CITATION: Alvey, R. (2021). Robotics in Healthcare. Online Journal of Nursing Informatics (OJNI), 25(2). https://www.himss.org/resources/online-journal-nursing-informatics
The healthcare field is constantly looking for ways to support and evolve the care that is being delivered to patients. In recent years, these efforts have included the incorporation of various technologies into healthcare delivery. While one such technological advancement -robotics- has yet to become a standard fixture of any healthcare organization, it is reasonable to believe that this will not remain the case for much longer. As such, it is important to understand how robots are currently being used throughout the healthcare field, as well as how they are being received by patients and healthcare professionals. Identifying any potential issues that could impact the current or future use of robots in the healthcare field is vital for the continued growth of these technologies.
The purpose of this literature review is to investigate and identify the ways in which robots are currently being utilized to reinforce or supplement the provision of patient care. In addition, this review will collect and analyze data related to the prevailing attitudes regarding the use of robots in patient care settings. This analysis will include the viewpoints of both healthcare professionals and patients.
Research for this review was performed by searching the following databases: ProQuest and CINAHL Complete. The following keywords were used to guide these searches: robot, robotics, nurse, patients, and healthcare. Initial search results were then filtered to include only peer-reviewed, full text articles. Additional filters were applied to ensure that the articles were written in the English language and published in the past three years. The search of the ProQuest database returned 200 results, while the search of the CINAHL Complete database returned 33 results, for a total of 233 articles.
After the initial 233 articles were identified, the articles were screened for possible inclusion or exclusion. Of the 200 articles identified in the search of the ProQuest database, only the 50 most relevant were considered for this screening process, while all the articles identified in the search of the CINAHL Complete database were screened. In total, 287 articles were excluded, leaving 17 articles eligible for inclusion in the literature review. Most of these articles were excluded because they were not relevant to the study, while others were removed from consideration due to the brevity of the article.
As the assembled literature was reviewed, two distinct themes began to present themselves. The first of these themes involved the various ways in which robotics is being leveraged in the modern healthcare field. The second theme that emerged had to do with the way in which certain populations of people regard the addition of robots and related technologies to the healthcare field.
Current Utilization of Robots in Healthcare
The literature review revealed that there are robots of different shapes and sizes that are currently being utilized in some healthcare settings (Grobbel et al., 2019). One setting that has been profoundly impacted by robotics is the operating room (Suriaga, 2019). Robot-assisted surgeries have been performed since 1985. Over the years, the associated technologies have continued to improve and provide benefits, such as increased dexterity and decreased fatigue, to surgeons. Other common healthcare-related uses for robots involve the delivery of medical supplies or medications to nursing units, the cleaning and sanitation of the healthcare environment, and the provision of companionship to patients (Grobbel et al., 2019). Other studies are being conducted to determine their effectiveness in other clinical situations. For example, feasibility studies have been conducted in Denmark to determine the benefits of using robots to provide passive mobilization to elderly hospitalized patients (Bertelsen et al., 2020).
Other studies have been conducted that were aimed at determining if the use of robots can increase the effectiveness of clinical education and training. An example of this is the study performed by Shaw et al. (2018) that involved the use of robots to act as physical surrogates for nursing students during clinical simulations. The nursing students involved in this study were required to remotely control the actions of a mobile robot that was outfitted with video and audio capabilities. This was done to identify any issues that might arise if this kind of robot were to be used to provide inclusion in clinical simulations for geographically distant students.
Current Attitudes Towards Robots
The literature also showed that there were a few ways in which the utilization of robots in the healthcare field is being perceived, by both the clinicians that provide these services, and by the patients that receive them. One article detailed a study that was conducted in an urban area of the western United States. This study found that older adult patients did not hold as many negative attitudes about robots as the researchers had hypothesized (Backonja, 2018). The researchers also discovered that most of the older adult patients involved in the study shared these feelings. A study was conducted in Portugal to help evaluate interactions between older adult patients and robots (Pereira et al., 2018). The results of this study were then planned to be incorporated into the technology, to strengthen future patient-robot social algorithms.
One particularly interesting fact is that most of the studies that involved patient perspectives on robots were conducted in countries other than the United States. For example, a study in Korea found that some nurses believed that robots can assist in specific efforts, such as with the prevention of falls or pressure ulcers (Lee et al., 2020). Similar studies were conducted in Taiwan (Liang et al, 2019). The nurses involved in that study also believed that robots could be of assistance to their practice, especially when they were used for repetitive tasks or treatments, or as playmates for pediatric patients. These nurses also cited specific concerns about their use, such as the potential for robots to reduce the number of employment opportunities for nursing staff.
A third study conducted in Finland was intended to assist in determining the readiness of healthcare professionals to incorporate robots into their existing practice and workflows (Turja et al., 2018). While healthcare professionals involved in this study did cite specific tasks such as lifting as being ones that the robots might be useful for, some admitted to having a lack of experience with robot-related technologies. This was important, as the participants’ acceptance of these technologies was directly related to their experience with them; the participants who had more experience with robots were more accepting of them.
Other studies were also used to measure acceptance of robots from one culture to another. For example, Coco et al. (2018) conducted a study that found healthcare professionals living in Japan were more receptive to the incorporation of robots into practice than the individuals that resided in Finland. The researchers attributed this level of acceptance to both cultural differences and the fact that Japan has a higher level of incorporation of robots in their healthcare processes than Finland currently has.
A review of the literature shows that, while the utilization of robots in the healthcare field is not widespread, it is something that will most likely propagate throughout the field in the coming years. Many of the articles included information related to the variety of ways that robots are currently being utilized. This includes providing surgical assistance, delivering supplies, performing cleaning and sterilizing duties, and providing companionship to patients.
As these roles and responsibilities of robots continues to expand and evolve, it is important to consider the feelings and perspectives of the patients, and the healthcare professionals, who will be encountering these machines. To this end, the literature review included information related to several studies that were conducted to ascertain the points of view of the aforementioned populations. Possessing this information can help to ease the transition to increased adoption of robotic technologies, as it allows for modification to the technologies, or to implementation strategies, to attempt to gain acceptance from those groups.
The overall strength of this collection of literature lies in the depth of the information provided; however, there are some weaknesses noted. Most importantly, many of the studies that measured the attitudes of patients and personnel toward robots were conducted in other countries, such as Korea, Taiwan, Japan, Portugal, and Finland (Lee et al., 2020; Liang et al., 2019; Turja et al., 2018; Pereira et al., 2018) . While this information was helpful in identifying potential attitudes that might be present in patients and personnel in the United States, it does not account for the variability that might exist based on the differing cultures found in these countries. In order to address this identified weakness, it will be necessary to perform another targeted literature search, to see if there are similar articles that contain information related to studies that were conducted in the United States.
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Robert S. Alvey, RN-BC, BSN is currently enrolled in the Jacksonville University Keigwin School of Nursing’s Master of Science program, with a specialization in nursing informatics. He is also presently employed as an informatics nurse for a hospital in Southern Maryland. Prior to obtaining his current position, Robert worked as a clinical analyst and obtained informatics nursing board certification through ANCC.