Presentation
MDD14 - Evaluation of Clinical Nurse Recognition of Patient Wearable Devices to Guide Care Delivery
SessionPoster Session 2
DescriptionBackground:
The applications of wearable technology within the healthcare industry are infinite. There are wearable devices that can detect falls, alert for anemia, and allow your hospital’s doctor to monitor your vital signs from home (Wu & Lo, 2019). These wearable devices may take the form of patches, wristbands, necklaces, rings, or commercialized smartphones and smartwatches. Healthcare monitoring has become a societal mainstay, with over 30% of adults in the United States owning a wearable device and 50% using it on a daily basis for health-related feedback, such as tracking steps or sleep data (Rising et al., 2021; Chandrasekaran et al., 2020). As wearable devices for health become a mainstay, focus turns to the providers who encounter these devices and how device information is incorporated into patient care. Specifically, if providers can identify the wearable device at time of patient encounter as something useful to inform clinical care plan management.
Through the study of provider awareness to other communicative wristbands, such as medical alert bracelets, insight is obtained regarding the awareness of wearable devices which occupy the same body location. Over 99% of queried emergency medicine providers in a United Kingdom study felt medical alert bracelets are important for clinical care planning, yet in a case study simulation, only 8.5% of those providers searched for and identified a medical alert bracelet during patient assessment (Morton et al., 2002; Al-Alwan et al., 2020). Farhy et al. (2019), found no reduction in safety events and describes the loss in opportunity to minimize safety events, sparking the need for novel pathways to garner provider attention and awareness to wearable alerts and for clinical care.
The continuity of care and integration of care components, such as medical alerts and wearable devices, have renewed attention of the nursing community given the increase in complexity of care. Gaps in continuity of care may lead to adverse events- untoward medical occurrences - which may end in patient injury or death. Jones and Johnstone (2019) specifically identified in their sample population of nurses in Australia the gap of ‘failure to communicate the information required to plan and deliver care safety (p. 154).’ Like medical alert bracelets, wearable devices are designed to deliver a health-related message. For example, smartphone-enabled medical alerts include communication capabilities such as contact notifications and whole-person system review (blood type, medications). As the tangent narrows between technologies such as wearable devices and the advancements in ‘smart’ medical alerts, ease of provider identification of wearable devices needs to be revisited. As such, medical alerts will be described as wearable devices throughout this paper.
Methods:
Measurement of situational awareness (SA) allows for evaluation of how users extract information from the environment and then attributes meaning to the external cue, informing a decision or action (Endsley, 1988; Endsley, 1995). Within the complexity of patient care within a hospital, for example, SA evaluation gives insight as to environmental conditions that support or inhibit patient safety (Endsley et al., 1998). One of the most common tools to objectively measure SA is the Situation Awareness Global Assessment (SAGAT). SAGAT queries the user during a simulation, asking questions to objectively exploring a user’s perception, comprehension, and projection given a situation (Endsley et al., 1998). While allowing for unbiased querying and response, SAGAT is typically used in time-dependent scenarios where aspects are frozen and the question is then presented to the user (Endsley et al., 1998).
The adaptation for the presented study utilized a patient-actor photo in a common scenario for emergency room and urgent care nurse-participants (patient interviewing and initial assessment). Open-ended questions as described in Table 1.0 were presented to nurse-participants immediately after viewing the patient-actor photo. The question structure aligned with the traditional SAGAT format goals of subjective user inquiry (Endsley, 1995). There was no interaction between researchers and nurse-participants during the completion of the online survey to mitigate concerns for bias or undue influence on the evaluation of the photo and questions.
Researchers at the University of Arizona and University of Florida conducted a study utilizing SAGAT methods to explore the ability of clinical nurses to identify a wearable device on a pediatric patient via a photo within an online Qualtrics survey. Emergency room and urgent care nurses across the United States were eligible to participate if they were able to legally practice nursing within the United States, had one year minimum of experience as a nurse, read proficiently in English, and had no physical limitations that would inhibit completion of a visual, online survey. The wearable device was placed on the right wrist of the patient-actor with 1:1 nurse-participant randomization of seeing a yellow or blank device color based upon previous device prototype feasibility findings (Johnson & Carrington, 2021). Nurses were provided the photo and asked the questions. Of the 40 nurses who were randomized to view the wearable device, 3 identified the device as a significant finding during their assessment of the photo. Descriptions of the wearable device as noted by the nurse-participants were recorded within the open-ended questions. Responses to the questions were analyzed via content analysis using ATLAS.ti and manual review of findings. Versus coding was utilized to compare decision-making processes based on the scenario presented in the patient photo (‘I would alert this physician instead of this physician’). Process coding was also used to denote actions elicited by the participant given the patient-actor photo (‘I am calling the physician’).
Discussion:
While the wearable device was infrequently identified by the nurses who completed the online survey, the use of the SAGAT format questions proved to support collection of detailed responses which will propel the authors’ future work in situational awareness testing and identification of patient devices. Nurses were keenly aware as to the facial expressions of the patient-actor, absence of caregiver in the photo, and background setting. Nurses were descriptive in their assessment of the patient-actor, providing insight as to the culture and norms surrounding emergency room and urgent care nurse patient assessment practices.
Use of the SAGAT question for garnering nurse feedback as to ease of identification of wearable devices on patients amassed a multitude of different perspectives across a wide array of nurse experience levels. The data collected confirmed previous literature findings regarding lack of practitioner identification of wearable devices, with only 3 of the 44 nurses who were randomized to view either yellow or black wearable devices noted the device within their responses to the SAGAT questions. The device color nor the role (emergency room or urgent care) was significant to the identification of the device. The SAGAT format permitted an additional data analysis method of content analysis given the rich descriptions nurses provided of their assessments and questions related to the patient.
The nurse-participant responses to the SAGAT format questions reflected their sensitivity to the peculiar dimensions of the patient-actor in relation to the background, as well as the background being an examination room environment rather than traditional emergency room bay settings. Nurses also noted the absence of resuscitative equipment in their responses, among other photo-related effects such as shadow on the patient-actor. Differences in light prompted some nurses to identify contusions, possible hematologic disorders, and evidence of domestic abuse. As the patient-actor was a child, nurses also were searching the environment of the photo for evidence of caregiver presence, noting it was typical to have a parent/guardian present for emergent or urgent care situations. The photo also made it challenging for the nurse-participant to view the wording on the band, which said ‘CLINICAL ALERT’ and included an alert symbol.
The applications of wearable technology within the healthcare industry are infinite. There are wearable devices that can detect falls, alert for anemia, and allow your hospital’s doctor to monitor your vital signs from home (Wu & Lo, 2019). These wearable devices may take the form of patches, wristbands, necklaces, rings, or commercialized smartphones and smartwatches. Healthcare monitoring has become a societal mainstay, with over 30% of adults in the United States owning a wearable device and 50% using it on a daily basis for health-related feedback, such as tracking steps or sleep data (Rising et al., 2021; Chandrasekaran et al., 2020). As wearable devices for health become a mainstay, focus turns to the providers who encounter these devices and how device information is incorporated into patient care. Specifically, if providers can identify the wearable device at time of patient encounter as something useful to inform clinical care plan management.
Through the study of provider awareness to other communicative wristbands, such as medical alert bracelets, insight is obtained regarding the awareness of wearable devices which occupy the same body location. Over 99% of queried emergency medicine providers in a United Kingdom study felt medical alert bracelets are important for clinical care planning, yet in a case study simulation, only 8.5% of those providers searched for and identified a medical alert bracelet during patient assessment (Morton et al., 2002; Al-Alwan et al., 2020). Farhy et al. (2019), found no reduction in safety events and describes the loss in opportunity to minimize safety events, sparking the need for novel pathways to garner provider attention and awareness to wearable alerts and for clinical care.
The continuity of care and integration of care components, such as medical alerts and wearable devices, have renewed attention of the nursing community given the increase in complexity of care. Gaps in continuity of care may lead to adverse events- untoward medical occurrences - which may end in patient injury or death. Jones and Johnstone (2019) specifically identified in their sample population of nurses in Australia the gap of ‘failure to communicate the information required to plan and deliver care safety (p. 154).’ Like medical alert bracelets, wearable devices are designed to deliver a health-related message. For example, smartphone-enabled medical alerts include communication capabilities such as contact notifications and whole-person system review (blood type, medications). As the tangent narrows between technologies such as wearable devices and the advancements in ‘smart’ medical alerts, ease of provider identification of wearable devices needs to be revisited. As such, medical alerts will be described as wearable devices throughout this paper.
Methods:
Measurement of situational awareness (SA) allows for evaluation of how users extract information from the environment and then attributes meaning to the external cue, informing a decision or action (Endsley, 1988; Endsley, 1995). Within the complexity of patient care within a hospital, for example, SA evaluation gives insight as to environmental conditions that support or inhibit patient safety (Endsley et al., 1998). One of the most common tools to objectively measure SA is the Situation Awareness Global Assessment (SAGAT). SAGAT queries the user during a simulation, asking questions to objectively exploring a user’s perception, comprehension, and projection given a situation (Endsley et al., 1998). While allowing for unbiased querying and response, SAGAT is typically used in time-dependent scenarios where aspects are frozen and the question is then presented to the user (Endsley et al., 1998).
The adaptation for the presented study utilized a patient-actor photo in a common scenario for emergency room and urgent care nurse-participants (patient interviewing and initial assessment). Open-ended questions as described in Table 1.0 were presented to nurse-participants immediately after viewing the patient-actor photo. The question structure aligned with the traditional SAGAT format goals of subjective user inquiry (Endsley, 1995). There was no interaction between researchers and nurse-participants during the completion of the online survey to mitigate concerns for bias or undue influence on the evaluation of the photo and questions.
Researchers at the University of Arizona and University of Florida conducted a study utilizing SAGAT methods to explore the ability of clinical nurses to identify a wearable device on a pediatric patient via a photo within an online Qualtrics survey. Emergency room and urgent care nurses across the United States were eligible to participate if they were able to legally practice nursing within the United States, had one year minimum of experience as a nurse, read proficiently in English, and had no physical limitations that would inhibit completion of a visual, online survey. The wearable device was placed on the right wrist of the patient-actor with 1:1 nurse-participant randomization of seeing a yellow or blank device color based upon previous device prototype feasibility findings (Johnson & Carrington, 2021). Nurses were provided the photo and asked the questions. Of the 40 nurses who were randomized to view the wearable device, 3 identified the device as a significant finding during their assessment of the photo. Descriptions of the wearable device as noted by the nurse-participants were recorded within the open-ended questions. Responses to the questions were analyzed via content analysis using ATLAS.ti and manual review of findings. Versus coding was utilized to compare decision-making processes based on the scenario presented in the patient photo (‘I would alert this physician instead of this physician’). Process coding was also used to denote actions elicited by the participant given the patient-actor photo (‘I am calling the physician’).
Discussion:
While the wearable device was infrequently identified by the nurses who completed the online survey, the use of the SAGAT format questions proved to support collection of detailed responses which will propel the authors’ future work in situational awareness testing and identification of patient devices. Nurses were keenly aware as to the facial expressions of the patient-actor, absence of caregiver in the photo, and background setting. Nurses were descriptive in their assessment of the patient-actor, providing insight as to the culture and norms surrounding emergency room and urgent care nurse patient assessment practices.
Use of the SAGAT question for garnering nurse feedback as to ease of identification of wearable devices on patients amassed a multitude of different perspectives across a wide array of nurse experience levels. The data collected confirmed previous literature findings regarding lack of practitioner identification of wearable devices, with only 3 of the 44 nurses who were randomized to view either yellow or black wearable devices noted the device within their responses to the SAGAT questions. The device color nor the role (emergency room or urgent care) was significant to the identification of the device. The SAGAT format permitted an additional data analysis method of content analysis given the rich descriptions nurses provided of their assessments and questions related to the patient.
The nurse-participant responses to the SAGAT format questions reflected their sensitivity to the peculiar dimensions of the patient-actor in relation to the background, as well as the background being an examination room environment rather than traditional emergency room bay settings. Nurses also noted the absence of resuscitative equipment in their responses, among other photo-related effects such as shadow on the patient-actor. Differences in light prompted some nurses to identify contusions, possible hematologic disorders, and evidence of domestic abuse. As the patient-actor was a child, nurses also were searching the environment of the photo for evidence of caregiver presence, noting it was typical to have a parent/guardian present for emergent or urgent care situations. The photo also made it challenging for the nurse-participant to view the wording on the band, which said ‘CLINICAL ALERT’ and included an alert symbol.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer