Robotic Assistants in Nursing: Issues in Safety, Hygiene, and the Not-So-Human Connection

As I read the headline, I thought, “What is the world coming to?” Robots performing nursing care?

I once joked with colleagues that since hospitals seem so intent upon reducing the number of care providers- both nurses and nursing assistants- that perhaps they could start using kiosks for the patient admission process. At the time, we all laughed at the thought, slapping each other’s backs. “Ridiculous,” many explained. “Can you imagine?” And that was that. We went back to our duties, never mentioning it again.

But now, I look again at the headline: Robot Assistant to Improve Elderly Care in Nursing Homes, by Chloe Kent (2019). Can they be serious?

It seems this is not yet in standard practice, but is part of two pilot studies in Europe- specifically, Finland and the Netherlands. The robot, formally introduced as a Social and Autonomous Robotic Health Assistant (SARA), is accessible through computers or tablets. Nurses and nursing assistants can access patient data and plans of care for individual patients. The pilot studies are currently focusing on locked units in nursing homes, where both dementia and psychiatric patients reside, but the hope is to also place SARAs in hospitals once they are approved for standard practice.

Having worked in adult psychiatry for many years, where I cared for patients with acute and chronic mental illness and dementias, I find this completely unrealistic. Have the safety risks resulting from a machine which moves freely about the unit been truly considered? These units are carefully monitored for any items which may pose a danger to patients and staff. Even items which seem completely innocuous are considered contraband, from toothbrushes to tv remotes. Some units don’t even allow patients to have bras. So, how does a moving machine work into this picture? How durable are they? Can they react in a manner to preserve both patient safety and their own? And if they are damaged, what is the economic impact? I have found no mention of the cost of such a highly advanced piece of technology, but one can only imagine they are extremely expensive to both purchase and maintain.

Aside from the dangers of injury, what about hand hygiene? Do these SARAs use soap and water to wash hands, wear gloves, and/or use hand sanitizer? How can they comply with standard precautions? Are their hands disposable? I highly doubt it.

Another consideration is the impact the presence of these machines may have on psychiatric and dementia patients. Can you imagine an elderly patient with dementia, who thinks it is 1940 and whose mother is coming to visit, seeing a robot rolling down the hall? What about a patient with paranoid schizophrenia, who has a delusion that artificial intelligence is out to destroy mankind? (You may be surprised how common this fear is.) Honestly, I can’t think of many patients with memory impairment or psychosis receiving these robots well.

Perhaps even more troubling than all of the concerns mentioned so far, I am deeply troubled by the thought that these patients, many of whom are already desperately starved for human interactions, will be doomed to even less contact with an empathetic, caring caretaker who can sit and genuinely listen to them. Is a SARA supposed to offer reassurance that they are cared for and valued? The human connection offered by nurses and nursing assistants is especially valuable, particularly for the countless patients who have no friends or family. For many, we are the only contact they have with another human being, aside from the other patients, who are either incapable or restricted from offering therapeutic communication and a caring touch. I know that in my times of greatest need, I do not want to see a robot wheeling into my room to assure me that all is well. It’s a machine, not a human.

So, I ask again, “What is this world coming to?” What does the future look like for patients, and what lasting impact may this have on the future of nursing?


Chloe Kent. (2019). Robot assistant to improve elderly care in nursing homes.

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