This work was supported by HRSA grant D09HP08061 Advanced Education Nursing Grants, entitled, "Nursing Informatics Program Focused on Diversity and the Underserved."
Problem statement: As healthcare reform unfolds in the United States, historical transformation is anticipated. However, the nursing shortage is a serious ongoing problem. Intensity and complexity of nursing responsibilities are increasing, and workload and stress contribute to attrition. While healthcare technology is rapidly evolving, can 21stcentury technology assist nurses with patient care and alleviate the nursing shortage? What is the state of applicable technology, and how can nursing take advantage of this?
Research objectives: The study aims were to (1) investigate a broad spectrum of literature for evidence of intelligent or robotic technology that can alleviate clinical nurses' workloads, (2) catalog technologies within a relational database with appropriate fields, and (3) offer possible solutions.
Setting and sample: Peer-reviewed academic journals within nursing, medicine, rehabilitation, pharmacy, electrical and computer engineering, general science, and technical news articles.
Intervention, if any: None
Data collection procedures: Literature searches were conducted using CINAHL, Ovid MEDLINE, and ISI Web of Science (2001 to 2011). Key search terms were (Robo* and Nurs*), and subject headings "Assistive technology" and "Robotics," combined with the term "Nurs*." The resulting 231 articles were screened, after excluding nonnursing publications; the remaining 56 articles were carefully reviewed. Publication reference lists were checked for additional resources.
Data analysis methods: Each identified technology was analyzed in terms of function type, whether possessing certain capabilities, developer, manufacturer (if applicable), and current status (eg, commercially available, still under development). Additional resources, particularly from the developers, were sought to obtain comprehensive information. Available video data were also examined for technology verification. To differentiate a multitude of nursing tasks, the Canadian Projet De Recherche En Nursing (PRN), the Belgian Nursing Minimum Data Set (B-NMDS), and the Nursing Taxonomy were chosen as categorizing frameworks. Each technology was then examined with these three schemes, and one key task/activity of the technology from each scheme was determined. Finally, all the technologies, along with associated data, that were deemed applicable to nursing were entered into the database.
Findings: Intelligent technologies or robots that may support nursing activities already exist in various capacities and are under rapid development worldwide. The three nursing category schemes used in the study offered several common threads (ie, care related to "mobility," "elimination," "hygiene," "administering medication" [or "treatment" in PRN], and "assessment" ["diagnosis" in PRN] being the most agreed on activities, and in a slightly lesser degree, "feeding," "monitor vs [or clinical signs]" and "teaching" [synonyms appear to be used such as "communication" and "emotional support"]).
Based on these findings, although not conclusive, the study categorized the main functions of technologies as follows:
(1) physical nursing tasks (such as "mobility"),
(2) patient education/coaching,
(3) communication/emotional/cognitive support, and
(4) monitor/vigilance. At least two technologies were identified under each category that has shown or appear effective in supporting nurses. For example,
(1) "Yurina" is an ingenious robot that can be a stretcher, wheelchair, walker, and/or diaper changing aid. Because it does all the laborious work, one nurse can safely transfer patient from/to bed, wheelchair, and bath. Yurina can be controlled either by voice commands or a joystick.
(2) "Louise" is an interactive adoptable patient discharge education virtual nurse and has been claimed to save nursing time, reduce readmission rates, and save $145 per patient (Jack and Bickmore, 2007).
(3) "Paro" is an interactive "therapy robot" resembling a baby seal that has been shown to calm the elderly and reduce nursing burnout.
(4) "Video Observation System" was successfully tested in a dementia unit where infrared and audio sensors triggered live video when anomaly was detected. Nurses were able to take quick action upon viewing the live video of the patients, and it was described as "extension of the eyes and ears."
No technologies were found for some activity categories such as "Administering Medication" (although numerous that deliver medications exit), "Respiration," and "Wound Care" that require complex skills.
Discussion and conclusions or recommendations: This study uncovered exciting intelligent technologies that can assist clinical nursing practice now or in the future. Multiple incentives and rapidly developing technology are bringing waves of intelligent technologies to healthcare. As new technology usually becomes inexpensive rapidly, one can predict that robots may soon perform some current nursing activities.
Robotic technology appears promising for simple and laborious tasks that overlap traditional unregulated personnel's responsibilities. As these advanced technologies become more affordable, the unregulated personnel population should be encouraged to become RNs. One thing that is clear is that a whole RN cannot be replaced by any intelligent technologies anytime soon. Instead, nurses should lead the orchestration of pervasive technologies around the patient, ease the workload, and spend their time on value-creating tasks.
In conclusion, this study critically examined intelligent technologies applicable to clinical nursing. Although the study uncovered far more questions than answers, one certainty is that the dawn of the 21st century can be the time that a nursing practice revolution begins.
Contact the corresponding author: Kayoko Katsuya ([email protected]).
Real Meaningful Use: Evolution or Revolution? Nursing Informatics Practice
Podium and poster presentations in this category describe innovative projects and lessons learned in the practice of nursing informatics.