Identifying Needs for the Use of Cyber-Physical Systems for Care in a Pediatric Hospital
García Fernández Miguel1* and Álvaro i Rodero Carla2
1García Fernández Miguel1* and Álvaro i Rodero Carla2
2Saint John of God Hospital, Pediatric nurse specialist, Barcelona, Spain
Submission: May 03, 2017; Published: August 04, 2017
*Corresponding author: García Fernández Miguel, Saint John of God Foundation, Research Nurse, Barcelona, Spain.
How to cite this article: García F M, Álvaro i R C. Identifying Needs for the Use of Cyber-Physical Systems for Care in a Pediatric Hospital. Acad J Ped
Neonatol. 2017; 5(2): 555717. DOI: 10.19080/AJPN.2017.05.555717
Keywords: Pet-Robots; Nursing; Care; Design thinking; Pediatrics; Cyber-physical systems (CPS)
Cyber-physical systems (CPS) are intelligent robotics systems, linked with the Internet of Things, or technical systems of networked computers, robots and artificial intelligence that interact with the physical world. In 2016 the project ‘Ethical aspects of CPS’ has been published by the European Parliament to provide insights into the potential ethical concerns and related unintended impacts of the possible evolution of CPS technology. Issues as delegation of tasks, safety, responsibility, privacy and social relations have been analyzed by this research, with the 2050 year in the horizon .
In Saint John of God University Hospital we have been using social robots since 2013 in the context of the collaboration between LaSalle University, Polytechnic university of Catalonia, Autonomous university of Barcelona and Saint John of God hospital, for the development of a social robot for therapeutic use in pediatrics. After several test the robotic platform selected for the deployment in the hospital was PLEO®, a pet robot with the aspects of a camarasaurus baby dinosaur that has different personalities with animals and primary behaviors such as hunger, fear, happiness, curiosity. The PLEO® generates affective behaviors in children aimed at satisfying the needs of the robot. After the deployment of the robots in the hospital a wide range of test and research have been done for to know the dynamics set between the different stakeholders, patients, families, health professionals and the robots .
Other technologies such as Immersive virtual reality have been used too for the treatment and prevention of pain and anxiety in front of procedures. Immersed in an era of rapid technological development healthcare professionals cannot just be passive receivers of new technologies and devices and become an industry testing ground but must be involved in device design from the outset .
To know the requirements that CPS, especially social robots, may have for its use in a pediatric hospital. Identify the needs of the health professionals related to what could offer this kind of technology to improve the quality of care.
This work has been divided in two parts. The first was a design thinking session with nurses, like end-users of the technology, to identify needs. The second was a survey with four open response questions administered over nurses of different departments in the hospital that have had contact with the PLEO®.
For the design thinking session we select a group of 9 nurses, all of them were pediatric nurse specialists, they work in different service of the hospital, from hospitalization ward to PICU or ER department. This group of nurse’s didn´t has previous experience with social robots. The reason of this selection was that we thought that a previous knowledge of PLEO® could induce the participants to think in PLEO® and no in a general robot or technology. We presented the participants the basic elements of the design thinking and asked them about things or aspects of the clinical assistance that the technology could take from the patient, family or environment; we divided these aspects in three initial challenges, clinical, emotional and social aspects.
In the first stage (divergence) of the session all participants, divided in three groups, proposed ideas about this three challenges, in the second stage (convergence) each group select one of the aspects and made a conceptualization of the ideas exposed. After the session the research team carried out an analysis of the results and a holistic conceptualization of the needs identified by the participants. This needs were grouped in a triangular pyramid
model in which the clinical, emotional and social aspects form
three hierarchical levels around all the model, in other level we
use the three faces of the pyramid to classify the needs in “what”,
“how” and “why”.
Against all prognosis the clinical aspects were not those in
which the nurses identified a greater number of needs, possibly
because the use of technologies for the obtaining of vital signs is
habitual in our context; Regarding clinical information there was
unanimity in that a device can obtain clinical information from
patients, but should not make decisions about this information,
the ability to decide is not delegable by nurses and consider
technology as an actuator. It was in the emotional and social
aspects where nurses assigned to technology a more relevant
role by proposing that new technologies applied to care should be
able to act as communication interfaces between the patient and
his family, friends, schoolmates, or even with nurses and doctors.
They also considered relevant that the new technologies could be
reactive to the child’s mood, proposing activities according to the
state of the child, as well as the assessment of pain, based on facial
patterns combined with vital signs. After this design thinking
session we designed an open response survey (Table 1) and we
administrated it between nurses with previous experience in the
use of social robots, nine nurses of the oncology department were
surveyed. The comments on the survey were analyzed following
the content analysis method.
About the first question the nurses mainly included the daily
hospital, ER department, surgical ward and hospitalization ward
like places susceptible to offer robots like a therapy. About the
second question the nurses said that the robot could distract,
make company, awaken imagination, facilitate the expression
of feelings, stimulates the responsibility of caring, interact with
children. It is viewed as an alternative to videogames or TV. About
the information that a robot could give to the nurse us didn´t
obtain any response, maybe because the nurses identified the
PLEO® like the unique alternative for robot companion and they
didn’t imagine this pet-robot like a clinical device.
About the third question they referred to a problem
communicating with patients due to lack of knowledge of them and
trust. It shows the robot as a facilitator of expression of feelings
and as a mediator between professionals and children, because
the robot is a toy. Finally, about the forth question some people
say it should be like a pet, other nuance it should have distinctive
aspects facing animals and should not be able to confuse one with
the other. They also granted the role of stimulating the child’s
caregiver role and no liability with caring for a pet. Should be able
to speak and show expressions in terms of feelings. It mentioned
that is an alternative to live animals, which cannot enter all areas
of the hospital. It must be disinfected. The responses obtained in
this survey were coherent with the needs identified in the design
The nurses that participate in the session identify different
needs in which the robot could we useful, against expected the
clinical aspects weren´t the one in which the nurses identifies
more needs. We interpret this fact because currently there are
many devices that address these aspects such as vital signs and
the nurses are familiar with them. The aspects where the nurses
identified more needs were the emotional and social giving
the robot the role of a mediator in the communication between
different users for example between the hospitalized child and the
school partners or between the family and the nurse.
Although nurses are not willing to delegate decision-making
related to clinical aspects they seem to do so in emotional and
social aspects, giving to technology, in that sense, a greater degree
of autonomy. In line with the recently published European Union
guidelines on the use of autonomous information systems, the
information obtained from patients belongs to the patients in the
custody of the persons who care for them, the technology involved
in collecting this information is a mere intermediary .