The Robots have arrived

Improvements in technology have advanced Nursing.

From manual methods of taking blood pressures, manual CVP readings etc to digital displays on the monitoring system.

Developments in urinalysis to the Clinical Information Systems being used now in most ICUs .

The arrival of the Robots and AI technology to their eventual and hopefully beneficial use as Nursing / Medical assistants.

Transcript

SPEAKER_00 0:00

In this episode, I'm going to talk about technology and equipment, etc., in nursing and how it's absolutely transformed our lives and has assisted us and has enhanced our role very much. And I want to take you back a little bit back in history to when I was a student nurse in the late 70s and early 80s. We had we started off having to learn how to take somebody's blood pressure on the old sphigmole manometers, the sphigmoles. And these were in a metal case. We used to carry around this metal box, and it used to open up and attach the cough to a patient's arm, inflate the cough, manually inflate the cough. Then you'd have your stethoscope, you'd put it on the rate on the um artery and a brachial artery, and you'd have to listen then for your systolic pressure and your diastolic and all this. And I know they still teach that in nursing school, etc., in the universities. But that skill really is is gone because now it's just a machine, and you just put the cuff on and press a button, and it digitally displays the um systolic, diastolic, amine arterial pressure on the monto. You know, the non-invasive blood pressure cuff. Absolutely brilliant when you think about it. But it's a shame that the old um skills are are being lost. But I can remember learning and being taught how to, you know, how to listen for your systolic, how to listen for your diastolic, etc. The other thing to mention is this um sphinc mode that we used to take people's patients' blood pressures with, I very well I can very rarely was it washed or cleaned. Like the cuff, there's all this talk about wiping down the cuff, but I never saw the cuff wiped down in between patients. The same cuff would do the whole ward of patients. Now, as time went on in the 80s and 90s, then infection control became more prevalent, and then people started to wipe down the cuff. But the cuff was the same cuff that was there for years. I can remember that. I remember a big hoo-ha when the cuff broke, and like there was no spare cuffs or anything like that. Now we've drawers full of disposable cuffs and everything, and each patient has um their you know, a cuff put on them and it's disposable, or it's kept just for that one patient, etc. It's absolutely brilliant now when you think about it. The other thing I can remember is the pay taking patients' temperatures. Now, back in the day in the late 70s, early 80s, the only way of taking a patient's temperature was with a glass thermometer. And all the wards, every patient had a glass thermometer in a little holder behind their bed. And woe betide you, if you broke that thermometer, it would be all hell to play, and you'd be told how much it cost and all this kind of thing. And I can remember um hearing stories. Now, when I was in the matter, I heard stories there of of poor nurses that did drop the thermometer, and the cost of the thermometer was actually subtracted from the salary. Yeah. I heard that. I heard those stories. Um the they they charged the nurse for the cost of replacing the thermometer. So like now it's all digital and timpanic and all this, and it's you know, it's absolutely brilliant. And again, a digital display of temperature, and it's no big deal. But in the days when I was a student nurse, we had to use those glass thermometers, and thank God they've gone out of fashion now. To get somebody's heart rate and or pulse, you know, you had to hold the radial artery and um count usually for 15 seconds, and then you times it by four to get your heart rate for for the minute. But the good thing about the manual taking of a patient's pulse, you could gain an awful lot of information from the physical um now, obviously, experience as time went on, you you learned this, but experience torture that you could, you know, you could feel whether the pulse was full and bounding, whether you know the blood pressure was good, whether it was weak and thready, which would mean the blood pressure was low, you could feel whether the pulse was irregular or regular, so you'd see if there's any potential um cardiac arrhythmias and things like that, atrial fibrillation. So you were taught all these things, and you did, as time went on, you learned these skills and things. That's another skill that is being lost in nursing, because now obviously with the digital display, when you take patients' blood pressure and all this kind of thing, it gives you a heart rate on on the display. So you but you don't know if that heart rate is regular or irregular, you don't know. You know it's it it gives you different information to what you can perceive from feeling somebody's pulse. I remember the old um in ICU we used to use the old CVP lines, central venous pressure lines, and taking patients' central venous pressure. That used to be a bit of a palaver, to be honest. And in some hospitals, in some ICUs, they kind of they were kind of rigid in as much as saying their policy said the patient had to be flat, and you know you'd have to lie the patient flat then and um get the transducer, and they they were manual trans people don't understand this, but it was a manual manometer. It was um kind of a a I can't even describe it, the manometer. It had centimeters printed on it, like a little measuring tape, and as you the fluid returned it off to the transducer and to the patient, you would watch where the fluid rolls, and you would see it going up and down with respiration. You had to wait a little while, and it was the midway point, say it was fluctuating between uh 12 and 8 uh centimetres, um your CVP would be 10. That's how you did it, but the patient had to be perfectly still and you had to need a good um flushing system, etc. Really, the patient should be semi-recumbent, not flat. Um I saw this in many ICUs, uh, you know, they got it all wrong, really. The patient should be semi-recumbent because that is the normal um pressures in the body, you know. If the semi-recumbent and you see the CVP is 10, well, the CVP is 10. It's you know, you you you don't want to because you rely on the patient for flat, that gives you a false CVP, gives you a much higher CVP. It's a false CVP. I've talked about that for 40 years, but anyway, nobody's listening to me. But the patient should be semi-recumbent, and that's I've been proved right over the years because now with the with the current monitoring systems, the transducer takes it from the semi-recumbent position. Whatever patient, whatever position the patient is, if you have all your your things in line, your transducer and your CVP line is clear and running, and there's a good connection, you will see the CVP uh displayed on the monitor is generally taken from a semi-recumbent position, and that's fact. CVPs have kind of gone out of fashion, to be honest. Very we used to be uh obsessed with CVPs. Now, certainly in cardiothoracic ICU, I understand it because it gives you indication, as I've talked about in an earlier episode. You know, if your CVP is rising, that can indicate that you've got a cardiac tamponade on your hands. But in general ICU, I it's kind of gone out of fashion. And a lot I've noticed now a lot of people don't even transduce the CVP, and it's kind of academic. A lot of doctors now don't even ask you about the CVP. Years ago, they would be obsessed about the CVP, but the fluid management, fluid in, fluid out, and the central venous pressure to give you some indication if the patient's being overloaded, etc. But now with the modern, they have the cardiac output machines, etc. Now with the modern um monitoring systems and things, CVP seems to be going out of fashion, certainly in general ICU. From my experience, the only problem with the current modern cardiac output machines that we're all using, etc., um a lot of nurses don't understand them. They don't understand cardic output, they don't understand cardiac index and systemic vascular resistance. And not only nurses, I say a lot of doctors don't don't appear to understand the the um cardiac dynamics of it all, because they they seem completely disinterested in the information. So there's no point having a cardiac output monitor attached to the patient if nobody's looking at the information. Plus, it all boils down to who's who's um calibrating it. You know, again it falls on the nurses to be able to have to do that, and um then there's no point recording things if nobody's acting on that information. Certainly, in in when I worked in cardiothoracic ICU, your your cardiac output would be very important. You do that with the Swangans, the Swangans catheter. They were very popular, and I think they still are in some ICUs. But um there's no point doing all those measurements if nobody's going to act on it. Medically, I'm talking about, because really you should be titrating your inotropes according to your cardiac output and your cardiac index and your systemic vascular resistance or administering diuretics, etc. But um a lot of doctors don't seem in the least bit interested in any of that information. But anyway, that's just something I've observed. I think a brilliant um progression of technology is ultrasound. That seems to have helped certainly doctors an awful lot. In you know, in in putting in central venous pressure lines, arterial lines, getting the lines in first time, and all this kind of stuff, much improved. And they can look at patients' chests, see if there's any pleural effusions, etc. And some of them would do like um, you know, some doctors would do things like echoes and all this kind of thing, bedside echoes and all this. It's a brilliant um tool. And from a nursing perspective, I think one of the brilliant things for ultrasound is like the bladder scan they're using now in surgical wards. I remember seeing that for the first time. I was mind-blown by that, that you could see if somebody was in retention of urine and with a little blad scan, a little ultrasound scan. And you know, before that it was all done on palpation and you know, on the history of the patient and everything. But it's absolutely brilliant that you can actually look and see if the you know, if the bladder is is is expanded and is retained urine and everything with the patient, you know, it has uh a blockage to the catheter or something like that. Absolutely brilliant. And the whole thing for the for the doctors, uh it has improved things tremendously, I think. And from the patient's perspective, it has improved, you know, the attempts of getting lines in has reduced. I can remember going back when I was a young staff nurse. God almighty, some of the doctors were absolutely useless at getting in a central venous pressure line with the seldinger technique and all this, and um, you'd have much more incidence of uh pneumothoraces than you do nowadays, which is brilliant. Now, in a previous episode, I've talked about the um the fact that we had a Bunsen burner in the in the sluice in the old days, which we did for um urinalysis. That was a huge palaver doing some of the urinalysis. I remember there were two types of tablets. You had to have two little um glass vials of urine, and you'd put a tablet in each, one was for the glucose, one was for the ketones, and you'd have to heat them up over the this little bunsen burner until the the tablet changed colour. And depending on the colour, it would tell you you know how much glucose approximately was in the urine, and how many, and the other one would tell you how many how much ketones was in the urine, and you then you had to record all this. God almighty, it was ridiculous when you think about it. And the other thing we used to have to do, talking about technology, people don't believe this, but this is true. We had uh urine analysis in the solution, you'd have the the container of urine, and you'd have this specific gravity weight. This thing was like a little mechanism used to put into the urine and it used to float in the urine, right? Bob up and down, a bit like what a boy, you know what on the sea bobs up and down, one of those things floats up and down. This thing floated in the urine, and depending on where it was floating in the urine, it had marcations on it, and that would tell you where the the line would be where the specific what what specific gravity the urine was. That's how we used to have to do that. I remember doing all that. So the then it went on to the the dipsticks and things, which are absolutely brilliant, and now it's gone on to like a digital readout now, and now we've reached a stage, apparently in some ICUs, some places, where it's all it's all um linked to the computer system, like the the machine will test the urine and give you the display, and then that transmits it to your clinical information system, and it's all all encompassed in the one system. It's absolutely brilliant. Because now talking about historical stuff, now before my time, but I'm sure you all do know, or you're all nurses listening to this, is you know, diabetes was named um diabetes mellitus, melitus, and the Latin uh there's diabetes melitus, and there's diabetes incipitus, and diabetes mellitus means sweet diabetes. Melitus is the Latin word for sweet, and insipidus is the Latin word for sour. So I'm going no, it's not not when I was a student nurse, but I know historically I was taught this, and this is true. In bad old days, they used to taste the urine. That's the only way they could just see if the if the person had diabetes mellitus, sweet urine, or diabetes insipidus, sour urine. So thank God we've moved on from that. Yeah, technology is a wonderful thing, really. It has transformed, certainly, it has transformed ICU nursing. Um, you know, the monitoring systems and everything is absolutely brilliant now. And the monitoring systems are, you know, linked in with the with the clinical information system, which is a computerized system and which monitors everything, and things are transcribed, transmitted to the clinical information system, and appear in real time. And the nurse either confirms or denies the the fact on the on them on the system. Unbelievable when you think about it. But I can remember going back going back to something else that I was thinking about. I where I worked in a neurosurgical ICU years ago back in the in the 90s, and I remember we used to have this monitor at the side of the bed, and the patient would have an ICP monitor, and you know, an intracranial pressure monitor, and it would be linked up to this monitor, very, very basic, and all it would show is a digital reading of a figure on it, like 8 or 10 or 12, and this figure would fluctuate, you know, depending on what the intracranial pressure was in the patient's brain. Now, if you had a severe head injury and you ventilated severe head injury, if the ICP, I think, and this is only for memory now, if I think if the ICP went above 12, um what we used to do then, we used to um disconnect the ventilator. This was standard protocol, you would disconnect the ventilator, you would hand ventilate the patient, then hyperventilate them with the ambient bag and oxygen, and blow off the CO2. That's what it was called. So if you blew off the CO2, then the ICP you would see coming down on your on your display, and it was kind of magical. It only took a few minutes, and you would see the ICP coming down from say 14 to 12 to 11 to 10 to 9, as the cerebral edema reduced as you as you um you know blew off your CO2. It's absolutely brilliant. Nowadays, I don't think um they do that, and I think now they've accepted kind of CO2s around the normal. Anything under eight, I think they accept now as normal. They say it doesn't really affect cerebral perfusion pressure that much. But anyway, that's another day's work. But I remember all that, and so I'm sure those monitors have improved and and a different display now on the new monitoring systems. I remember with some degree of affection as well the old what we called the old 24-hour ICU charts. And uh some of those charts, and uh, as you as you know, I worked in multiple ICUs, some of those charts were absolutely brilliant. And and the the amount of work that went into designing them was astronomical. I know myself I was involved in designing the Matters uh 24-hour ICU chart, and was quite proud of that in my day that I managed that. Now, obviously, many people were involved, it was a collaboration thing, but I remember that, and we managed to get it so that it folded down the big 24-hour charts actually folded down then into an A4 sheet so that it could easily go into the medical notes for that 24-hour period. Because before that the charts were very rigid, you know, it was made from the very high quality paper. The problem with the high-quality paper we found certainly in the matter was you you couldn't file them, you know, you couldn't um get them into the medical notes or anything like that. So you had these stacks and stacks and stacks. Say you had a patient there weeks, you had stacks and stacks and stacks of these 24-hour charts all folded up and and bound, and we'd have to bind them up with string and all sorts of things. It was an absolute nightmare for medical records, etc., because what do you do with these things? There were hundreds of these things, and they had to store them all. But there was a degree of pride with the old 24-hour chart, and um I remember working with this particular nurse going back. No, this just shows you how neurotic some people are. This girl was like a calligrapher, and she wrote the most beautiful writing on the Icy chart, and all her um observations were uh, you know, absolutely beautiful. She used a special pen and etc. and everything. The problem with her she became so neurotic about it she would not allow anybody else to write on her chart. So then the problem with that is when she went to break, you weren't allowed to write the blood pressures or the heart rate or the rhythm or anything like that, or you know, ventilator observations on her chart. What you had to do, you had to write them all on a scrap of paper for when she came back from break, and then she would transcribe it onto the ICU chart. Unbelievable when you think about it. Now, obviously, it took a clinical incident when something, you know, when it all went tits up when she had to break. I didn't know what you know. So you had to write on the chart. All the blood pressures were all you know in the patient's boots. You know, it had to be recorded. So she eventually had to be spoken to by you know by ICU nurse management because it was absolutely ridiculous. It just shows you the length that some people go to and taking pride in their work, but she took it to the the you know, the nth degree. Now we have the system, we have the clinical information system, as as you all know. I'm sure a lot of ICUs are using that system, and it captures an awful lot of information, and um certainly Big Brother is watching you now, definitely. Um, you know, it captures nearly everything that's happening to the patient, and you know, the ventilator observations, everything occurring on the monitoring system, it's all transmitted onto the clin onto the clinical information system, and then and the nurse then confirms or denies it. The same with drug administration is now all on the clinical information system. You don't have a separate drug administration chart or recommendation. Or anything like that. Unbelievable now when you think about it. In the space of what 10-20 years, how things have transformed. Now I'm sure a lot of ICU still using the old chart, but eventually they will go in onto a clinical information system and capturing all that's happening. And certainly, Big Brother is now certainly watching you. But like all computerized systems and all things that capture data, there's the old adage, shit in, shit out. That's it. If you put crap data into your computer, you'll get crap data out. So the data being captured is only as good as the people putting in the data. Now, as technology has advanced and as it continues to advance, it'll improve things, certainly in intensive care nursing, and certainly I'm sure on the general wards and in the AE department and in the theaters, etc., it'll enhance all aspects of patient care, etc. And I've always predicted, um I don't want to take any any kudos for this, but I've always predicted that eventually robots will be involved in in nursing and in I certainly in IUCU nursing. But I always envisaged that the robots, when they do arrive, would be like assistant nurses and would be assisting us, you know, getting things. Bring me, fetch me, carry me. You know, the robot would come with you to the bedside and you'd say, bring me a meepor eight by six, off it would run. Well, it wouldn't run, but it would roll. I presume the robot would roll, off it would go to the storeroom, get your meeport, whatever, bring it back to you who's with the patient, and then you'd be able to say, No, that is a four by two Meepaw. I asked you for an eight by six, off you go again, and it would off it would go back to the storeroom, get a MEPOR 8x6 eventually, bring it to you to help you, you know, help the nurses, and and I presume always presumed when they did arrive that they'd have AI, you know, artificial intelligence, you'd be like a computer, you could ask it questions or ask it to add up things, calculate this for you, do this, blah blah. So they would be assisting the nurses, etc. But anyway, lo and behold, wasn't I looking at the internet a few months ago, and I saw this article, I thought, oh my god, I don't believe this is happening. They actually have robots in ICU in Chicago. So I read the article about the robots, and I thought, oh, you know, they'll be helping the nurses, they'll be like assistant nurses. And I just was curious as to what they actually had the robots doing in the ICU. Well, now it says it all really. No, they're not helping the nurses. The robots are there, they're working in the ICU. No, they're not helping the nurses, they're absolutely nothing to do with the nurses. The doctors, the medical profession have taken over the robots, right? And what they're doing, they've mounted cameras on the robots, and the can they're kind of remote doctors, these robots. Remote viewing doctors, shall we call them that? We've all come across them. These doctors, they spend most of the time on the computer and don't actually go into the room with the patient. But anyway, these the robots are doing the exact same. But the robot will go into the what they've got them doing now in Chicago. I couldn't believe this when I read it, but it's true. They're actually going into the route, the isolation rooms, that's where they're using them. They're sending the robot in with the cameras on and remote viewing and all this into the isolation room where the patient has an infectious disease, so that the risk of the doctor catching an infectious disease is reduced. Right? Can you believe that? And so the patient's in the room with the nurse, and in comes the robot with his cameras, and then the robe the nurse can show the robot this, you know, show that show them the arterial line that's hanging out, that's malfunctioning, can show the robot this, and then the robot's transmitting it outside to some screen where the doctor can view it. Can you actually believe that is happening? Well, that is true. That is that is actually happening. That's what they're doing. So the medical profession have taken over the robots in this ICU in Chicago. Now, hopefully, as time goes on, they will be adapted and will become assistant nurses because that is what they would be brilliant at is kind of bring me, fetch me, carry me, go and get things and bring it to me. And it could help the doctors as well in that regard. But I think um the robots have arrived, they're not in the future. The robots have arrived and they are being controlled by the medical profession, not the nursing profession. And I'll leave you with that. I think that says it all. Good night and God bless.