Office of Research and Scholarship Newsletter: March 2024

Interview with EMCON's Dr. Karen Giuliano.

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Introduction

Greetings!

The Office of Research and Scholarship is pleased to kick-start a quarterly newsletter with an interview from Professor Karen Giuliano, and a selection of the most recent faculty publications.

Please join us in fostering a vibrant scholarly community!

Interview with Karen Giuliano

Office of Research and Scholarship: Dr. Giuliano, as a jointly appointed Professor in the Elaine Marieb College of Nursing & the Institute for Applied Life Sciences at the University of Massachusetts Amherst and Co-Director of the Elaine Marieb Center for Nursing and Engineering Innovation, can you please share what led you to your area of work?

Dr. Karen Giuliano: As far back as I can remember, I have been driven by a deep curiosity about how things work. My father was a tireless tinkerer who could transform any object into a tool, always looked for better ways of doing things, and had a special knack for making work seem like play. These early experiences provided me with a determined “can-do” attitude, a habit of questioning the status quo, a tolerance for failure, and a restless impatience when told that things “have always been done this way.” My nursing practice has always included a propensity to play with ideas and do things differently, and my practice and clinical research interests are largely driven by a passionate desire to improve the delivery of care for nurses and the experience of care for patients and their families.

Throughout this unconventional journey, from a critical care staff nurse to my current role as tenure-track faculty at the University of Massachusetts Amherst, I have had many opportunities to participate in interdisciplinary clinical outcomes research and medical product development as a staff nurse, clinical nurse specialist, and project lead from the clinical, industry, and academic perspectives. While passionate about my central clinical research interests in technology innovation and its responsible use in critical and acute care, the foundation of this approach is dedicated to the values and lessons of my earliest experiences in critical care bedside nursing: supporting and preserving the dignity and humanity of person-centered patient care. Early in my career as a critical care nurse, I realized how vitally important a nursing perspective could be in the design of technology for meeting the critical care needs of patients, nurses, and other professionals who provide this care. As the nation’s largest group of health care professionals, nurses use more products than any other health care professional, and thus nurses have a uniquely practical and care-sensitive perspective on the development and design of medical products. Nurses are in a unique position to identify and address everyday health care issues, challenge assumptions and the status quo, address unrecognized and unarticulated needs, and ensure that clinical outcomes research serves as the foundation for validating the effectiveness of any proposed healthcare innovation. In my current roles as a researcher and co-Director of the Elaine Marieb Center, our hope is to share the lessons I learned along the way and to help other nurses see the value of their knowledge in improving healthcare and patient outcomes through interdisciplinary innovation.  

Karen Giuliano
Karen Giuliano.

ORS: That’s a great origin story. Is there anything specific about your current work that you would like to highlight? 

KG: As a clinical nurse specialist at Baystate Medical Center in the 1990’s, the first technology evaluation project we initiated was to compare the accuracy of tympanic and electronic oral thermometers in intubated patients. The hospital purchasing department began a clinical trial of tympanic thermometers without input from clinicians. In the absence of effectiveness data, the plan was to implement the tympanic thermometers and remove the electronic oral thermometers in current clinical use. When the nursing staff tried the tympanic thermometers, their impression was that they were not as accurate or as easy to use as the electronic oral thermometers. They described how they “just knew in their gut” that this was not the right decision. Although I thought they were probably right, my response was “the gut’s not going to tell administration not to buy those thermometers!” We quickly formed a project team, asked for a hold on the purchase, wrote a research proposal designed to measure the clinical effectiveness of tympanic thermometers against the gold standard of pulmonary artery core temperature, obtained approval from the institutional review board and funding, and completed our first research study together. This study was quickly followed by a second study addressing the same issue. Both studies were published in highly regarded journals, remain some of our most frequently cited articles, and, most significantly, no tympanic thermometers were ever purchased! End-user experience matters, although it is too often relegated to an afterthought or anecdote in the absence of credible empirical evidence. In this case, we challenged the precedent of administrative decision-making without nursing end-user input.

During and since my tenure at Baystate Medical Center, I have had opportunities to work on numerous technology development projects. As reflected in both publications and presentations, I have dedicated myself to clinical research designed to answer practical questions on the use and performance of a variety of critical care practices and technologies. Examples include “How can we improve accuracy in medication infusion calculations?” “What is the best practice for central venous pressure measurement accuracy?” “Can we use oral thermometry with intubated patients?” “Can the use of point-of-care blood analyses improve patient care and be cost-effective?” “Can continuous cardiac output measurement be done accurately without placing the patient fl at in bed?” “Can a program of continuous veno-venous hemofiltration be safely developed and implemented by critical care nurses?” “What are best practices for 12-lead electrocardiography (ECG) and cardiac monitoring?” “ Do clinical differences exist among different pulse oximetry (SpO2) technologies?” “What is the best method for early detection of sepsis?” and, most recently, “Can the use of improved oral care reduce the incidence of nonventilator hospital-acquired pneumonia?” and “Can we improve the safety of IV medication infusion with IV smart pumps?” Since the first publication in 1990, we remained active in disseminating our collaborative work through peer-reviewed publication and national and international interdisciplinary conference presentations with nursing with the hope of helping to narrow the research to practice gap.

ORS: Your work is filling such an important gap in the science. What is coming up next for you? 

KG: The collective health of both our nation and the globe provides the foundation for all individuals to thrive and be fully contributing members of society. There is an urgent need for a radical shift in the way U.S. healthcare is designed, delivered, paid for, and distributed. Finding effective solutions to these challenges presents a unique opportunity to reshape society towards a more equitable, effective, and sustainable system of healthcare. We see interdisciplinary collaboration, beginning with nurse-engineer teams, as the key to providing a foundation for addressing the formidable challenge of improving healthcare.  

In 2019, the U.S. spent almost 17 percent of its GDP on healthcare—more than any other high-income country—yet ranked last in most important healthcare outcomes, access to care, administrative efficiency, and equity. The U.S. healthcare system faces a myriad of challenges that are ready for disruption and the integration of technology. Traditional healthcare education does not include exploring innovation as part of its curriculum. Unfortunately, nurses most often operate in silos and rarely cross paths with individuals trained to transition ideas to prototypes and testable solutions. The Elaine Marieb Center hopes to change that! Teaming engineers with nurses will create interdisciplinary teams capable of identifying and solving real-world healthcare problems. We hope to empower the next generation of nurses as healthcare innovation leaders who recognize the value of interdisciplinary collaboration and patient-centered clinical outcomes for developing effective and transformative innovations in healthcare.  

ORS: What are some of the challenges and lessons you have learned along the way? 

KG: The biggest challenge is constantly being told “no”. However, at the same time as being told “no”,  we have learned some important lessons along the way: make patient care and end-user needs a centerpoint of the work; be passionate and follow your passion; take advantage of the opportunities you are given—do not let fear or uncertainty stop you; work with groups, be interdisciplinary and collaborative; view others success as important as your own, openly share anything in your work that can help others, take every chance you can to mentor and be mentored; share success and never miss an opportunity to celebrate the success of others; be persistent—never take no for an answer (well, almost never… 😊); and have FUN!

ORS: Some very nice rules to live by. As a final question, could you share what are you hoping to do in the next three to five years?

KG: We have a very specific goal in mind by September 1st, 2029. We would like to see the Elaine Marieb Center for Nursing and Engineering Innovation be financially and operationally efficient, effective, and sustainable. We hope to make our vision so compelling that we continue to increase success in obtaining endowed donor funds. We're trying to build business operations that don't have a lot of rules. I can't stand being crushed by rules. However, always remember that rules tell you what you CAN’T do, but they don’t define what you CAN do-hah! This also includes establishing a steady research infrastructure so that we can increase our grants and the broadest interest and engagement in the Center. We are working hard toward all of these goals and thank you for the opportunity to be highlighted in the first issue of the Research Newsletter!

A Selection from Recent Publications