Academic literature on the topic 'Bed-exit alarm'

Abstract Background Although a patient care system may help nurses handle patients’ requests or provide timely assistance to those in need, there are a number of barriers faced by nurses in handling alarms. Methods The aim of the study was to describe the implementation and experience of an innovative smart patient care system (SPCS). This study applied a cross-sectional descriptive design. We recruited 82 nurses from a medical center in Taiwan, with 25 nurses from a ward that had introduced an SPCS and 57 nurses from wards that used the traditional patient care system (TPCS). The major advantages of the SPCS compared to the TPCS include the specification of alarm purposes, the routing of alarms directly to the mobile phone; the capability of immediate communication via phone; and three-stage bed-exit alerts with low false alarm rate. Results Approximately 56% of nurses in the TPCS wards perceived that the bed-exit alert was easily ignorable, while this rate was reduced to 32% in the SPCS ward. The immediate communication via phone was considered as the most helpful function of the SPCS, with a weighted average score of 3.92/5, and 52% of nurses strongly agreed (5/5) that this function was helpful. The second-highest ranked function was the three-stage bed-exit alert, with an average score of 3.68/5, with approximately 24% of nurses strongly agreeing (5/5) that this function was helpful. The average response time using TPCS was 145.66 s while it was 59.02 s using the SPCS (P < .001). Among the 110 observed alarms in the SPCS ward, none of them were false bed-exit alarms. In comparison, among 120 observed alarms in the TPCS wards, 42 (35%) of them were false bed-exit alarms (P < .001). In this study, we found that 30.91% of alarms using SPCS were processed because nurses received and responded to the alert via mobile phone. Conclusions A smart patient care system is needed to help nurses make more informed prioritization decisions between responding to alarms and ongoing tasks and finally assist them in adjusting their work in various situations to improve work efficiency and care quality.

The first uncomfortable twinges started when I was a grad student, churning out my Master’s thesis on a laptop that I worked on at the library, in my bedroom, on the kitchen table, and at the coffee shop. By the last few months, typing was becoming uncomfortable for my arms, but as any thesis writer will tell you, your whole body is uncomfortable with the endless hours sitting, inputting, and revising. I didn’t think much of it until I moved on to a new city to start a PhD program. Now the burning that accompanied my essay-typing binges started to worry me more, especially since I noticed the twinges didn’t go away when I got up to chat with my roommate, or to go to bed. I finally mentioned the annoying arm to Sonja, a medical student friend of mine visiting me one afternoon. She asked me to pick up a chair in front of me, palms out. I did, and the attempt stabbed pain up my arm and through my elbow joint. The chair fell out of my hands. We looked at each other, eyebrows raised.Six months and much computer work later, I still hadn’t really addressed the issue. Who had time? Chasing mystery ailments around and more importantly, doing any less typing were not high on my likely list. But like the proverbial frog in slowly heated water, things had gotten much worse without my really acknowledging it. That is, until the day I got up from my laptop, stretched out and wandered into the kitchen to put some pasta on to boil. When the spaghetti was ready, I grabbed the pot to drain it and my right arm gave as if someone had just handed me a 200-pound weight. The pot, pasta and boiling water hit the floor with a scalding splash that nearly missed both me and the fleeing cat. Maybe there was a problem here.Both popular and critical understandings of the body have been in a great deal of flux over the past three or four decades as digital media technologies have become ever more pervasive and personal. Interfacing with the popular Internet, video games, mobile devices, wearable computing, and other new media technologies have prompted many to reflect on and reconsider what it means to be an embodied human being in an increasingly digitally determined era. As a result, the body, at various times in this recent history, has been theoretically disowned, disavowed, discarded, disdained, replaced, idealised, essentialised, hollowed out, re-occupied, dismembered, reconstituted, reclaimed and re-imagined in light of new media. Despite all of the angst over the relationships our embodied selves have had to digital media, of course, our embodied selves have endured. It remains true, that “even in the age of technosocial subjects, life is lived through bodies” (Stone 113).How we understand our embodiments and their entanglements with technologies matter deeply, moreover, for these understandings shape not only discourse around embodiment and media, but also the very bodies and media in question in very real ways. For example, a long-held tenet in both popular culture and academic work has been the notion that media technologies extend our bodies and our senses as technological prostheses. The idea here is that media technologies work like prostheses that extend the reach of our eyes, ears, voice, touch, and other bodily abilities through time and space, augmenting our abilities to experience and influence the world.Canadian media scholar Marshall McLuhan is one influential proponent of this notion, and claimed that, in fact, “the central purpose of all my work is to convey this message, that by understanding media as they extend man, we gain a measure of control over them” (McLuhan and Zingrone 265). Other more contemporary media scholars reflect on how “our prosthetic technological extensions enable us to amplify and extend ourselves in ways that profoundly affect the nature and scale of human communication” (Cleland 75), and suggest that a media technology such as one’s mobile device, can act “as a prosthesis that supports the individual in their interactions with the world” (Glitsos 161). Popular and commercial discourses also frequently make use of this idea, from the 1980’s AT&T ad campaign that nudged you to “Reach out and Touch Someone” via the telephone, to Texas Instruments’s claim in the 1990’s that their products were “Extending Your Reach”, to Nikon’s contemporary nudge to “See Much Further” with the prosthetic assistance of their cameras. The etymology of the term “prosthesis” reveals that the term evolves from Greek and Latin components that mean, roughly, “to add to”. The word was originally employed in the 16th century in a grammatical context to indicate “the addition of a letter or syllable to the beginning of a word”, and was adopted to describe “the replacement of defective or absent parts of the body by artificial substitutes” in the 1700’s. More recently the world “prosthesis” has come to be used to indicate more simply, “an artificial replacement for a part of the body” (OED Online). As we see in the use of the term over the past few decades, the meaning of the word continues to shift and is now often used to describe technological additions that don’t necessarily replace parts of the body, but augment and extend embodied capabilities in various ways. Technology as prosthesis is “a trope that has flourished in a recent and varied literature concerned with interrogating human-technology interfaces” (Jain 32), and now goes far beyond signifying the replacement of missing components. Although the prosthesis has “become somewhat of an all-purpose metaphor for interactions of body and technology” (Sun 16) and “a tempting theoretical gadget” (Jain 49), I contend that this metaphor is not often used particularly faithfully. Instead of invoking anything akin to the complex lived corporeal experiences and conundrums of prosthetic users, what we often get when it comes to metaphors of technology-as-prostheses is a fascination with the potential of technologies in seamlessly extending our bodies. This necessitates a fantasy version of both the body and its prostheses as interchangeable or extendable appendages to be unproblematically plugged and unplugged, modifying our capabilities and perceptions to our varying whims.Of course, a body seamlessly and infinitely extended by technological prostheses is really no body. This model forgoes actual lived bodies for a shiny but hollow amalgamation based on what I have termed the “disembodimyth” enabled by technological transcendence. By imagining our bodies as assemblages of optional appendages, it is not far of a leap to imagine opting out of our bodies altogether and using technological means to unfasten our consciousness from our corporeal parts. Alison Muri points out that this myth of imminent emancipation from our bodies via unity with technology is a view that has become “increasingly prominent in popular media and cultural studies” (74), despite or perhaps because of the fact that, due to global overpopulation and wasteful human environmental practices, “the human body has never before been so present, or so materially manifest at any time in the history of humanity”, rendering “contradictory, if not absurd, the extravagantly metaphorical claims over the past two decades of the human body’s disappearance or obsolescence due to technology” (75-76). In other words, it becomes increasingly difficult to speak seriously about the body being erased or escaped via technological prosthetics when those prosthetics, and our bodies themselves, continue to proliferate and contribute to the piling up of waste and pollution in the current Anthropocene. But whether they imply smooth couplings with alluring technologies, or uncoupling from the body altogether, these technology-as-prosthesis metaphors tell us very little about “prosthetic realities” (Sun 24). Actual prosthetic realities involve learning curves; pain, frustrations and triumphs; hard-earned remappings of mental models; and much experimentation and adaption on the part of both technology and user in order to function. In this vein, Vivian Sobchak has detailed the complex sensations and phenomenological effects that followed the amputation of her leg high above the knee, including the shifting presence of her “phantom limb” perceptions, the alignments, irritations, movements, and stabilities offered by her prosthetic leg, and her shifting senses of bodily integrity and body-image over time. An oversimplistic application of the prosthetic metaphor for our encounters with technology runs the risk of forgetting this wealth of experiences and instructive first-hand accounts from people who have been using therapeutic prosthetics as long as assistive devices have been conceived of, built, and used. Of course, prosthetics have long been employed not simply to aid function and mobility, but also to restore and prop up concepts of what a “whole,” “normal” body looks like, moves like, and includes as essential components. Prosthetics are employed, in many cases, to allow the user to “pass” as able-bodied in rendering their own technological presence invisible, in service of restoring an ableist notion of embodied normality. Scholars of Critical Disability Studies have pushed back against these ableist notions, in service of recognising the capacities of “the disabled body when it is understood not as a less than perfect form of the normative standard, but as figuring difference in a nonbinary sense” (Shildrick 14). Paralympian, actress, and model Aimee Mullins has lent her voice to this cause, publicly contesting the prioritisation of realistic, unobtrusive form in prosthetic design. In a TED talk entitled It’s Not Fair Having 12 Pairs of Legs, she showcases her collection of prosthetics, including “cheetah legs” designed for optimal running speed, transparent glass-like legs, ornately carved wooden legs, Barbie doll-inspired legs customised with high heel shoes, and beautiful, impractical jellyfish legs. In illustrating the functional, fashionable, and fantastical possibilities, she challenges prosthetic designers to embrace more poetry and whimsy, while urging us all to move “away from the need to replicate human-ness as the only aesthetic ideal” (Mullins). In this same light, Sarah S. Jain asks “how do body-prosthesis relays transform individual bodies as well as entire social notions about what a properly functioning physical body might be?” (39). In her exploration of how prostheses can be simultaneously wounding and enabling, Jain recounts Sigmund Freud’s struggle with his own palate replacement following surgery for throat cancer in 1923. His prosthesis allowed him to regain the ability to speak and eat, but also caused him significant pain. Nevertheless, his artificial palate had to be worn, or the tissue would shrink and necessitate additional painful procedures (Jain 31). Despite this fraught experience, Freud himself espoused the trope of technologically enhanced transcendence, pronouncing “Man has, as it were, become a prosthetic god. When he puts on all his auxiliary organs, he is truly magnificent.” However, he did add a qualification, perhaps reflective of his own experiences, by next noting, “but those organs have not grown on him and they still give him much trouble at times” (qtd. in Jain 31). This trouble is, I argue, important to remember and reclaim. It is also no less present in our interactions with our media prostheses. Many of our technological encounters with media come with unacknowledged discomforts, adjustments, lag, strain, ill-fitting defaults, and fatigue. From carpal tunnel syndrome to virtual reality vertigo, our interactions with media technologies are often marked by pain and “much trouble” in Freud’s sense. Computer Science and Cultural Studies scholar Phoebe Sengers opens a short piece titled Technological Prostheses: An Anecdote, by reflecting on how “we have reached the post-physical era. On the Internet, all that matters is our thoughts. The body is obsolete. At least, whoever designed my computer interface thought so.” She traces how concentrated interactions with computers during her graduate work led to intense tendonitis in her hands. Her doctor responded by handing her “a technological prosthesis, two black leather wrist braces” that allowed her to return to her keyboard to resume typing ten hours a day. Shortly after her assisted return to her computer, she developed severe tendonitis in her elbows and had to stop typing altogether. Her advisor also handed her a technological prosthesis, this time “a speech understanding system that would transcribe my words,” so that she could continue to work. Two days later she lost her voice. Ultimately she “learned that my body does not go away when I work. I learned to stop when it hurt […] and to refuse to behave as though my body was not there” (Sengers). My own experiences in grad school were similar in many ways to Sengers’s. Besides the pasta problem outlined above, my own computer interfacing injuries at that point in my career meant I could no longer turn keys in doors, use a screwdriver, lift weights, or play the guitar. I held a friend’s baby at Christmas that year and the pressure of the small body on my arm make me wince. My family doctor bent my arm around a little, then shrugging her shoulders, she signed me up for a nerve test. As a young neurologist proceeded to administer a series of electric shocks and stick pins into my arms in various places, I noticed she had an arm brace herself. She explained that she also had a repetitive strain injury aggravated by her work tasks. She pronounced mine an advanced repetitive strain injury involving both medial and lateral epicondylitis, and sent me home with recommendations for rest, ice and physiotherapy. Rest was a challenge: Like Sengers, I puzzled over how one might manage to be productive in academia without typing. I tried out some physiotherapy, with my arm connected to electrodes and currents coursing through my elbow until my arm contorted in bizarre ways involuntarily. I tried switching my mouse from my right side to my left, switching from typing to voice recognition software and switching from a laptop to a more ergonomic desktop setup. I tried herbal topical treatments, wearing an extremely ugly arm brace, doing yoga poses, and enduring chiropractic bone-cracking. I learned in talking with people around me at that time that repetitive strains of various kinds are surprisingly common conditions for academics and other computer-oriented occupations. I learned other things well worth learning in that painful process. In terms of my own writing and thinking about technology, I have even less tolerance for the idea of ephemeral, transcendent technological fusions between human and machine. Seductive slippages into a cyberspatial existence seem less sexy when bumping your body up against the very physical and unforgiving interface hurts more with each keystroke or mouse click. The experience has given me a chronic injury to manage carefully ever since, rationing my typing time and redoubling my commitment to practicing embodied theorising about technology, with attention to sensation, materiality, and the way joints (between bones or between computer and computant) can become points of inflammation. Although pain is rarely referenced in the myths of smooth human and technological incorporations, there is much to be learned in acknowledging and exploring the entry and exit wounds made when we interface with technology. The elbow, or wrist, or lower back, or mental health that gives out serves as an effective alarm, should it be ignored too long. If nothing else, like a crashed computer, a point of pain will break a flow of events typically taken for granted. Whether it is your screen or your pinky finger that unexpectedly freezes, a system collapse will prompt a step back to look with new perspective at the process you were engaged in. The lag, crash, break, gap, crack, or blister exposes the inherent imperfections in a system and offers up an invitation for reflection, critical engagement, and careful choice.One careful choice we could make would be a more critical engagement with technology-as-prosthesis by “re-membering” our jointedness with technologies. Of course, joints themselves are not distinct parts, but interesting articulated systems and relationships in the spaces in-between. Experiencing our jointedness with technologies involves recognising that this is not the smooth romantic union with technology that has so often been exalted. Instead, our technological articulations involve a range of pleasures and pain, flows and blockages, frictions and slippages, flexibilities and rigidities. I suggest that a new model for understanding technology and embodiment might employ “articulata” as a central figure, informed by the multiple meanings of articulation. At their simplest, articulata are hinged, jointed, plural beings, but they are also precarious things that move beyond a hollow collection of corporeal parts. The inspiration for an exploration of articulation as a metaphor in this way was planted by the work of Donna Haraway, and especially by her 1992 essay, “The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others,” in which she touches briefly on articulation and its promise. Haraway suggests that “To articulate is to signify. It is to put things together, scary things, risky things, contingent things. I want to live in an articulate world. We articulate; therefore we are” (324). Following from Haraway’s work, this framework insists that bodies and technologies are not simply components cobbled together, but a set of relations that rework each other in complex and ongoing processes of articulation. The double-jointed meaning of articulation is particularly apt as inspiration for crafting a more nuanced understanding of embodiment, since articulation implies both physiology and communication. It is a term that can be used to explain physical jointedness and mobility, but also expressive specificities. We articulate a joint by exploring its range of motion and we articulate ideas by expressing them in words. In both senses we articulate and are articulated by our jointed nature. Instead of oversimplifying or idealising embodied relationships with prostheses and other technologies, we might conceive of them and experience them as part of a “joint project”, based on points of connexion that are not static, but dynamic, expressive, complex, contested, and sometimes uncomfortable. After all, as Shildrick reminds us, in addition to functioning as utilitarian material artifacts, “prostheses are rich in semiotic meaning and mark the site where the disordering ambiguity, and potential transgressions, of the interplay between the human, animal and machine cannot be occluded” (17). By encouraging the attentive embracing of these multiple meanings, disorderings, ambiguities, transgressions and interplays, my aim moving forward is to explore the ways in which we might all become more articulate about our articulations. After all, I too want to live in an articulate world.ReferencesAT&T. "AT&T Reach Out and Touch Someone Commercial – 1987." Advertisement. 13 Mar. 2014. 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