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NURSING SCIENCE
Robotic Tutor for Nursing

By Shannan Hamlin, PhD, RN, Pam Qian, PhD and Vaibhav Unhelkar, PhD

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ursing is a science-based profession.
We must continually monitor and evaluate our practice to ensure our care remains evidence based. Nurses, the largest segment of the hospital workforce, have the most significant impact on reducing hospital-acquired infections, such as central line-associated bloodstream infections (CLABSI). Over the past decade, CLABSI rates have dramatically improved by implementing evidence-based prevention strategies1. However, this trend has reversed due to nursing shortages, including hospital-based nurse educators, and the long-term impact of COVID-192. We need innovative solutions for efficient and effective nursing education and skill acquisition.
Once a central line is placed, preventing infection becomes a nurse’s responsibility. The central line dressing change is a complex procedure prone to preventable errors that can result in a CLABSI. Maintaining sterility during the procedure is the greatest challenge for nurses, yet it is critical to prevent infection. Regular training and direct observation by expert nurses, with just-in-time coaching, ensure protocol adherence. Houston Methodist uses quarterly Infection Controls on Nursing (ICON) training with frequent dressing change observations to validate the maintenance of nursing skills.
ICON has been a success. Sterile technique compliance rates increased from 13% pre-ICON to 96% and higher post-ICON. Most importantly, patient CLABSI rates have consistently remained below the national benchmark since 2022. These results highlight the impact of quality nursing care on positive patient outcomes. With a shortage of expert nurses, maintaining ICON training while addressing other essential patient issues associated with nursing care is challenging.
In collaboration with Rice University, we explored robotic technology as an adjunct to traditional nurse-to-nurse training. After a lengthy exploratory phase, the central line dressing change emerged as a critical skill that could benefit from robot-assisted training. First, the procedure is performed frequently, and accuracy is essential for patient care. Second, the dressing change process is error-prone and can cause infection, with a higher risk of death.
Houston Methodist nurses have played a key role in developing the robot. All levels of nurses participated in workshops, think tanks, surveys, focus groups and, recently, interaction with the robot. This unique level of nurse engagement has facilitated nurse-centric technology advancement for patient care and outcomes. Preliminary data indicates that nurses have a more positive attitude toward robots and are more accepting of them in society.
Robotic tutoring assistance for nursing is a novel technological aid for nursing education. Involving nurses early in the design ensures that nursing values and patient-centered care remain at the forefront as technology advances, rather than just reacting to new technology that proclaims to help nurses.
References:
  1. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. Dec 28 2006;355(26):2725-2732.
  2. Fakih MG, Bufalino A, Sturm L, et al. Coronavirus disease 2019 (COVID-19) pandemic, central-line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts. Infect Control Hosp Epidemiol. Jan 2022;43(1):26-31.