Robots in Nursing - False Rhetoric or Future Reality?: How might robots contribute to hospital nursing in the future? A qualitative study of the perspectives of roboticists and nurses

Introduction. The challenge of the global nursing shortage coupled with a rising healthcare demand prompts consideration of technology as a potential solution. Technology in the form of robots is being developed for healthcare applications but the potential role in nursing has not been researched in the UK. Methods A three-phased qualitative study was undertaken: interviews with 5 robotic developers (Phase 1); nine focus groups /interviews with 25 hospital Registered Nurses (RN) in Phase 2, and 12 nurse leaders in four focus groups (Phase 3). Data was analysed using framework analysis for Phase 1 and reflexive thematic analysis for Phase 2 and 3 data based on the Fundamentals of Care framework. Results Roboticist interviews confirmed that a taxonomy of potential robotic automation was a useful tool for discussing the role of robots. In Phase 2, RNs described activities that robots might undertake and commented on those which they should not. RNs more readily agreed that robots could assist with physical activities than relational activities. Six potential roles that robots might undertake in future nursing practice were identified from the data and which have been labelled as advanced machine, social companion, responsive runner, helpful co-worker, proxy nurse bot, and feared substitute. Three cross-cutting themes were identified: • a fear of the future; • a negotiated reality and • a positive opportunity. In phase 3, nurse leaders considered the RN results and four themes were identified from their discussions: • First impressions of robot in nursing; • The essence of nursing; • We must do something and • Reframing the future. Conclusions Robots will be a future reality in nursing, playing an assistive role. Nursing must become technically proficient and engage with the development and testing of robots. Nurse leaders must lead policy development and reframe the narrative from substitution to assistance. A number of navigational tools have been developed including a taxonomy of nursing automation and the six robotic roles which may be useful to inform future debate in nursing

Skype on Wheels: Implementation of video-calls to reduce feelings of loneliness and social isolation for older people living in care

The outcome of concern was to explore whether video-calls could become ‘normalised’ within a complex care environment to reduce feelings of loneliness and social isolation in older people. As part of this thesis, some research data were published in BMC Geriatrics and have been presented in their published format (chapter six). A scoping review of the current internet-communication interventions used to reduce loneliness and social isolation for older people was conducted as part of ‘technology horizon scanning’ to ensure the most updated technologies had been researched and noted. This was an on-going process and an initial systematic search of the literature was conducted in August 2016, then March 2017 (after peer review feedback) and then finally July 2018.Background: Older people in care may be lonely with insufficient contact if families are unable to visit. Face-to-face contact through video-calls may help reduce loneliness, but little is known about the processes of engaging older people living in care in using video-calls. Aims: 1-To explore how to normalise the use of video-calls within the care environment, 2-To examine how video-call communication for older people might reduce loneliness and social isolation. Sub aims: 3- To identify the barriers and facilitators to using video-calls within a care environment for older people, care staff and social contacts, 4-To explore how staff and social contacts’ attitudes towards using video-calls change after implementation. Design: A mixed methods approach of ethnography and feedback forms using collaborative action research (CAR) methodology included five core steps taken across two cycles of research: (1) Recruitment of older people and relevant social contacts. (2) Planning how best to implement the intervention. (3) Implementation of video-calls. (4) Reflection to identify barriers to and benefits of using video-calls. (5) Re-evaluation to tackle the identified barriers. Intervention: The video-call intervention comprised a wheeled device (Skype on Wheels (SoW) that could hold an iPad or tablet and telephone handset and used Skype to provide a video-call service for residents and their social contacts. In cycle two, Skype TV (STV) was an additional form of delivering video-calls on a larger screen and trialled alongside SoW. Methods cycle one: Seven care homes and one community hospital in the South West of England participated. Care staff (n=32) were collaborators who implemented the intervention by agreeing the intervention, recruiting older people without dementia (n=34) and their distant family (n=19), and setting up video-calls. Ethnographic data included field notes and reflective diaries on observations and conversations with care staff, older people and family which were maintained over 15 months and analysed using thematic analysis. Results cycle one: Four care homes implemented the intervention. Eight older people (23%) with their respective family contacts made use of video-calls. Older people were able to use SoW with assistance from care staff and enjoyed the use of video-calls to stay better connected with distant family. However, five barriers towards implementation were staff turnover, risk averseness, the SoW design, lack of family commitment, and staff attitudes regarding technology. Methods cycle two: Four care homes continued to cycle two. This consisted of three key activities to address the identified barriers in cycle one to improve implementation. Namely; 1- focus groups to allow residents (n=28) to aesthetically personalise SoW, 2- video-calls using SoW between school pupils (n=4) and residents (n=20) to build new social contacts and trial the use of a prompt sheet to improve the quality of conversations, and 3- inter-care home video-calls using SoW and STV between residents (n=22) across care homes to increase socialisation. Residents with dementia but with the mental capacity to consent (n=7) were included in cycle two. Additionally, the usability, content and face validity, and usefulness of scales to measure outcomes of loneliness (CELS), social isolation (LSNS-R and LSNS-6), well-being (SWEMWBS) for residents, and staff attitudes towards technology (ATTS) were tested. Scales were given at baseline and follow-up (6 months) and were analysed for simple descriptive statistics. Field notes on observations, feedback forms and structured interviews with residents, social contacts and care staff were maintained over 10 months and analysed using thematic analysis. Results cycle two: Personalisation of SoW and an alternative method of accessing through STV, along with introducing a non-familial social contact to video-call increased the uptake of participation from residents, and helped retain residents in the intervention over a longer period. The use of a ‘prompt’ sheet with school pupils improved the quality of conversations between older people and pupils. All residents with dementia were capable of participating in all activities and found them beneficial, even though they did not always remember using video-calls between sessions. Care staff attitudes towards video-calls improved after acting as a ‘facilitator’ during activities. Exploration of the usefulness of scales to measure key outcomes concluded that the LSNS-6 and CEL scales are useful and appropriate for residents with dementia, or who are end of life. However, the SWEMWBS was not useful, and the ATTS needed further exploration with care staff. Conclusion: These findings suggest that video-calls for residents with and without dementia can to some extent be normalised within a complex long-term care home environment over some months, whereas it was not feasible in a community hospital because of the short patient stays. However, it is still unclear how effective video-calls are in reducing loneliness and social isolation within care. The current research suggests that care homes adopt implementation activities in the order of 1- residents to aesthetically personalise video-call technology, 2- allow residents to engage in non-familial social contacts to become familiar and improve acceptability and 3- help residents accustomed to video-calls to reconnect with distant family members.National Institute for Health ResearchUniversity of Plymout