The Increasing Centrality of Robotic Technology in the Context of Nursing Care: Bioethical Implications Analyzed through a Scoping Review Approach

Abstract

At the dawn of the fourth industrial revolution, the healthcare industry is experiencing a momentous shift in the direction of increasingly pervasive technologization of care. If, up until the 2000s, imagining healthcare provided by robots was a purely futuristic fantasy, today, such a scenario is in fact a concrete reality, especially in some countries, such as Japan, where nursing care is largely delivered by assistive and social robots in both public and private healthcare settings, as well as in home care. This revolution in the context of care, already underway in many countries and destined to take place soon on a global scale, raises obvious ethical issues, related primarily to the progressive dehumanization of healthcare, a process which, moreover, has undergone an important acceleration following the outbreak of the COVID-19 pandemic, which has made it necessary to devise new systems to deliver healthcare services while minimizing interhuman contact. According to leading industry experts, nurses will be the primary users of healthcare robots in the short term. The aim of this study is to provide a general overview, through a scoping review approach, of the most relevant ethical issues that have emerged in the nursing care field in relation to the increasingly decisive role that service robots play in the provision of care. Specifically, through the adoption of the population-concept-context framework, we formulated this broad question: what are the most relevant ethical issues directly impacting clinical practice that arise in nursing care delivered by assistive and social robots? We conducted the review according to the five-step methodology outlined by Arksey and O’Malley. The first two steps, formulating the main research question and carrying out the literature search, were performed based on the population-context-concept (PCC) framework suggested by the Joanna Briggs Institute. Starting from an initial quota of 2,328 scientific papers, we performed an initial screening through a computer system by eliminating duplicated and non-English language articles. The next step consisted of selection based on a reading of the titles and abstracts, adopting four precise exclusion criteria: articles related to a nonnursing environment, articles dealing with bioethical aspects in a marginal way, articles related to technological devices other than robots, and articles that did not treat the dynamics of human-robot relationships in depth. Of the 2,328 titles and abstracts screened, we included 14. The results of the 14 papers revealed the existence of nonnegligible difficulties in the integration of robotic systems within nursing, leading to a lively search for new theoretical ethical frameworks, in which robots can find a place; concurrent with this exploration are the frantic attempts to identify the best ethical design system applicable to robots who work alongside nurses in hospital wards. In the final part of the paper, we also proposed considerations about the Italian nursing context and the legal implications of nursing care provided by robots in light of the Italian legislative panorama. Regarding future perspectives, this paper offers insights regarding robot engagement strategies within nursing.

Digital nursing practice theory: A scoping review and thematic analysis

“…The future of nursing is expected to become dominated by increasingly more disruptive and complex digital technology (Gibelli et al, 2021). As such, the theories identified within this review will become of increasing importance for the furtherment of nursing knowledge to account for technological change.…”

“…The future of nursing is expected to become dominated by increasingly more disruptive and complex digital technology (Gibelli et al, 2021). As such, the theories identified within this review will become of increasing importance for the furtherment of nursing Technology as an agent within the care environment-the recognition by nurses that the presence or absence of technology can influence clinical outcomes due to its design or functionality.…”

Can artificial intelligence and robotic nurses replace operating room nurses? The quasi-experimental research

“…Rapid developments in technology, especially in the fields of artificial intelligence and robotics, help the complement of both the health sector and all other sectors [ 7 ]. Imagining the health care provided by robots seemed completely unrealistic until the 2000s; however, today, in some countries such as Japan, nursing care is provided by assistive robots to a great extent [ 8 ]. It is of great importance for health institutions to follow and use technological developments in order to provide services in accordance with the right to receive quality health care [ 2 ].…”

“…Japan, one of the leading countries in robotic technologies, which spent 16.7 billion Japanese Yen for projects on nursing care robots in 2015 is now planning to increase this figure to 404.3 billion Japanese Yen by 2035 [ 2 ]. This revolution in the provision of care, which continues in many countries and is targeted to be used and realized globally in the near future, has significantly progressed after the outbreak of the COVID-19 pandemic [ 8 ].…”

Can nurses in clinical practice ascribe responsibility to intelligent robots?

“…9,10 While there is the inevitable reality of robotics integration and exploration in nursing, there are also frantic efforts to determine which of the ethical designs is best for robots and nurses working harmoniously. 11 This article may pave a step closer to the goal of capacitating nurses with ethical and moral understanding to discern ethically and morally, especially in this advanced healthcare system.…”