proof positive - UCLA School of Nursing

Wireless technology’s influence on everyday life has been substantial – it’s
hard to be in any public space these days without seeing people texting, talking on their
smartphones, or working on their laptops. But could wireless devices also improve our
health
Several UCLA School of Nursing
faculty members are doing more than just
asking the question; they are involved in
developing wireless tools and studying their
potential impact on key goals such as the
ability to identify early symptoms and assist
patients with their self-care.
Pressure ulcers, also known as bedsores,
represent a major quality of life problem
for nursing-home residents that, in many
cases, could be prevented. Dr. Barbara
Bates-Jensen, associate professor at the
school, believes technology could go a long
way in improving pressure ulcer care.
Bates-Jensen has employed a handheld
wireless device – previously confined
to the cosmetics industry – that measures
water in skin tissues. “When there is cell
and tissue damage, the first response is an
inflammatory reaction, which leads to
increased fluid in the tissues,” Bates-Jensen
explains. “We hope this device is capable of
picking up that increase in fluid to provide
an early-warning sign for impending skin
damage.”
In their initial studies, Bates-Jensen
and her colleagues were able to use the
technology to predict 25-30 percent of the
skin damage before it was visible a week
later, suggesting that the device improves
the ability to detect damage at an early stage.
“If we can predict something before we
can see it, that increases the likelihood that
we can develop interventions that would
prevent the ulcer from occurring,” Bates-
Jensen explains. “Currently with patients
who have pressure ulcers or who are at
risk for them, we provide preventive
strategies that are fairly generic. If this
device works as well as we hope, we have
the potential for the first time to target our
interventions at specific anatomic sites
based on where we see the damage.”
She is now in the midst of a larger
study, funded by the National Institute
of Nursing Research and taking place
in two dozen nursing homes, to look at
the effectiveness of the technology in
individuals with darkly pigmented skin.
This is an important patient population,
Bates-Jensen explains, because the current
standard for detecting early signs of
pressure ulcers involves looking for redness
on the skin, which is much easier to see in
patients with light skin than in patients
with dark skin.
Bates-Jensen is also working with the
UCLA Wireless Health Institute in an
effort to improve the technology. The goal
is to develop a device that is slightly larger
and with multiple electrodes, so that it
can envelop the entire bony area to get
more accurate readings; the research team
will then test the device, called the subepidermal
moisture scanner, against the
existing technology in nursing-home
subjects. “We believe this is going to be far
more useful clinically,” Bates-Jensen says.
Bates-Jensen’s interest in technology
to improve nursing care dates to her time
as a graduate student at UCLA, when
she developed a tool that became widely
used to assess pressure ulcers, now referred
to as the Bates-Jensen Wound Assessment
Tool. Her work since that time has
convinced her that technology has the
potential to dramatically improve the care
that’s delivered in nursing homes, beyond
her specific interest in wound care.
“The nursing-home environment
continues to struggle with both inadequate
staffing and high turnover rates,” Bates-
Jensen notes. “Technology has the potential
to provide a vehicle for continuity of care
and continuity of information flow. It also
allows us to create large national databases
that can then be evaluated for best-care
practices, something that is particularly
needed in wound care. Unfortunately,
nursing homes tend to be far behind
hospitals in technology hardware and
software, so it’s also important to look for
low-tech solutions.”
Dr. Eufemia Jacob, assistant professor at
the school, has begun research testing the
effectiveness of a wireless pain intervention
program in children ages 10-17 with
sickle cell disease, an inherited blood
disorder. The study provides participants
“The nursing-home environment continues
to struggle with both inadequate staffing and high
turnover rates. Technology has the potential to
provide a vehicle for continuity of care and continuity
of information flow.”
— Dr. Barbara Bates-Jensen
with an iPhone that has a customized
Web-based application, enabling them to
keep an electronic diary by answering
questions about pain and other symptoms
twice a day. The information goes directly
to a UCLA-based server, and if the child
checks off the same symptom for 48-72
hours, a nurse practitioner contacts him
or her to inquire further.
“For most healthy children, ignoring
symptoms is not a big deal because the
symptoms are likely to go away in a couple
of days,” says Jacob. “But for children
with sickle cell disease, this can lead to a
painful episode. Too often, their treatment
is delayed and they end up going to the
emergency department with symptoms
that could have been prevented if they had
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