A Review of Exoskeletons Considering Nurses.

Daily tasks of nurses include manual handling to assist patients. Repetitive manual handling leads to high risk of injuries due to the loads on nurses' bodies. Nurses, in hospitals and care homes, can benefit from the advances in exoskeleton technology assisting their manual handling tasks. There are already exoskeletons both in the market and in the research area made to assist physical workers to handle heavy loads. However, those exoskeletons are mostly designed for men, as most physical workers are men, whereas most nurses are women. In the case of nurses, they handle patients, a more delicate task than handling objects, and any such device used by nurses should easily be disinfected. In this study, the needs of nurses are examined, and a review of the state-of-the-art exoskeletons is conducted from the perspective of to what extent the existing technologies address the needs of nurses. Possible solutions and technologies and particularly the needs that have not been addressed by the existing technologies are discussed.

Realizing the Value of Nursing Through Innovative Regulation.

Nursing regulation is a specialty area of nursing practice that some may perceive as only performing licensing and disciplinary functions. However, highly effective boards strive to meet their mission of public protection through continuous innovation. This article describes several innovative programs initiated by a board of nursing. Among the examples include regulatory waivers during the pandemic, collaborations with stakeholder organizations, a resource for nursing peer-review committees, and an alternative remediation option for practice breakdown. With strong leadership and committed teams, regulation can both protect the public and play a part in actualizing the value of nursing.

Kasulis' intimacy/integrity heuristic and epistemological pluralism in nursing.

Epistemological pluralism is a recognized feature of nursing knowledge, which embraces both objective, scientific knowledge and situated knowledge that include subjective experience, values and affect, and is encountered in relationship. While there is a lively literature about describing and validating the need for pluralism in nursing's knowledge base, there has been less discussion of how to work with and across different kinds of knowing that are used in practice. In this paper, I describe Kasulis' heuristic framework for understanding more clearly what is entailed in different kinds of knowledge, and what some of their advantages and disadvantages might be. The framework was created by Thomas Kasulis, an American scholar of Japanese philosophy who identified broad orientations in Asian and Western philosophies that he characterized as 'intimacy' and 'integrity', respectively. Kasulis emphasized that his framework is a heuristic, a tool for making distinctions more clearly between different styles of thinking, that can manifest not only between cultural traditions from different parts of the world, but also between subcultures within one of the dominant orientations. He breaks his two orientations down by five distinguishing categories of objectivity, relating, affect, embodiment and transparency. In this paper, each category is described and discussed in relation to aspects of nursing knowledge. Looking at different epistemological viewpoints in this way helps to clarify their differences, and to explain the difficulty of reading across them, when they entail basic assumptions that are not commensurable with each other. Kasulis' framework offers a new way of reading across viewpoints commonly seen in the epistemological pluralism of nursing. It is a tool that can sharpen critical discernment about what is at stake, what can be gained, and what might get missed while operating in either the intimacy or integrity orientation.

A Critical Ethnography of Outreach Nursing for People Experiencing Homelessness.

People experiencing homelessness have a high prevalence of substance abuse and mental and physical problems. Although they have very complex health needs, they face many barriers that reduce their access to health care and social services. Several research studies have shown the need to implement adapted nursing interventions to address these crucial access issues. In this article, we present the results of a critical ethnography of outreach nurses who work with homeless people (n = 12). Robert Castel's theoretical model, which focuses on the process of social disaffiliation, provided the conceptual underpinnings for this research. Our qualitative data analysis revealed four categories, namely 1) the professional role and identity of nurses; 2) the social function of outreach nursing; 3) clinical realities and 4) disaffiliation and stigmatization. Our findings highlight the need to raise awareness among health care providers about the ethical, clinical and organizational issues of homelessness, particularly the mechanisms of exclusion and stigmatization in health care settings that affect people experiencing homelessness.

Methods for Cleaning and Managing a Nurse-Led Registry.

BACKGROUND: Clinical registries provide insight on the quality of patient care by providing data to identify associations and patterns in diagnosis, disease, and treatment. This has led to a push toward using large data sets in healthcare research. Nurse researchers are developing data registries, but most are unaware of how to manage a data registry. This article examines a neuroscience nursing registry to describe a quality control and data management process. DATA QUALITY PROCESS: Our registry contains more than 90 000 rows of data from almost 5000 patients at 4 US hospitals. Data management is a continuous process that consists of 5 phases: screening, data organization, diagnostic, treatment, and missing data. These phases are repeated with each registry update. DISCUSSION: The interdisciplinary approach to data management resulted in high-quality data, which was confirmed by missing data analysis. Most technical errors could be systematically diagnosed and resolved using basic statistical outputs, and fixed in the source file. CONCLUSION: The methods described provide a structured way for nurses and their collaborators to clean and manage registries.

Implementation of Technology to Enhance Nursing Practice Peer Review Processes.

Nursing Peer Review is a foundational and essential element of professional nursing practice. It is a systematic methodology to improve nurse and patient outcomes. The process can be labor-intensive and cumbersome in managing data from diverse data sources, especially if the process is manual. Directors of Professional Practice in a health care system partnered with an external vendor to create an interactive software platform where technology was leveraged to streamline the review process including review of aggregate data and trend analyses and generate reports using an electronic database. This resulted in a 75% reduction in the number of steps and subsequently the time required to complete the review process from initial screening to referral and closure. The generation of actionable data facilitated active engagement of clinical nurses in addressing identified clinical issues using process improvement and evidence-based practice methods. A critical feature of the software platform is that it provides actionable data that can be used to improve patient safety and fosters accountability for clinical nurses to promote self-regulation of nursing practice.

Human-centered approaches that integrate sensor technology across the lifespan: Opportunities and challenges.

Children, parents, older adults, and caregivers routinely use sensor technology as a source of health information and health monitoring. The purpose of this paper is to describe three exemplars of research that used a human-centered approach to engage participants in the development, design, and usability of interventions that integrate technology to promote health. The exemplars are based on current research studies that integrate sensor technology into pediatric, adult, and older adult populations living with a chronic health condition. Lessons learned and considerations for future studies are discussed. Nurses have successfully implemented interventions that use technology to improve health and detect, prevent, and manage diseases in children, families, individuals and communities. Nurses are key stakeholders to inform clinically relevant health monitoring that can support timely and personalized intervention and recommendations.

Nursing issues in enteral nutrition during prone position in critically ill patients: A systematic review of the literature.

BACKGROUND: Early enteral nutrition (EN) and prone position may both improve the outcome of patients affected by moderate to severe Acute Respiratory Distress Syndrome. Recent guidelines suggest to administer early EN also during prone position. However, EN intolerance, such as high residual gastric volumes, regurgitation or vomiting, may occur during pronation. AIM: This systematic review aims to assess the occurrence of high residual gastric volume, regurgitation or vomiting episodes, that can be encountered in patients receiving EN during prone position. METHODS: We have conducted a systematic review. We queried three scientific databases (MEDLINE, EMBASE and CINAHL) from inception until November 19, 2019 without language restrictions, using keywords and related MeSH terms. All relevant articles enrolling adult patients receiving invasive mechanical ventilation and evaluating the use of early EN during prone position were included. RESULTS: From 111 records obtained, we included six studies. All studies but one reported no differences with respect to gastric residual volumes between supine and prone positions. A 24-hours EN administration protocol seems to be better, as compared to an 18-hours feeding protocol. The need to stop EN and vomiting episodes were higher during prone position, although the rate of high gastric volume was similar between supine and prone positions. Ventilator associated pneumonia, lengths of stay and mortalities were similar between supine and prone positions. Only one study reported lower mortality in patients receiving EN throughout the entire day, as compared to an 18-hours administration protocol. CONCLUSION: Protocols should be followed by healthcare providers in order to increase the enteral feeding volume, while avoiding EN intolerance (such as EN stops, high residual volume, regurgitation and vomiting).

Artificial Intelligence and Robotics in Nursing: Ethics of Caring as a Guide to Dividing Tasks Between AI and Humans.

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever-expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as well as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI-at least for the foreseeable future-is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care.

In search of the changeable: An analysis of visual representations of nursing in Norwegian and Danish professional nursing journals, 1965-2016.

In this study, we demonstrate how perceptions of nursing are constructed in close connection with the development of the Nordic welfare states. Drawing on Gillian Rose's framework for analysing the social and political implications of visual materials, we analysed selected visual representations of nursing published in Danish and Norwegian professional nursing journals in the period 1965 to 2016. The analyses were conducted in an iterative process in three phases. First, we reviewed all visuals spanning the entire period to obtain an overview of developmental trends in the material. Second, selected visuals and associated captions were subjected to more thorough analysis. Third, we further examined and discussed the visuals in light of societal and political movements and ideologies in Danish and Norwegian healthcare policies over this period. Our analysis shows that visual representations of the nurse-patient relationship and of the patient's and the nurse's roles and responsibilities changed over this period and that the visualisations corresponded with and supported developments in the Danish and Norwegian welfare states as these first consolidated and then moved towards individualisation and the competition state. Our study demonstrates that nurses in these states are political actors implementing health policies embedded in various knowledge regimes.

Nursing leadership in policy formation.

This article provides broad definitions of the concepts of policy, politics, and power, which will be developed further in subsequent articles. The article describes the critical role of nurses in health policy formation at local, organizational, and national levels and outlines the unique strengths and sources of influence that nurses possess and must employ if health care in the United States is to become safer, more accessible, holistic, and more affordable. Many of these same talents can be used at international levels to affect health care worldwide. The basic premise of this article-and actually of the entire issue-is this: When informed nurses are actively involved in shaping healthcare policy at any level, desired outcomes will be substantially improved.

Triggers for nursing policy action: Getting to the critical point to solving "ordinary problems" in nursing.

Two "ordinary problem" policy issues are analyzed, with the examination of how nurses, individually and organizationally, collaborated and advocated to address these issues by triggering local, state, and national action by stakeholders. Ultimately, the policy process through which nurses arrived at a Critical Point that triggered policy-based action to resolve these "ordinary problems" is presented. The first nursing issue is the national nursing shortage of 1966, which led to political action by members of the American Nurses Association, with policy implications focused on increasing the salary of the newly graduated nurse. The second nursing issue is that of needle-stick injuries experienced by health-care workers with analysis of the actions of individual nurses and nursing organizations' stakeholders that triggered the development of state and federal laws, regulations, and policies that protect health-care workers from these injuries. Common filters affecting triggers for policy action are integrated throughout the policy dialogue.

Design and ergonomic assessment of an infusion set connector tool used in nursing work.

Nursing is a physically demanding job characterized by a high prevalence of fatigue and musculoskeletal disorders. One of the high-exertion and repetitive nursing tasks is the manual connection of an infusion set to a medical fluid bottle. Such physical work can be eased by the design of new hand tools. Correspondingly, this study designed and ergonomically assessed an infusion set connector tool (ISCT) and compared it with that of manual connection. First, a prototype of ISCT was designed to perform infusion set connecting task in the mechanical form. Subsequently, 12 nurses were asked to connect an infusion set to medical bottle in the form of manual and mechanical tasks and these tasks were evaluated using ergonomic indices including muscular activity level, force, posture, and subjective (Borg scale CR10) measures. Results showed that the activity levels (root mean square) of the extensor digitorum communis, flexor carpi radialis, biceps, triceps, and deltoid muscles remarkably decreased when the nurses used the ISCT. The postures of the wrist, arm, and shoulder regions were corrected from Rapid Upper Limb Assessment action level 3 to 2 when the designed tool was used. Additionally, the subjective perception of exertion was significantly lower with the use of the prototype.

Robust IoT-based nursing-care support system with smart bio-objects.

BACKGROUND: The significant advancement in the mobile sensing technologies has brought great interests on application development for the Internet-of-Things (IoT). With the advantages of contactlessness data retrieval and efficient data processing of intelligent IoT-based objects, versatile innovative types of on-demand medical relevant services have promptly been developed and deployed. Critical characteristics involved within the data processing and operation must thoroughly be considered. To achieve the efficiency of data retrieval and the robustness of communications among IoT-based objects, sturdy security primitives are required to preserve data confidentiality and entity authentication. METHODS: A robust nursing-care support system is developed for efficient and secure communication among mobile bio-sensors, active intelligent objects, the IoT gateway and the backend nursing-care server in which further data analysis can be performed to provide high-quality and on-demand nursing-care service. RESULTS: We realize the system implementation with an IoT-based testbed, i.e. the Raspberry PI II platform, to present the practicability of the proposed IoT-oriented nursing-care support system in which a user-friendly computation cost, i.e. 6.33 ms, is required for a normal session of our proposed system. Based on the protocol analysis we conducted, the security robustness of the proposed nursing-care support system is guaranteed. CONCLUSIONS: According to the protocol analysis and performance evaluation, the practicability of the proposed method is demonstrated. In brief, we can claim that our proposed system is very suitable for IoT-based environments and will be a highly competitive candidate for the next generation of nursing-care service systems.

The robot nurses are coming to a workplace near you.

As robot technology rapidly encroaches into most areas of our lives, second-year Kingston and St George's universities nursing student Jack Sherry remains optimistic that he will still have a job, jsherry38@gmail.com.