services. In medical healthcare institutions, the largest labor force with clinic knowledge comprises of nurses. In line with this purpose,increasing the knowledge in nursing practices, using new technologies becomes important. The purpose of this article is to examine the innovations in the healthcare technologies and its effects on both Turkey and worldwide. Key words: Nursing Practices, Health Technologies, Telehealth, Telenursing

Introduction acquiring the knowledge, skills and attitute has become a requirement in nursing (Hegarty, Rapid and suprisingly astonishing innovations in Walsh, Condon, & Sweeney, 2009; Isık & Kaya, science and technology have brought a fierce and 2011). confidential competition among countries and this competitions made the countries to improve Hence, use of information technologies is one of their existing technologies inevitable. the major components of basic competency areas Additionally, citizen’s expectations to live in a of nursing and medicine. Nurses, when more prosperous environment increased the determining the technology that they use, renew improvements in technology. Consequently, use policies and procedures which are applicable, of techonology has become an obligation rather usable and reliable , also concern the level of than a priviladge. Medical healthcare sector has effectiveness, cost, social, legal and ethical become the pioneer of this technology aspects (Barton, 2010). Technology systems such improvement sector, plus brought up the concept as healthcare mobile applications, robotic of health technology, which has importance in surgery, nanotechnology, smart wearable making the life meritable. Health technology is technology, web based care and education defined as the application of organized applications, health informatics, tele-medicine knowledge and skills in the form of devices, applications, wound care technologies, medicines, vaccines, procedures and systems programmed barcode infusion systems, developed to solve a health problem and improve simulation, social network applications; are used quality of lives (WHO, 2013). for a variety of applications such as, acceptance of physician requests, prevention of errors and In contemporary society, information and side effects, barcode retrieval for drug communication technologies advance inevitably, applications, decision support systems, nursing so that it affects the shape of healthcare services. education, establishment of standard nursing care Like all other professions, correct and efficient plans, clinical guidelines, procedures etc. use of technology affects nursing as a profession. (Canadian Nurses Association, 2006; Hegarty et Nursing institutions accepts technology as an al. 2009; Valiga, 2012; Doyle, Garrett, & Currie, important variable that affects the healthcare 2015). practice and efficient use of technology, www.internationaljournalofcaringsciences.org

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Efficient use of healthcare technology systems • In alerting changes of patient condition have important roles • In escalation of maintenance time • • In decreasing the patient care costs In organization and management of • nursing services In identifying possible future diseases • In statistical evaluation and development • In recording, storing and sharing the of research database patient information • In distribution of health benefits (Potter • In facilitating clinical decision making & Perry,1997; Menke, Broner, • In speeding up the communication Campbell, McKissick, &Edwards- network • Beckett, 2001; Hovenga, Gadre, & In standardization of nursing care Heard, 2005; Langowski, 2005; Ay, planning 2007; Barton, 2010; Lammintakanen, • Averting medical complications Saranto, & Kivinen,. 2010). • Commuting clerical work

Table 1. Intelligent Wearable Patient Tracking System Sensors

Sensor Types Signals Signal Source

Skin Electrodes Electromyogram (EMG) Muscle electrical activity Electrodes placed in the head Electroencephalography (EEG) Electrical activity of brain skin potentials Skin Electrodes Electrocardiogram (ECG) The waves of P, Q, R, S, T, U Accelerometer Activity, Mobility, Declination Posture and Limb movements Piezoelectric / Piezoresistive Respiratory rate Unit breathing sensor Phonograph Heart sounds Record with heartbeat microphone help Glucosemeter Blood sugar Evaluation of the amount of glucose in the blood Pulseoximeter Oxygen satiety Oxygen hemoglobin in blood Temperature probe and skin Body or skin temperature Body or skin tape Woven metal electrode Galvanic skin response Skin electrical conductivity Stepper Number Of Step Walking PPG sensor Volumetric blood value Finger and ear lobe

Tele Health-Tele Nursing This includes systems and procedures including a simple phone call , medical videoconferences, Tele health is "the sharing of health data, the ability of doctor/nurse to monitor the patient education and healthcare information between data online, video system usage for online health personel and patients, students and other doctor/patient/nurse visits, teleconsulting, health personel, education, telecommunication, conducting remote surgical operations via using telephone, computer, interactive television robotics.This system, provides a bidirectional or a combination of them (Koch, 2006). communication between healthcare personnel and patients. www.internationaljournalofcaringsciences.org

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The system includes devices (blood pressure, With tele nursing, changes in the patient's oxygen saturation, electrocardiogram), video condition can be detected and intervened early, camera, computer, monitor, and internet responsiveness to patients' treatment and care can connection that provide the measurement of life be improved, satisfaction can be improved, and signs in the patient section. With this system, the they can help return to their role in daily life measuring apparatuses are attached to the body (Downe-Wamboldt et al., 2007; Reinhardt, of the patient, the patient data is transferred to 2010). the computer by a cable, transmitted to the health In Turkey, services for tele nursing have been professionals, or interviewed by the health given in the fields of application in some health professionals through the video-conference centers and scientific studies and although the method (Jenkins & White, 2001; Frantz, 2004; importance has been put forward, the definition Koch, 2006). The telehealth system provides for of job has not been done yet. In order for early identification and intervention of changes telehealth services to be widespread, it is in the patient's condition, reducing the number of necessary to determine the task and definition of home visits, urgent visits to the hospital and tele nursing, to be seen as a field of expertise, to hospital admission, hospitalization, effective be disseminated at national politics level, to be communication, reducing the cost of care, and included in clinical applications, administrative increasing the patient's self-care (Ratliff & Forch, support and financial resources should be 2005; Koch, 2006; Hain, Ng, Aronow, Swanson, determined. & Bolton, 2009). Tele-health services are helping to improve care management and quality of life, Electronic Health Records (EHR) especially for patients with chronic illnesses. The Electronic Health Records are resources that International Nurses Association (ICN) defines patient datas are recorded digitally and tele-nursing as "the use of communication transmitted securely and only can be accessed by technologies in nursing to improve patient care," users who have proper authority. Computer and while the American Nurses Association (ANA) computer controlled systems, bring extraordinary defines "nursing practices such as information extents to diagnosis and treatment in modern about patients' health status, Activity ", approved medicine, provide convenience and accelerates in 1999 as a component of nursing practice. the medical processes. It provides many complex Within the scope of tele nursing, telephone yet similar cases to be interpreted easier, safer nursing, tele-triage and tele-home care nursing and correct and enables medical data to be are applied to the patient. At the same time, accessible without any distance. Thus, patient education, high-risk group of patients, examination, evaluation, diagnosis, treatment, counseling and communication are maintained access to information about health, education and (Valanis, Tanner, Moscato, & David, 2003). In professional help can be provided easily. EHR tele triage practice, the nurse ensures that the provides not only readable and interdisciplinary patient identifies their health problem and directs data sharing but also facilitates evaluation of it to the necessary resources. In tele maintenance data(Ay, 2009; Yanamadala, Morrison, practices, nurses collect and evaluate the Curtin, McDonald, & Boussard, 2016). information of patients and direct them to Nurses are the biggest medical personnel who are appropriate health resources at the appointed direct caregiver to patients and determines the time. It also follows systems that include alarms, patient needs (Hovenga et al., 2005) Hence, sensors and other equipment that help people nurses are the primary users of the computerized with social and health care needs live longer system. Both many quantitative and qualitative without external care. As part of the tele-home data are recorded by nurses (Cho &Park 2003; service, the station is equipped with a Park, Cho, & Byeun, 2007). These data supports videoconferencing unit connected to a regular nursing practices not only for the improvement telephone line. Patients provide the necessary of nursing information systems but also for home monitoring equipment (such as a hospital information system improvement. glucometer, blood pressure monitor, pulse oximeter). The necessary measurements are Effective use of computers has significant followed and necessary interventions are influence on maintaining patient care and performed (Lorentz, 2008). improving quality. Indeed, contemporary information systems mitigate repetitive www.internationaljournalofcaringsciences.org

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bureaucratic procedures, reduce the need for do not reflect professional performance in patient paperwork, and increase the time spent directly records (Erdogan, 2003). Easy to use information on patient care. This increases the quality of the retention system that allows information flow care provided (Kleinbeck &Dopp 2005; Ay, and usage among the units in Turkey, enables 2007) as it allows time and labor to be used more inquiry on the records kept on the computer, is efficiently and patiently. flexible enough to reflect patient changes in the diagnosis, treatment and care of all health In addition, the EHR also provides standardized professions, And must be reliable in auditing. care plans that can guide patient care nurses in detail, record patient care and care results, Robotic Surgery improve patient care quality, and help with Robotic surgery is defined as surgery performed managerial decisions such as charging, by a physician via a robot. This is a new performance assessment, and determining the technology that has recently opened new number of nurses needed. horizons for medical science and physicians use Nursing is a system that provides nursing support this technology for an increasing number of for nursing knowledge, management of data for different surgical procedures. There are many care, nursing practice, tools, phases reasons why robotic surgery is so widely used development.(Erdemir, Hanoglu, & Akman, and accepted in the medical world. These 2005). Nurses use the information system for include; that the area of surgical incision is small, many different purposes, such as registering care patients have little pain, bleeding and infection and treatment and monitoring their results, rates, have a short period of discharge and registering development and change in patient shortness of discharge and do not disturb the status using clinical or other methods, patient in terms of cosmetics and chemotherapy communicating between departments and shifts, (Palep 2009). and statistically evaluating outcomes of Nurses play important roles during robotic healthcare (Elkin, Perry, &Potter, 1996). This surgery practices ; especially in pre-surgery system facilitates clinical decision making, period; proper positioning of the patient, increases time allocated to the patient, preperation of the system and its control, standardizes nursing care plans, improves written securing the surgery team. During surgery; communication between nurses, ensures that supporting the surgeon to conclude the surgery patient records are kept in order and creates a correctly, maintaining the asepsis, reading the database. In addition, these records establish a data on the videoscopic screen correctly and legal document for the protection of the nurse quickly, taking necessary precautions in case of and increase the responsibility of the nurse. At a possible power insufficiency. Nurses also have the same time, the number of observations that many important roles in post-surgery period; result in forced reminders increases. Additionally such as controlling the airway clearence, Blocks medical errors and improves the quality preventing medical complications(Tabor, 2007; of care.Moreover,it generates data for statistical Ucuzal & Kanan, 2008; Celik, 2011). evaluations and surveys as the data about the patient provides for the recording and storage of In Turkey, many fields of urology, general, plans. (Potter &Perry 1997; Menke et al., 2001; chest, cardiovascular surgery, orthopedic Hovenga et al., 2005; Ay, 2007) surgery, plastic surgery, otorhinolaryngology and gynecological surgery are conducted with the In Turkey, electronic medical records and web- help of robotic surgery. Nurses also adapt based maintenance programs are generally used themselves to this continuously improving for outsourced computer programs. These technology as an important member of the programs do not conform to the Turkish Health surgery team and integrate these improvements System, language structure, legal regulations and to their practices in compliance with their duties cultural structure in Turkey. Prepared packaged and responsibilities. programs written in Turkey do not respond adequately because they are written by Gamma Knife Radiosurgery individiuals who do not have sufficient Gamma Knife radiosurgery, is a treatment which knowledge of software and hardware, or who allows to perform a surgery without any cuts, the have little knowledge of computers or have no location of diseased brain tissue is determined by knowledge about occupational functions. They www.internationaljournalofcaringsciences.org

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coordinates and destroyed or the growth of neural implants, plastic and reconstructive diseaed tissue is stopped by gamma rays . It is a implants, dental implants, ophthalmic systems, technique which can be conducted without any catheters, insulin pumps, syringe, adhesives and general anesthesia, which has %25-%30 lower blood substitute systems are used in our clinics. costs, which do not cause any pain or uneasiness Nanotechnology is expected to have a very on patient or hair loss, which causes no infection important place in the future as materials, or blood loss risk due to no need for surgical devices and systems with more functional, faster, wounds, which enables patients to return their less space-consuming, less energy-consuming daily lives the day after the surgery (Kayhan, new features are produced. 2005). While nanotechnology has been talking about In gamma knife radiosurgery preoperation benefits to human health and medical practice, it patient preperation process, the nurse takes place has recently been stressed that can cause toxic, ;in the training of patient on the treatment plan, mutagenic systemic effects in individuıals. It is supply of necessary equipment and preperations, stated that nanotechnological products entering the preperation of Gamma Knife unit and medical applications may cause possible toxic conducting a healthy communication among effects on nerves, respiration, digestion, blood team members. During the operation nurses take and skin due to their molecular properties place; in preperation of sterile material (Berk&Akkurt, 2012). preperation during stereotactical frame insertion, For this reason, nurses working in clinics need to assisting the doctor during operation procedures, be aware of the molecular structures and sizes of conducting final controls before Gamma Knife nanoparticles and develop protective applications operation and maintaining the sterile to prevent them from being inhaled and removed environment during frame extraction. In post- from the skin. surgery period nurses take place in, monitoring the life signs, pain and bleeding check, In Turkkey nanotechonological products, preventing medical complications and providing especially the one used in early diagnosis of discharge training (Tekin, 2010; Celik, 2010) cancer, effects in cancer patients, new possible symptoms, individual treatment interpretations of This technique applied in specific and limited patients, records of nurse observations will be centers both in Turkey and worldwide; has able to provide the distinguishing data from the become one of the standard treatment methods of traditional treatment. Additonally, it is suggested neurosurgery with its wide application area, that; researches on the long term effects of sharpness, low complication and high success nanotechnology in certain fields such as pain rate. For this reason, it is very important for control, wound recovery and diabetes nurses working in the field of surgery to have management should be conducted and nurses continuous training on Gamma knife should provide consulting services to patients on radiosurgery technology in terms of safety and this field. quality. Wound Care Technology Nanotechnology Wound care has been an important topic Nanotechnology provides great contributions to throughout history and many methods of wound the field of health through the development of care have been developed. Today, wound care, medicine, drug development, diagnosis, one of the special branch nursing fields, requires treatment, prevention of disease and traumatic special knowledge and skills. Another aspect of injuries, control of pain, protection and nursing care is comprised of making use of new development of human health, water technologies and efficient use of these decontamination, information and technologies. Both acute and chronic illnesses communication technologies and production of can be successfully healed with new injuries, durable and light materials(Singh et al., 2009) new treatments and care initiatives which Additionally, gene treatment through nonorobots, become a major problem for patients. There are a discovery of the secrets of DNA and treatment of number of wound care products such as films, genetic diseases will be enabled (Botstein & foams, hydrocolloids, alginates, hydrogels, etc., risch 2003). Today, clinic systems such as which can be used according to the clinical orthopedic prosthesis, cardiovascular implants, scene. When choosing a large number of www.internationaljournalofcaringsciences.org

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dressing materials developed, nurses should be Conclusion and Suggestions careful not to make the dressing material simple, As a result, nurses are healthcare personel who expensive, highly absorbent, and not stick to the has a key position in maintaining health and wound. improvement. Studying newer trends which Numerous biological and synthetic dressing affect nursing profession, and researching on the materials have been developed in the world and effective use of these newer trends play an in Turkey, especially for the treatment of chronic important role in reconstruction of nursing wounds, to reduce pain, accelerate epithelization, practices. For this reason, continuous training of reduce the frequency of dressing change, and all healthcare professionals are quite important in shorten the duration of treatment (Baskan, 2005; tems of quality and safety of healthcare practices. Eski, Nisancı, Yapıcı, Deveci, & Sengezer, Use of information and communication 2007). In this direction, nurses use new technologies will increase the quality of nursing technological products to improve the quality of practices and the quality of healthcare; while care and the duration of wound healing. contributing to the nurses and nursing managers on the road to professionalism. Intelligent Wearable Patient Tracking Systems References Intelligent wearable patient tracking systems is Akbulut F.P. & Akan A. (2015). Smart Wearable designed for monitoring an individual for 24 Patient Tracking Systems. National congress of hours a day and warn in case of necessary medical technology. Mugla, Turkey. conditions. Recipients include wearable items Ananthanarayan S. & Siek K.A. (2012). Persuasive such as jewelery, eyeglass, watch, clothes(PWC Wearable Technology Design for Health and Wellness. 6th International Conference on Health Research Institute, 2014). This may Pervasive Computing Technologies for Healthcare include monitoring the individual’s heath (PervasiveHealth) and Workshops, USA. activity, measurement of the individual’s glucose Ay F.A. (2007). Process of Nursing. In: Ay FA (ed). level and warning against possible dangers Basic Nursing: Concepts, Principles, Practices. (Akbulut&Akan, 2015). Istanbul Medical Publishing, 60-74. Barton A.J. (2010). Patient-centeredness and Intelligent Wearable Patient Tracking Systems technology-enhanced care. Clin Nurs Spec , are a new trend envisioned by individuals to be 24:121-122. able to monitor their health status in real time by Baskan S. (2005). Contribution of surgical measuring data related to their own health and developments to the treatment of infectious thus help them to protect their health. Medical diseases. Journal of ANKEM , 19:14-18 parameters such as blood glucose level, body Berk S. & Akkurt I. (2012). Nanoparticle: The Scared weight, blood pressure, heart function, and the Dream of Your Future. Tuberk Toraks 60(2):180- level of oxygen in the body can be recorded in 4. the individual measurement applications as well Botstein D. & Risch N. (2003). Discovering as the healthy life items such as the number of Genotypes underlying human phenotypes:past successes for mendelian diseasei future daily steps, sleeping period, meal level, stress approaches for complex disease. Nuture Gene tic, level (Ananthanarayan & Siek, 2012). 33, 228-237. As a component of tele nursing; the data that Canadian Nurses Association (2006). Toward 2020: intelligent wearable patient tracking systems Visions for nursing, http://www.cdha.nshealth.ca/towards-2020- provide are transmitted to health professionals visions. and enables early diagnosis and intervention Cho I. & Park H.A. (2003). Development and opportunities. At the same time, it is enabled that evaluation of a terminology-based electronic patients take more responsibility in their nursing record system . J Biomed Inform , 36: 304- treatment and healthcare and reinforces health 312. services provided at home. In Turkey, studies on Celik S. (2011). Information Update in Surgical Care. intelligent wearable patient tracking system Journal of Acıbadem University Health Sciences, technologies has a priority in research funds and 2(2): 61-65. researchers are encouraged.

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