Nurses and Engineers Join Forces to Revolutionize Health Care

Visit any hospital in the country, and you’re likely to see one piece of equipment at the bedside of nearly every patient: an IV smart pump. This infusion device is a computerized version of the traditional IV, equipped with a drug library meant to protect against potentially dangerous errors in delivering drugs. Yet, today’s smart pumps have user interfaces that are not easy to use, increasing both the time it takes to use them and the rate of IV administration error, according to Karen Giuliano, professor in the Elaine Marieb College of Nursing and the Institute for Applied Life Sciences (IALS) at UMass Amherst.

“The most ubiquitous piece of equipment used in critical care doesn’t work well,” she said.

Giuliano saw firsthand these challenges with IV smart pumps—and so many other medical devices—when she was a critical care nurse at Baystate Medical Center in Springfield. There, she became interested in how medical device innovation could “improve the delivery of care for nurses and the experience of care for patients and their families.” She realized it was vitally important for nurse end users to be involved in the development of health care technology from the earliest stages—not simply given new devices once the product was complete. “As the largest group of health care providers in the country, nurses use more products than any other health care professional and thus have unique insights on developing and designing medical products,” she said.

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This notion inspired UMass Amherst to establish the Elaine Marieb Center for Nursing and Engineering Innovation. Formed in January 2021 with a seed grant from alumni Theresa and Michael Hluchyj (a nurse and engineer, respectively), the center was soon expanded thanks to a major gift from the Elaine Nicpon Marieb Charitable Foundation. A partnership between UMass Amherst’s Elaine Marieb College of Nursing and College of Engineering, and co-directed by Giuliano and Frank Sup, associate professor in the Department of Mechanical and Industrial Engineering, it is believed to be the first center at a university focused on nursing and engineering innovation.

According to Sup, UMass Amherst has a long tradition of collaboration between engineers and nurses. He has collaborated with nursing faculty on developing assistive technologies to help patients with physical movement and rehabilitation. With the center, UMass hopes to formalize and expand such interdisciplinary collaborations, leveraging the expertise and insights of both professions to address health care challenges at the forefront of patient care. Through clinical and industry partnerships, the center is working to quickly develop, test, and deploy new life science technologies and solutions that can lead to meaningful improvements in health care. The center also provides hands-on training to the next generation of nurses and engineers.  

Already, in less than two years, the center has gained attention for its contributions. It was named a 2022 “Healthcare Hero” by BusinessWest.com, and its researchers have been awarded top honors and funding support for their work.

From left, Juan Jiménez, Karen Giuliano, and Jeannine Blake working in the IV Smart Pump laboratory. Their program of research is focused on both usability and flow rate accuracy, with the goal of improving the overall safety of IV medication administration in acute care.

Opening the Door to Innovation

The center’s “Network of Innovation” includes nursing and engineering faculty, undergraduate and graduate students, and postdoctoral fellows, all participating in interdisciplinary research. In UMass Amherst’s Life Science Laboratories, where IALS is housed, the center has established a Product Usability Lab along with additional lab space for product testing and other research. The proximity to other researchers working in a variety of fields allows for cross-pollination and has led to new partnerships. To test usability of products in development, the researchers also use the nursing college’s Clinical Simulation Lab, and a simulation lab at UMass Amherst Center at Springfield.

The center has several major research initiatives—including projects on IV smart pumps and robotic technology in nursing—and also supports projects in development by other nurse-engineer teams, including providing financial support through its pilot grant program. Recent examples of such projects include the development of non-contact, pain-free monitoring devices for adults, and of handheld tablets to assist with lifestyle changes for patients with osteoarthritis.

The center also sponsors many interdisciplinary training and research experiences for engineering and nursing students—whether as research assistants, honors students working on theses, or interns through the Core Summer Internship Program. These experiences will shape students’ thinking as they enter the workforce and prepare them with skills to lead in interdisciplinary innovation, said Giuliano.

“The nursing students will no longer be satisfied with the status quo. They're going to expect a lot more from medical manufacturers and clinical environments to meet their needs, as well as their patients’ needs,” she said. “And the engineers are going to realize that in addition to their technical skills, the hands-on operational knowledge and experience of nurses is a fundamentally important part of medical product development."

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Avery Minkin ‘23, a mechanical engineering major, is working on his honors thesis research through the center, studying the effectiveness of motion capture tools in giving feedback to nurses during procedures like intramuscular injections. Minkin and center graduate students, Gina Georgadarellis and Seonhun Lee, are contributing engineering knowledge to the project, while collaborating nursing faculty and students bring nursing expertise. After graduating, Minkin hopes to create products that combine mechanical and electronic components to benefit an end user, and said, “This research has given me the opportunity to go outside the walls of typical engineering applications/projects, collaborate with other professionals, and problem solve to hopefully improve lives.”

Valerie Casimir ‘25, a student in the Elaine Marieb College of Nursing, contributed to the IV Smart Pump research, in collaboration with a senior undergraduate engineering student, Braedon Fedderson, through the Core Summer Internship Program in 2022. “This research showed me the importance of interdisciplinary collaboration, and really opened my eyes to a lot of different issues that can affect patient safety,” she said. “When I am doing clinical work now, I find myself thinking critically about how to make things safer and better for the patient. It definitely sparked my interest in doing research—something I never thought I would enjoy—in the future.”

Research to Improve the Future of Health Care

The center’s research initiative focused on IV smart pumps is led by Giuliano together with Juan Jiménez in mechanical and industrial engineering and Jeannine Blake, a UMass Amherst PhD graduate in nursing and a postdoctoral fellow in Jiménez’s lab.  

According to Blake, adverse events associated with IV smart pumps are among the most frequent sources of error related to medical technology reported to the U.S. Food and Drug Administration (FDA).  When the researchers tested the IV pumps using setups in the lab observed during actual clinical use, they found differences between the IV flow rates programmed into the pumps and the flow of medications actually delivered. This difference likely contributes to significant undetectable IV medication error during actual clinical use in the hospital, something this team intends to study further in partnership with Baystate Medical Center.

“Unfortunately, this is just one example of a device that may work well in the isolation of a product development lab, but the usability does not translate to the clinical environment, and that can lead to serious concerns for patient safety,” said Blake. The team’s research aims to improve the usability and functionality of IV smart pumps in hospitals.

“We believe our work will lead to changes in standards at the national level,” said Giuliano, whose paper with Blake on IV smart pump clinician knowledge was named the Association for the Advancement of Medical Instrumentation (AAMI)’s Best Research Paper in 2021.

Another major research thrust at the center is robotic technology in nursing, an initiative led by Sup and Tracey Cobb, clinical instructor in nursing. Robots are currently used in health care settings to perform repeated tasks with precision, such as assisting with surgical procedures, and Sup anticipates their use to expand in coming decades working alongside nurses—whether for delivering supplies and medications, disinfecting surfaces, or assisting patients with mobility. He said it’s important to be thoughtful and collaborative in developing technologies that will be effective and welcomed in health care settings.

In partnership with Baystate, the UMass researchers have conducted clinician surveys and focus groups to gain insights on the challenges confronting health care providers and to understand how robotic technology may be able to help. They’re also sharing information (including the video below) with the providers about possible uses of robots in health care, and learning about their perceptions of robots.

“There are privacy, safety, and liability issues to consider. We also know that what makes sense on paper may not work in real health care settings,” said Sup. “We want to find solutions that can be used ethically and respectfully, leveraging the skills of nurses and other health care providers in ways that reduce stress and burnout and help mitigate the effects of nursing shortages."

The center’s partnership with Baystate also includes a group of engineering capstone students using a systems approach to study the problem of patient falls, and a collaboration with Baystate’s human resources staff using big data to optimize staff nurse satisfaction and retention. Students in the Core Summer Internship Program will work at Baystate Medical Center this summer on clinical issues, including safe patient handling, medication dispensing safety and efficiency, pressure injury in critical care, and more.

Cidalia Vital, nurse scientist at Baystate who works closely with the UMass researchers, said, "The research collaboration between Baystate and UMass Amherst supports the advancement of nursing and engineering science at the point of care with a real-world perspective. I believe it could have a real impact on the health care system."

In September 2022, the center hosted its inaugural symposium convening experts in academia, health care, and industry. The program highlighted the paradigm-shifting potential of nurse-engineer collaborations and the power of industry-academic partnerships to drive innovation for the health care industry.

Going forward, the center aims to foster industry partnerships in order to develop and spin out intellectual property. The center is also poised to expand its impact outside the country. Giuliano received a Fulbright U.S. Scholar Program Award in Nursing and Public Health Care to work as a visiting research professor at Edinburgh Napier University (ENU) School of Health and Social Care in Scotland in the 2023–24 academic year. There, she will develop curriculum to prepare nurses and other frontline care providers to lead health care and technology innovation.

This story was originally published in April 2023.

(All photos by Jon Crispin).