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The Nurse-­Engineer: A New Role to Improve Nurse Technology

Interface and Patient Care Device Innovations


Mary Ellen Smith Glasgow, PhD, RN, ACNS-BC, ANEF, FAAN1, Alison Colbert, PhD, PHCNS-BC2,
John Viator, PhD3, & Stephen Cavanagh, RN, PhD, MPA, FRSPH, FInstLM, FAAN4
1 Nu Eta, Dean and Professor, Duquesne University, Pittsburgh, PA, USA
2 Epsilon Phi, Associate Dean of Academic Affairs and Associate Professor, Duquesne University, Pittsburgh, PA, USA
3 Professor and Director, Biomedical Engineering Program, Duquesne University, Pittsburgh, PA, USA
4 Dean and Professor of Nursing, University of Massachusetts, Amherst, Amherst, MA, USA

Key words Abstract


Nurse-engineer, technology, patient care
devices, innovation Purpose: The purpose of this article is to describe two innovative bio-
medical engineering and nursing collaborations designed to educate a new
Correspondence cadre of professionals and develop new knowledge and innovations (robots,
Dr. Mary Ellen Smith Glasgow, Duquesne patient care devices, and computer simulation).
University, School of Nursing, 600 Forbes Organizing Construct: Complex health problems demand a highly skilled
Avenue, Fisher Hall, 540B, Pittsburgh, PA
response that uses teams of professionals from various disciplines. When
15282.
the biomedical engineering lens is expanded to include the practical per-
E-mail: glasgowm@duq.edu
spective of nursing, opportunities emerge for greater technology–nurse
Accepted June 27, 2018 interface and subsequent innovation. A joint nursing-­ engineering degree
program provides the ideal preparation for a well-­informed nurse-­engineer
doi:10.1111/jnu.12431 who can explore new and innovative solutions that will improve care and
patient outcomes.
Approach: A review of the literature provides the background on innova-
tion and engineering in nursing and a rationale for the development of
two innovative joint degrees, as well as a description of those programs.
Findings: These innovative programs will advance healthcare-­related tech-
nology and maximize the potential contribution of the nursing profession
in the design and implementation of creative solutions. They also have
the potential to increase the skills and knowledge for students enrolled in
biomedical engineering or Bachelor of Science in nursing programs indi-
vidually, providing them with interdisciplinary training and exposure.
Clinical Relevance: Important patient care improvement opportunities
are missed when nurses are not actively engaged in patient care device
innovation and creation. Innovative nurse and engineer collaborations are
needed in various forms to leverage nurse ingenuity and create patient
care innovations.

Biomedical engineering emerged during the 1960s out nursing care is vital to making those advancements
of concern for patient safety, especially as it related clinically meaningful and efficient. A biomedical engi-
to the potential electric shock hazards of medical devices neering background would greatly enhance a nurse’s
(Shaffer & Shaffer, 1992). Today, biomedical engineers ability to interface with technology and create technical
are charged with advancing healthcare for diagnostic solutions such as robots, patient care devices, or com-
and therapeutic purposes (Bhat & Kumar, 2013). Those puter simulation for patient care needs and nursing
professionals are designing solutions to problems across care delivery. Conversely, a healthcare background
the spectrum of health care, including direct care sur- with requisite clinical experience would greatly en­
gical robots, rehabilitation devices, and workflow hance a biomedical engineer’s ability to solve clinical
enhancers—and expertise in both engineering and problems.

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The Nurse-­Engineer Glasgow et al.

An innovative approach to solving clinical problems single application area, but is a discipline defined by
that combines both perspectives has the potential to mathematical methods and an inherent philosophy of
cause a significant paradigm shift in patient care inno- analyzing and designing solutions at the holistic, or
vations, nursing practice, and healthcare overall. When systems, level. Thus, systems engineering overlaps with
nurses learn about existing healthcare delivery practices all engineering disciplines, including biomedical engi-
and tools from the traditional nurse perspective and neering as applied to nursing practice in this article.
through the lens of a biomedical engineer, opportuni-
ties emerge for greater technology–nurse interface and
Changes in Technology
subsequent innovation. Nurses with this expanded
education and training will have the ability to be Health care continues to experience unprecedented
involved in all phases of biomedical innovation—from change that has witnessed the move to increased care
the identification of the clinical problem, through the in the community, the care of populations, and the
development of a technical solution, to clinical out- growth of walk-­in clinics staffed by nurse practitioners.
comes evaluation (PR Newswire, 2014). Ultimately, As Huston (2013) observed, however, it is the adop-
these nurses will have knowledge and a unique world- tion of new technologies that will have the greatest
view to create technologies that improve health out- impact on nursing and the way that nurses care for
comes, create efficiencies, and decrease medical errors. patients and patient outcomes. It is expected that the
The purpose of this concept paper is review what is pace of change will increase as new models of care
known about formal collaborations between nursing are developed and pressures to stem the rising cost
and engineering and to introduce two innovative joint of care continue to mount. The need to align antici-
degree programs in nurse-­ engineering. pated technological advances, capital investment, patient
Partnerships between health and engineering are not outcomes, and cost savings has resulted in a number
new and there have been highly successful collabora- of “futurist” predictions of what health care will look
tions between medicine and engineering, culminating like, for example, “Healthcare and Life Sciences
in the development of the pacemaker (1958), the CT Predictions 2020” (Deloitte, 2014). Many of these pre-
scanner (1970), and slow-­ release medicines (1980). dictions are already available to clinicians, including
Despite these life-­saving advances and improvements wearable monitoring devices, personalized genetic inter-
to patient quality of life and independence, there con- ventions, the adoption of machine-­learning into diag-
tinue to be challenges with the safety, continuity, nostic and treatment practices, and robotic medical
efficiency and cost effectiveness of health care. One and social applications. All this is in addition to the
of the reasons suggested for this is the view that our continued development of electronic health records and
healthcare system is fragmented, a cottage industry the creation of distributed networks of information
that is not a coordinated system at all but rather a across sites and providers. These technologies create
collection of parts working together (Compton & Reid, new avenues for research and clinical practice. What
2008). To bring about change and optimize a system, is less well articulated is how the nursing workforce
there is only so much improvement that can be achieved can be more actively involved in this technology-­
by the improving of parts such as rules, regulation, dependent future.
procedures, and controls (Compton & Reid, 2008).
There also needs to be more collaboration at the inter-
Nursing
face of scientific and professional disciplines. To bring
about change and reform to our health services we Nursing care is becoming increasingly more compli-
must draw upon the skills, resources, and experiences cated as well. Ebright (2010) suggested this is not
of scientists, engineers, and, increasingly, nurses. due just to increased patient acuity and related com-
It is important to note that this approach is new, plexity of care, but also because of the adoption of
and thus the vocabulary and nomenclature for the new technologies that can impact the organizing, pri-
joint specialty is still evolving. In this discourse, we oritizing, and decision making of nursing care delivery.
describe methods from engineering, particularly bio- Huston (2013) has said that the greatest challenges
medical and systems engineering. While these fields for nurses include the integration of new technologies
are not synonymous, there is significant overlap in into practice and managing the human technology
these two interdisciplinary areas. Biomedical engineer- interface. There are also myriad ethical and data secu-
ing, like many of the academic fields of engineering, rity issues. Concerns over technology in health care
is applied to a particular area, namely human health. and the impact this can have on patients and nursing
In contrast, systems engineering is not limited to a care have been heard for some time (Henderson, 1985)

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and continue today, as seen with Carol Huston’s (per- problems; however, nurses focus on the “art of caring”
sonal communication, 2017) American Nurses Asso­ and “practice of health promotion,” while engineers focus
ciation webinar “Touch Vs Tech: Leading Care in a upon the “art of design” and the “practice of building”
Technology-­ Driven Environment Without Losing the (Oerther, 2017). Hendrickson (1993) advanced the idea
Human Touch.” Nurses are working within a rapidly that a new professional was needed, the nurse-­engineer,
changing environment, and one where there are oppor- to specify, build, and educate practitioners and patients
tunities to engage technologies to improve patient in the use of information systems. This idea was the
outcomes (Tiffin, 2013). topic of further discussion by Eisenhauer (2015), who
The future of nursing care will require nurses to advocated for the creation of a new discipline, nursing
become more than just sophisticated users of technol- engineering, along the lines of biomedical engineering
ogy. The changing clinical nursing environment requires instead of the combination of two distinct disciplines:
a more proactive role for nurses in research and design, nursing and biomedical engineering. Eisenhauer argued
and in the policy and practice issues that surround that we do not currently have an integrated educational/
new health devices and care modalities. In an era professional program to view nurse-­ engineering as a
that expects multidisciplinary education and practice, full discipline but rather a meshing of nursing to a
nursing collaborations with less traditional professional technical degree. To date, no universities have created
partners—including engineers—are becoming increas- an entirely new discipline, namely nurse-­ engineering,
ingly important. Two recent examples of these innova- but a few universities have created unique collaborations
tive partnerships are a first-­ generation telerobotic or joint degrees to improve patient experiences or im­
intelligent nursing assistant, designed by Duke University provement of healthcare system efficiencies.
nursing and engineering students after the Ebola out- Building on these ideas, the role of a nurse-­engineer
break in 2014. The telerobotic intelligent nursing assis- for the future of health care will need to encompass
tant serves as an alternative to human contact that (a) designing and implementing new equipment, tech-
diminishes the risk to healthcare providers caring for nologies, and systems; (b) creating safe patient care
patients with infectious diseases. Although the telero- environments; (c) ensuring that there is an ethical
botic intelligent nursing assistant is still in the initial and data security framework for care; and (d) devel-
development phases, nurses and engineers hope to oping effective communication strategies and messaging
create a better interface between humans and robots for practitioners, patients, and their caregivers. There
to provide care using fine motor skills and to resemble is also an important policy and public information
humans in appearance to improve patients’ comfort role in communicating with future healthcare leaders
level (Morgan, 2016). Second, labor and delivery (L&D) (Hendrickson, 1993).
nurse managers and physicians specializing in obstetrics Nursing input will be required in the conceptual,
and gynecology at Beth Israel Deaconess Medical Center research, and developmental stages of any new product
collaborated with Massachusetts Institute of Technology or system. Too often nursing is only involved in the
engineers on complex nursing staff allocation in a testing or evaluation of a finished product, when major
busy labor and delivery unit. Nurse managers partici- functionality changes may not be possible. Nurses have
pated in computer simulations to assess decision making been employed by engineering companies in sales,
with regard to variations in L&D patient census and marketing, or support roles, and less so in research
staff resource allocations. Increasing unit census is and development activities. Delivering health care is
associated with patient care delays in real life and more complex in care environments that have differ-
computer simulation. Computer simulation is a feasible ent nursing practice models, administrative systems,
and valid method of demonstrating the sensitivity of and practice venues, including the hospital, community,
care decisions to shifts in patient volume. Nurses, and home. This presents the need to identify a sys-
physicians, and engineers anticipate using simulation tematic methodology to analyze patient and nursing
to improve clinical resource management (Molina et al., needs.
2018). As nursing and engineering increasingly work together,
ethics and data security issues will become more impor-
tant. Korhonen, Nordman, and Eriksson (2015) sug-
A New Professional: The Nurse-­Engineer
gested that technology from an ethical perspective needs
The idea of creating formal education and professional to be considered as either a service (human rights,
connections between nursing and engineering has been privacy, and confidentiality), a process (human dignity,
around for nearly 25 years. Both nurses and engineers autonomy, uniqueness, informed consent), or a product
use science and technology and creatively solve practical or device (safety, benefits, prevention of harm). In

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each case, the need for technology and nursing to by two to four follow-­ on courses in signal and image
have a common understanding is essential in the realm processing. The problem is even more dramatically shown
of nursing and caring science, with our emphasis on by the impossibility of a formally educated engineer to
ethics, dignity, and human good. A future challenge not only appreciate and understand, but to implement
will require new ways of communicating the potential clinical processes and procedures enabled by nursing
of new technological and practice advances to healthcare education and subsequent nursing practice.
leaders, managers, the patient, caregivers, politicians, A review of the international literature was con-
and the general public. ducted to identify if there were examples of joint
Currently, scholarly publications, nurse-­led research, undergraduate degrees in nursing and education. No
evidence-­ based best practice guidelines, and the pres- undergraduate programs were found (except at
ence of nursing peer-­ reviewed journals clearly docu- Duquesne University); however, opportunities for joint
ment nurses’ contributions to the healthcare knowledge graduate nursing and engineering graduate degrees
base. In addition, there are some examples of tradi- exist. Vanderbilt University, for example, has a joint
tionally educated nurses who have improved patient degree where students study for 2 years in the master
care through new invention creation (Nursingen­ of science in nursing program and three in the bio-
trepreneurs.com, 2013). According to Metler (2005), medical engineering PhD program. The intent of the
42 nurses have been responsible for only 94 inventions program is to prepare nurses, amongst other things,
from 1865 to 2003. Recent examples of patient care in the science and development of health care and
improvements include (a) the Bili-­Bonnet, a latex-­free related devices.
compression net bonnet used to hold eye guards in Several institutions have already implemented cur-
place, thereby reducing the risk of ultraviolet light ricula or innovation space to facilitate nursing contri-
exposure when neonates are treated for jaundice butions in this arena. For example, the University of
(Paolucci, 2000); (b) the Aqua-­ Box, a wall-­ mounted Detroit Mercy Colleges of Engineering and Nursing
canister that allows contaminated fluids to be treated partner to provide assistive devices to disabled indi-
with a Food and Drug Administration–approved dis- viduals while teaching innovation, technology, and
infectant and then disposed (Elghanayan, 2000); and collaboration to students. Nursing students are offered
(c) the Neonur, a device that measures the complex insights and background in specific disabilities to inform
choreography of sucking, breathing, and swallowing engineering about anticipated device needs. Some
that can indicate developmental issues in premature examples of multidisciplinary devices include a baby
infants, developed to decrease the risk for failure to carrier that attaches to an electronic wheelchair, a
thrive, currently affecting half of all newborns with crib that opens sideways to accommodate a mother
congenital heart defects (University of Pennsylvania in a wheelchair, and a smart technology walker to
School of Nursing, 2014). help lift patients in the event of a fall (McClelland
Because of the nature of their healthcare role, nurses & Kleinke, 2013).
are in the unique and ideal position to see what is There are examples of projects designed specifically
working, what is not working (Kliger, Lacey, Olney, to bring together these two professions to solve health-­
Cox, & O’Neil, 2010), and what needs to be done to related problems. MakerNurse, with support from the
enhance and improve the patient’s experience and Robert Wood Johnson Foundation, was initiated in
outcome. Since nurses are the primary care providers 2013 with the goal of examining nurse innovation in
of patients in care settings, it is therefore likely many U.S. hospitals and identifying tools and resources that
important patient care improvement opportunities are help nurses develop and execute their innovative ideas
being missed when nurses are not being engaged or to lead to improvements in patient care. In essence,
participating in technological innovation. As a result, MakerNurse supports nurses in building their own
the we posit that nurses are a vitally important, medical devices with the support of engineers.
untapped resource of the technology–nurse interface MakerHealth provides the tools, platforms, and training
or technology–patient experience interface. to assist this community of nurses to make the next
Notably, the sequential nature of nursing and engi- generation of health technology. Engineers listen to
neering education makes it difficult for an individual nurses with respect to what they wish to prototype
educated in one or the other discipline to self-­ educate and provide the tools for nurses to create new patient
to become a nurse-­ engineer (Heywood, 2005). For care devices or modify equipment to make it safer
instance, in order to understand and develop new medi- and more efficient. One MakerHealth space, at The
cal imaging technology, an engineer must master a University of Texas Medical Branch in Galveston, con-
sequence of 2 years of university mathematics, followed tains equipment such as three-­ dimensional printers,

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laser cutters, and sewing machines, with engineers from understanding a cultural, holistic view of a com-
who provide expert advice once a month. Innovations munity. Similarities between these diverse practice dis-
that came about as a direct result of the MakerHealth ciplines allowed engineering faculty to train engineering
spaces include the DIY Burn Bath, a portable shower students as practitioners broadening the perspective of
to direct water over specific areas of burn victims’ both engineers and nurses involved.
bodies rather than the traditional approach of nurses The process of educating nurse-­engineers in a com-
manually holding a showerhead for hours at a time mon curriculum not only obviates these problems, but
(Rice, 2015; Robert Wood Johnson Foundation, 2014). provides an opportunity for educational synergy. This
type of synergy has been shown in many dual-­degree
programs, such as law and business, though the dis-
Potential Impact of Nurse-­Engineering Education
parate programs in nursing and engineering may not
Graduates of programs that educate students in the make it so obvious. While the connection between
fundamentals and applications of biomedical engineer- engineering design and nursing care may be abstract,
ing, coupled with the basic sciences and clinical practice in general, the senior year engineering capstone is an
of nursing, are qualified to populate the interface of opportunity to bring together the concepts of all prior
technology and patient care. One scenario that is rel- studies (Todd, Magleby, Sorensen, Swan, & Anthony,
evant in today’s fast-­paced technology commercialization 1995).
landscape is product development and testing of novel In an effort to better meet the complex needs of
medical devices in small-­ scale startup companies. patients, and the healthcare system overall, two uni-
Typically, founders of biomedical device companies versities moved to develop joint nursing and engineer-
provide the initial engineering innovation, often by ing programs. Both approaches are described below.
establishing a portfolio of intellectual property that The University of Massachusetts–Amherst is in the
establishes the base of a business venture and early curriculum planning stage, and details regarding the
funding (Brinton et  al., 2013). With successful fund- strategic decisions and investments made toward that
raising, founders inevitably hire new talent to continue goal are provided. Duquesne University has already
engineering development and to plan and conduct begun their joint degree program; this report describes
clinical testing. With smaller ventures, a nurse-­engineer their curriculum, programmatic elements, and plans
can fulfill the roles of both technology developer and for academic outcome evaluation.
clinical evaluator, reducing costs and streamlining the
product development process. Indeed, this advantage
University of Massachusetts–Amherst
can be found in later stage ventures, with nurse-­
Model
engineers keeping engineering development closely tied
to clinical testing and, even more importantly, to ­clinical
Overview: Pathway to Collaboration
utility.
One related course example was designed by Oerther The colleges of nursing and engineering at the
(2017), who introduced Florence Nightingale’s environ- University of Massachusetts–Amherst are planning the
mental theory as a framework to guide experiential curriculum for a joint degree in nurse-­ engineering.
learning of multidisciplinary engineering and nursing The foundations of the joint degree planning were
teams for student design experiences with Engineers laid in 2008, after both colleges each received an
without Boarders, United Nations Millennium Devel­ annual fellowship from alumni of $25,000 to support
opment Goals, and other global experience over a 10-­ research in the area of clinical health care and engi-
year period. As he noted, diverse disciplinary teams neering. The intent of the fellowship was that students
created innovative ideas, which were not produced by work on research projects from both disciplines and
single disciplines working on the same problem. Team seek solutions to real problems in the clinical setting
members also gained insight on how different disciplines using engineering-­ based approaches. There was the
address an issue from their disciplinary perspective and overarching belief that modern healthcare problems
professional code of ethics. Nightingale’s environmental required a multidisciplinary approach to identify last-
theory moved nursing beyond the bedside to focus on ing, patient-­centered solutions. The 1-­year fellowships
how to improve the patient’s broader environment. By were awarded to PhD students at the beginning of
utilizing a guided theory, Nightingale’s framework among their studies following a joint nursing and engineering
nurses and engineers, the nurses benefitted from under- review of credentials. To date, a total of 12 fellow-
standing why microscopic chemical measurements are ships have been awarded, with 6 completing their
critical to environmental health, and engineers benefitted doctorates.

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Since the beginning of the fellowship program, the beginning of some faculty re-­ orienting their research
projects can broadly be categorized into studies of to the college of nursing priorities, either through
problems related to information services, patient safety, participation in National Institutes of Health summer
and service optimization. One group of projects exam- institutes or through a competitive process funding
ined new ways of delivering health-­ related services work with experienced researchers in their chosen
and information via telecommunications technologies, field.
designing and implementing an electronic way of report-
ing falls in community geriatric facilities, and evaluating
Examples of Joint Nursing and Engineering Projects
the usability of consumer health informatics platforms
for patients with diabetes and cardiac conditions. There Joint nursing and engineering projects have examined
was also a study of Hispanic patients’ use of handheld a number of important healthcare issues. Some of these
diabetic monitoring devices in the management of include the design and implementation of an electronic
HbA1c levels. The use of tracking technology to study falls-­
reporting device for the post–acute care system at
the eye-­ scanning habits of nurses was designed to a major elderly care center. This device continues to be
determine if variations could lead to identifying medi- used to monitor falls in this facility. In terms of systems
cal errors in simulated clinical settings before they engineering, one Fellow developed a computer-­ based
impact patient safety. The premise of this study was optimization and simulation model to improve capacity
that health professionals can be taught optimum visu- allocation of inpatient beds at a major healthcare facility
alization strategies for the safe administration of medi- that generally admits over 25,000 inpatients annually
cines in the hospital or home. and approximately 650 beds. The Fellows in these studies
The fellowship program has provided an opportunity have gone on to complete postdoctoral studies.
for doctoral students in both nursing and engineering
to be exposed to outstanding opportunities to collabo-
Space: Institute of Applied Life Sciences (IALS)
rate with faculty across both colleges, while at the
same time have funds for the cost of education and The opportunity of collaborative space emerged with
supplies or equipment for their research. There have the creation of the IALS, which became operational
been other advantages from the fellowship program, in 2016. The IALS aims to facilitate the translation
including increasing the opportunity for nursing faculty of fundamental discoveries of medical devices, biomol-
to develop their own research with engineering faculty, ecules, and delivery vehicles that benefit human health.
for example, in the area of eye-­tracking technologies. The IALS also trains researchers skilled in the discovery,
There were issues the college of nursing needed address development, and manufacture of medical devices and
to capitalize on the benefits of growing interdisciplinary biomolecules and in life science entrepreneurship.
opportunities. First, the college needed to review its Currently, the IALS has more than 175 faculty mem-
research priorities to guide the type of collaborations bers associated with five schools and colleges and 28
and the priorities for new faculty hires. Further, there departments, and manages 30 core equipment facilities
were few spaces where faculty could work in an organized into three centers: the Center for Bioactive
explorative manner; and the college of nursing had Delivery, Center for Models to Medicine, and Center
no experimental laboratories of its own. These chal- for Personalized Health Monitoring (CPHM). Facilities
lenges were addressed in the 2011–2012 academic year and space are available to both academic researchers
when the faculty conducted a self-­review of its research and industry partners, with the CPHM becoming the
aspirations and capabilities. The most important result focus of our current nurse-­ engineering collaboration.
from this review was that four areas of research pri- The CPHM goal is to accelerate the development and
orities emerged: symptom management, healthy aging, commercialization of low-­cost, multifunction, wearable,
social justice, and health systems. wireless sensor systems for personalized health care
During the following academic year, the college of and biometric monitoring. This is achieved by conduct-
nursing was able to hire two tenure-­track faculty with ing basic and translational research, training current
postdoctoral training in the symptom management field, and future workforces in an emerging digital health
with one having expertise in using wearable devices. industry, creating a space for multidisciplinary research,
These nursing hires occurred at the same time that and developing new ways of collaboration with clinical
the college of engineering was also hiring researchers partners and industry.
developing and building wearable health devices. This, The bringing together of faculty across campus in
in effect, began to coalesce and expand interdisciplinary the IALS facilitated the College of Nursing being awarded
research ideas in health care. It also marked the a number of grants, including a National Institute of

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Nursing Research of the National Institutes of Health in hiring at the second attempt because there was
$1.23 million P20 award in 2016. The creation of the greater clarity in the experience and skills that were
UManage Center for Building the Science of Symptom needed to advance the mission of both colleges. This
Self-­Management seeks to develop technologies to help included being a prominent scholar; a focus on the
people manage symptoms of chronic illness, including device side of nursing and engineering as a prime
fatigue and impaired sleep. Further, the Center will focus; scholarship that complimented nursing, engineer-
build capacity for developing wearable or handheld ing, and IALS priorities to foster interdisciplinary work;
self-­management systems for the early self-­identification a strong desire to keep a health focus to scholarship;
and reporting of symptoms to improve the self-­ the ability to develop courses that are relevant to
management of symptoms of chronic conditions. The nursing and engineering; the ability to supervise joint
Center also works to mentor nurse scientists in the final year nursing and engineering honors students
development of a program of research through the projects; and the interest in participating in the writ-
awarding of pilot grants. ing of a nurse-­ engineer degree curriculum.
Examples of pilot studies awarded to nurse research- Curriculum development was occurring during the
ers include the “Saccade parameters of persistent cancer-­ time that the IALS was being opened and faculty
related fatigue: biomarker detection using computational hires were being made. In 2016, the College of
eyeglasses.” This project explores the use of a newly Engineering created the biomedical engineering degree,
developed, wearable, eye-­ tracking technology called with the first cohort of students entering in the fall
iShadow to detect errors in parameters potentially of 2017. Meanwhile, the College of Nursing undertook
associated with subjective reports of fatigue in breast a major review of its undergraduate nursing curricu-
cancer survivors. If successful, measurements of sac- lum, with approval expected for the fall of 2018. Work
cadic parameters in response to a stereotyped saccadic continues on shaping what a joint nursing-­engineering
fatigue task delivered on a screen might serve as a curriculum needs to advance the healthcare needs of
new “objective” marker of cancer-­ related fatigue to patients of the future.
use in self-­ monitoring and physiological assessment.
The study of real-­time, continuous cortisol monitoring
Duquesne Model
has seen nurses and polymer scientists work towards
the goal of validating the feasibility of a wearable,
Overview: First Joint Degree Program
real-­time, continuous, cortisol sweat sensor, and to
test the relationship between changes in cortisol and The novel, first-­of-­its-­kind, 5-­year bachelor of science
symptoms of fatigue. This capability will provide oppor- in nursing and biomedical engineering (BME/BSN)
tunities to develop new ways of self-­ managing stress degree was launched in the fall of 2015. It is a com-
and stress-­ related symptoms, such as fatigue.  Other bination of the traditional 4-­year engineering program
projects in the early stage of development include a and the 1-­ year accelerated second degree program
nurse midwife investigating the sleep patterns of women (already offered by the university). By providing stu-
during pregnancy using a wearable device to promote dents with the knowledge of both disciplines, graduates
self-­
monitoring and self-­management of sleep, and a will be better prepared to design and apply techno-
geriatric nurse practitioner who is evaluating the effi- logical healthcare solutions in a manner that is realistic,
cacy of using a wrist-­worn personal health monitoring feasible, and patient centered. Enrollment in each BME
device to help older individuals with chronic pain cohort is limited to approximately 20 students to
improve their sleep patterns. emphasize a high-­ quality classroom environment and
mentored research.
The curriculum is highly structured and academically
Strategic Hires: Joint Nursing and Engineering
demanding (Figure  1). The first 3 years comprise the
Faculty
university core requirements and the foundation BME
The growing collaboration between the Colleges of courses. Students also take two nursing prerequisite
Nursing and Engineering led to conversations about courses: nutrition and human development. Year four
joint hires and ways to maintain the planning momen- is primarily nursing courses, with electives and remain-
tum necessary for a joint degree in nursing and engi- ing core curriculum requirements. Year five combines
neering. In the fall of 2017, the first joint hire was the remaining advanced nursing courses and the final
made, with the new faculty having their home in the BME capstone experience. Students graduate after the
college of nursing. This occurred following a failed summer of their fifth year, prepared to immediately
search during the previous year. We were successful take the registered nurse licensing exam (NCLEX-­ RN).

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BME/BSN Dual Degree Curriculum {206 credits}


Year 1 Year 4
FALL SEMESTER Total: 17 credits FALL SEMESTER Total: 16 credits
MATH 115* Calculus I 4 cr. UPNS 119 Contemporary Professional Nursing 3 cr.
PHYS 211* General Analycal Physics I w/Lab 4 cr. UPNS 124 Cultural Issues in Health Care 3 cr.
CHEM 121* Chemistry I w/Lab 5 cr. UPNS 200 Fundamentals of Nursing Pracce and 6 cr.
BMED 100 Introducon to BME 3 cr. Clinical Ethics
UCOR 100† Research and Informaon Skills 1 cr. UPNS 218 Health Assessment 4 cr.
SPRING SEMESTER Total: 16 credits SPRING SEMESTER Total: 18 credits
MATH 116* Calculus II 4 cr. UPNS 309 Pharmacology 3 cr.
PHYS 212* General Analycal Physics II w/Lab 4 cr. UPNS 323 Adult Health and Illness 6 cr.
CHEM 122* Chemistry II w/Lab 5 cr. UPNS 411 W Nursing Ethics Across the Lifespan 3 cr.
BMED 110 Intro to Programming for Engineers 3 cr. UCOR† Global Diversity Core 3 cr.
UCOR† Theology Core 3 cr.
Year 2 SUMMER SEMESTER Total: 12 credits
FALL SEMESTER Total: 18 credits UPNS 423 Evidence Based Approaches to 3 cr.
MATH 215* Calculus III 4 cr. Professional Nursing Pracce
BIOL 4 cr. BMED 490 Research in BME 3 cr.
111/111L* Biology I: Cells, Genecs, Development
BMED 499 BME Elecve 3 cr.
BMED 201 Electronics and Instrumentaon I 3 cr. BMED 499 BME Elecve 3 cr.
BIOL 207/208* Anatomy and Physiology I w/Lab 4 cr.
UCOR 101 W† Thinking & Wring Across the Curriculum 3 cr. Year 5
SPRING SEMESTER Total: 17 credit s FALL SEMESTER Total: 17 credits
MATH 314* Differenal Equaons 3 cr. UPNS 326 Pathophysiology for Nursing Pracce 3 cr.
BIO 112* Biology II w/Lab 4 cr. UPNS 339 W Genecs in Nursing and Health 3 cr.
BMED 202 Electronics and Instrumentaon II 3 cr. BMED 440 Capstone I 5 cr.
BIOL 209/210* Anatomy and Physiology II w/Lab 4 cr. UCOR 132† Philosophy 3 cr.
UCOR 102† Imaginave Literature and Crical Wring 3 cr. UCOR† Creave Arts Core 3 cr.
SPRING SEMESTER Total: 20 credits
Year 3 UPNS 344 Nursing for Children's Health 3 cr.
FALL SEMESTER Total: 18 credits UPNS 348 Nursing for Maternal-Newborn Health 3 cr.
MATH 301* Probability & Stascs I 3 cr. UPNS 355 Behavioral Health 3 cr.
BMED 310 BioSignals and Systems 3 cr. UPNS 356 Populaon Health 3 cr.
UPNS 103 Nutrion for Wellness 3 cr. BMED 441 Capstone II 5 cr.
UCOR† Faith and Reason Core 3 cr. BMED 499 BME Elecve 3 cr.
BMED 210 Thermodynamics 3 cr. SUMMER SEMESTER Total: 18 credits
BMED 430/530 Engineering Computaon 3 cr. UPNS 400 Crically Ill Adult 6 cr.
SPRING SEMESTER Total: 19 credit s UPNS 422 Role Preparaon 3 cr.
MATH 302 W* Probability and Stascs II 3 cr. UPNS 426 Leadership & Management in Clinical 6 cr.
BMED 320 Biofluid Dynamics 3 cr. Environments
UCOR† Social Jusce Core 3 cr. UPNS 430 Gerontological Nursing Pracce 3 cr.
UPNS 113 Human Development & Health Promoon 3.cr
Across the Lifespan Bold = Biomedical Engineering Course
BMED 220 Introducon to Biomaterials 3 cr. Italic = Nursing Course
BIOL 203/204* Introductory Microbiology w/Lab 4 cr. * = Science Course

= University Core Course
Revisions to curricula are ongoing. W = Wring Intensive

Figure 1.  Duquesne University School of Nursing BME/BSN dual degree curriculum.


608 Journal of Nursing Scholarship, 2018; 50:6, 601–611.
© 2018 Sigma Theta Tau International
Glasgow et al. The Nurse-­Engineer

The Duquesne University BME/BSN program has been focuses on clinical care and the patient experience for
approved by the Pennsylvania State Board of Nursing BME students, and an elective for nursing students
and is accredited by the Commission of Collegiate Nursing that introduces engineer concepts and provides oppor-
Education. The BSN and BME programs are also approved tunities for developing healthcare solutions.
by the Pennsylvania Department of Education. Graduates
of the program are prepared to take the Fundamentals
Evaluation: Innovation in Assessing Academic
of Engineering Exam, the first step towards professional
Outcomes
licensure. Engineers with 4 of more years of verifiable
work experience in the industry are then eligible to While nursing and engineering have their own
take Professional Engineering Exam. discipline-­specific accreditation methods and agencies,
this unique paradigm needs a new evaluation tool
capable of providing accurate metrics and assessment.
Bringing It All Together: The Capstone Project
This assessment is made more complicated by the
The capstone project is a required component of fundamental differences of the two disciplines and
the BME curriculum for all students, the culmination due to the small numbers of graduates in the early
of the educational process in biomedical engineering. years of this program. At Duquesne, evaluation will
The work is completed in two five-­credit courses dur- necessarily consist of establishment of educational out-
ing the fifth year of study. For the capstone, a student comes and assessment of early career progression.
team will study a healthcare-­focused clinical problem, Additionally, the program will institute a method for
and the team provides an engineering solution that monitoring continual improvement of academic rel-
is informed by the classroom and clinical experience evance with respect to student feedback and success,
gained through nursing courses. This solution will often employer satisfaction, job placement, salary, and career
be a medical device or process. Steps include conduct- advancement.
ing, deterministic, and statistical studies of the problem, In order to minimize the administrative burden
designing a solution, constructing a prototype, testing brought about by two formal accreditation agencies
the solution, and conducting an engineering and eco- for nursing and engineering, there will be an internal
nomic analysis of the solution. At the end the fifth review committee responsible for tracking progress of
year, students will present their projects to a team the program. This review committee will consist of
composed of faculty, engineering and healthcare pro- nursing and engineering faculty members, as well as
fessionals, and industry leaders. faculty members from health professions fields. This
committee will review student outcomes annually. These
outcomes will be established as additional to the exist-
Broader Goals: Benefits to Both the Program and
ing ones used in nursing and engineering accreditation.
the Academic Community
The initial embodiment of the review committee will
In addition to the combined program, the curriculum establish the outcomes that are unique to the nurse-­
components are designed to offer benefits for students engineer concept. Finally, we will form an external
enrolled in the BME or BSN program as well. The advisory board composed of industry and academic
program was conceived to provide a culture of inno- leaders in engineering, nursing, and industry. This
vation for all students and to provide opportunities advisory board will review curriculum and educational
for cross-­discipline learning and collaboration. This will resources and provide insight into new innovations
include guest speakers (showcasing successful nurse and the evolution of the professional landscape so
and healthcare engineers), internship opportunities, that the dual-­ degree program can maintain relevance
structured health-­related hackatons (single-­day competi- to industry and academia.
tive events, where teams work collaboratively to create The program is currently in the implementation
a software or hardware product solution to a prede- phase, and there is no formal summative outcome
fined clinical problem) available to all students, and data to report at this time. Twelve students have been
collaborative events designed to encourage creativity officially enrolled; as of this writing, two have entered
and partnership. Each spring, students will present the fourth year, when the intensive nursing courses
their capstone projects at a healthcare engineering begin. Those students will complete final capstone
conference. This will include outside speakers, projects next fall, leading to graduation. Student
MakerNurse and Health style events, and poster pres- response has been positive, in terms of recruitment
entations from students in earlier years of the program. and initial retention. Anecdotally, advisors and program
There are also plans to develop a BME elective that administrators have noticed that because students’ first

Journal of Nursing Scholarship, 2018; 50:6, 601–611. 609


© 2018 Sigma Theta Tau International
The Nurse-­Engineer Glasgow et al.

3 years are in the challenging BME program, they Having a new and unique demographic of nurses
are not as connected to the nursing program, faculty, to examine patient care through a nontraditional lens
or students. This is being addressed by more frequent will undoubtedly result in important questions being
and deliberate communication, assigning a nursing asked, such as how can existing patient care activities
faculty mentor earlier in the process, and providing be more effectively and efficiently delivered? Such
opportunities for health-­related engineering experiences questions will be a catalyst to novel research develop-
during the first 3 years. For example, one second-­year ments and inventions, with the expected result being
student is currently completing a research experience a greater number of new and relevant patient care
in a local hospital, helping their simulation team to devices, robotic solutions, and workflow efficiencies
design a more realistic seizure presentation for their that improve health. Nurses are in the best position
high-­fidelity mannequins. to assess the functional health status and technology
needs of patients given their close interactions with
patients. Other innovative nurse–engineer collaborations
Conclusions
are needed in various forms to leverage nurse ingenu-
New biomedical and nursing degree collaborations ity and positively impact patient care.
and the MakerNurse movement have the potential
to appreciably change the nurse–technology interface
landscape. Nurse-­ engineers and nurse–engineer col- Clinical Resources
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