Changing how the world thinks about nursing

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Interaction and intelligence

January 22, 2007 -- Today The Scotsman ran Angus Howarth's "Robot nurses could be on the wards in three years, say scientists." The piece reports on a project by European Union-funded scientists, working at universities in the U.K. and Ireland, to develop machines to "perform basic tasks" at hospitals. These include cleaning up spills, guiding visitors around, and perhaps distributing medicines and taking temperatures. The piece isn't so different from many other recent press items that blithely suggest such robots are "nurses," though this one does pack an impressive array of anti-nurse imagery into a small space (e.g., "nursebots," "'mechanised 'angels'"). Unsurprisingly, the piece consults no real nurse; in fact, it's not clear from the piece if even the "engineers and software experts" working on the "IWARD" project have done that.

The piece reports that the "[r]obot nurses" could be "bustling around hospital wards in as little as three years." It explains that the "mechanised 'angels'" would "perform basic tasks such as mopping up spillages, taking messages and guiding visitors to hospital beds," that they could "distribute medicines and even monitor the temperature of patients remotely with laser thermometers," and that "[w]orking in teams, the intelligent robots will be able to communicate with each other and co-ordinate their duties." It is also "hoped" that the robots will "ease pressure on hospitals and free staff to spend more time with patients."

The article says that the "engineers and software experts" pursuing the project are from the universities of Warwick, Cardiff, Dublin and Newcastle. The only quotes seem to be comments the project leader, software expert Thomas Schlegel of Germany's Fraunhofer Institute, made in an article in The Engineer:  

The idea is not only to have mobile robots but also a full system of integrated information terminals and guide lights, so the hospital is full of interaction and intelligence. Operating as a completely decentralised network means that the robots can co-ordinate things between themselves, such as deciding which one would be best-equipped to deal with a spillage or to transport medicine. ... But the human-robot interaction will be tricky, as the robots will have to be able to deal with people with different injuries and disabilities as well as the elderly and seriously ill patients.   

That all sounds sensible, except that we don't see anything about "interaction" with hospital workers, like, for instance, oh what are they called...oh yeah, nurses. We do appreciate that at least in this piece, Schlegel does not refer to the mobile robots as "nurses."

Of course such technology could be very helpful. Some tasks might be suitable for mobile robots. As the piece suggests, if robots kept the wards cleaner, they might reduce the rate of dangerous nosocomial infections. The piece also suggests that the robots might recognize "unauthorised visitors." We could imagine some problems with that technology, but it might also provide additional security in settings in which there may be some external threat to the patient. And if robots could help nurses be more efficient, that would be valuable.

But it's hard to imagine such technology succeeding without extensive involvement from nurses and others currently involved in the relevant tasks. It's easy to envision such robots actually impeding care (as some other forms of new hospital technology have) if they do not function at a very high level. If we are unable to make reliable automatic blood pressure cuffs (we have seen them malfunction on countless sick patients), how likely are these robots, which will require complex software, image and voice recognition technology, to succeed? Unfortunately, there is rarely much indication in such pieces that nurses are involved in the development of these new technologies. The idea seems to be that nursing is so simple and obvious that anyone can see what it is--which is also why many pieces like this fail even to consult a nurse--so it's just a matter of making some robot replicate it.

Our concern remains that these machines, which even under the most optimistic scenarios will be performing only the most basic tasks, are being presented and will be viewed as "nurses." This not only suggests that nurses have very basic, low-skilled jobs, but also invites decision-makers to unduly reduce nurse staffing under the mistaken assumption that such machines can actually replace real nurses. Moreover, many of the above tasks are not even things skilled nurses generally do--guiding people around the hospital, cleaning up spills--and suggesting that they are shows little regard for the years of college-level science training it takes to become a nurse.

We recognize the claim that the robots will "free staff to spend time with patients," which often appears in these pieces. This suggests that to the extent nursing does not consist of "bustling" around doing menial physical work, it is unskilled handholding. Few are likely to take such phrases as meaning, "spend more time doing advanced assessments and treatments," especially when the piece makes sure to suggest that nurses are "angels," i.e., noble but unskilled spiritual beings. We also suspect that once the perceived nursing role had been reduced to emotional support--an activity that decision-makers have already effectively eliminated at many U.S. hospitals through short-staffing--it will be easier to justify further denursification. It's pretty clear that there is little room in current hospital budgets for "spending time with patients."

We hope that Mr. Howarth and The Scotsman will consider the real nature of nursing the next time they do a piece about the development of hospital robots.

See the article "Robot nurses could be on the wards in three years, say scientists" from the January 22, 2007 edition of The Scotsman.