Evaluating Nursing Work Systems and Identifying Barriers for Robotic Technology Integration: Observational Study

Background: Robotic technology has the potential to assist nurses, but the complexity and unpredictability of health care environments cannot be replicated in a laboratory setting. Furthermore, there is a lack of experiential evidence that robotic technology will meaningfully impact nursing. Collaborative development of technology and real-world usability studies offers the ability to address problems early in the design process when functional changes can be implemented. Objective: The purpose of this study was to use an observational study and systematically evaluate the work system of inpatient nurses to identify barriers to the integration of robotic technology. The objectives are to use an observational study of active hospital units to gain a deeper understanding of nursing tasks, workflow, and the health care setting; identify barriers to the integration of robotic technology using the people, environment, tools, and tasks (PETT) scan from the Systems Engineering Initiative for Patient Safety framework; and synthesize the work system components of the PETT scan into themes. Methods: We used the practice-oriented model of the Systems Engineering Initiative for Patient Safety, the PETT scan, to identify barriers for robotic technology use and innovation. A convenience sample of nursing staff was observed as they worked. Units included the emergency department, medical and surgical intensive care unit, preop or postanesthesia care unit, and general medical-surgical floor. The total number of observation hours per unit was based on data saturation, which occurred at variable times during the day shift, and was arranged with unit management. A total of 53 hours across 16 sessions were recorded. Multiple rounds of inductive and deductive coding were conducted. Briefly, a 3-phase iterative data analysis process was used—initial inductive content analysis, a deductive phase to organize emergent categories into a PETT scan, and finalization of the PETT scan with the identification of overarching themes. Results: Observations across all units yielded a broad set of barriers to integrating robotic and other health care technologies. Using the PETT scan, 78 barriers were identified and were summarized into 20 themes with supporting subthemes and exemplars. Conclusions: By systematically observing nursing workflows and synthesizing barriers into themes, this study provides new insight into the conditions that enable or constrain robotic integration. Findings suggest that robotic technologies are presently best suited for auxiliary and background roles. Broader integration into patient care workflows will depend on designs that align with clinical workflows, support interoperability and robustness, and address ethical, accountability, and coordination challenges inherent in nursing care, as well as maintained organizational support.