technology

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Assessment 03 – Evidence-Based Proposal and Annotated

Bibliography on Technology in Nursing For this assessment, you will write a 4–6 page annotated bibliography where you identify peer- reviewed publications that promote the use of one of the technologies presented below that enhance quality and safety standards in nursing. Before you complete the detailed instructions in the courseroom, first review the technologies below and select the one you’re most interested in researching. After selecting one of the following technologies to be the focus of your assessment, return to the courseroom to review the detailed instructions there.

 Artificial Intelligence: AI in healthcare can analyze complex data sets, assist in diagnosis, predict patient deterioration, and even suggest treatment options. It's a rapidly evolving field with vast potential to revolutionize healthcare.

 Data Management Resources: These tools help in the collection, storage, and analysis of vast amounts of patient data. Proper data management can lead to better patient outcomes, more efficient operations, and significant research advancements.

 Workflow Management Systems: These systems streamline and automate routine tasks and operations in healthcare settings. They can improve efficiency, reduce errors, and enhance the overall quality of care.

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Annotated Bibliography on Technology in Nursing

Learner’s Name

Capella University

NURSFPX4040: Managing Health Information and Technology

Instructor Name

August 1, 2019

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Technology in Nursing

Pulse oximetry is one of the most common methods of measuring the percentage of

oxygen saturation in blood (Narayen et al., 2016). Pulse oximeters play a crucial role in critical

care settings by detecting low levels of oxygen saturation. Pulse oximeters are also adopted by

anesthesiologists in recovery, emergency, and pediatric wards; operation theatres; and neonatal

units (Hendaus, et al., 2015). This annotated bibliography provides insight into how pulse

oximeters are used, their limitations and accuracy, and patient outcomes.

Annotated Bibliography

Hendaus, M. A., Jomha, F. A., & Alhammadi, A. H. (2015). Pulse oximetry in bronchiolitis: Is it

needed? Therapeutics and Clinical Risk Management, 11, 1573–1578.

https://doi.org/10.2147%2FTCRM.S93176

This article discusses the use of pulse oximetry in pediatric wards. The authors state that

hospitals in the United States admit a significant number of children every year with

bronchiolitis and other respiratory problems. These problems are usually monitored with

the help of a pulse oximeter, an instrument used to measure the saturation of oxygen in

the blood. Oxygen saturation levels are used by health care providers to evaluate a

patient’s respiratory status and are one of the deciding factors for a patient’s discharge.

Pulse oximetry is frequently used in pediatrics (in pediatric intensive care units and

pediatric wards) and in emergency departments. Pulse oximeters are used to monitor

oxygen saturation during resuscitations, while estimating perfusion, while detecting

pulsus paradoxus, and while screening infants for congenital heart disease. Though the

source does not fully explain why the limitations occur, it identifies several cases in

which pulse oximeters are likely to be inaccurate. Pulse oximeters have certain

Commented [A1]: Comprehensive information regarding the

types of pulse oximetry devices, selection criteria, decision makers,

and associated costs is not available in the selected papers. The two

types of pulse oximeters and their advantages over the others is

provided; however, information on the various types of pulse

oximeters is not available and the associated costs are not provided.

This paper does mention that this technique is cost-effective which

can fulfill the required criteria.

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limitations due to inadequate signals. Inadequate signals occur in cases of anemia, bright

external light, dark skin, nail polish, low perfusion, and intravenous dye. Pulse oximeters

show low readings in cases of venous pulsations such as severe right heart failure,

tricuspid regurgitation, and blood pressure cuffs or tourniquets above the site of the pulse

oximeter. Pulse oximeters might not detect hypoxemia in patients with elevated arterial

oxygen tension levels because of the sigmoidal shape of the oxyhemoglobin dissociation

curve. Also, pulse oximeters provide unreliable readings in cases of methemoglobinemia.

The source highlights several limitations, which will help readers exercise caution when

using pulse oximeters. However, despite these limitations, the use of pulse oximeters in

pediatrics is recommended because they are handy and allow for noninvasive measuring

of arterial oxygen saturation.

Jubran, A. (2015). Pulse oximetry. Critical Care, 19(1), 272.

https://doi.org/10.1186%2Fs13054-015-0984-8

This article provides insight into the principles, accuracy, functioning, and outcome of

pulse oximeters. It discusses the potential advantages of multiwavelength pulse oximeters

over conventional pulse oximeters. Multiwavelength pulse oximeters are capable of

estimating the blood levels of carboxyhemoglobin and methemoglobin, whereas

conventional pulse oximeters assume that dyshemoglobins such as carboxyhemoglobin

and methemoglobin are absent because they can only distinguish between hemoglobin

and oxyhemoglobin. Hence, physicians prefer to use multiwavelength pulse oximeters for

more accurate results. In hospital settings, the transfer rate from a postsurgical care floor

to the intensive care unit (ICU) is an important factor that influences the use of pulse

oximeters. The resource reviews a study by Ochroch et al. in which patients were Commented [A3]: Deals with criterion 3: Organizational factors

that influence the selection of a technology in health care setting.

Commented [A2]: Meets criterion 3 as it deals with

organizational factors that influence the selection of a technology in

health care setting.

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monitored by pulse oximeters either continuously (oximeter group) or intermittently

based on clinical needs as judged by a physician or a nurse (control group). The rate of

ICU transfers for pulmonary complications was lower in the oximeter group than in the

control group. Additionally, for patients who did require ICU transfers, the estimated cost

of treatment from enrollment to the completion of the study was lower for the oximeter

group ($15,481) than for the control group ($18,713) despite the patients in the oximeter

group being older and having higher comorbidity. The reduction in pulmonary transfers

to the ICU in the oximeter group was speculated to be the result of early recognition and

treatment of postoperative pulmonary complications. As cited in Jubran, another study by

Moller et al. indicates that anesthesiologists considered pulse oximetry to be of immense

value as it guides clinical management.

oximeters because they believe that maintaining oxygenation within limits might help

prevent irreversible injury. Pulse oximetry is, therefore, a key part of the standard

protocol for monitoring critically ill patients.

Narayen, I. C., Blom, N. A., Ewer, A. K., Vento, M., Manzoni, P., & te Pas A. B. (2016).

Aspects of pulse oximetry screening for critical congenital heart defects: When, how

and why? Archives of Disease in Childhood – Fetal and Neonatal Edition, 101(2),

F162–F167. http://doi.org/10.1136/archdischild-2015-309205

This article describes how pulse oximetry is being implemented worldwide for the

screening of critical congenital heart defects (CCHD). The use of pulse oximetry to

screen for CCHD is highly recommended because it is effective, quick, simple, and cost-

effective. The authors state that training parents and caregivers and using tools that are

computer based can improve pulse oximetry screening. Pulse oximetry helps detect

significant pathology and is reliable for keeping track of CCHD, which requires constant

Anesthesiologists recommend the use of pulse Commented [A4]: Deals with criterion 3: Organizational factors

that influence the selection of a technology in health care setting.

Commented [A5]: Fulfills the rubric criteria: Justify the

implementation and use of a selected technology in a health

care setting. And also fulfills: Describes organizational factors influencing

the selection of a technology in the health care setting.

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diagnosis and immediate medical intervention. In almost every infant with CCHD,

clinically undetectable hypoxemia is identified by pulse oximeters. Early studies of

neonatal pulse oximetry screening for CCHD showed accurate details. As a result, the

U.S. Secretary of Health and Human Services advised adding CCHD screening to the

recommended uniform screening panel. According to a meta-analysis of 13 screening

studies, pulse oximetry screening reported a specificity of 99.9 percent, a sensitivity of

76.5 percent, and a false positive rate of 0.14 percent. Therefore, the authors concluded

that the universal screening criteria were met by pulse oximetry screening. Pulse

oximetry screening shows no difference in accuracy when pre-ductal and post-ductal

pulse oximetry measurements are performed. The authors also observed that pulse

oximetry screening done 24 hours after birth increases the risk of late detection of CCHD

in infants but decreases the false positive rate. Therefore, the use of pulse oximeters can

be crucial for the early detection of CCHD and helps reduce mortality and improve

postoperative outcomes.

Nitzan, M., Romem, A., & Koppel, R. (2014). Pulse oximetry: Fundamentals and technology

update. Medical Devices: Evidence and Research, 7, 231–239.

https://doi.org/10.2147/MDER.S47319

This article offers comprehensive insight into how pulse oximetry works; particularly, it

looks at the techniques involved in measurement, the limitations of using the techniques,

and the accuracy that can be expected while determining oxygen saturation. Oxygen

saturation (SaO2) is the measurement of the percentage of oxygen in hemoglobin. Pulse

oximeters detect the significant decline of oxygen in the respiratory function of patients.

Measurements of oxygen saturation in pulse oximeters (SpO2) are often inaccurate when

Commented [A6]: Fulfills the rubric criteria: Justify the

implementation and use of a selected technology in a health

care setting.

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critically ill patients receive supplemental oxygen. The difference between SpO2 and

SaO2 determines the accuracy of a pulse oximeter. Though the outcome of pulse oximetry

in measuring SaO2 in sick patients is 3–4 percent inaccurate, pulse oximeters quickly

detect the abrupt drop of SpO2 in anesthetized patients and in patients in intensive care

units. Despite the limitations of pulse oximetry, SpO2 values obtained from the pulse

oximeter are considered reliable for the detection of deterioration in respiratory function.

Further, pulse oximetry has the advantage of being a noninvasive technique to measure

oxygen saturation. Studies suggest that pulse oximetry should not be the only method to

monitor SaO2 in the neonatal intensive care unit because of infants’ vulnerability to

retinopathy of prematurity, which is induced by the high partial pressure of oxygen in

arterial blood. The authors conclude that technological advancements in pulse oximeters

over the years have enabled them to diagnose and monitor patients better.

Conclusion

Despite their limitations, pulse oximeters are recommended for monitoring oxygen

saturation levels in patients with respiratory problems. The use of pulse oximeters helps reduce

the rate of pulmonary transfers of patients from a postsurgical floor to the ICU. They play a

crucial role in screening infants for CCHD, and therefore, the use of pulse oximeters in pediatric

wards is highly recommended. Pulse oximetry helps in the early detection of certain diseases,

thereby preventing irreversible damage to organs and reducing the rate of mortality. Pulse

oximeters are a cost-effective resource in hospitals. They can easily detect a significant decline

of oxygen in the respiratory function of patients. The rate of transfers to the intensive care unit

due to pulmonary complications was significantly lower in patients who were continuously

monitored using pulse oximeters than in patients who were intermittently monitored using pulse

Commented [A8]: Fulfills criteria 3: Describes organizational

factors influencing the selection of a technology in the health

care setting.

Commented [A7]: Fulfills the criteria: Justifies the

implementation and use of a selected technology in a health

care setting. Provides an in-depth and well-researched

analysis of the impact of the technology on quality care and

patient safety.

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oximeters. The readings obtained from pulse oximeters are reliable and help make immediate

adjustments to a patient’s oxygen supply, which can help prevent irreversible damage or death.

The limitations of conventional pulse oximeters are overcome by multiwavelength pulse

oximeters, which can estimate the levels of carboxyhemoglobin and methemoglobin in blood.

Medical practitioners in interdisciplinary teams, such as pediatricians, pulmonologists, and

anesthesiologists, can collectively use the readings obtained from pulse oximetry to assess the

condition of a patient before administering treatment. Hence, pulse oximetry is valuable in

hospital settings, helping medical practitioners decide the correct course of treatment and provide

immediate and effective care to patients.

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References

Hendaus, M. A., Jomha, F. A., & Alhammadi, A. H. (2015). Pulse oximetry in bronchiolitis: Is it

needed? Therapeutics and Clinical Risk Management, 11, 1573–1578.

https://doi.org/10.2147%2FTCRM.S93176

Jubran, A. (2015). Pulse oximetry. Critical Care, 19(1), 272.

https://doi.org/10.1186%2Fs13054-015-0984-8

Narayen, I. C., Blom, N. A., Ewer, A. K., Vento, M., Manzoni, P., & te Pas, A. B. (2016).

Aspects of pulse oximetry screening for critical congenital heart defects: When, how and

why? Archives of Disease in Childhood – Fetal and Neonatal Edition, 101(2), F162–

F167. http://doi.org/10.1136/archdischild-2015-309205

Nitzan, M., Romem, A., & Koppel, R. (2014). Pulse oximetry: Fundamentals and technology

update. Medical Devices: Evidence and Research, 7, 231–239.

https://doi.org/10.2147/MDER.S47319