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Lukkien DRM, Stolwijk NE, Ipakchian Askari S, Hofstede BM, Nap HH, Boon WPC, Peine A, Moors EHM, Minkman MMN. AI-Assisted Decision-Making in Long-Term Care: Qualitative Study on Prerequisites for Responsible Innovation. JMIR Nurs 2024; 7:e55962. [PMID: 39052315 PMCID: PMC11310645 DOI: 10.2196/55962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/16/2024] [Accepted: 05/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Although the use of artificial intelligence (AI)-based technologies, such as AI-based decision support systems (AI-DSSs), can help sustain and improve the quality and efficiency of care, their deployment creates ethical and social challenges. In recent years, a growing prevalence of high-level guidelines and frameworks for responsible AI innovation has been observed. However, few studies have specified the responsible embedding of AI-based technologies, such as AI-DSSs, in specific contexts, such as the nursing process in long-term care (LTC) for older adults. OBJECTIVE Prerequisites for responsible AI-assisted decision-making in nursing practice were explored from the perspectives of nurses and other professional stakeholders in LTC. METHODS Semistructured interviews were conducted with 24 care professionals in Dutch LTC, including nurses, care coordinators, data specialists, and care centralists. A total of 2 imaginary scenarios about AI-DSSs were developed beforehand and used to enable participants articulate their expectations regarding the opportunities and risks of AI-assisted decision-making. In addition, 6 high-level principles for responsible AI were used as probing themes to evoke further consideration of the risks associated with using AI-DSSs in LTC. Furthermore, the participants were asked to brainstorm possible strategies and actions in the design, implementation, and use of AI-DSSs to address or mitigate these risks. A thematic analysis was performed to identify the opportunities and risks of AI-assisted decision-making in nursing practice and the associated prerequisites for responsible innovation in this area. RESULTS The stance of care professionals on the use of AI-DSSs is not a matter of purely positive or negative expectations but rather a nuanced interplay of positive and negative elements that lead to a weighed perception of the prerequisites for responsible AI-assisted decision-making. Both opportunities and risks were identified in relation to the early identification of care needs, guidance in devising care strategies, shared decision-making, and the workload of and work experience of caregivers. To optimally balance the opportunities and risks of AI-assisted decision-making, seven categories of prerequisites for responsible AI-assisted decision-making in nursing practice were identified: (1) regular deliberation on data collection; (2) a balanced proactive nature of AI-DSSs; (3) incremental advancements aligned with trust and experience; (4) customization for all user groups, including clients and caregivers; (5) measures to counteract bias and narrow perspectives; (6) human-centric learning loops; and (7) the routinization of using AI-DSSs. CONCLUSIONS The opportunities of AI-assisted decision-making in nursing practice could turn into drawbacks depending on the specific shaping of the design and deployment of AI-DSSs. Therefore, we recommend considering the responsible use of AI-DSSs as a balancing act. Moreover, considering the interrelatedness of the identified prerequisites, we call for various actors, including developers and users of AI-DSSs, to cohesively address the different factors important to the responsible embedding of AI-DSSs in practice.
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Affiliation(s)
- Dirk R M Lukkien
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | | | - Sima Ipakchian Askari
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Bob M Hofstede
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Henk Herman Nap
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Wouter P C Boon
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Alexander Peine
- Faculty of Humanities, Open University of The Netherlands, Heerlen, Netherlands
| | - Ellen H M Moors
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Mirella M N Minkman
- Vilans Centre of Expertise of Long Term Care, Utrecht, Netherlands
- TIAS School for Business and Society, Tilburg University, Tilburg, Netherlands
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Groeneveld S, Bin Noon G, den Ouden MEM, van Os-Medendorp H, van Gemert-Pijnen JEWC, Verdaasdonk RM, Morita PP. The Cooperation Between Nurses and a New Digital Colleague "AI-Driven Lifestyle Monitoring" in Long-Term Care for Older Adults: Viewpoint. JMIR Nurs 2024; 7:e56474. [PMID: 38781012 PMCID: PMC11157177 DOI: 10.2196/56474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/25/2024] Open
Abstract
Technology has a major impact on the way nurses work. Data-driven technologies, such as artificial intelligence (AI), have particularly strong potential to support nurses in their work. However, their use also introduces ambiguities. An example of such a technology is AI-driven lifestyle monitoring in long-term care for older adults, based on data collected from ambient sensors in an older adult's home. Designing and implementing this technology in such an intimate setting requires collaboration with nurses experienced in long-term and older adult care. This viewpoint paper emphasizes the need to incorporate nurses and the nursing perspective into every stage of designing, using, and implementing AI-driven lifestyle monitoring in long-term care settings. It is argued that the technology will not replace nurses, but rather act as a new digital colleague, complementing the humane qualities of nurses and seamlessly integrating into nursing workflows. Several advantages of such a collaboration between nurses and technology are highlighted, as are potential risks such as decreased patient empowerment, depersonalization, lack of transparency, and loss of human contact. Finally, practical suggestions are offered to move forward with integrating the digital colleague.
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Affiliation(s)
- Sjors Groeneveld
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands
- TechMed Center, Health Technology Implementation, University of Twente, Enschede, Netherlands
| | - Gaya Bin Noon
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Marjolein E M den Ouden
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
- Research Group Care and Technology, Regional Community College of Twente, Hengelo, Netherlands
| | - Harmieke van Os-Medendorp
- Domain Health, Sports, and Welfare, Inholland University of Applied Sciences, Amsterdam, Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, Netherlands
| | - J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Section of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Rudolf M Verdaasdonk
- TechMed Center, Health Technology Implementation, University of Twente, Enschede, Netherlands
| | - Plinio Pelegrini Morita
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Knop M, Mueller M, Kaiser S, Rester C. The impact of digital technology use on nurses' professional identity and relations of power: a literature review. J Adv Nurs 2024. [PMID: 38558440 DOI: 10.1111/jan.16178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/20/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
AIM This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments. DESIGN Literature review. DATA SOURCES PubMed and CINAHL databases were searched in April 2023. METHODS We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023. RESULTS Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented. CONCLUSION Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required. IMPLICATIONS FOR THE PROFESSION Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession. IMPACT The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care. REPORTING METHOD We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Michael Knop
- Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
| | | | | | - Christian Rester
- Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
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Haltaufderheide J, Lucht A, Strünck C, Vollmann J. Increasing efficiency and well-being? a systematic review of the empirical claims of the double-benefit argument in socially assistive devices. BMC Med Ethics 2023; 24:106. [PMID: 38037080 PMCID: PMC10687833 DOI: 10.1186/s12910-023-00984-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side. METHODS Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed. RESULTS The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices. DISCUSSION We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument.
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Affiliation(s)
- Joschka Haltaufderheide
- Medical Ethics with a Focus on Digitization, Joint Faculty for Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, 14476, Potsdam, Germany.
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Annika Lucht
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Christoph Strünck
- School of Life Sciences, University of Siegen, Siegen, Germany
- Institute of Gerontology at Technical University Dortmund, Dortmund, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
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Wong J, Young E, Hung L, Mann J, Jackson L. Beyond Plan-Do-Study-Act cycle - staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care. BMC Health Serv Res 2023; 23:772. [PMID: 37468953 DOI: 10.1186/s12913-023-09741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents' quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects' generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams' perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR). METHODS We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants' perspectives. RESULTS Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool 'START' to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents' needs. CONCLUSIONS Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.
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Affiliation(s)
- Joey Wong
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | - Erika Young
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Lillian Hung
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jim Mann
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Jackson
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Hung L, Mann J, Perry J, Berndt A, Wong J. Technological risks and ethical implications of using robots in long-term care. J Rehabil Assist Technol Eng 2022; 9:20556683221106917. [PMID: 35733613 PMCID: PMC9208036 DOI: 10.1177/20556683221106917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The pandemic provides a unique opportunity to examine new directions in innovative technological approaches in long-term care (LTC) homes. While robotics could enhance staff capacity to provide care, there are potential technology risks and ethical concerns involved in technology use among older people residing in communal aged care homes. This qualitative descriptive study explores the technological risks and ethical issues associated with the adoption of robots in the specific context of LTC homes. Methods The research team including patient and family partners employed purposive and snowballing methods to recruit 30 LTC participants: frontline interdisciplinary staff, operational leaders, residents and family members, and ethics experts in dementia care. Semi-structured interviews were conducted. Thematic analysis was performed to identify themes that capture empirical experiences and perspectives of a diverse group of LTC stakeholders about robotic use. Results Technological risks include safety, increased workload, privacy, cost and social justice, and human connection. The findings offer practical insights based on the LTC perspective to contribute to the robot ethics literature. We propose a list of pragmatic recommendations, focusing on six principles (ETHICS): Engagement of stakeholders, Technology benefit and risk assessment, Harm mitigation, Individual autonomy, Cultural safety and justice, Support of privacy. Conclusions There is both a growing interest as well as fear in using robotics in LTC. Practice leaders need to reflect on ethical considerations and engage relevant stakeholders in making technology decisions for everyday care.
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Affiliation(s)
- Lillian Hung
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jim Mann
- Community Engagement Advisory Network, Vancouver, BC, Canada
| | - Jennifer Perry
- Alzheimer Society of British Columbia, Vancouver, BC, Canada
| | - Annette Berndt
- Community Engagement Advisory Network, Vancouver, BC, Canada
| | - Joey Wong
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Waizinger O, Shpigelman M, Shental R, Yunis B, Shimoni P, Od Cohen Y, Kagan I. Diabetes nurse practitioners in the shadow of the COVID-19 pandemic: Challenges, insights, and suggestions for improvement. J Nurs Scholarsh 2021; 54:453-461. [PMID: 34854227 DOI: 10.1111/jnu.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. DESIGN A descriptive qualitative research using content analysis of interviews. METHODS Participants were invited through the National DiNPs' Forum. Semi-structured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. FINDINGS Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles; and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. CONCLUSIONS The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth. CLINICAL RELEVANCE Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.
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Affiliation(s)
- Orit Waizinger
- Nursing Care Coordinator in Diabetes, Haifa and Western Galil District, Clalit Health Services, Tel Aviv, Israel
| | - Miriam Shpigelman
- Nursing Care Coordinator in Diabetes, Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | - Rachel Shental
- Coordinator of Diabetes Care for Adults, Rambam Health Care Campus, Haifa, Israel
| | - Bushra Yunis
- Coordinator of Diabetes Care, Central District, Meuhedet Health Services, Tel Aviv, Israel
| | - Pnina Shimoni
- Nursing Care Coordinator in Diabetes, Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | | | - Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
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