**4. Practical examples of POCD**

There are many possibilities in the field of POCD. Very well-known are of course the virus testers, the pregnancy tests, and the aforementioned blood glucose tests. However, there are interpretations of how POCD could also be understood that are related to existing adjacent knowledge areas such as the "quantify-self movement."

### **4.1 Quantify-self movement**

In addition, the "quantify-self movement" can be mentioned; the use of the socalled activity trackers (ATs). Activity trackers (ATs) can play an essential role in supporting patients in self-management. ATs can, for instance, contribute in dealing with the nursing diagnosis of "sedentary lifestyle" in patients with heart failure or diabetes.

ATs are small, noninvasive devices that are mostly worn on the wrist. The number of steps users take along with other health measures is registered as a variable related to physical activity. Mostly in combination with an associated mobile application, this gives the person in question insight into their own health behavior.

ATs may be a promising addition to the care process enhancing the physical activity patterns of patients. Using ATs, nurses can use a tool to deliver tailored treatment to patients enhancing their capacity for self-management [5].

### **4.2 How to implement point-of-care diagnostics: A quantify-self (QS) example**

There are various frames of reference on the basis of which the relationship can be established between the use of POCD and its individual application in the care plan. In the following overview (see **Table 1**), which is an extraction from a table previously published in the *International Journal of Nursing and Health Care Research* (vol. 5, p. 1312), a classification system for nurses has been used as reference. This concerns the following nursing classification: NANDA-I for diagnoses; Nursing Intervention Classification (NIC) for interventions; and Nursing Outcome classification (NOC) for nursing outcomes.

In the context of this chapter, the use of ATs can be seen as part of POCD; the point here is not only to look at the (benefits of the) measurement itself, but also to ensure careful implementation in the personal care plan. It is just an example; in many technological diagnostic applications, it can be related in such a way to a knowledge framework and a process-based use.

This approach could potentially catalyze the adoption and implementation of healthcare technology support in general. The propensity to use a technological tool is greater if a direct relationship with the benefits for the end users can be established (**Figure 1**).

### **4.3 Infrared**

There are also POCD developments in the field of infrared measurements. The forehead thermometer is an example of this, although some questions can still be asked about the specificity of the measurements [6].


### **Table 1.**

*Activity trackers as part of POCD in the personal care plan [5].*

Superficial inflammation can now also be detected with infrared applications. This is being developed, for example, for the better detection of wound healing in burn patients. In this regard, nurses have recently been able to use the so-called hyperspectral imaging (HSI) cameras. Recordings from such a camera, which was developed by NASA, can provide insight into where wound exudate accumulates. The blood flow and oxygen supply in and around the wound area can also be provided relatively easily, without being burdensome for the patient [7].

The blood circulation measurement in the foot in diabetic patients is also an example of POCD. It was already known in the first century BC that local temperature

### **Figure 1.**

*A quote from an AT user.*

increase is a symptom that can indicate a (starting) inflammation/infection. Celsus, a Roman, already described "dolor, calor, tumor, and rubor" as inflammatory symptoms. And to date, not much has been added to that as "loss of function" as a symptom. Many nurses will be aware that these phenomena can occur when the deeper tissues in the foot are affected, in conjunction with nervous system abnormalities, neuropathies, and/or abnormalities of the blood vessels in the legs, and related angiopathies.

Diagnosis to prevent diabetic foot neuropathy (DFN) seems simple for professionals and relies on these historical principles. But it might become even easier for the patient using POCD: ask the person to use a measuring device (i.e., TempStat™) daily at home, more or less as if he were using a bathroom scale, but in this case, local heat is measured in the toes and sole of the foot. If a location the size of a pinhead with an elevated temperature is present, a message can be sent with a mobile phone to the general practitioner or nurse specialist, so that immediate action can be taken [8–10].

The thermal detection of phlebitis by using infrared techniques is an example of an innovation, currently in the experimental phase.

It is well known to clinical nurses that phlebitis is a common, painful complication of peripheral catheter infusion, occurring around the infusion needle insertion opening. Not only is it painful, but it can also lead to a longer hospital stay and even, rarely, death. The severity of phlebitis is currently scored using the "visual infusion phlebitis scale," the so-called (VIP) score, ranging from 0 (no phlebitis) to 5 (thrombophlebitis). In many cases, the scoring takes place when the damage has already been done and there is already an onset or already advanced thrombophlebitis at the time of the first measurement. Based on an experimental pilot study with expensive thermal cameras, which in principle were not developed for medical applications, thermal measurements were performed in adult I.C. patients (see **Figure 2**). A first pilot trial with relatively cheap smartphone applications shows that a very affordable and practical early thermal detection of ignition sources also seems possible. Further developments and trials will be needed before it will be possible to use the aforementioned camera's and measurement methods in practice [11].

### **4.4 Further developments related to POCD**

What are the developments now and in the future in technological diagnostics? Out of many, the following are prominent promising examples:

1.*Hyperautomation technology* deals with the application of artificial intelligence (AI) and machine learning (ML) to increasingly (digitally) automate human processes. It concerns an intelligent form of robotization, in which self-learning computers (i.e., "avatars") continuously try to improve the results of their own

### **Figure 2.**

*Infrared image of a patient with a VIP 1 score. The maximum temperature at the insertion site (left circle) is 36.4°C and that of the proximal reference point (right circle) is 34.4°C. ΔT in this case is 2.0°C [11].*

actions. "Babylon Health" is a well-known British company that mainly focuses on this [12].


8.*Swallowable Tech*: Sensors, such as "Smart-Pills," are oral capsules designed to collect data in the digestive tract for (additional) diagnostics such as local temperature and acid measurements. There are also capsule-shaped pills (partly in an experimental stage) that photograph and film the journey through the body [20, 21].

### **4.5 POCD and cost-effectiveness**

Questions about cost-effectiveness (in the long run) when implementing POCD are not easy to answer scientifically. Because what is "quality of care" in relation to "efficiency in care provision"? What exactly do you measure that against? What is an acceptable gold standard? And in what (technological, professional) context is that valid?

The literature does talk about the way in which efficiency can be achieved by means of POCD; waiting times and lead time can be saved, as well as on transfers, reports, and other logistics processes: POCD could be more efficient.

It is hardly possible to find the scientific generalizability of a verifiable, workable, efficiency approach, on the basis of which demonstrable time and (financial) resources can be saved and where the quality of care is guaranteed. POCD could also be seen as a task burden. POCT can be added to the daily work practice of, for example, nurses, tests that were previously performed in the laboratory. It seems important in this context to look closely at adoption processes that can play a role in POCD [21–23].

### **4.6 Adoption of POCD**

Implementing diagnostic technology does not happen by itself. Whether these will actually be used depends on several factors. The nature of the technological innovation, personal factors, team composition, and the degree of urgency that management attributes seem to play a role. The awareness that diagnostic technology has specific advantages for the patient, but could also lead to a reduction in the task—workload of nurses, can be a positive influencing factor. This means that some diagnostic tests can offer a solution, not only to be able to diagnose quickly and efficiently so that you can act as a professional nurse, but also to be able to act appropriately on the basis of these quick and accurate results for use to immediate plan (preventive) actions to be carried out by the patient himself [22, 23].

Furthermore, the broad adoption of the aforementioned technology in regular general practice depends on many aspects. Other frequently mentioned influencing factors in the literature are:

