Assistive robotic systems in nursing care: a scoping review

With the help of the assistive robotic systems (Table 3) in Song et al. [23] and Ahn et al. [24], health data and patient information are entered into a robotic system upon admission to a hospital. Individual task plans are created and the robotic system navigates the patients to the appropriate departments, including diagnostic departments, using a follow-me function. The goal is to channel requests directly upon entering the hospital and facilitate the input and processing of patient information [23, 24], but also to provide directions for visitors and patients [25]. The Terapio robot was developed for medical or nursing rounds. The robot accompanies staff during walk-throughs or rounds and enables patient data entry and progress display [26]. In Stoevesandt et al. [27], the Pepper robot was used to educate patients about magnetic resonance imaging. In addition, assistive robotic systems are used as a communication channel [28], for example in case of an emergency [29].

Assistive robotic systems to support activities of daily living (Table 4) were developed for groups of people with special care needs. Their aim is to make everyday life easier and to maintain the independence of those affected. For this purpose, the technical systems provide step-by-step instructions or provide objectes [14, 30‐32]. The robots Ed [31, 32] and iRobot [14] were developed to provide audiovisual instructions on how to perform specific activities. The Ed robot was developed for people with dementia or mild cognitive impairment. It guides users to make tea and wash their hands [31, 32]. The NAO robot assists people with neuromuscular diseases at home by reaching for objects and providing them to the person [30].

The assistive robotic systems for pick-up and delivery activities could be divided into the following four sub-areas: Assistive systems for food and beverage service, for medication delivery, for contact reduction in infections, and user-related delivery services.

Assistive robotic systems for food and beverage service (Table 5) deliver meals and beverages directly to patients [29, 33‐35]. The i-merc robotic system enables delivery of special dietary foods after input from dietitian staff [34]. As a robot for inpatient long-term care, Care-o-Bot 4 serves small snacks and drinks to residents [35].

Some assistive robotic systems deliver medications directly to patients (Table 6) [28, 29, 33, 36‐38]. In this context, the robot in Haider et al. [33] is directly linked to the hospital pharmacy and delivers the ordered medication to the patients from there. The robot TUG is also stocked by the pharmaceutical staff in the pharmacy, but this robot delivers the order to the ward staff [39‐41]. The WDBOT robotic system includes the complete ordering and delivery process: the required medications are ordered by the nursing staff at the corresponding ward. The robot collects the medications and is distributed to the patients together with the nursing specialist. For safety reasons, the nurse checks the medication and confirms the dispensing on a tablet [42]. Another system was developed for use in an oncology department. Its purpose was to transport radioactive materials [43].

The goal of these assistive robotic systems is to minimize physical contact between patients and staff, both to prevent infection and to reduce the workload of health care professionals. In light of current events, the systems were developed and tested for the clinical care of COVID-19 patients (Table 7). The automated systems are designed to deliver drinks, meals, or medicines to infected individuals [44‐47]. A system was developed to deliver materials to caregivers in an isolation room [45, 46].

In addition to delivering food, beverages, or medications, assistive robotic systems are also used to deliver and transport laboratory materials, documents and further undefined objects (Table 8) [48‐53]. The intelligent nursing trolley can be navigated by caregivers via a smartphone and delivers wound materials (hospital) or laundry (inpatient long-term care) to the destination, depending on the application. The goal is to reduce walking distances, thereby reducing the burden on nursing staff [35, 55‐56]. The CASERO robot transports clean laundry to the station and takes the dirty laundry with it [10, 57, 58]

A key feature of the systems described in Table 9 is being able to interact with people. Ienca et al. [59] describe a growing share of assistive technologies for people with dementia or cognitive impairment, which focus on social-assistive functions or telemedicine. The Giraff robot is an example of this [14, 59]. Assistive robotic systems for this application area enable robotic communication between health care professionals, caregivers, relatives and patients. For example, communication is possible via speech recognition or via input into a tablet [43, 52, 60]. The IVO & Tommy system allows communication between COVID-19 patients and caregivers. Communication was enabled by audio and touch screen functions. The aim was to protect staff from infection by reducing contact [60].

One function of this category (Table 10) is the monitoring and documentation of patients' vital signs. The IVO & Tommy robot also has the function of reading vital signs in the patients' room via an integrated camera, where, on the other hand, the Silbot robot enables daily recording of general condition and mental state [37, 53, 60, 61]. Another safety aspect is the reminder function, such as medication reminders [53, 61, 62]. The robotic system of Arthanat et al. [63] is also capable of sending alerts to predefined individuals, such as family members, if medications have not been taken. In addition to medication reminders, the Pearl robot also handles personal hygiene reminders and meal and drink reminders [64].

The function of navigation belongs to this category, as these systems support the safe mobility of individuals. The ARNA robot accompanies patients. It serves as a walking aid and thus provides stability [49, 50]. The robotic system at Mahajan & Vidhyapathi [62] additionally performs lifting and carrying of objects, such as oxygen equipment, IVs, and drains. The target users for this system is individuals in acute inpatient settings during the postoperative period. For orientation in hospitals, robots also serve as a mobile navigation system using follow-me function [23, 38].

Complex assistive robotic systems for assistance (Table 11) perform multiple tasks in the areas of service, communication, safety, social participation and employment. The Kompaii and RAMCIP robots assist individuals by providing information and communication functions. Kompaii can send an emergency call to a control center or remind people to take medication. RAMCIP is additionally able to record fall events. In addition to entertainment functions, such as music playback function, game function and weather service applications, there is the possibility to use video telephony. In some cases, the systems also move autonomously in space, detect obstacles, and can deliver light items such as medication or water to the person [53, 65‐67]. The Care-o-Bot 3 robot was specifically designed for inpatient long-term care and home settings. It performs simple pick-up and drop-off services, serves drinks, speaks directly to residents, and provides entertainment through memory games, music, and poetry. In the home setting, it is possible to interface with an emergency call center, which can, for example, send an emergency call in case of a fall event [10, 53, 57‐58].

Results were summarized from four studies. Two of the studies followed a qualitative research approach and one study each followed a quantitative and mixed-method approach.

Mutlu & Forlizzi [40] used a qualitative ethnographic research design to explore the effects and changes on organizational and social-communicative factors during the use of an autonomous robot for fetch and delivery activities in an acute internal medicine ward and an obstetrics unit. The results, analyzed according to the principles of grounded theory, were able to describe differences in terms of perceived benefits, acceptance, interactions, and work-organizational changes. The differences relate in particular to the integration of the robot into the workflow and to the perception and interaction with the technical system. On the acute internal medicine ward, the robot was hardly tolerated. The integration into work processes and the resulting interruptions within the daily work routine were perceived as disturbing. In contrast, the robot could be integrated into work processes on the obstetrics ward. In the study by Summerfield et al. [41] similar results are described. Here, the use of a medication delivery robot was evaluated in an intensive care unit. The change in the medication delivery process contributed to additional activities being transferred to nurses. This contributed to decreased acceptance toward the technical system. Another problem was the technical failures of the robot, which led to further delays in the workflow and additional deliveries. The study by Arthanat et al. [63] also indicated that acceptance is based on technical aspects, such as navigability, humanoid characteristics, user interface, and adaptability. The aim of the study was to test an assistance robot with a group of relative caregivers and to collect their views on a possible integration into a home setting. The technical problems also led to a rejection attitude. Other reasons for rejection were the technical complexity and the failure to develop assistive robotic systems with a hands-on and person-oriented approach.

Furthermore, in Mutlu & Forlizzi [40] the culture-specific and the social-emotional context play a role. Due to the disease spectrum of the patients in the internal medicine ward, a special relationship between nurses and their patients could be observed. Therefore, in conjunction with a work environment characterized by stress and noise, deliveries and the attention they required were perceived as disruptive to the robot. Negative attitudes extended to physically and verbally assaulting the robot. In contrast, the nurses in the obstetrics ward described the relationship with the robot as positive, helpful, and friendly. Due to patient transports or emergencies, the internal medicine department often had a stressful work environment. Objects standing around also presented obstacles for the robot and led to collisions with staff, patients or visitors. Such incidents triggered dissatisfaction towards the robot, but this was less frequently recorded on the obstetrics ward. Regardless of the focus of care, respondents rated it critically when the robot stopped in the corridors for several minutes. This caused anxiety among nurses, as the robot was seen as a disruptive factor in the event of an emergency. Complementing this, Kirschling et al. [39] found in their study that such technical and situational difficulties reduced the utilization of the robotic system.

Results were summarized from two studies. One study followed a qualitative approach and the other a mixed method approach. Acceptance of and attitudes toward assistive robotic systems in home care can be described as heterogeneous. Wang et al. [32] investigated the attitudes of older people with a mild form of Alzheimer's disease and their relatives towards a assistive robotic system to support activities of daily living in the home setting. From the semi-structured interviews, different perspectives on the use can be described. A part of the elderly persons and their relatives rejected the robotic system in principle, while other persons were open to the idea but did not see a current personal need for such technological support. The negative attitude was justified from different perspectives. On the one hand, the participants did not see it as necessary, since home care was already provided by their relatives. On the other hand, the associated cost factor and the desire for human care represented a hurdle. Also, the elderly respondents from the study by Wu et al. [65] noted that they could not demonstrate an individual need for a robotic system. Rather, they described a threat of dependency from the use of robotic technologies. The resulting stigma combined with the desire for independence within care had a negative impact on acceptance. Furthermore, the potential of loneliness and dehumanization was described. There was a risk that contact with relatives would be restricted and that interpersonal relationships could suffer as a result. In contrast, Wang et al. [32] acknowledged that the use of assistive robotic systems could reduce worry, anxiety and stress, which could lead to a better relationship between relatives and care recipients. The assessment of the role that an assistive robotic system could take in such a care constellation ranges from a friend that supports social and emotional needs to a machine that enables the execution of household activities and offers little scope for personal relationships. The older persons interviewed assess the robot as a measure against social isolation and note that contact with a machine can never replace that with a human being. Building a relationship is seen as potentially possible, however, according to the interviewees, it will never be like the relationship with a human. For some older people, it was important to learn how to use new technologies so as not to become alienated from modern society. Other factors influencing acceptance were age and existing technology skills. The family caregivers had a positive attitude towards the use of assistive robotic systems. Interestingly, they assumed that the persons in need of care were also positively disposed towards the use [32, 65].