Understanding the Challenges Nurses Encounter with Monitoring Technologies in a NICU

Abstract

A neonatal intensive care unit (NICU) provides an optimal environment for the care of preterm babies. Bedside nurses are fundamental to this care provided to preterm babies in the NICU. Modern NICUs are technology-intensive space, instrumented with several monitoring technologies to help the nurses track the babies in their care. These technologies help the nurses in a way that is essential for the successful operation of the NICU. To understand how these monitoring technologies function in the NICU from the viewpoint of the nurses, we conducted semi-structured interviews with seven nurses who work at a NICU in the US. We then performed a thematic analysis on the interviews and we found that, despite the utility of the monitoring technologies, they also pose several challenges to the nurses in performing their duties. More specifically, we discovered that: (1) all elements of the monitoring technologies posed a challenge in some way; (2) in a few specific situations, the nurses were able to make up for some of these challenges; and (3) the nurses suggested improvements to all elements of the monitoring technologies. Based on these findings, we describe six areas of future research that argue for the design of monitoring technologies as a way to empower nurses. These include: improved vital signs monitoring that facilitate kangaroo care, using voice to manage alarms, video feeds controlled by nurses in the patient rooms, giving more control over the alarm sounds to the nurses, having a common interface and leveraging augmented reality to help the nurses control the monitoring technologies.

Keywords:

• NICU
• nurses
• monitoring technologies
• alarms
• NICU phones
• workflow

Acknowledgements

We would like to thank our interview participants and the NICU administrators and staff who gave us so much of their time to make this work possible.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 These are monitors from a company called Space Labs (Spacelabs Healthcare, 2023). The current line of monitors was installed in 2019–2020.

2 We use sensor as a catchall term to mean lead, cuff, probe, or electrode – the element of the monitoring system that actually attaches to the babies’ body and measures physiological phenomena of some form.

3 The phones were manufactured by a company called ASCOM (ASCOM Phones, 2023). These phones started to be used when the NICU was updated to individual rooms. Since then there have been some updates, so the current set being used is a combination of 12-year-old ASCOM phones and newer models.

4 Babies can be positioned on their belly, on their back with their head elevated, or on one side with the help of specially designed pillows. Many nurses mention that it is important to reposition the babies often to make sure their head does not become misshapen from being in the same position for too long. The nurses also reposition the babies to help them with digestion, where their head is propped up, or to help them with breathing, by putting them on their belly.

Additional information

Funding

This work was supported by the National Science Foundation under grant [IIS-2139724].

Notes on contributors

Krishna Venkatasubramanian

Krishna Venkatasubramanian is an assistant professor of Computer Science and the director of the Accessible and Socially Responsible Technologies Lab at the University of Rhode Island. His work focuses on human-computer interaction with the aim of designing for accessibility and health-related applications.

Tina-Marie Ranalli

Tina-Marie Ranalli is an independent consultant and researcher. She earned her PhD from the University of Pennsylvania. Her research interests include applying humanistic critical thinking to design problems in human-computer interaction.

Priyankan Kirupaharan

Priyankan Kirupaharan is currently pursuing a PhD in Computer Science at the University of Rhode Island. His research interests include virtual reality, accessibility, and HCI for development. He completed his BS in Computer Science at the University of Sri Jayewardenepura in Sri Lanka.

Dhaval Solanki

Dhaval Solanki is an assistant teaching professor of Biomedical Engineering and the co-director of the Wearable Biosensing Lab at the University of Rhode Island. His current research interests include wearable devices, digital health technologies, biosignal processing, virtual reality, and technologies for neuro-rehabilitation.

Kunal Mankodiya

Kunal Mankodiya is an associate professor of Biomedical Engineering and the director of the Wearable Biosensing Lab at the University of Rhode Island. He collaborates with medical experts to develop and evaluate wearable and digital health technologies for monitoring the body, brain, and behaviors.