From care practices to speculative vignettes-design considerations for robots in good care

The care sector has become one of the test beds for developing robotic technologies, which have been promised to mitigate problems with aging populations and labor shortages. Despite these promises, the practical application of such technologies have been met with limited success. Apart from technical limitations, other challenges exist in the way we approach designing these technologies. Critical to the development in the care sector is understanding the complexity of the contexts, the needs and goals of diverse actors, and how these are socio-materially scaffolded. This paper presents a study conducted at the intersection of a value sensitive design and speculative design to understand these sensitivities. Based on the data collected in interviews (n = 6) and card workshops (n = 6) from care workers and residents in mobile care and care home contexts in Austria, we developed five themes capturing situated practices and understandings of good care as built on trust-developing routines, negotiations between different actors, affective and reciprocal dimension of care, care worker self-care, and material mediations. Subsequently, we created six speculative vignettes which serve as rhetorical devices to emphasize the tensions that arise with any technological intervention entering and reshaping existing care practices and relations. We argue that our approach can support robot designers to develop a rich understanding of the values and tensions in the specific context under study from the before design and development begin.

The entwinement of policy, design and care scripts: Providing alternative choice-dependency situations with care robots

The use of robots to assist feeding has become important for people with an impaired arm function. Yet, despite large-scale dissemination strategies, it has proven difficult to sustain the use of this technology. This ethnographic study draws on the script approach to discuss the use of robots to assist feeding. The empirical work was done at locations in Denmark and Sweden. Drawing on document studies, interviews, observation of meals and video footage, we discuss (1) policy strategies promoting ideas such as self-reliance; (2) design visions promoting ideas such as empowerment; (3) and three scripts of care: (a) the script of choice, (b) the script of eating alone and (c) the script of eating together. We argue that scripts entwine and give rise to and prevent the use of robots. The study contributes to the script literature and the care robot literature by substantiating that care robots may generate choice-dependency situations for users. Rather than the somewhat overflowing 'self-reliance' and 'empowerment', alternative configurations of choice and dependency emerge, in which some situations fit users better than others. We conclude that although sustaining the use of feeding robots is difficult, in some cases, useful choices arise for both end-users and care providers.

The Increasing Centrality of Robotic Technology in the Context of Nursing Care: Bioethical Implications Analyzed through a Scoping Review Approach

At the dawn of the fourth industrial revolution, the healthcare industry is experiencing a momentous shift in the direction of increasingly pervasive technologization of care. If, up until the 2000s, imagining healthcare provided by robots was a purely futuristic fantasy, today, such a scenario is in fact a concrete reality, especially in some countries, such as Japan, where nursing care is largely delivered by assistive and social robots in both public and private healthcare settings, as well as in home care. This revolution in the context of care, already underway in many countries and destined to take place soon on a global scale, raises obvious ethical issues, related primarily to the progressive dehumanization of healthcare, a process which, moreover, has undergone an important acceleration following the outbreak of the COVID-19 pandemic, which has made it necessary to devise new systems to deliver healthcare services while minimizing interhuman contact. According to leading industry experts, nurses will be the primary users of healthcare robots in the short term. The aim of this study is to provide a general overview, through a scoping review approach, of the most relevant ethical issues that have emerged in the nursing care field in relation to the increasingly decisive role that service robots play in the provision of care. Specifically, through the adoption of the population-concept-context framework, we formulated this broad question: what are the most relevant ethical issues directly impacting clinical practice that arise in nursing care delivered by assistive and social robots? We conducted the review according to the five-step methodology outlined by Arksey and O'Malley. The first two steps, formulating the main research question and carrying out the literature search, were performed based on the population-context-concept (PCC) framework suggested by the Joanna Briggs Institute. Starting from an initial quota of 2,328 scientific papers, we performed an initial screening through a computer system by eliminating duplicated and non-English language articles. The next step consisted of selection based on a reading of the titles and abstracts, adopting four precise exclusion criteria: articles related to a nonnursing environment, articles dealing with bioethical aspects in a marginal way, articles related to technological devices other than robots, and articles that did not treat the dynamics of human-robot relationships in depth. Of the 2,328 titles and abstracts screened, we included 14. The results of the 14 papers revealed the existence of nonnegligible difficulties in the integration of robotic systems within nursing, leading to a lively search for new theoretical ethical frameworks, in which robots can find a place; concurrent with this exploration are the frantic attempts to identify the best ethical design system applicable to robots who work alongside nurses in hospital wards. In the final part of the paper, we also proposed considerations about the Italian nursing context and the legal implications of nursing care provided by robots in light of the Italian legislative panorama. Regarding future perspectives, this paper offers insights regarding robot engagement strategies within nursing.

Interactions between healthcare robots and older people in Japan: A qualitative descriptive analysis study

AIM

This study aimed to describe the interactions between healthcare robots and older persons in two selected institutions.

METHODS

A qualitative descriptive analysis study using simultaneous observations of healthcare robot and older person interactions was conducted at two healthcare institutions in Japan. The Pepper robot equipped with Care Prevention Gymnastics Exercise programs was used in two situations: (a) exercise regimen led by Pepper; and (b) interactive dialogue between Pepper and older persons during the exercise process. These interactions were recorded using audiovisual equipment and analyzed using content analysis thereby revealing four thematic categories. Interpretation and discussion were structured based on assumptions of the Transactive Relationship Theory of Nursing.

RESULTS

The analysis revealed four thematic categories: (a) intermediary participation of healthcare practitioners; (b) technologies of care for practice; (c) human-robot interactions involving artificial intelligence; and (d) valuing safety in nursing through technology.

CONCLUSION

Interactions between healthcare robots and older persons may improve quality of care. However, issues regarding fidelity and functionality of dialogic conversations, and ensuring safety and security of using healthcare robots are recognized as critical nursing practice concerns in healthcare robot use in institutional settings.