Nurses are notorious for not taking their lunches, and although that is probably the worst thing they could do, it is a fact of life in some facilities. On the other hand, not having anything to eat for 12 hours definitely has its downsides. Your blood sugar can drop, and this can make you tired, irritable, and unable to concentrate. Obviously, these aren’t conducive to good nursing, so what are you supposed to do?
Snacks are your friend when you are a nurse. You could eat snacks that are bad for you, though, such as candy bars, donuts, and the like. The trick is to eat snacks that have some nutritional value and can qualify as healthy. This includes snacks high in protein and complex carbohydrates. It is possible to eat healthy on the go. Here are seven items that are quick and easy to eat, yet still healthy.
1. String Cheese
String cheese is a great portable snack. Not just any cheese, but string cheese. They can easily fit in your pocket, allowing for portability, fast eating, and protein goodness at 6g each. String cheese has a good amount of protein in it, but you have to be wary of the amount of fat you are eating. Cheese, though high in protein, can also have a great deal of fat at 6g. They are only 80 calories, but too many can transform it into an unhealthy alternative. The solution is to get the low fat version of the cheese. Have several of these portable snacks on hand and be sure to wash your hands and chow down when you have a second.
2. Protein Bars
Protein bars are another portable way to keep you from feeling hungry. Not only does a small amount of protein make you feel full, it also provides a slow, long lasting surge of energy. These bars come in different amounts of protein, and you don’t necessarily need the bar that has the most protein in it. You should consider two things when picking a protein bar. One is the amount of calories in the bar. It does you no good to eat a 500 calorie protein bar. You may as well eat a candy bar. The second consideration is taste. Get a variety of protein bars and try them out. Eating healthy and quick does not have to be an ordeal.
3. Fruit
Fruit is a double-edged sword, but it is portable and quick like the others. Unfortunately, fruit is a simple carbohydrate, meaning it gives a quick, short energy boost. The upside of fruit is that you also get fiber and nutrients. However, you may find yourself hungry in a few short hours. You can easily eat an apple, which has a less significant effect on blood sugar, or some diced pears in their own juice. Try to stay away from the more sugary fruits, such as bananas, pineapples, and peaches. Fruit is not the best choice, but it is better than candy bars or a bag of chips.
4. Wrapped Sandwiches
You may not have time for a full sandwich, but you may be able to sneak in a sandwich wrapped in a tortilla. These wraps can be found at some convenience stores, such as those that specialize in selling food in addition to candy. If not, there are pre-packaged wrap sandwiches at the grocery store. This option is really like a full meal, but you need to be wary of a few things. Most pre-packaged foods come with a high amount of sodium, which could be a problem if you have high blood pressure. Depending on the type of foods on the wrap, you could run into fat and calorie problems as well. Lean chicken and greens are your best bet.
5. Nuts
Nuts are one of the perfect on-the-go snacks. You can pop a handful in your mouth and keep going. Again, this is another food that is very high in protein, depending on the type of nut you choose. The type of nut will also determine fat quantity. Most nutritionists recommend almonds for a quick snack. However, one ounce of almonds has 163 calories, 14g of fat, and 6g of protein. The good news is that they are low in saturated and trans fats. Although this nut is high in fat, it is mostly good fats, making them a good option for a quick snack.
6. Yogurt
There are a million ways to eat yogurt, and all of them seem rather quick. Unfortunately, it is what you put in the yogurt that can make the calories skyrocket. Very few people can eat it plain, but it is probably better for you if you do. Yogurt, though high in protein, calcium, and calories, can still be a problem. One solution is to buy low-fat yogurt and stay away from ones with added sugar. Some yogurts even come in a handy packet that allows you to essentially “drink” the meal. This is a decent fast snack, but like the others, you should read those nutritional facts closely before you make it your go-to fast snack.
7. Meal Replacement Shakes
Finally, if you are desperate, you can opt for a meal replacement shake. Nurses are used to giving these to patients who need to put on weight. Ironically, they are also used for people who want to lose weight, such as Slim Fast. Although these milkshakes can give you the boost you need, you once again need to be careful. They are ridiculously high in calories. If you are going to have a meal replacement shake, it is very important to not eat anything else. In a pinch, you can down a shake, get your protein, get your fats, get some calories, and continue on with your shift. It can be a slippery slope, though, so pay attention to what you are eating. This snack will not do you any good if you combine it with other high fat, high calorie foods. As with the other snacks, you need to look at meal replacement shakes in conjunction with the entirety of your eating habits. Count your calories, fat, and protein. Make sure you are not overdoing it in your rush to get a meal, and always read the labels.
Across the United States, nurses everywhere are facing a dilemma. Many registered nurses came into the profession through the two-year degree, or Associate’s Degree in Nursing (ADN). The ADN allowed them to sit for boards and have all the rights and privileges of any other registered nurse. Great nurses came from this program, but now all of that is in jeopardy.
The Bachelor of Science in Nursing (BSN) is now the preferred degree of a majority of hospitals. This degree requires four years of college study as opposed to the two required for an ADN. Nurses coming into the profession with an ADN can’t get a job and those who are working with an ADN are at risk of losing their jobs.
What’s So Great About a BSN, Anyway?
Part of the reason for the increased interest in BSN degrees is that hospitals are now required to have a certain percentage of four-year degree nurses to achieve Magnet status. This status is designed to draw more attention to the hospital and increase better patient outcomes.
“The American Nurses Credentialing Center (ANCC) devised the Magnet Recognition Program to draw attention to top health care facilities,” says Nancy Brook, RN, MSN, NP, a health and wellness coach and author of The Nurse Practitioner’s Bag. “This recognition means that 100% of the organization’s nurse managers have a BSN or graduate degree. Achieving Magnet status also means that there are generally a higher number of nurses holding a BSN degree for jobs in direct patient care. Approximately 50% of all nurses associated with direct patient care in a Magnet-recognized hospital currently have a BSN.”
In general, this designation increases the prestige of hospitals, and that means they are eager to comply with the strictures determined by the ANCC. It also means that those who have an ADN have to get a BSN or risk losing their jobs. Many hospitals will now no longer consider a nurse without a four-year degree.
“According to Magnet, increased professional development means increased proficiency in direct patient care, as well as more successful outcomes for patients,” says Brook. “Investing in BSN education means that an organization’s nurses are kept more up-to-date with the rapid evolution of newer technologies that are becoming more commonplace in hospital settings.”
Magnet status isn’t the only reason that ADNs are in the hot seat. Research has shown that patient outcomes are better when the nurse treating the patient has an advanced degree. In a 2003 study published in JAMA, Linda H. Aiken and her colleagues found a 10% increase in the proportion of hospital staff nurses with baccalaureate degrees is associated with a 5% decline in patient mortality following common surgical procedures. A 2008 follow-up study published in the Journal of Nursing Administration confirmed that BSN-prepared nurses improve patient outcomes.
Why are these numbers showing that the BSN is superior? Isn’t a nurse a nurse? Not necessarily. “You want someone to have a bachelor’s degree,” argues Wendie A. Howland, MN, RN-BC, CRRN, CCM, CNLCP, LNCC, a legal nurse consultant and owner of Howland Health Consulting. “They get a better education. They learn more things. They get classes like psychology. Trying to get full semesters of some of these specialties is impossible in two years. I know a lot of diploma nurses who can’t do an assessment. They don’t think like nurses. They do tasks and follow orders. They don’t realize scope of what you can do as an RN. Nursing is not what you do with your hands. It has to do with the nursing plan of care. Task-focused programs like the ADN will not give you those skills.”
The ADN vs. the BSN
Many nurses feel that there is no difference between the ADN and the BSN. Nurses claim that the BSN is only for managerial work or that the same information is compressed into two years instead of four. Marilyn Stoner, RN, PhD, explains the difference: “The additional coursework for BSN focuses on four primary areas: research/evidence-based practice, community/public health, leadership, and nursing science in the form of theories and models that guide practice.” With this additional teaching, the BSN is far more than just an expanded ADN. It is a different animal, and now hospitals are seeing it as superior due to the research studies.
For reasons such as these, the profession is changing. The studies and the relative lack of education in an ADN program are making the designation untenable in the hospital. “Nursing experts and national organizations agree that a registered nurse (RN) needs at least a baccalaureate degree to meet these demands, “says Melissa DeCapua, DNP, PMHNP, a health care adviser for telenursing startup PointNurse. “In 2010, about 50 percent of RNs possessed a bachelor’s degree. Since then, both the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) have developed initiatives to increase this number to 80 percent by 2020.”
But, nurses say, what about experience? Surely experience should count for something and add to a nurse’s worth, regardless of title or degree. A nurse of 20 years with an ADN is a better nurse than one with five years’ experience and a BSN.
Not necessarily, argues Howland. “Experience gives you a better conceptual framework, and it makes it easier to learn more stuff,” she says. “Experience is helpful, but it is only part of being a professional. You have to have both education and experience. Education helped me get the most out of my experience and to ask better questions.”
What should a nurse do if they are at the end of their careers and suddenly facing the need to convert to a BSN? Stoner recommends that, “. . . [N]urses who have less than 5 years to work seriously consider whether it is worth the significant investment in time, money, and disruption to their lives to return to school. I also recommend nurses consider whether their employers will contribute toward the cost of their education and raise their salary once the degree is completed.”
For some, it isn’t worth the time and money. Some facilities are grandfathering in nurses who are close to retirement, but not all. In fact, many experts disagree with this practice, insisting that all nurses have their BSN regardless of age for the sake of the patient’s safety and outcome.
It seems unfair that nurses have to pay for the privilege of having an advanced degree when they are being forced to get it. To work as a nurse, you need to go to school, and that’s almost an ultimatum. It is certainly not the way to make nurses appreciate their facility or their job. When asked to pursue something that may not be in your plans or risk being fired, the nurse gives up the right to make his or her own decisions. It also means a large outlay of money, putting the nurse into debt.
“If you want to be a nurse, then you have to plan for the loans,” says Howland. “You have to do what it takes to be a nurse. If that involves taking out loans, if it is going to cost money, then you will have to pay it back. You have to realize how much you have to know and do. You are paying all of this money and you can make a difference in people’s lives because of it.”
Easy to say when the money isn’t coming out of the pocket of the hospital, although many facilities do have scholarships for those who pursue higher education. They also tend to get paid more. Unfortunately, these measures do not cover the entire cost of pursuing a BSN, and the nurse will still have to sustain some debt to continue working in the profession.
Looking Ahead
In the end, it comes down to professionalism. The ADN nurse is a professional to a degree, but a BSN nurse is now considered the gold standard of professionalism. Would you want someone to work on your loved one who doesn’t have the best degree possible?
Howland has some final thoughts on what it means to be a professional: “Sure, there are good people with lower level education who succeed in life, but don’t let that ‘we all have the same license and sit for the same exam’ fool you. Better education makes you better at what you do. There are any number of people who can give you examples of BSNs or MNs who don’t know how to take a rectal temp and marvelous crusty old LPNs who saved the resident’s butt one dark and stormy night, but for every single one of those, I will see your anecdote and raise you half a dozen godawful errors made by nurses who didn’t take the coursework and didn’t get exposed to the idea of autonomy in school.”
Many ADN nurses will disagree with these experts, and that’s to be expected. Some diploma nurses are still working hard at the bedside, and to hear they aren’t good enough is insulting. Unfortunately, the tide is changing to an all BSN nursing workforce. Despite the awesome nurses out there who have a diploma or an ADN, the accrediting bodies and the facilities will demand the BSN. Does it really make a difference? There are studies pointing to the fact that patient outcomes are better with BSNs, but none that really examine how patients fare when taken care of by an ADN with 20 years’ experience.
In the end, it feels like it is about the letters after a nurse’s name and not the care they give. Despite this dichotomy, this difference of opinion, this body of evidence, it seems the ADN cannot survive. If you are an ADN nurse, it is time to take a good, hard look at what your future means and what you are going to have to do to remain part of the profession.
“You are so overburdened. The situation has made it impossible to give the care you need to. We need more of you. We need much better staffing ratios. It’s really that simple.” –Congresswoman Jan Schakowsky (D-Illinois), author of Nursing Staffing Standards for Patient Safety and Quality Care Act (HR 1602), in a speech on Capitol Hill at the Nurses Take DC Rally
It had rained in Washington, D.C., for 15 straight days, but on May 12, 2016, the weather held off. Nurses from all over the country gathered under cloudy skies and congregated around a simple speaker stand with flags to either side stating, “Safe Nursing Ratios Save Lives.”
The ground was boggy, causing many nurses to sink into the mud, but none could turn their eyes away from the Capitol building that hung over the scene, a reminder of the power of the people. On this misty, humid, and rain-free day, nurses made their demands for safer staffing ratios known with the smell of wet grass in their noses and a cheer in their throats for the thoughts so passionately and aptly expressed by the many speakers.
The speakers roused the crowd with inspired words, and nurses held up signs in support of the legislation. They shared heartfelt stories of nurses and patients who have suffered poor ratios on the front lines. What happened on this slate gray day in front of the great building of government? Promises of safe ratios, belief in the power of legislation, and a comradery that transcended specialty, geography, and years of service rang out from Congresswomen and nurses alike.
Why Ratios?
Of all of the problems nursing has—bullying, burnout, and nurses leaving the profession—why are all of these people focusing on ratios? It is because ratios affect patient safety the most, and nurses are always focused on patient safety first.
Janie Harvey Garner, RN, founder and executive director of Show Me Your Stethoscope, was asked why she chose this issue for her group. “Because I have been that nurse with the third patient in the ICU,” she says. “I’ve been the nurse with the nine patients on med/surg. It’s not safe for anybody, and quite honestly, though I am extremely concerned about hurting a patient, I’m also very concerned about hurting a nurse because second victim syndrome is a super health issue, for me anyway. I don’t think it is with hospital organizations, but it sure is with me. Kim Hyatt died. Let’s not make it in vain.” (Hyatt committed suicide after making a medication error, which may or may not have been related to staffing issues.)
Rebecca Love, BA, MSN, RN, ANP, regional director for the North East region of Show Me Your Stethoscope and founder of HireNurses.com, went even further when she stated, “I think what we’re seeing in the hospital is verging on the level of we are choosing which patients are going to live and which patients are going to die every day when we come in and deal with the ratios that we are dealing with.”
In fact, Kelsey Rowell, RN, thinks that staffing ratios may be leading to some of the other problems that face nurses. “I think we’re spread so thin that it’s really causing nurses to experience compassion fatigue and feel tired. I think ratios are something that’s going to be ultimately good in a long haul.”
Ratios are the most important issue in nursing because it is about the patients. There is no way to get around that fact, and that is why this legislation is so important. Nurses need to stand up and be heard. People can and will die when nurses are spread too thin, and that not only hurts patients, but it severely impacts the psychology of the nurse.
The general public doesn’t even know this is an issue because they don’t know what nurses do. “Nurses need to speak about the value of their work,” says Sandy Summers, RN, MSN, MPH, founder and executive director of The Truth About Nursing, and coauthor of Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk. “Moving their heads up high and saying, ‘I can’t possibly take care of four ICU patients, someone is going to die. I can barely take care of two.’ So working on safe staffing issues is ultimately joining our mission of working to educate the public about the value of nursing, the work that nurses do to save lives.”
The Legislation
The hubbub at the Capitol was due to the legislation that is now in the House of Representatives called HR 1602. There is also a Senate bill for nurse to patient ratios, but it is still in its very beginning stages. Like the California laws, this bill calls for mandatory ratios across the country. Here is what the bill proposes hospitals will have to offer nurses who work for them:
“[A] hospital’s staffing plan shall provide that, at all times during each shift within a unit of the hospital, a direct care registered nurse may be assigned to not more than the following number of patients in that unit:
One patient in trauma emergency units.
One patient in operating room units, provided that a minimum of 1 additional person serves as a scrub assistant in such unit.
Two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, postanesthesia units, and burn units.
Three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, deliver, and postpartum units.
Four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units.
Five patients in rehabilitation units and skilled nursing units.
Six patients in postpartum (3 couplets) units and well-baby nursery units.”
Nurses posing with Congresswoman Jan Schakowsky
This bill was proposed by Congresswoman Jan Schakowsky (D-Illinois), a woman of great charisma and passion for nurses and ratios alike. She is moved by health care and the plight of nurses everywhere. “If we really want to improve patient care, we have to improve the nurse staffing ratio,” says Congresswoman Schakowsky. “There’s just no question about it. It is nurses that are on the frontlines. If they have too many patients, then nurses just can’t do the job that we need done.”
In the House, different representatives can agree to co-sponsor a bill, or lend their support to its cause. Two of those representatives are Congresswoman Donna F. Edwards (D-Maryland) and Congresswoman Joyce Beatty (D-Ohio), and both are passionate about the cause.
After a rousing speech to the nurses assembled, Congresswoman Beatty spoke with similar eloquence as to why she supports the bill: “It makes a difference in the lives of not only nurses but in the lives of patients. It’s good for patients. It’s good for health care. I want to say thank you for being out here because getting a bill passed and moving it along the way is standing up for what you believe in. I can go back to the house floor and I can say I believe in nurses.”
Congresswoman Edwards was similarly supportive of the bill and of nurses. “We want to make sure that our patients and our nurses are operating in the kind of environment that allows them to provide quality health care,” she explains. “That quality is jeopardized when nurses have so many patients to care for when they have some other responsibilities that don’t involve direct patient care.”
Nurses and Health Care
It’s great to talk about getting more nursing at the bedside, but nurses cost money. With the rising cost of health care, it may not be feasible to expect that the system could support better nurse ratios. The Affordable Care Act aims to get more people health insurance, but how does this impact nurses? More patients mean more work, higher ratios, and more stress. What is the solution?
Nurse talking to Congresswoman Donna F. Edwards
Congresswoman Edwards doesn’t see this as a problem: “It’s really clear that even under the Affordable Care Act, we’ve always known that we’re going to be in an environment where we need more nurses, more qualified care in medical settings, and that’s going to be really important with so many more people coming in to the system requiring care that staffing ratios are [an] important component of that kind of quality care.”
Obviously, this will need to be addressed if more patients are coming into the system. If there are no ratios in place, this could lead to very unsafe staffing in most facilities. That makes it even more important to pass this legislation . . . and to find ways to get more nurses to the bedside.
Congresswomen Schakowsky also wants more nurses: “We need to make sure that health care providers are also increased to make sure that we can actually deliver the care to these millions more people.”
“We’re trying to marry the two of the insurance and having good medical services,” says Congresswoman Beatty. “I don’t see them on separate ends. You can’t be for health care and be against good nursing. You can’t be for good nursing and be against health care.”
Despite the positive talk, the increase in patients will trickle down to nurses. This legislation needs to pass so that the facilities can’t just continue to add to the nurse workload because there are more patients than they know what to do with.
Ways to Improve Ratios
Ratios are obviously a problem, but legislation cannot possibly be the only solution. For starters, there are some flaws in the bill proposed, but laws can take a very long time to come into effect. Patients are dying now. Nurses are suffering now. There has to be something else nurses can do to impact this issue.
Rowell has a few ideas. “I think it’s going to start with awareness,” she says. “Maybe it’s going to be starting with people standing out and voicing everything going on and the severity of it. If we continue to let the business of the profession run what we do, we will focus on profit over patients’ safety, and that is a big deal.”
There are other factors that stand in the way, as well. Love points out that “I think that there are powerful interests at play that oppose this kind of change. Largely insurance and health care and hospital administrators because nursing costs money and the only way that we’re going to be able to fight that is when we state we will have mandated safe staffing levels.”
It is certainly true that insurance isn’t going to support staffing ratios. The more they keep costs down, the better. Unfortunately, this often comes at the expense of patients and nurses. With the Affordable Care Act, insurance companies will look to cut costs even more, and that is a dangerous precedent for the movement.
It is also true that facilities don’t tend to listen to nurses. They are seen as complainers, but even then, nurses can find a way to maneuver themselves into a better situation. “We have to encourage patients and their families, and caregivers to start questioning a lot more,” says Andrew Lopez, RN, president and CEO of Nursefriendly.com. “We have to feed them the information they need. Social media is an excellent vehicle. We can do that. Social media gives us a platform where we can go on to Facebook, we can go on to Twitter, and go on to communities where we will be welcomed as nurses, as ambassadors of health.”
Deficiencies to the Bills
One of the problems with the bill is that it doesn’t provide for an acuity scale. Although it is mentioned, a scale is not specifically written out. This can leave the door open for facilities to exploit it by giving nurses the required number of patients but swamping them with patients requiring a great deal of care.
“We want the hospitals to be working with the nurses to figure out exactly what number needs to be there,” says Congresswoman Schakowsky. “Obviously, when there’s greater acuity, we need to have even more nurses that are available. It’s clearly a big factor. We haven’t put a number in the bill but we want that taken into clear account.” However, leaving the negotiation to the hospitals may not be the best idea.
Congresswoman Beatty agreed and showed a remarkable knowledge of what nurses experience every day. “I think that’s one of the things we’re going to work through. Certainly when you know if a patient is sicker than another patient, they require more care. If you’re in intensive care or if you get an infection, the requirements are that it takes more work.”
Another glaring oversight of the bill is the lack of ratios for those in long term care and rehabilitation. In these specialties, registered nurses can have up to 40 patients with minimal support staff under them.
Summers stated that this was one problem with the bill that needed to be addressed. “A nurse told me in her rehab center, there are two nurses for every 17 ventilated patients. That is so reckless. But taking care of ventilated patients is hard. Their tubes always get blocked up. They get secretions and coughing. Eight and a half patients each? That’s reckless. She thought that wasn’t as bad as they have on the floor which is 40 patients each or 50, I think.”
Clearly, this is a problem, and it needs to be addressed in the bill. It is an oversight that has caused many to withdraw their support. For this reason and others, national groups like the American Nurses Association are not as supportive. “The ANA is not supportive of the current legislation, but that does not necessarily mean that they’re not supportive of us,” explains Garner. “I think they’re in general supportive of a grass root effort, but they certainly do not back the current legislation that we’re supporting.”
The Future
Although there are some flaws with the bill, the future may rely on its passing. This is why nurses support it—it is the best thing out there for the problems they face. What is the future of nursing and this bill?
Caroline Thomas from EmpowerRN states, “I think you know the future of nursing is very bright obviously. Statistically, we have a huge gap in the amount of nurses that we have and the amount of nurses that we’re going to need in the future. Having a degree in nursing, it opens up a lot of doors other than just the traditional. I definitely recommend it; I think it’s a great time to get in to it.” Despite the flaws, nursing still remains a profession that is worthy of pursuit.
Love has a completely different take on the future of nursing and of ratios: “I believe what’s going on, is that we are becoming so overburdened with the amount of patients that we are caring for that it is driving down the quality of care. It’s forcing nurses out of the profession and eventually we are going to end up with nobody by the bedside to care for patients. I think the future of nursing and the future of health care are at risk.”
Where is Show Me Your Stethoscope going from here? Garner is optimistic. “We’re going to continue to do nurse advocacy. We’ll also continue to do patient advocacy. Mostly, I see us doing what nurses want us to do because we’re a nurse’s organization. I don’t want to unionize the world. All we want to do is do what nurses want to do.”
In the end, nurses are fighting for their patients and themselves when everyone else doesn’t understand the struggle or even knows it exists. Advocacy for nurses is needed. Education of the public is also necessary. Legislation is only one road. Starting a dialogue and standing up for nurses is the way to lasting change. This is the future of the staffing ratio debate, and with this rally, nurses are off to a great start.
Imagine that you live in Kansas, far from the bustling world of large hospitals, world-class doctors, and instant health care. Besides yourself (a nurse), there is a doctor and another nurse. In this neck of the woods, most patients are more concerned with the health of their crops and livestock than with their own.
One day, you manage to wrangle a farmer into your exam room and give a quick listen over his heart. You pause, furrowing your brow. Something doesn’t sound quite right, but you aren’t sure what it is. The doctor, for all her training, knows it is a murmur, but is unsure if the sound warrants a trip to the nearest hospital or if it was there before. If it is new, then a trip is required, but your farmer patient doesn’t want to be bothered. What do you do?
This is where the technology of telemedicine steps in to help determine what the heart sound is, if it has been there before, and if the patient is in danger. Telemedicine has been around for a long time, but most health care providers don’t understand it. It is far more than a patient and a doctor chatting over Skype.
[et_bloom_inline optin_id=”optin_13″]
In fact, those heart sounds you are hearing can be amplified, recorded, and transmitted through the use of an emerging technology—the electronic stethoscope.
“With the advent of applications and HIPAA compliant mechanisms, we have the ability to listen to heart sounds over long distances,” states Ami Bhatt, MD, FACC, director of the adult congenital heart disease program at Massachusetts General Hospital and an assistant professor of medicine at Harvard Medical School. This is an emerging technology, however, and it hasn’t quite been used in this way just yet.
“As the technology emerges, our first steps are to set up systems to use these devices in providing remote health care in a controlled environment where we can see if they help improve patient care,” Bhatt continues.
Weighing the Pros and Cons
Privacy is a large issue with the use of electronic stethoscopes in health care. Arvind Badrinarayanan, BSc, BVSc & AH, a veterinarian entrepreneur in India and founder of MUSE Inc., a medical device start-up company, is working on a low-cost electronic stethoscope. “One of the biggest concerns is encryption,” says Badrinarayanan of the privacy issues. “We are working heavily on that. One of the main features of our devices is that there is no way that the person can identify the patient. All of the identifying information is stripped off the file. The only one who has access to the data is the one who uploaded it themselves.”
Ami Bhatt, MD, FACC
How would this technology increase the health of the patient, though? “There are two ways telemedicine is conducted,” explains Bhatt. “One way is synchronous where the patient and provider are on the screen at one time. There is also asynchronous, in which the patient fills out a checklist or interview and it is sent to the doctor.” The use of electronic stethoscopes to crowdsource diagnoses would be more in line with the asynchronous type of telemedicine.
Electronic stethoscopes have other applications in addition to sending files to other doctors. For instance, the electronic medical record could benefit from sound files. “For our own purposes, we could record heart sounds one year and follow up next year with the recorded information. Recorded sounds in the medical record can give a comparison to what someone heard last time,” Bhatt explains. This would help a provider better diagnose changes and can help multiple providers of the same patient compare current sounds to previous ones.
Analytics are another way this technology can help patients. “We will be able to analyze heart sounds and compare them to known diagnoses, or severity of a diagnosis,” explains Bhatt. “For instance, this sound I heard is comparable with mild disease while this one is heard with more severe disease. Will every caregiver who sees a patient at intervals always catch progression of disease? We may rely on costly tests to tell us that. If I can use analytics from sound files, I may be able to catch that disease earlier and start treatment sooner. It is a far less expensive way to figure out when the disease is progressing.”
Overcoming the Barriers
Besides the privacy issue, this technology is not catching on, and that is primarily due to the price. Electronic stethoscopes are usually out of the price point for some providers, making them relatively rare in the care setting. This is especially true of rural areas that may not have the funds for such equipment—though they are the ones who would benefit most from the telemedicine technology.
Badrinarayanan saw this problem and decided to help make an electronic stethoscope that is more affordable for those who live in rural areas. “One of the many things we are doing is changing the way the products are developed, “ he says. “Most electronic stethoscopes are created in large research facilities. We use rural makerspaces, which are low-cost schools. These grassroots production hubs bring innovations to less-served rural areas. Practitioners and others can go and learn there. We can have the rural people do it themselves, and discover what the best ways are to solve their needs. In this way, we can decrease the cost of electronic stethoscopes for rural health care providers.”
“The ideology is that today’s digital stethoscopes are centered on cardiologists or high-end professional physicians,” says Badrinarayanan. “No medical device companies think about others who could use them. GE came out with pocket ultrasound, but the going rate is out of budget of the average physician. For these devices to have an impact, they must be accessible. We need to create a device that caters to the bottom of the pyramid.”
In the end, electronic stethoscopes, crowdsourcing diagnoses, and the use of recorded media are the wave of the future, but they aren’t quite here yet. Many practitioners worry about the privacy issue, and this is likely the main cause for reluctance to using the equipment. Convincing practitioners that this technology will be helpful to the patient is another hurdle that has yet to be crossed, and the staggering cost of the devices keep them out of the hands of the people who could use them most.
What is the future for telemedicine and the use of “smart” devices? Bhatt has a few ideas: “The idea of having a telemedicine cart is what we are working on. This would integrate both the ability to communicate with a provider in another hospital and assess recordings. We can have a blood pressure cuff and a stethoscope on the cart so that we can use them to let the other provider hear them. This is just one potential way that the technology will integrate.”
Until the technology and devices are accepted by mainstream medicine, these wonders will stay on the sideline. However, technology continues to encroach upon health care, and it is only a matter of time before electronic sound files are part of the medical record, heart sound diagnoses are crowdsourced, and electronic stethoscopes are a commonplace tool in the hands of the rural and urban provider.
