Fears about Social Robots in Nursing

Abstract

As the nursing sector's shortcomings remain unchanged, social robots are becoming increasingly relevant. While real-life encounters are uncommon, the media and fiction continue to impact people's perceptions of robots. Capabilities and shortcomings are frequently exaggerated, producing a vision of automated technology that will replace human labor. This article focuses on the topic of worries associated with robot use. Most stakeholders are concerned about disenfranchisement and data protection. They create uncertainties about how the introduction of robots will affect people's lives and work situations. This article compiles the concerns of various parties and advocates for the transparent and participatory development of robots in nursing.

Full text

Felix Carros, Sabine Jockisch, Mehrbod Manavi, Volker Wulf (2023): Fears about Social Robots in
Nursing. 9th International Conference on Infrastructures in Healthcare, DOI:
10.48340/ihc2023_pd020
Fears about Social Robots in Nursing
Felix Carros1,3, Sabine Jockisch2, Mehrbod Manavi1, Volker Wulf1,3
1University of Siegen, 2Franziskaner-Hof Attendorn, 3Fraunhofer FIT
{felix.carros, mehrbod.manavi, volker.wulf}@uni-siegen.de;
sabine.jockisch@franziskaner-hof.de
Abstract. As the nursing sector’s shortcomings remain unchanged, social robots are
becoming increasingly relevant. While real-life encounters are uncommon, the media and
fiction continue to impact people’s perceptions of robots. Capabilities and shortcomings
are frequently exaggerated, producing a vision of automated technology that will replace
human labor. This article focuses on the topic of worries associated with robot use. Most
stakeholders are concerned about disenfranchisement and data protection. They create
uncertainties about how the introduction of robots will affect people’s lives and work
situations. This article compiles the concerns of various parties and advocates for the
transparent and participatory development of robots in nursing.
Introduction
Social robots are increasingly becoming relevant in the care sector. Many
research projects have been carried out in care homes (Aarskog et al. (2019);
Paluch and Müller (2022)) and in rehabilitation (Langer and Levy-Tzedek (2021);
Feingold-Polak and Levy-Tzedek (2021)) with different robots they could show
that the usage of such systems can be beneficial. The topic receives a lot of
attention, to our knowledge for two reasons, for one the situation in nursing
homes in Europe is not becoming better but worse, there is a lack of people
willing to work under the given conditions in nursing, and at the same time a
growing number of people in need of care. Robots are seen as one possible
solution to the workforce's shortcomings. Second, there is a movement towards a
higher degree of digital applications in nursing, but they are difficult to explain as
code cannot easily be explained in the media. Robots are often used as examples

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of how the nursing sector increasingly uses digital assistance, even if they are not
as common as other digital artifacts such as tablets. In the media, it is often
portrayed as if the use of robots in nursing homes is on the verge of a significant
breakthrough. Rarely are the limitations of such a system pointed out adequately.
This leads to worries and fears among many actors in nursing homes about how
this could change their lives and work.
Context
The presented fears in this publication are not the result of one particular study,
they are a combined collection of previous work (see Carros et al. (2020);
Unbehaun et al. (2019); Carros et al. (2022a,b, 2023d)). Experiences gained while
working with robots in nursing homes for many years. The collections of fears
that we present here have been written, weighted, and evaluated by an
interdisciplinary team of authors who are practitioners and researchers. Our
research is grounded in practice based research (Schmidt (2018); Ogonowski et
al. (2018); Krüger et al. (2022)) and participatory design (Wagner (2018); Krüger
et al. (2022); Weber et al. (2023)). For seven years (2017-2023) we have been
using robots in nursing homes. We tested several robots and developed the
capabilities of the robots with a design case study methodology Wulf et al. (2011,
2015); Kotthaus et al. (2023). In the first years we focused on the robot Pepper in
nursing homes (Carros et al. (2020)) we later expanded this work to other robots
such as AIBO (Helm et al. (2022)), Android robots (Carros et al. (2022d); Hille et
al. (2023)) and worked together with other national and international research
projects that worked with robots in nursing settings (Carros et al. (2022c); Chang
et al. (2022)) and expanded our work to other disciplines like ethics Störzinger et
al. (2020); Haberland et al. (2022). We have done hundreds of interviews, spent
years with the robot in nursing homes, included citizens in our research (Carros et
al. (2022e)) and are writing this study with an interdisciplinary team of
practitioners and researchers.
Fears about Social Robots in Nursing Care
Over the years we have seen many positive reactions and emotions toward robots
and their application in the field. However, there are also more critical voices. The
topic of fears toward robotic systems in care is not completely new and we
already addressed parts of it in previous work (Carros (2019); Habscheid et al.
(2018)), others also did research on it, but with a quantitative approach while we
use qualitative data (Coco et al. (2018)). However, after several years we see a
need for an update to these, as the technology developed, and our experience has

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grown. We predominantly focus on fears expressed by people working in the
field.
Fears of Residents
During discussions and interviews with residents of nursing home facilities and
the people caring for them, four recurring fears emerged:
Cost-Saving Measures: Robots could be used to replace humans to make care
homes more profitable instead of using them to assist human workers to enhance
the quality of care.
Monitoring of Residents: It is unclear what happens with the data that the robot
is recording. Bad actors might try to get access to this data.
Inhuman Interaction: Daily interactions become increasingly inhuman and are
mostly done by robots. Human workers minimize contact with the residents and
leave conversations and rehabilitation to the robots.
Loneliness: The replacement of human workers with robots could lead to less
human contact.
Three of the four fears are about care being dehumanized by the use of humanoid
robots. This clearly shows the importance of people and human warmth for the
residents and that this cannot be replaced.
Fears of People Working in Nursing
A somewhat different picture of fears emerged among care workers compared to
residents, but with a similar message at the core:
Work Replacement: The usage of robots could be intended as replacements for
human workers, similar to the situation in some industries where robots take over
the work of humans. Instead of being used to increase the quality of work.
Structuring Work: Robots are not as flexible as humans are, their abilities limit
their flexibility, and they can often not read a room and act accordingly or go
outside and search for someone who got lost. There is a fear that the structure that
a robot needs to work properly is going to influence the work flexibility of care

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workers. They could be forced to amend to the needs of robots in order to work
together, limiting the flexibility of the workers and effectively creating a hierarchy
where workers have to cater to the needs of the robot.
Acceptance because of Resignation: Residents can feel helpless because they
need help for their daily life due to their help condition. There is a fear that they
accept the robot and its demands because they do not know what else to do or
because they feel too weak to say no.
Manipulation by Mimicking Human Behavior: The imitation of human
behavior that is sometimes shown in conversations by the robot when saying
things like "I’m also feeling good" or "Should we do sport together?" is
manipulating the capabilities of the robot. The robot does not feel and does not do
sport. By mimicking this, the robot gives the perception to do and feel these
things. This is done to create some kind of connectedness to the human interaction
partner, but this connection is not real and to some degree manipulation.
Being Responsible for Malicious Systems: Residents are using robots because
care workers say that it is safe to use them. Care workers lend trust to the robot. If
the robot is using the data to manipulate the residents, if it uses the data for
malicious practices, then there is a certain responsibility of care workers, because
they convinced the residents to use them. Without the care workers, there would
be no introduction of robots in care homes.
Monitoring of Nurses: Robots have cameras, microphones, and many other
sensors. These constantly collect data for the robot to work. They are needed for
the robot system, but they can also be used for other purposes. Management could
try to gain access to this data to control care workers. Another possibility is that
an algorithm is tracking the work of care workers and creating monitoring reports.
Wrongful Monitoring: If a robot creates monitoring reports about how long
workers need for specific work steps and where they are doing these. There is a
danger that this monitoring is naive and not aware of the complex work. If a care
worker takes longer with one task (e.g., bathing) it is possible that it is not because
the worker is slow but because the resident requires psychological assistance and
is having a breakdown while bathing, resulting in a longer conversation while
bathing.
Medical Profiles: Sound recordings and videos might be able to create medical
information. Cameras could detect if a person has problems with their back by
doing gait analysis. While this is a useful tool, this information could be
maliciously used against the workers and be transmitted to management or third
parties.
Psychological Profiles: Speech recognition and speech interactions could be used
to generate psychological profiles of the care workers. These profiles could be
given to management or be used by the robots to manipulate the care workers in
doing work that is favorable for the management or the robot.

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The fears expressed here focus on disenfranchisement and data protection.
Incapacitation of one’s competence to manage one’s work and to be able to do
this independently without supervision and feedback to the home’s management.
A gloomy picture of robots is drawn here, which seems like an extended arm of
the management.
Fears of Relatives
Fears also arise among relatives of nursing home residents:
Changing Conversation Patterns: Conversations with robots are designed in
order to be pleasant and avoid negative emotions. This bears the risk that the
conversation patterns of residents change, as the robot will always simulate
interest, even if the conversation is repetitive. The robot will also not react to
aggressive or negative comments towards it. This could lead to a situation where
residents get used to talking to a robot and unlearn human conversation patterns.
Data Security: Data recorded by the robot, such as camera images or audio
recordings, could fall into the wrong hands. These data could be used against the
interest of the residents.
Human Replacement: Robots should not be the only interaction partner for
residents. It is important that humans take care of the residents.
The concerns are similar to the ones that residents and nurses expressed. Relatives
act mostly as advocates for the residents and have fewer personal concerns.
Discussion
The fears of the various players have similarities at their core. Topics such as data
protection and the disenfranchisement of human decision-makers are prevalent.
This contrasts with the image that is painted through fiction and media, where
robots are frequently depicted as powerful machines with various powers that
overshadow humans. While fiction is often an inspiration for technology
development Krings et al. (2023), it does not easily translate to the same results.
Often missing from these is an examination of the tasks of people working in the
field. Working with people in need of care is a complex profession that requires
specific training and certain talents, such as emphatic intelligence (Teófilo et al.

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(2019); Digby et al. (2016)) and domain specific knowledge. Abilities that are
often underdeveloped in robotic systems (Pepito et al. (2020)).
We believe that it is important to know the fears of the different groups during
development and to respond to them appropriately. Participatory design of
software might be an answer to it, as well as long-term research, as other
researchers also point out (e.g., Tuisku et al. (2019); de Graaf et al. (2019)),
opinions about robots often change to a more realistic view that sees robots as
recreational instead of a replacement. Developers need to closely work with the
people affected by the technology, otherwise, the developed robots risk staying
unused. We further see a need to explain technology, its abilities, and its limits.
People working in the field do not have the time to understand each technical
detail, and there is a need for easy explanations, otherwise, there is a risk of not
being used because of not fully understanding the device. Lastly, we want to
address the topic of manipulation. Robots simulate emotions and do not feel.
Residents respond to the simulated emotions of the robot with real feelings. This
is a one-sided emotion exchange that is simulated by a robot displaying behaviors
that look like human emotions. There needs to be some degree of transparency,
reminding residents that the emotions of the robots are not real ones.
Limitations
In our studies and practical experience, the robot was utilized to activate residents
with recreational activities rather than functions that attempted to replace care
workers. If other activities, such as medicine decision-making, are delegated to
robots, people’s perceptions of them may shift. We also generally worked with
friendly-looking robots; anxieties may differ with other robots (for example, if the
robot is tall and muscular). Finally, our findings are not representative. Our results
are based on experiences in a few nursing homes and nursing institutions.
Acknowledgments
All those engaged deserve our gratitude. The knowledge of this publication was
created in a collaborative effort with many different actors. We are deeply
thankful for the given opportunity.
The presented work has partly received funding from the BMWK under grant
agreement no. 01MF22009A.

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