Introduction
Many countries are increasingly facing challenges of an ageing population which include the provision of care for the elderly persons with deteriorating health, and diminishing mental and physical capabilities. This is coupled with the challenge of declining workforce and deficiencies of healthcare practitioners. Technological advances can offer surged remote monitoring as well as management of elderly patient with chronic diseases.
Robots’ utilization in this field is receiving growing attention in study. Robotic technologies applications encompass medication, surgery, dispensing, and stroke suffers’ rehabilitation. Trivial pet-like robotic technology can offer companionship where elderly chronic patients can no longer offer care for an actual animal. Nonetheless, the adoption and uptake of robotic technologies in nursing is yet to meet original forecasts for the care provision. Certain robots introduced to age-care facilities have never been utilized by residents and have since dropped out of commercial production (Eimontaite et al., 2019).
The reason for the lack of desired uptake might be that robotic technology designers have never sufficiently investigated the desires and the needs of nursing staff and aged-care facilities’ residents. Researchers have demonstrated that the elderly are specifically willing and ready to accept robotic technologies whenever they speak to a perceived need and they see that they are able to provide surged autonomy.
Designers might further have failed to acknowledge the seniors have distinguished attitudes towards these robotic technologies than the young population. The seniors have shown greater levels of technological mistrust and always find them increasingly sophisticated to utilize. They are further more probably to give up when face with challenges instead of seeking for help. Despite of this emerging development in nursing, robotics in Saudi Arabia is still unexplored in the area of geriatric nursing. The main objective of this study is to investigate the attitudes and knowledge of Saudi nurse managers towards the adoption of robotics for remote monitoring and management of elderly patient with chronic illness in an aged-care facility.
Background
There remains a scarcity of research probing the acceptance of robotic/assistive technologies with elderly patients and their respective caregiver and nurse managers. Previous studies have showcased that impediments to the utilization of assistive or robotic technologies encompass feeling of discomfiture amongst the elderly patients with chronic illness alongside lack of knowledge and negative attitudes amongst the nurse managers whereas enabling factors/drivers include comfort and ease of use, positive attitude, a feeling of surged personal security and safety, as well as gratification whenever goals are accomplished (Ivaldi et al., 2017).
Abilities and attitudes remain significant variables in the utilization of these robotic technologies by the senior population. Ethnographic researchers probing how seniors utilize available assistive technologies have buttressed the significance of the ability of robots to help independence and uphold the users’ dignity.
This study seeks to generate recommendations that robotic technology designers need to take into account how robot shall fit within user accommodation, work to come up with an easy interface for the seniors, and make sure that robotic assistive technologies can interact effectively with elderly persons with diverse abilities (Kangasniemi, Karki, Colley & Voutilainen, 2019). This study will emphasize on the significance of matching the ability of robots to the needs of the users (Chen, King, Thomaz & Kemp, 2014).
While robots are able to take different forms, based on their specific tasks, the degree to which they seem human is believe to dictate their acceptance, with a plunge in acceptance in case they appear uncannily human-like. Research has demonstrated that people favor less human-looking robotic technologies and other studies have suggested that the seniors would prefer robots to appear serious and view them as being there for task performance, whereas the younger individuals favor increasingly human-like as well as lively robots (Pochwatk et al. 2015).
Aim of the Study
The study aims to prove that the designer of robotic technology is crucial for their use especially among the older patients and those with various forms of disabilities.
Objectives of the Study
The study has three objectives.
- The primary objective of the study is to investigate the attitudes and knowledge of nurse managers towards the adoption of robotics for remote monitoring and management of elderly patient with chronic illness in an aged-care facility.
- To develop recommendations that robotic technology designers need to take into account when developing the technologies particularly in regards to user interface.
- To prove that there is a direct relationship between the usage and acceptance of robotic technology among elderly and disabled patients and the user interface of the technology involved.
- To highlight some of the things that are considered crucial for usage of robotic technology among both nursing staff and elderly patients.
Research Question
What are the crucial elements robotic technology designers need to take into account on how their technologies fit within user accommodation, have an easy interface for senior patients, and ensure elderly persons with diverse abilities can interact effectively with their technologies?
Hypothesis
If the robotic technology developers consider user accommodation, an easy interface for senior patients, and ensure elderly persons with diverse abilities can interact effectively with their technologies then there will be more buy-in from nurse managers on the adoption of these technologies.
Study Significance
The current study offers an initial desirable guide for the appearance and tasks suitable for a robotic assistive technology to provide help/assistance for the elderly patients with chronic illness in the aged-care facilities and outline the pertinent concerns. The study intends to identify and suggest the best guide for designers of robots and age-care facilities seeking to utilize novel technologies (Ito et al., 2015).
It will help nurse managers in caring for the elderly by using appropriate robots for effective falls detection, monitoring elderly persons’ locations, in both rest homes and independent living as well as recommend robotic use in dementia care. This is because the study seeks to identify various task of robots like a social robot and chore robot where the former might provide companionship in dementia care, rest homes, hospital, and independent living while latter might assist in heavy items’ lifting, delivering drinks, cleaning, putting electronics on or off and helping with mobility (Çelik. Hikmet & İhsaniye, 2017).
The study will be importance since it will understand why the saudi nurse managers have negative or positive attitudes and knowledge towards the robots yet these are effective assistive technologies that can relieve nurses from many redundancy of works.
Definition of Terms
There are several key terms that have been used in the report. This section gives definition of the core terms.
- Robotic technology – the design and management of robots for purposes of replicating human actions.
- User interface – the space or platform where humans interact with computers
- Age-care facilities – homes for the elderly that take care of both their health and general wellness.
- Geriatric nursing – aspect in nursing that involves taking care of the elderly and the aging.
- Chronic illness – a disease or health condition that persists more than three months. These conditions or diseases cannot be prevented by vaccines or treated (Chien et al., 2019).
- NARS – Refers to the Negative Attitudes Towards Robots Scale, which in turn highlights the different undesirable opinions people have regarding the use of robotic technology.
- HRI – human-robot interaction.
Literature Review and Framework
There are various studies that have already been conducted on the negative attitudes towards robot scales. Ivaldi et al. (2017) argue that there has been significant bias in the measurement of the impact of robot technology on patients. The issue of measurement of impact is debatably relevant to the designers only. This has been made so due to the profitability margin. Ivaldi et al. (2017) reveal that technology has indeed advanced not only geriatric nursing, but nursing in general. Korn (2019) notes that in Saudi Arabia, whereas there are currently no nurses who have specialized or adopted robotic technology, there is significant interest in the same. However, the challenge recorded is the low understanding of the importance of using robots in nursing.
Due to the fact that there is no active push for more knowledge on the impact of robots on nursing industry, it is arguable that the attitudes towards the same are negative. Korn (2019) argues that one of the reasons nursing managers in Saudi Arabia have a negative attitude towards robots is the fact that there have been myths on human-robot interactions within the society. The scholar explains that one of the common myths regarding human-robot interactions is the fact that robots will take over human jobs, rending the nurses jobless. Whereas there are cases where robots have been used to replace humans, this is not the case in nursing (Tuisku, Pekkarinen, Hennala & Melkas, 2019).
It is important to note that communication barriers are also highly associated with the negative attitudes nurse managers have towards robots. Chen et al. (2014) argue that communication barriers not only affects the older patients but also the nurses themselves as some are more comfortable speaking Arabic. Chien et al. (2019) argue that a significant percentage of elderly people will have differences in speech patterns compared to the average or younger age generations. Additionally, robotic technology that requires speech has to consider the fact that elderly and gaining patients might also suffer from speech disabilities. Therefore, one of NARS main complaints is that robots that use speech recognition do not work due to the fact that they are programmed to understand a specific type of voice.
It is important to note that nursing managers in Saudi Arabia are also assumed to have a negative perception of robotics technology due to the fact that they have not adopted the technology in the field yet. This, coupled with the fact that the society is largely conservative, makes it difficult for the industry to move forward in regards to embracing robotic technologies. It is arguable that a significant majority of the elderly and aging population, who are the core patients in gentry nursing, also speak Arabic, which is the main language in the region. Thus, robotic technologies developers have to consider translation for people in non-English speaking countries when manufacturing their technologies as it will make adherence easier.
Theoretical Framework
Ivaldi et al. (2017) argue that human-robot interaction is characterised by heterogeneity. The theory suggests that the interaction between humans and robots is diverse and is often affected by various elements. For example, as mentioned in the literature review, language and the fact that there is little knowledge on the positive impact robotics technology have in nursing have made it difficult for the industry to effectively implement the same.
Thus, it is arguable, that to some extent, the NARS scores in Saudi Arabia will be high. The human-robot interaction theory also suggests that the only way to alter people’s attitudes towards robots is through proper understanding of the workings of the robot, and a friendly user interface. Ivaldi et al. (2017) explain that these two factors will ensure that both the nurse managers and the gaining and elderly patients appreciate the impact and importance of robotic technology in geriatric nursing.
Methods
Research Design
The study will use a descriptive research design. This design was selected due to the fact that it allows the researcher to collect the characteristics of the population, thus, feeding directly into the aim and research objectives. It is also important to mention that the research study will use constructivism research philosophy. The choice on the research philosophy is based on the fact that different people are expected to have different experienced with the robotic technologies. Additionally, it is assumed that even though the participants might have experienced the use of the same technology, their experiences will be different. It is also important to note that the research philosophy is also based on the fact that the participants will be from the same community, thus, have the same cultural bias, yet it is expected that they will offer differing opinions.
Sample of the Study
The participants will be drawn from the nursing departments of several age-care facilities. The sample will be made up of nurse managers and middle nurse managers.
Sampling Design
The study will use both random sampling and stratified sampling design and methodology. The random sampling will be used to select the larger group from the facilities. However, it is not possible to select equal numbers of participants who have had an experience with robotic technologies. Thus, the stratified sampling methodology will be used to make this comparison.
Sample Size
The study will involve a total of 150 participants drawn across various age-care facilities. The number per facility will depend on the overall number of the available staff.
Inclusion and Exclusion Criteria
Only nurses who are in middle or senior management will be included in the study. This is due to the fact that the study will focus on opinions and thoughts on robotic technology adoption in the industry.
Research Instruments
Questionnaire will include demographic info, list of robot task for subjects to rate on five-point scale from “not at all useful (one) to extremely useful (5) alongside negative attitude toward robots scale (NARS) on which participants will rate how they are seeing robots on fourteen items rated. The NARS items scores will be summed hence creating a total score; and NARS will have high internal consistency alongside a low score indicating an increasingly positive attitude (Chien et al., 2019). The research instrument selected, questionnaire, is ideal as it complements the research design selected as well. Additionally, it offers a viable way of collecting primary data.
To measure the negative attitudes, the Negative Attitude Towards Robots Scale is used. Korn (2019) explains that NARS was developed using responses from various participants regarding their personal experiences and beliefs regarding robotic technology. The development of NARS combined the participant’s responses to 14 research questions. It is arguable that the 14 questions are very comprehensive. Additionally, these questions only sought to analyze personal opinion but did not, in a comprehensive way, show a reliable system of measurement of the impacts. There have been various attempts to validate the tool and make sure that it also measures impact effectively. Korn (2019) argues that this is one of the most criticized element of NARS.
Korn (2019) argues that one of the limitations of NARS is that the original version only considered a specific sample. The scholar notes that there are various disadvantages associated with the use of a longitudinal research approach in different cultural scenarios. Ideally, such a tool, that was meant to be tested and used in various settings should have used a cross-sectional research design. It is arguable that the validity and reliability of NARS is affected by the use of the longitudinal approach that did not consider how the tool will be implemented across different samples. Currently, as Korn (2019) confirms, different samples have had to translate and re-invent the same tool in order for it to be reliable and valid in their set-up. This has further ensured that both nurse managers, nursing staff, aging, and the elderly patients have a negative attitude towards robotics technology.
Validity and reliability
The research instrument selected is both valid and reliable. To ensure its validity and reliability, the research conducted a pre-testing after the development of the tool. The testing sample was collected from a facility that was not identified as one of the sample facilities. Thus, the researcher applied the content validity approach. This ensured that no participant who was involved in the testing was also involved in the actual study. It is important to mention that through this, the researcher also used the over-time, test-retest reliability approach.
Data Collection
Data will be collected through two methods, namely secondary and primary data collection methods. The secondary data collection methods acquired information from desktop research and previous studies done on the same topic. A bit of the data collected through the secondary approach has been presented in the literature review. On the other hand, the researcher will use a questionnaire to collect the primary data. Both types of data will be used to write the final report.
Data Analysis
The study will use a combination of qualitative and quantitative data analysis methods. The researcher will use the grounded theory of qualitative design and descriptive statistics for the quantitative design.
Ethical Consideration
There are several ethical considerations that the researcher has to consider when conducting the research. The first is how the study affects the cultural norms of the participants. This is important due to the fact that in Saudi Arabia, there are several cultural norms that have to be adhered to at all times. For example, it would be unethical for the researcher to use male research assistants to interact with female nurse managers without their guardians. However, the involvement of guardians might hinder the responses. Due to this, it is important for the researcher to have both female and male research assistants to ensure that the cultural norm is observed.
Secondly, an ethical issue that might come up with the safety of the data collected. This concern goes hand in hand with the safety of any personal information that might be collected during the study. To curb this concern, the researcher will not collect any personal information that might lead to the identification of the participants. Additionally, the participants will be assured that the data collected is only for academic purposes. The researcher will take the participants through the proper way of disposing of the raw data once the research is concluded. It is also important that the researcher assures the participants that their participation is voluntary and they are free to pull out of the study at any point and for whatever reason they feel like.
Additionally, it is important that the researcher gets permission and buy in from the age-care facilities before conducting the study. This will ensure that the research runs smoothly with the support of the management. Additionally, this will make it easier for the targeted nursing managers to participate in the study.
Limitation of the Study
One of the limitations of the study is the amount of time and cost needed to do the study. Since this is an academic study, the time line provided for the collection of both secondary and primary data, and the analysis of the collected data is short. A longer period would allow the researcher to delve deep into the study and find more complex relations between the design of the robotic technology and its usage among the aging and elderly patients of the different age-care facilities. Additionally, the researcher has to personally fund the project and this limits the scope. This is due to the fact that research studies can be significantly expensive.
The researcher will have to move from one facility to the other in order to conduct the study effectively. The logistic costs are high plus the additional fact that the researcher will have to get at least two research assistants in order to get the data collected on time.
References
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Chen, T. L., King, C. H. A., Thomaz, A. L., & Kemp, C. C. (2014). An investigation of responses to robot-initiated touch in a nursing context. International Journal of Social Robotics, 6(1), 141-161.
Chien, S. E., Chu, L., Lee, H. H., Yang, C. C., Lin, F. H., Yang, P. L.,… & Yeh, S. L. (2019). Age Difference in Perceived Ease of Use, Curiosity, and Implicit Negative Attitude toward Robots. ACM Transactions on Human-Robot Interaction (THRI), 8(2), 9.
Eimontaite, I., Gwilt, I., Cameron, D., Aitken, J. M., Rolph, J., Mokaram, S., & Law, J. (2019). Dynamic Graphical Signage Improves Response Time and Decreases Negative Attitudes Towards Robots in Human-Robot Co-working. In Human Friendly Robotics (pp. 139-149). Springer, Cham.
Ito, H., Miyagawa, M., Kuwamura, Y., Yasuhara, Y., Tanioka, T., & Locsin, R. (2015). Professional nurses’ attitudes towards the introduction of humanoid nursing robots (HNRs) in health care settings. Journal of Nursing and Health Sciences, 9, 73-81.
Ivaldi, S., Lefort, S., Peters, J., Chetouani, M., Provasi, J., & Zibetti, E. (2017). Towards engagement models that consider individual factors in HRI: On the relation of extroversion and negative attitude towards robots to gaze and speech during a human–robot assembly task. International Journal of Social Robotics, 9(1), 63-86.
Kangasniemi, M., Karki, S., Colley, N., & Voutilainen, A. (2019). The use of robots and other automated devices in nurses’ work: An integrative review. International journal of nursing practice, e12739.
Korn, O. (2019). Social robots: Technological, societal and ethical aspects of human-robot interaction. Cham: Springer.
Pochwatko, G., Giger, J. C., Różańska-Walczuk, M., Świdrak, J., Kukiełka, K., Możaryn, J., & Piçarra, N. (2015). Polish version of the negative attitude toward robots scale (NARS-PL). Journal of Automation Mobile Robotics and Intelligent Systems, 9.
Tuisku, O., Pekkarinen, S., Hennala, L., & Melkas, H. (2019). “Robots do not replace a nurse with a beating heart”: The publicity around a robotic innovation in elderly care. Information Technology & People, 32(1), 47-67.