Robots and Robotics in Nursing.

Technological advancements have led to the use of robots as prospective partners to complement understaffing and deliver effective care to patients. This article discusses relevant concepts on robots from the perspective of nursing theories and robotics in nursing and examines the distinctions between human beings and healthcare robots as partners and robot development examples and challenges. Robotics in nursing is an interdisciplinary discipline that studies methodologies, technologies, and ethics for developing robots that support and collaborate with physicians, nurses, and other healthcare workers in practice. Robotics in nursing is geared toward learning the knowledge of robots for better nursing care, and for this purpose, it is also to propose the necessary robots and develop them in collaboration with engineers. Two points were highlighted regarding the use of robots in health care practice: issues of replacing humans because of human resource understaffing and concerns about robot capabilities to engage in nursing practice grounded in caring science. This article stresses that technology and artificial intelligence are useful and practical for patients. However, further research is required that considers what robotics in nursing means and the use of robotics in nursing.

Characteristics of interactive communication between Pepper robot, patients with schizophrenia, and healthy persons.

Background: Expressing enjoyment when conversing with healthcare robots is an opportunity to enhance the value of human robots with interactive capabilities. In clinical practice, it is common to find verbal dysfunctions in patients with schizophrenia. Thus, interactive communication characteristics may vary between Pepper robot, persons with schizophrenia, and healthy persons. Objective: Two case studies aimed to describe the characteristics of interactive communications, 1) between Pepper as a healthcare robot and two patients with schizophrenia, and 2) between Pepper as a healthcare robot and two healthy persons. Case Report: The "Intentional Observational Clinical Research Design" was used to collect data. Using audio-video technology, the conversational interactions between the four participants with the Pepper healthcare robot were recorded. Their interactions were observed, with significant events noted. After their interactions, the four participants were interviewed regarding their experience and impressions of interacting with the Pepper healthcare robot. Audio-video recordings were analyzed following the analysis and interpretation protocol, and the interview data were transcribed, analyzed, and interpreted. Discussion: There were similarities and differences in the interactive communication characteristics between the Pepper robot and the two participants with schizophrenia and between Pepper and the two healthy participants. The similarities were experiences of human enjoyment while interacting with the Pepper robot. This enjoyment was enhanced with the expectancy of the Pepper robot as able to entertain, and possessing interactive capabilities, indicating two-way conversational abilities. However, different communicating characteristics were found between the healthy participants' impressions of the Pepper robot and the participants with schizophrenia. Healthy participants understood Pepper to be an automaton, with responses to questions often constrained and, on many occasions, displaying inaccurate gaze. Conclusion: Pepper robot showed capabilities for effective communication pertaining to expressing enjoyment. The accuracy and appropriateness of gaze remained a critical characteristic regardless of the situation or occasion with interactions between persons with schizophrenia, and between healthy persons. It is important to consider that in the future, for effective use of healthcare robots with multiple users, improvements in the areas of the appropriateness of gaze, response time during the conversation, and entertaining functions are critically observed.

Balance of Autonomic Nervous Activity, Exercise, and Sleep Status in Older Adults: A Review of the Literature.

While older people are frequently known to experience sleep disturbances, there are also many older people who have a good quality of sleep. However, little is known about the balance of autonomic nervous activity, exercise habits, and sleep status in healthy older adults. This study reviews the literature regarding balance of the autonomic nervous activity, exercise, and sleep in healthy older adults. Relevant articles were searched from electronic databases using the combination of the following keywords: "Autonomic nervous activity", "sleep status", "sleep", "healthy older adults", "aging", "heart rate variability (HRV)" and "exercise". Articles were included if they met inclusion criteria: (1) Published in English, (2) Article types: research and review articles, (3) Main outcome was related to the autonomic nervous activity, lifestyle, sleep, and/or healthy aging, and (4) Fully accessed. From 877 articles that were identified, 16 articles were included for review. Results showed that the autonomic nervous activity changes with increasing age, particularly a constant decline in cardiac vagal modulation due to the significant decrease in the nocturnal parasympathetic activity. In addition, the autonomic nervous activity was also related to sleep status and lifestyle, particularly the capability to exercise. In preparing older people toward a healthy aging, maintaining good sleep quality and exercise is suggested.

Intentional Observational Clinical Research Design: Innovative Design for Complex Clinical Research Using Advanced Technology.

The growing use of robots in nursing and healthcare facilities has prompted increasing research on human-robot interactions. However, specific research designs that can guide researchers to conduct rigorous investigations on human-robot interactions are limited. This paper aims to discuss the development and application of a new research design-the Intentional Observational Clinical Research Design (IOCRD). Data sources to develop the IOCRD were derived from surveyed literature of the past decade, focusing on clinical nursing research and theories relating robotics to nursing and healthcare practice. The distinction between IOCRD and other research design is the simultaneous data generation collected using advanced technological devices, for example, the wireless Bonaly-light electrocardiogram (ECG) to track heart rate variability of research subjects, robot application programs on the iPad mini to control robot speech and gestures, and Natural Language Processing programs. Even though IOCRD was developed for human-robot research, there remain vast opportunities for its use in nursing practice and healthcare. With the unique feature of simultaneous data generation and analysis, an interdisciplinary collaborative research team is strongly suggested. The IOCRD is expected to contribute guidance for researchers in conducting clinical research related to robotics in nursing and healthcare.

Development Issues of Healthcare Robots: Compassionate Communication for Older Adults with Dementia.

Although progress is being made in affective computing, issues remain in enabling the effective expression of compassionate communication by healthcare robots. Identifying, describing and reconciling these concerns are important in order to provide quality contemporary healthcare for older adults with dementia. The purpose of this case study was to explore the development issues of healthcare robots in expressing compassionate communication for older adults with dementia. An exploratory descriptive case study was conducted with the Pepper robot and older adults with dementia using high-tech digital cameras to document significant communication proceedings that occurred during the activities. Data were collected in December 2020. The application program for an intentional conversation using Pepper was jointly developed by Tanioka's team and the Xing Company, allowing Pepper's words and head movements to be remotely controlled. The analysis of the results revealed four development issues, namely, (1) accurate sensing behavior for "listening" to voices appropriately and accurately interacting with subjects; (2) inefficiency in "listening" and "gaze" activities; (3) fidelity of behavioral responses; and (4) deficiency in natural language processing AI development, i.e., the ability to respond actively to situations that were not pre-programmed by the developer. Conversational engagements between the Pepper robot and patients with dementia illustrated a practical usage of technologies with artificial intelligence and natural language processing. The development issues found in this study require reconciliation in order to enhance the potential for healthcare robot engagement in compassionate communication in the care of older adults with dementia.

The experience of older persons with mental health conditions who interact with healthcare robots and nurse intermediaries: The qualitative case studies.

Background: Caring expressions between humans and nonhuman intelligent machines are futuristic prototypes with healthcare robots as major advocates. Objective: To examine the experience of older persons with mental health conditions, particularly patients with schizophrenia and with dementia in the interaction with healthcare robots and intermediaries in a transactive relational engagement. Methods: Two qualitative case studies were conducted using sophisticated audio-video technologies to record the conversation and activities that were carefully documented. Following the procedure for qualitative descriptive analysis, a framework based on the Transactive Relationship Theory of Nursing was employed to analyze and interpret the data. Results: Three themes were revealed, including feelings for the other, inspiring meaningful responses, and demonstrating expressions of joy. The description of the experience of older persons involved in the conversation with humanoid robots was feeling for the other while inspiring meaningful responses in demonstrating expressions of joy. Conclusion: This study provided initial evidence that the transactive engagements of robots with older persons with schizophrenia and dementia and nurse intermediaries in psychiatric and mental health settings can result in occasions of 'joy' for the patients. These findings suggest that transactive engagements with robots facilitate expressions of joy among older persons with schizophrenia and dementia. However, these findings are not intended to prescribe nursing care actions but to describe the experience of older persons who are in transactive engagements with intelligent machines, indicating the importance and value of healthcare robots in nursing older persons with schizophrenia and with dementia.

Aesthetic expressions as data in researching the lived-world of children with advanced cancer.

Background: Understanding the true world of children needs a special method. Using aesthetic expressions through artworks with reflections assists nurse researchers in exploring children's feelings, thoughts, and behaviors in relation to their health and well-being. Objective: This article focuses on the use of aesthetic expressions as innovative data sources in a study of the lived worlds of children experiencing advanced cancer. Method: The use of aesthetic expressions in Gadamerian hermeneutic phenomenology and aesthetics, by means of van Manen's approach using draw and write, is examined as a suitable approach in a study of the lived worlds of children experiencing advanced cancer. Results: The aesthetic expressions through the Draw-and-Write method of data generation were well-suited to a hermeneutic phenomenological study involving the group of Filipino children living with advanced cancer. The children drew images and figures of themselves, their families, classmates, friends, and teachers in several places and events during the series of two days. The drawings showed their facial expressions, home, parents, hospital stay, school activities, extracurricular activities, and other daily activities. Conclusion: Aesthetic expression linked to art and connected to human experience drew the participants into different realms and expanded their perceptual capacities so that the fullness of the meaning of the experience was appreciated. The understanding of the experience through aesthetic expression provided sensitivity to and awareness of the variation of experience among children with advanced cancer. It is hoped that this paper can contribute to an understanding of aesthetic expressions as pathways to understanding and support health professionals as they embark on their goal of creating or restoring a comfortable relationship with children.

Potential legal issues when caring healthcare robot with communication in caring functions are used for older adult care

The issue of older adults' care is becoming a serious concern in Japan, which has a rapidly aging population and a low birthrate. The development of robots is pushed forward as a measure to compensate for the healthcare worker shortage. The purpose of this paper is to consider the potential legal issues of caring healthcare robot (CHR) for older adults' care. A CHR must recognize the speech, face, and presence of older adults, and make judgments and relay information based on acquired information. CHRs fulfill the caring function by being close to patients, to know them deeply, and to look after them. Therefore, communication functions by advanced artificial intelligence based on caring in nursing are essential for CHRs. The ability to maintain and improve the activities of daily living (ADL) of older adults is to facilitate activities through bidirectional information relay. Furthermore, without guarantees on the safety and ascription of responsibilities, the introduction of CHRs in clinical practice will not proceed. As laws differ from country to country, it is necessary to examine Japanese policies and related laws when using CHRs in Japan. Currently, there are no central rules on information security. In Japan, the law is made after a case has occurred; thus, dealing with novel issues as they occur will not have the benefit of legal guidance. Creating a broad legal framework or taking preventive measures at an early stage is needed. Therefore, as a first step, establishing guidelines for the use of CHRs will be valuable

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Disruptive Engagements With Technologies, Robotics, and Caring: Advancing the Transactive Relationship Theory of Nursing.

Human caring, founded on a Japanese caring perspective and nursing theory, fosters innovative and creative ideas for an aging society. The growing reality of health care dependency on technology presents a temptation to give robots utility as partners in nursing practice. Human caring expressed in human-to-human relationships, and also between humans and nonhumans, is a futuristic model for health care, with humanoid robots as major supporters. The purpose of this article is to explore this disruptive technology, along with its functions and characteristics. Tanioka's Transactive Relationship Theory of Nursing is shared along with its relevance for addressing technological disruptions in health care.

Knowing the occasion of a peaceful death in intensive care units in Thailand.

The purpose of this study was to describe how nurses know the occasion of a peaceful death. The data were generated from individual in-depth interviews with ten nurses who practised in adult intensive care units in the southern region of Thailand. Using a content analysis method, four processes of knowing the occasion of a peaceful death were isolated. They were visual knowing, technological knowing, intuitive knowing, and relational knowing.The clinical implications of these processes provide opportunities for nurses to practise the best end-of-life care during a critical time in a patient's life.This study also strengthens cross-cultural nursing during end-of-life care in high-technology settings, such as the intensive care unit.

Thai Buddhist intensive care unit nurses' perspective of a peaceful death: an empirical study.

AIM: To describe the concept of a peaceful death from Thai Buddhist intensive care unit (ICU) nurses' perspectives. METHOD: A descriptive qualitative study of data generated from individual in-depth interviews of ten intensive care nurses who practiced in adult ICUs in the southern region of Thailand. Content analysis was used to analyse the data. FINDINGS: Four core qualities of a peaceful death emerged as described by Thai Buddhist nurses who practised in the ICUs. These core qualities are: peaceful mind; no suffering; family's acceptance of patient's death; and being with others and not alone. CONCLUSION: Thai Buddhist nurses described a peaceful death as 'a situation in which persons who are dying have peace of mind, and do not show signs and symptoms of suffering. Peaceful death occurs when family members declare acceptance of their loved one's dying and eventual death. Such a death is witnessed by relatives and friends and the dying person is not alone.' The findings encourage nurses to be with, and provide palliative care for, dying patients and families.

Transforming practice using a caring-based nursing model.

Today's health care environments are calling for new models of care delivery grounded in essential values. This article describes the results of a 2-year funded research project that intentionally grounded an acute care unit in the perspective of nursing as caring. Outcomes of care for patients, families, staff and the organization are described.

Philosophical underpinnings of an emergent methodology for nursing as caring inquiry.

Two research approaches congruent with the theory of nursing as caring are described: group interpretive phenomenology and nursing as caring research as praxis. The idea of praxis and the theory of communicative action are explored for congruence as philosophical underpinnings of a possible eventual methodology for developing knowledge of nursing as caring.

Choosing personhood: intentionality and the theory of nursing as caring.

Drawing on a story of a nursing situation for practical context, this article explores the meaning of intentionality within the theoretical context of Nursing as Caring. May's definition of intentionality as the structure that gives meaning to experience is interwoven with the concepts of the theory of Nursing as Caring to explore the topic. Mayeroff's concepts of hope and commitment contribute to an understanding of intentionality in relation to Nursing as Caring. The major thesis of this article, that intentionality is consistently choosing personhood as a way of life and the aim of nursing, is demonstrated in the practice situation.