Nurses and other health care workers deal with unprecedented levels of work-related stress as a result of treating patients during the COVID-19 pandemic. High stress levels in health care settings decrease quality of care, and that has a negative impact on patient outcomes:
- A study published in the International Journal of Environmental Research and Public Health found a marked increase in “cognitive failures” (lapse of perception, memory, or action) among nurses who experienced high levels of stress as a result of treating COVID-19 patients.
- Research reported in the American Journal of Critical Care determined that the stress, burnout, and depression that nurses experienced from treating COVID-19 patients will have a long-term negative impact on the nursing profession and patient outcomes.
No single solution exists to remedy the ill effects of overwork and high stress levels among nurses. However, innovative technologies combined with new approaches to patient care and nursing management promise to alleviate many of the conditions that contribute to the problems faced by nurses, health care providers, and the nursing profession.
Nursing apps and other technologies can help nurses spend more time treating patients and improving health outcomes by making critical information readily available and minimizing time-consuming record-keeping and other administrative tasks. The apps and technologies described in this guide can help nurses work more effectively and reduce stress to enhance patient outcomes and experiences.
Nursing Apps and Resources
Professionals in all fields increasingly rely on their smartphones to keep in touch with team members and others. Many smartphone nursing apps and resources provide instant access to medical information and services.
These are among the apps, technologies, and information resources that deliver the benefits of tech innovations to nurses, nursing students, and nurse educators.
Nursing Central App
Nursing Central (free) provides instant access to up-to-date information on medical procedures, tests, drugs, and diseases on iPhones or Android phones. Nurses can use the app to search the PubMed database, and nursing students benefit from the Grasp study system that brings study material to their smartphones.
Epocrates (free) is a drug information service that’s supported the clinical decisions of more than 1 million health care professionals since 1998. The service’s nursing app, which runs on iPhones and Android phones, checks for potential drug interactions for as many as 30 brand, generic, over-the-counter, and alternative drugs in a single search. The app features hundreds of dosing calculators, medical equations, and similar resources. The Epocrates Plus version costs $17 a month and adds more information about alternative medicines, recent research findings of note, and additional laboratory and medical content.
Human Anatomy Atlas
Human Anatomy Atlas ($25) uses thousands of 3D models to demonstrate the design, structure, and operation of the human body. While the app is of greatest use to nursing students, nurses and other medical professionals may also use it. The program features dissectable male and female gross anatomy models to demonstrate common muscle actions. The app is available for iPhones and Android phones.
Google Translate (free) supports bilingual translations of conversations in 71 languages, text translations in 108 languages, and speech translations in dozens of languages. (In offline mode, text translations are available in 59 languages.) The app runs on iPhones and Android phones and provides instant translations of photographed text in 90 languages using the phone’s camera or images imported from the phone.
Skyscape Medical Library
Skyscape Medical Library (free) is a decision support application that runs on iPhones and Android phones and is intended for doctors, nurses, health care workers, and students. The medical resources available in the free version of the app include a drug interaction database, a clinical calculator designed to support medical decisions, and a clinical consulting database with evidence-based information on hundreds of diseases and symptoms.
NurseGrid (free) is a nursing app for iPhones and Android phones that provides 24/7 access to a nurse’s schedule and supports team scheduling and shift transparency. The program lets nursing team members compare schedules for easy shift swapping and scheduling of time off. Nurses can let staff know their availability for additional shifts or trades and manage schedules across multiple work sites.
Taber’s Medical Dictionary
Taber’s Medical Dictionary is available for iPhones and Android phones as a free preview of the 24th edition of the medical dictionary; complete access to the dictionary’s 75,000-plus entries via app or website costs about $40 annually. The dictionary’s entries feature about 130 videos, 33,000 integrated audio pronunciations, and 1,300 full-color illustrations on a range of medical topics.
- Professional Nursing provides ready access to information on diseases, disorders, treatments, diagnoses, drug uses and interactions, IV compatibility, and dosing calculators.
- Critical Care Nursing is a point-of-care reference and drug database designed specifically for critical care environments. It covers pharmacology and clinical subjects, decision support, and nursing diagnoses.
- Oncology Nursing covers such topics as primary care sites, patient education, and oncology-specific evidence summaries developed in conjunction with the Oncology Nursing Society.
- Gerontology Nursing combines general nursing information with content geared specifically to the care of older adults, including risk assessment, pharmacology considerations, and multisystem disorders common in geriatric patients.
Keener (free) is a self-care app available for iPhones and Android phones that helps prevent nurse burnout by helping users keep tabs on their mental and physical health. One of its unique features is the Shift Reflection tool that maintains a record of how a nurse feels after each shift. The app features inspirational videos recorded by nurses and
health care experts in well-being that help nurses devise strategies to improve their resilience, confidence, and mood.
Medscape (free), available for iPhones and Android phones, offers access to medical news and commentary from various medical specialty experts in addition to information on diseases and drugs. Other features of the program include medical calculators, drug interaction checkers, pill identifiers, and videos that step through specific procedures.
Mental Health Apps for Nurses: Improved Mood, Less Stress
Stress has long been an occupational hazard for nurses
; but , stress levels among front-line health care workers have soared during the pandemic. A survey of nurses that the American Nurses Foundation conducted in December 2020 found that more than half of nurses reported feeling exhausted (72%), overwhelmed (64%), anxious or unable to relax (57%), or irritable (57%) in the previous 14 days.
One of the most debilitating aspects of work-related stress and burnout among nurses is the feeling that stress is an inherent part of the job that they’re powerless to avoid. In fact, nurses have developed many winning strategies for coping in stressful situations that help prevent the tensions of their work that lead to burnout and post-traumatic stress disorder (PTSD).
Many mental health nursing apps are available to help nurses cope with work stress. They’re designed to complement rather than replace the services provided by trained mental health professionals. These programs help health care professionals deal with stress, anxiety, moderate depression, and other mental health issues.
With the rise of smartphones in the early 2010s, the first mental health apps became components of the initial digital health strategies of countries and the World Health Organization (WHO). Today, a growing number of mental health clinicians are embracing the apps after proving their effectiveness in treating the symptoms of anxiety, depression, and other mental health conditions.
These are among the mental health apps that help nurses and others to improve their mood and cope better with the stress in their lives.
MoodKit is a $5 app for iPhones that applies cognitive behavioral therapy (CBT) techniques to change people’s thinking patterns. It helps them become more self-aware and encourages healthy attitudes. In addition to providing more than 200 activities designed to improve a person’s mood, the app includes a journaling feature with 12 journal templates for recording and rating moods.
Happify is a free program that runs on iPhones and Android phones and uses science-based games, activities, and positive messages to improve a person’s mood. The goal of the program is to use CBT and evidence-based interventions to replace negative thought patterns with positive ones. The iPhone version features more than 65 tracks as well as games and meditations; the Android version includes more than 30 tracks. The app also provides a 20-page “character strength report.”
Talkspace Therapy and Counseling
Talkspace matches people with a licensed therapist in their state who provides mental health services via text, audio, and video using iPhones or Android phones. The therapist responds at least once each day and is available five days a week. The app’s vendor claims that the program is as effective as face-to-face therapy sessions and that people experiencing anxiety and depression improved their symptoms within two months. The therapy sessions cost from $65 to $99 per week.
Quit That! Habit Tracker
Quit That! is a free app for iPhones meant to help people break bad habits, such as smoking, drinking, or taking drugs, by closely monitoring their progress. Counters show at a glance the number of minutes, hours, days, weeks, months, and years it’s been since the person quit the habit. The app also calculates how much money the person has saved since breaking the bad habit, and it lets users schedule a time to quit in the future. This can be a useful app for nurses struggling with addictions.
Headspace uses mindfulness and meditation to help people reduce the stress in their lives; it’s available for iPhones and Android phones on a subscription basis for $13 a month or $70 a year (seven- and 14-day free trials are available, respectively). The app teaches meditation and mindfulness skills and includes hundreds of guided meditations on topics ranging from coping with anxiety and stress to sleeping better and improving focus. It also provides Mindful Moments: meditations lasting two or three minutes designed to serve as a mental reset during especially stressful or anxious events.
MindShift is a free app that helps people overcome worry, stress, anxiety, and panic. Available for iPhones and Android phones, the program includes a daily check-in feature for tracking mood and anxiety level over time, goal-setting tools, and guided relaxation and meditation exercises. The app educates users about the causes of anxiety and offers tips for adopting healthy habits and positive thought patterns.
The U.S. Department of Veterans Affairs created PTSD Coach, a free app for iPhones and Android phones, to help treat current and former service members suffering from post-traumatic stress disorder (PTSD). Included in the app are a self-assessment for identifying PTSD symptoms and information about professional mental health services and other support resources. Tools in the app help people manage stress in their daily lives via relaxation techniques, self-talk, anger management, and other strategies.
Calm is a mental health app that provides guided meditation sessions for people who are new to mindfulness as well as those with meditation experience. The app is available for iPhones and Android phones and features Sleep Stories, which celebrities such as Matthew McConaughey and Stephen Fry narrate. Also provided are breathing and stretching exercises, relaxing music, and an original Daily Calm that helps people kick-start their day or unwind before bedtime. The program costs $15 a month, $70 a year, or $400 for a lifetime subscription.
Communication Tools in Nursing
Nurses need to communicate clearly with physicians, patients and patient families, other nurses, and all members of the health care team. Communication tools in nursing can help ensure the clear and consistent communication of vital information. The following are among the most popular tools that help ensure that nurses maintain clear, consistent, and complete communication with all parties involved with a patient’s care.
Ticket-to-Ride ensures that team members involved in patient handoffs communicate all the information required to keep the patient safe. The process relies on a form of electronic record that travels with the patient and lists pertinent information for all parties. For example, when a patient who’s a fall risk is transported to the radiology department, the patient’s ticket will bring the fall risk to the attention of transport and radiology staff. All involved health team members sign a designated area of the ticket to confirm that they’ve been apprised of the patient’s condition.
Hourly rounding is the practice of nurses making rounds of their patients once each hour. Purposeful hourly rounding involves checking four things:
- The patient’s position (whether the patient is comfortable)
- The patient’s possessions (whether the patient has everything needed)
- The patient’s personal needs (whether the patient has to go to the bathroom, for example)
- The patient’s pain (whether the patient is experiencing pain or discomfort)
Obstacles to completing hourly rounding include patients sleeping, uncertainty about nursing assignments, responding to emergencies, unclear rounding policies, and failure of nurses to ask other nurses for help when they’re unable to complete their hourly rounds.
Patient teach-back improves communication with patients by asking them to state in their words what they need to know about their health and what they or others must do about it. Using this feedback, nurses can confirm that their patients understand what they’ve been told about their treatment. The Show Me technique is a related method that asks patients to demonstrate the action they’ve just been taught for their self-care.
The aviation industry has widely used the I’M SAFE self-checklist to ensure that pilots are fit to fly. However, the checklist works well for nurses and others whose professions put the lives of others in their hands. The technique covers six aspects of a person’s health and well-being:
- Illness: In addition to being concerned about the potential of spreading any cold or flu, nurses must ensure that they’re able to perform to their full capacity.
- Medication: Nurses need to be aware of how any prescription or over-the-counter drugs they’re taking may affect their duty to provide optimum patient care.
- Stress: Issues related to work or personal circumstances may prevent nurses from giving their work their full attention.
- Alcohol and drugs: Even small amounts of alcohol or other legal drugs may impair nurses’ ability to meet the required standard of care.
- Fatigue: Lack of sleep, overwork, and other factors may cause nurses to become too tired to fulfill professional duties.
- Emotion: Nurses must have an emotionally stable state of mind to perform at their best and avoid endangering patients.
Mnemonic Communications Protocols for Nurses
Many of the adverse events that a patient experiences during hospitalization occur because of miscommunication between nursing staff during patient handoffs. The result is a disruption in the continuity of care, omission of critical data, medication errors, and other adverse outcomes.
Nurses use several techniques to prevent miscommunication when handing off patients and in other situations. Among the methods are several mnemonics, including ISHAPED, TAGEET, SBAR, IPASS, and BATHE.
ISHAPED (Introduce, Story, History, Assessment, Plan, Error prevention, Dialogue) was created by INOVA Health System as a way to standardize patient-centered bedside handoff between caregivers. An electronic version of the technique has been integrated with electronic health records to display information that is pertinent to the patient’s current location. This is especially helpful during patient transfers.
- Introduce includes communicating any patient allergies, code status, contact information, provider teams, and advanced directives.
- Story describes the patient’s illness, treatment plan, admission screening information, and learning assessment.
- History covers the patient’s emergency room records, past physicals, medical and surgical history, and medications taken in the past 72 hours.
- Assessment describes vital signs, daily activities, diet orders, pain management, intake and output summary, and lab results.
- Plan presents the goals of the patient’s care plan, orders that haven’t yet been acknowledged or completed, as-needed medications, and nursing orders.
- Error prevention provides high-alert warnings and medication information specific to the patient.
- Dialogue involves the information provided about the patient in the shift report and whether the patient and the patient’s family were included.
TAGEET (Tune in, Approach and introduce, Ground self, Engage and respond, End encounter, Tune out) is a form of therapeutic communication and engagement that uses verbal and non-verbal methods to create a safe and empathic environment for patients to understand their illness and learn the best ways to deal with it.
- Tune in makes the nurse fully aware of and present in the current situation, including the nurse’s own thoughts, feelings, and behaviors.
- Approach and introduce puts the patient at ease by letting them know with whom they are interacting. This is especially important in situations such as COVID treatment where caregivers’ faces are hidden behind protective equipment.
- Ground self entails taking a deep breath, standing or sitting upright, and quickly relaxing any tense muscles.
- Engage and respond relates to verbal and nonverbal communication, such as making eye contact and using posture and gestures to put the patient at ease. It includes moderating your tone of voice to match the message, and listening attentively.
- End encounter ensures that the patient understands the information being communicated and knows what to expect next, whether an encounter with another caregiver, treatments, or further tests.
- Tune out gives the nurse an opportunity to reflect on the encounter, check their feelings about it (both positive and negative), and, if necessary, share their thoughts and debrief team members.
SBAR (Situation, Background, Assessment, Recommendation) can help guide conversations in four ways:
- Situation: Identify yourself, state your location, name the patient involved, and explain the matter at hand.
- Background: Briefly present pertinent information such as the patient admission date and the reason for the admission.
- Assessment: Describe your sense of the patient’s current state based on your observations, emphasizing any reasons for concern.
- Recommendation: State the course of action that needs to be taken in a specific time frame.
The person who initiates the conversation then asks the other party to repeat key points and required actions to ensure that the message has been received and is understood.
IPASS (Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver) was designed for patient handoffs between physicians and is now used by other members of health care teams. The goal of IPASS is to create a “shared mental model” of each patient so the decisions of individual caregivers support common goals.
- Illness severity: Explain whether a patient is stable, unstable, or at risk of deterioration.
- Patient information: Share information such as the patient’s name, age, medical history, symptoms, and diagnosis
- Action list: List actions that will be taken to care for the patient and responsibilities of the caregivers.
- Situation awareness and contingency planning: Share plan for potential situations the patient may face and factors that could affect the patient's care such as do not resuscitate/do not intubate (DNR/DNI) status.
- Synthesis by receiver: Have information receiver summarize information that has been shared, ask questions, and restate action items.
The BATHE (background, affect, trouble, handling, empathy) Protocol also serves as a template for the many brief but critical conversations between nurses, doctors, team members, patients, and other involved parties. BATHE consists of the following:
- Background: Describe the circumstances that led to the current situation.
- Affect: Explain the impact the situation is having on the patient and others.
- Trouble: Present the causes for concern, beginning with the most serious or time sensitive matters.
- Handling: Assess where the situation stands at the moment and concerns about the future.
- Empathy: Express empathy and recap the situation to confirm that the other party understands what needs to happen next.
Clear and effective understanding prevents efforts that endanger patients’ health. These approaches help keep communications in health care settings complete and unambiguous. These are ISHAPED: Introduce, Story, History, Assessment, Plan, Error Prevention, Dialogue; TAGEET: Tune-in, Approach and introduce, Ground self, Engage and respond, End encounter, Tune-out; SBAR: Situation, Background, Assessment, Recommendation; BATHE: Background, Affect, Troubles, Handling, Empathy.
New Technology in Nursing
The American Nurses Association notes that any fundamental transformation of an industry or a profession occurs not because of the arrival of new technologies, but due to some “unthinkable event” that reshapes the world and forever alters our day-to-day lives.
The COVID-19 pandemic is one such unthinkable event, and the result is an opportunity to reinvent the health care system and reimagine nurses’ roles within the system. New technologies in nursing enable innovative processes and work environments that make health care more effective and more affordable.
These are among the technologies that promise to disrupt the nursing profession and the provision of health care.
Centralized Command Centers
Next-generation command centers in nursing environments will combine up-to-the-second data flows with artificial intelligence to create a “patient experience center” that integrates all aspects of patient care. In particular, centralized command centers will put patient and family experience at the forefront, supported by clinical and safety coordination, operations management, and data management in a modular approach that does away with departmental silos. As a result, nurses and other health care workers will have a real-time view of their patients’ status via a single dashboard interface.
Patient-Wearable Medical Devices
While wearable fitness trackers continue to grow in popularity, more sophisticated wearable monitors join them in delivering information about the person’s health directly to caregivers. For example, smartwatches such as the Apple Watch Series 6 monitor blood oxygen saturation, track the wearer’s sleep, and include an electrocardiogram sensor. Additionally, Omron Healthcare offers a wearable oscillometric blood pressure monitor that measures the wearer’s activity, including steps taken, distance traveled, and calories burned.
Electronic Health Records
Early versions of electronic health records (EHRs) were plagued with problems related to their lack of usability, difficult access, and inability to share information. New EHR systems are addressing these issues; the new systems are being developed in response to changes that the Centers for Medicare and Medicaid Services (CMS) has proposed. Hospitals participating in Medicare’s Promoting Interoperability Program will be encouraged to report data to public health agencies and other health care providers electronically using standard formats.
To reduce errors in EHRs, hospitals will be provided with nine checklists covering system interfaces, patient identification, reporting test results, and other areas.
Automated IV Pumps
IV infusion pumps are a critical tool in many aspects of health care. Some smart versions of the devices have experienced a high failure rate, resulting in dozens of product manufacturer recalls in the past several years. New releases of automated IV pumps are equipped with more built-in safeguards, such as alerts, prompts, and more accurate flow monitors. They also link wirelessly with the EHR systems, providing a wealth of useful data for nurses and health care providers.
Smart Hospital Beds
Today’s hospital beds incorporate sensors and other technologies that transform them from furniture into real-time data collection devices. A patient’s breathing, pulse, temperature, and other vitals are transmitted from the bed to the nurse’s central monitoring station. A tablet computer attached to each bed displays the patient’s status and makes the information available to other network nodes. The beds also indicate whether the patient is resting comfortably or trying to get up. Some can adjust their position to support the patient automatically.
Remote patient monitoring allows health care providers to improve patient outcomes while reducing costs. Portable monitors can be useful in health care settings and non-health care settings to provide a steady stream of real-time data about the patient’s health status. For example, continuous glucose monitors alert patients with diabetes whenever they need to take insulin, and patients with hypertension can have their blood pressure monitored without requiring a trip to their health care provider.
Telehealth and Remote Health Monitoring Apps
An extension of portable monitors is complete telehealth and remote monitoring applications. Telehealth uses telephones and other standard communication devices along with mobile technology, such as mental health and nursing apps, to provide remote clinical services. Remote patient monitoring apps transfer the patient’s health data to caregivers and can prompt patients to provide more information.
The first use of robots in health care assisted surgeons in operating rooms to increase the surgeon’s dexterity and prevent fatigue. Robots now are being used to deliver medications to patients and medical supplies to hospital departments. They also clean and sanitize work environments and provide companionship to patients.
Once-in-a-lifetime events such as the COVID-19 pandemic spur foundational changes to the health care industry. These technologies promise to transform the nursing profession and patients’ health care experience. These include digital health portals and remote patient monitoring, autonomous robots and surveillance to enhance safety and security, AI and automation used to make nurses more efficient, augmented and virtual reality to improve training and patient care, and data analytics and interoperability applied to public health efforts.
IG #1: Healthcare Tech Trends for 2021: New Tools to Watch, HealthTech
IG #2: Standardizing Handoff Communication, American Nurse
A New Therapeutic Communication Model “TAGEET” to Help Nurses Engage Therapeutically with Patients Suspected of or Confirmed with COVID-19, Journal of Clinical Nursing
5 Ways to Improve Your Nurse Communication Skills, TravelNursing.com
Four Evidence-Based Communication Strategies to Enhance Patient Care, American Academy of Family Physicians