By Julia Konow
Nursing students at Worcester State University are not only learning how to become nurses, but they are also embarking upon the future participation of teaching a robot how to perform nursing-assistive tasks.
A Tele-Robotics in Healthcare event at Worcester State University on Feb. 20, 2019 expanded the conversation of technological advancements in the healthcare field for students, staff, and faculty members. The presentation was by Dr. Zhi Li, a Worcester Polytechnic Institute assistant professor in the robotics engineering program. The event was held in the Eager Auditorium within the Sullivan Academic Center from 5:30 to 7:00 p.m. At the presentation, Li discussed TRINA, or Tele-Robotic Intelligent Nursing Assistant, a robot she has been working on in her lab.
“I think that, as a nursing student, it is important to learn about tele-robotics in the healthcare field because this could greatly benefit patients for generations to come,” said Dominique Alves, a 19-year-old sophomore studying nursing at Worcester State. “In areas where there are a significant shortage of nurses, tele-robotics could help solve the problem. It also creates a safer environment for the caregiver in circumstances where the patient may be severely contagious.”
The presentation discussed new research opportunities to study the synergy of human healthcare and robotic systems, as well as how to augment a healthcare provider’s capability to meet the challenges within their daily profession in a safe and effective way.
“Professor Li contacted me and asked about developing a collaborative relationship with WPI and WSU,” said Paula Bylaska-Davies, an associate professor of nursing who has worked at Worcester State University for 13 cumulative years. “They have robots and we have the nursing program, so they will come here with TRINA and we will demonstrate nursing so TRINA can mimic nursing movements.”
There are only two TRINAs in the United States: one being at Worcester Polytechnic Institute and the other at Duke University, Bylaska-Davies explained. She believes that tele-robotics is a very important aspect of the future of healthcare, which can already be observed with tele-robotics in operation rooms.
The TRINA development is largely in response to highly infectious disease outbreaks, like Ebola. It aims to protect and assist healthcare workers with routine tasks of taking care of patients, as well as handling contaminated gear or materials. The robot can complete about 26 patient-caring tasks that are assistive for nurses. Some of these tasks include food preparation, handing over food and medicine, giving patients cups, doing laundry, changing blankets, collecting, stacking, and more.
“I had not realized how far along they were in creating medical robots,” said Kathryn Johnston, a 20-year-old sophomore studying nursing at Worcester State. “I was really surprised by the types of tasks that the researchers were trying to accomplish with TRINA. I figured that, at some point in the future, we would begin incorporating advanced technology into hospitals, however I assumed that this would be for more mundane tasks.”
The goals for the robot are for it to be versatile, safe due to its proximity with humans, capable of light or medium duty tasks, mobile in hospital settings, less than $100,000 in cost, and able to facilitate audio and visual communication between a nurse and patient. At the event, Li used a powerpoint with various photographs, charts, diagrams of software architecture, graphs, videos of TRINA performing nursing-assistive tasks like removing blankets, and more.
Besides teaching at Worcester Polytechnic Institute, Li also directs the Human-Inspired Robotics Lab, which enhances the synergy between robotic and human systems. Li’s research interests include tele-nursing robots, rehabilitation robots, human-inspired motion coordination, and human-robot collaboration. Her research focuses upon intuitive and intelligent teleoperation interfaces, high-level learning and planning of human-robot collaboration, and shared control of complex robot motion coordination. Li has participated in a number of published scholarly works as well. But for many students at Worcester State University, tele-robotics in the healthcare field was an unfamiliar topic.
“This was my first time hearing about telerobotics in the healthcare industry and I was very surprised by what they have been able to accomplish with it already,” said Emma Crowley, a 20-year-old nursing student at Worcester State. “I think it will be very interesting to see what other advances are made in the near future. One of the interesting things that I learned at this event that I had not realized before was just how many logistics come into play when working on something like this.”
There have been considerable advancements in technology in recent decades that allow for conversations like the one held at Worcester State University to continue for students preparing for healthcare careers. The Cerner Corporation revealed findings about how the involvement of technology and robotics with patient care is an emerging trend. Robotics can contribute to sustainability and profitability of healthcare systems. Another benefit is that robots can often improve operational efficiencies by completing repetitive clinical tasks, like monitoring vital statistics for a patient. This helps to reduce a clinician’s workload while providing maximum care to patients.
“I think the use of tele-robotics, especially in healthcare, is very interesting,” said Kara Balboni, a 21-year-old nursing major and president of the Student Nurses’ Association at Worcester State University.
Another main topic throughout the tele-robotics in healthcare presentation was the limited perception in direct teleoperation, which involves precise orientation control. There is a narrow field of view, lack of depth perception, reduced situational awareness, and other factors involved in robot teleoperation. Women perform worse than men in spatial skill tasks, like mental rotation, which is important to note because the current United States nursing population largely consists of more women than men.
Li showed a video of volunteers stacking cups with different fields of view to demonstrate how perception impacts coordination and to help understand the best locations for cameras on the robot. The people in the video had cameras on their hand, arm, clavicle, and other locations that impacted their perception while performing the task to prove how location of sight alters movements. Continuing the study of human perception and action coordinance in various telepresence tasks is a continuous future goal for TRINA research.
“I found it really interesting that they were able to create a robot that could mimic human movements through motion sensors on the skin,” said Johnston. “I also found it interesting how much the robot was able to do. Maneuvering a metal hand to grip and open a drawer sounds incredibly difficult, both in the creation of the technology and in the manipulation on the user’s end.”
Even with all of the success in developing an already intricate and advanced nursing robot, Li revealed that there is still work to be done and improvements to be made before the nursing assistive robot is actively used in a practical healthcare setting. It is a large robot, which can make maneuvering in small hospital rooms difficult. TRINA can also can be quite noisy and possibly intimidating to some patients. Another issue is that the robot completes tasks at a much slower pace than human healthcare professionals. For example, changing the blanket of a patient takes TRINA over eight minutes, operating 95 times slower than human experts, which is something that needs to be addressed as a future improvement.
“That’s the problem with the robot industry—can we create a quieter, more human-like robot?” said Li. “The problem we are having is how the nurse can have less physical exertion to control TRINA. That’s something we want to change in the future.”
Another issue that Li discussed within the presentation is the fatigue of nurses who are operating TRINA. Nurses use their bodies to perform a manipulation of the robot, which can be quite taxing. Li’s research has concluded that operators become fatigued, especially in their arms and lower backs, so Li’s lab will continue researching how to minimize this fatigue issue. To do this, many nursing students and faculty members will be involved to provide feedback regarding the design.
“I think that it is something that is going to become more prominent in the field of healthcare in the coming years,” said Crowley. “I think that it is important to learn about tele-robotics in the healthcare field because it is something that I will probably be working with for a majority of my nursing career.”
Despite the enthusiasm that many audience members felt while hearing Li’s presentation, there were many questions about various aspects of the robot, like its impact on labor and human relations. Members of the audience inquired about TRINA’s application in occupational therapy settings, in which Li responded that it can help with communication between an at-home patient and nurse via audio or video. Audience members were also curious about the critically important self-cleaning abilities of TRINA when working with patients who have contracted highly infectious diseases. Li explained that the goal is for the robot to have a coverage of protective gear that it will be able to peel off of itself.
“I would like to learn more about this because it affects my life in a huge way,” said Johnston. “The nursing job description will be directly impacted by the capability of these machines.”
Using tele-robotics in healthcare is an important topic to consider ethically, and Johnston is hesitant about the idea of the robot impeding nurse and patient relations because she believes that this healthcare relationship is such a crucial aspect of recovery and healing. Despite these hesitations, Johnston and many fellow nursing students believe that educating oneself about up-and-coming technological advancements in the healthcare field, like TRINA, is essential.
“It is extremely important to learn about tele-robotics in healthcare because these machines are going to directly influence our careers in the near future,” said Johnston. “With robots being able to carry out more and more tasks, nursing actions will have to change to accommodate. On the other end, it is important to learn about tele-robotics from a patient’s point of view. If these machines will be taking care of us, we will want to know that they are capable and safe.”
During the question-and-answer portion of the event, a Worcester State student in the audience inquired about the robot’s role in minimizing a nurse’s connection to the patient, in which Li responded that the robot will help with aspects of communication without severing that bond. A faculty member asked about the robot overtaking a nurse’s profession, but Li explained that the main goal is that the robot aids nurses, never replacing their profession in any way.
“My research focus is to shape the technology to aid the user and profession, but not take over the nursing profession,” said Li. “Collaboration with the Nursing Department is important. The robot must be designed to fit the dynamics of healthcare. The robot will become a very accessible embodiment of the therapist for patients who have to stay at home.”
Many people have various perspectives about the future of tele-robotics in the healthcare field. A Pew Research Center study revealed that 79 percent of Americans think that doctors will likely use computer programs to diagnose and treat most diseases within 20 years. About 21 percent of Americans believe that this will definitely happen, while 20 percent of Americans believe that it will definitely not or probably not occur. Many students pursuing healthcare fields hope to learn more about these technological advancements to better understand changes that their professions may undergo.
Going forward, Li and the Worcester State University Nursing Department hope to have more collaboration in regards to tele-robotics in healthcare research. Li and Worcester State professors are in the process of submitting a grant to the National Science Foundation, which funds projects to support technology and science.
“Hopefully in the future I will work more closely with students at Worcester State University,” said Li. “Our lab at WPI is open to you. I have been writing proposals with faculty at Worcester State, and we are considering to have students come to WSU to work in your lab and work peer-to-peer with students.”
Li is not the only one who hopes that Worcester State students in the healthcare field learn more about tele-robotics in healthcare in the coming years.
“I would love to learn more about tele-robotics in the future,” said Alves. “This is my first time really hearing about it and I would love to see the progress it makes in the years to come, and potentially even help contribute to that progress.”
Many nursing students at Worcester State believe that the conversation of tele-robotics in healthcare is one that is increasingly important to discuss. Alves did not know much about tele-robotics in the industry previously, but it ended up surprising her how much humans are able to technologically produce nowadays and how large of an impact technology can have on healthcare practices.
“When we are learning about disease processes and their corresponding treatments and surgical procedures, it has become clear that minimally invasive instruments are increasing in popularity,” said Balboni. “Because these types of procedures are likely the way healthcare is moving, I believe it is very important for nursing students to be educated in them.”
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