Nationwide, nurse practitioners (NPs) have had to adapt rapidly in response to the COVID-19 pandemic. NPs are transitioning to telehealth — and designing brand-new processes for virtually delivered care — are offering COVID-19 testing and are following the most current recommendations for treating patients who have been diagnosed with COVID-19.
AANP member Craig Nuttall, DNP, FNP-C, says he first felt the pandemic hit his state of Utah almost three months ago. Dr. Nuttall, who is an associate teaching professor at BYU College of Nursing and who works in an emergency room (ER) says, “We didn’t see anything in the ER to begin with. The volumes were really low and hours were getting cut. Suddenly, COVID-19 hit us really hard and still continues to place a lot of stress upon all of us nurses, physicians and health care providers.”
While working in the ER as cases rose, Dr. Nuttall and his colleagues began to discover a problem — how to properly assess a patient’s heart and lungs while respecting social distancing and personal protective equipment (PPE) guidelines.
“The new precautions restrict a clinician’s ability to assess the patient. You aren’t supposed to be within six feet of a patient in isolation, but to use a traditional stethoscope, you have to be within 24 inches. Some PPE also makes it difficult to use a traditional stethoscope, and some masks aren’t compatible at all,” Dr. Nuttall explains.
The solution to this stethoscope problem got its origin from an existing project. Dr. Nuttall, who is also a wilderness medicine-trained provider, runs a humanitarian mission in India each year: the Garhwal Himalaya Mountain Rescue Project, where he and a group of nursing students provide education to local health care workers and care for individuals living in remote areas who often go without access to health care, deemed “untouchables.”
“With my work in resource-limited environments, we can’t often buy an expensive medical device,” says Dr. Nuttall. “Instead, we say ‘let’s create something more affordable,’ or ‘let’s use what we have access to.’ To better care for patients in India, we decided that we wanted to record a patient’s heart sounds to allow for a cardiology specialist to review.”
He partnered with Dr. Chia-Chi Teng, an associate professor at BYU Ira A. Fulton College of Engineering. The duo, who had worked together on previous health tech projects, found a 3D-printed, open source stethoscope that was originally designed for use in the Gaza Strip.
“While that original design was created to improve access to high-quality health care in underserved areas, our stethoscope project has evolved to fit our current needs as we fight the COVID-19 pandemic,” says Dr. Nuttall. “We added Bluetooth, microphone and Wi-Fi capabilities to the existing stethoscope design to allow for real-time livestreaming."
The stethoscope consists of a 3D-printed stethoscope head, which costs about $1, a gaming microphone, which costs less than $5, and audio cable that connects the microphone to a smartphone. Using the accompanying mobile app, designed by Dr. Teng, a clinician can listen to a patient’s heart and lung sounds via Bluetooth earbuds from up to 50 feet away. The mobile app is currently undergoing testing, but it will soon be made available for free. This means that, combined with the 3D-printed parts and inexpensive microphone, the entire stethoscope can be produced and used in practice for less than $20.
“While Bluetooth stethoscopes are currently available, they’re often very expensive. They also do not livestream sound, even though most clinicians are trained to listen to a patient’s heart and lungs in real time, not via a recording,” says Dr. Nuttall. “Our stethoscope provides clinicians with the option of listening live or recording sounds, and we’ve made it open source because we want others to use it.”
Currently, Dr. Nuttall shares that he and about 20 different health care providers are using the 3D-printed, Bluetooth stethoscope. “I feel like I’ve been able to do great health assessments while keeping myself and patients safe,” he says. “I come dressed in full PPE wearing Apple AirPods. I explain to the patient that I want to do a health assessment and keep everyone safe by testing out this new device, and there’s been an overwhelmingly positive response. I’ve heard many patients say, ‘I feel like I’m in the space age,’ or, ‘I can’t believe you’d do something like this for us.’”
An academic article will soon be published on the stethoscope and its results, and the next step for Drs. Nuttall and Teng is to adapt the stethoscope for telehealth usage — particularly as COVID-19 has led to an increase in virtually delivered health care. Dr. Nuttall envisions a future where clinicians might be able to send one of these stethoscopes to each patient and use them in tandem will a full telehealth platform.
Dr. Nuttall also encourages other NPs to identify innovative solutions for their unique challenges: “If you are working on the front lines, you are the one facing problems — and you are the one who can push health care to the next level. Sometimes, we may not think we can make a difference, but that’s exactly why we should. NPs: Don’t be afraid to speak up! Many times, it’s a simple solution for you that can make a big difference for many others.”
AANPconnect is the NP destination for distance learning and networking in 2020. Beginning September 10, more than 55 continuing education (CE) sessions can be viewed at your convenience and on your schedule through the end of the year — including sessions on emergency care, infectious disease, pulmonology and cardiology. Plus, keynote speaker Katie Duke will share her experience working in the epicenter of the COVID-19 pandemic in New York City and how she ultimately became a COVID-19 patient herself.
AANPconnect will also highlight 2020 as International Year of the Nurse and Midwife! Celebrate with AANP by spreading the word, sharing social media graphics and submitting your own story related to international nursing.