Abstract
Aim
To evaluate nurses' workload during the coronavirus disease 2019 (COVID‐19) pandemic and to identify their perception of medical serviced robots (MSRs) that may help with or replace the tasks of nurses in negative‐pressure isolated wards and general wards.
Design
Cross‐sectional survey.
Methods
A researcher‐made questionnaire was applied that assessed nurses' current workload and their attitudes towards and perceptions of MSRs. A visual analogue scale (VAS) from 1 to 10 was used to assess workload. Perceptions evaluated on a 5‐point Likert scale ranging from one point for ‘strongly disagree’ to five points for ‘strongly agree’. A higher VAS score indicated a higher workload. On the other hands, a higher Likert score indicated a more positive perception and three points was neutral. The questionnaire was conducted on 150 nurses in negative‐pressure isolated wards for the management of COVID‐19 and 150 nurses in general wards. Quota sampling technique was used as sampling technique. Data analysis was performed through independent t‐tests, chi‐square tests and two‐tailed tests. The p‐value <0.05 was interpreted to statistically significant.
Results
Two hundred eighty‐two participants responded and 142 belonged to the negative‐pressure isolated ward. The overall response rate was 94%, and 94.7% in the negative isolated ward. The mean score ± standard deviation for nursing‐related psychological stress at the current work site was 7.18 ± 1.58 points, and the mean score for physical workload was 7.65 ± 1.48. The need for MSRs was rated as 3.66 ± 0.86 out of 5. Overall, a positive attitude towards MSRs was confirmed, with no difference between ward groups. The overall ratings were 3.14 ± 1.15 for perceived availability and 3.26 ± 1.13 for perceived efficiency. Both nurse groups perceived that MSRs were most available and efficient for monitoring and measurements. Nurses in negative‐pressure isolated wards perceived MSRs more positively than did nurses in general wards regarding setting of alarms (p = 0.003) and delivery of medical devices/materials (p = 0.013). Based on these results, functional development of MSRs associated with monitoring, measurements, setting of alarms and delivery should be prioritized. No patient or public contribution.
Keywords: COVID‐19 pandemic, negative‐pressure wards, nursing staff, robotics
1. INTRODUCTION
Recently, core technologies of the 4th industrial revolution are increasingly being applied to medicine (Nam et al., 2019). Among them, robots are actively being used in medicine, although this trend is generally limited to the application of surgical robots (Leal Ghezzi & Campos Corleta, 2016). Few robot models directly contact or monitor patients in clinical environments, although some such models have been tested experimentally (Saadatzi et al., 2020). The development of robot technology has increased expectations for medical service robots (MSRs) to replace and reduce the workload of healthcare staff in hospitals (Lee et al., 2018, 2022). However, there were not many studies about the specific definition and function of MSRs. Nevertheless, in a previous study that MSRs were defined as a robot capable of assisting healthcare staff that could be placed and used in hospital wards, positive perceptions were identified by both healthcare staff and patients (Lee et al., 2022).
The recent coronavirus disease 2019 (COVID‐19) pandemic has increased the demand and need for contactless environments and led to the use of robots in various circumstances (Manley et al., 2021; Seidita et al., 2021; Yang et al., 2020). In hospitals, treating patients with COVID‐19, healthcare staff and especially nurses, have experienced the considerable workload of caring for patients in negative‐pressure isolated wards to prevent airborne infection (Choi et al., 2022; Noh et al., 2021). In addition, it is reported that the workload of caring for patients and psychological stress in general wards other than negative‐pressure isolation wards has also increased compared with before COVID‐19 pandemic (Choi et al., 2022). To reduce the workload on healthcare staff, various technologies have been applied, such as telemedicine (Bahl et al., 2020). MSRs are also available for use; however, the specific areas that can be utilized through MSRs are also not well known and practical application of MSRs requires additional preparation. Moreover, prior to earnest development of MSRs, it is essential to examine the areas or tasks for which MSRs are best suited, as well as how the robots are perceived by nurses, who will be the main users. However, there is a lack of such studies to date (Lee et al., 2018, 2022). Such basic data are also necessary for robot development.
Accordingly, the purpose of this study was to evaluate nurses' workload and psychological stress in general wards and negative‐pressure isolated wards after the COVID‐19 pandemic and their perception of MSRs through the survey to provide basic data for the development of MSRs. Also, by comparing of the survey result by both wards, we try to find out which functions should be prioritized in the development stage.
2. METHOD
2.1. Participants
The participants of this study were nurses treating patients with COVID‐19 in negative‐pressure isolated wards. A control group of nurses working in general wards of the same hospital was also established. The number of participants required was calculated using G*Power 3.1.9.4 given Cohen's effect size of d = 0.5, a significance level of 5%, power of 80%, and an allocation ratio of 1:1. The minimum number of participants required in each group was 64. Considering withdrawal of participation, a total of 300 participants was enrolled, with 150 in each group.
2.2. Study design
This descriptive‐comparative survey study investigated the perception of MSRs by nurses who treated patients with COVID‐19 in negative‐pressure isolated wards and compared these perceptions with those of nurses working in general wards. The sampling technique for the survey was used to quota technique. Although the distribution of the group can be known in advance, this non‐probability sampling technique was used, because it was difficult to probability sampling due to restrictions on visiting another medical institutions during COVID‐19 pandemic and relatively small numbers of expected participants.
2.3. Study tools
2.3.1. General characteristics
General characteristics of participants were assessed, including age, sex, total clinical experience and type of current workplace.
2.3.2. Level of work stress and physical workload at current workplace
A visual analogue scale was used to assess the overall psychological stress and physical workload associated with nursing work at the current workplace. The participants were asked to select three domains that imposed the greatest psychological and physical workload at their current workplaces. Nursing domain was divided into the following areas based on the nursing work classified by Lee et al. (2018) and Hong and Shin (2019): safety management, measurement/monitoring, nutrition support, defecation support, hygiene management support, transport/activity, wound management, counselling/education, communication and patient and medical record management (Table 1). Additionally, the physical workload of wearing protective equipment to prevent COVID‐19 exposure and the stress from risk of exposure to various infectious diseases were evaluated on a 5‐point Likert scale ranging from one point for ‘strongly disagree’ to five points for ‘strongly agree’. A higher score indicated a higher perceived workload and three points was neutral.
TABLE 1.
Classification and abbreviation of nursing services used in the survey (adapted from Lee et al., 2018 and Hong & Shin, 2019).
| Nursing domain | Abb | Nursing services |
|---|---|---|
| Safety management | S01 | Fall prevention |
| S02 | Injury prevention | |
| Measuring/Monitoring | S03 | Assessment of vital sign |
| S04 | Body weight/Height measurement | |
| S05 | Intake and output measurement | |
| S06 | Setting of alarms | |
| Nutrition support | S07 | Feeding care |
| S08 | Gastrostomy care | |
| Defecation support | S09 | Bathroom movement aid |
| S10 | Toilet aid | |
| S11 | Diaper exchange | |
| Hygiene management support | S12 | Skin care (sore, wounds) |
| S13 | Bed bath | |
| S14 | Shampoo | |
| S15 | Bed linen change | |
| S16 | Patient clothes exchange | |
| Transport/Activity | S17 | Position change and preventing sore |
| S18 | Movement assistance | |
| S19 | Movement assistance with a stretcher or a wheelchair | |
| S20 | Supervision of ambulation | |
| Wound management | S21 | Dressing |
| Counselling/Education | S22 | Hospitalization information |
| S23 | Admission/Discharge information | |
| Communication | S24 | Communication with other department |
| S25 | Communication with patients | |
| Patient and medical record management | S26 | Nursing records system management |
| S27 | Medical device management | |
| Others | S28 | Delivery of medical devices/materials |
| S29 | Classifying medicines by ward/patient |
Abbreviation: Abb, Abbreviation.
Nurses working in negative‐pressure isolated wards who had previous experience of working in general wards also evaluated the changes in their psychological stress and physical workload on a 5‐point Likert scale ranging from one point for ‘significantly decreased’ to five points for ‘significantly increased’. Furthermore, the nurses were also asked to select the nursing domain with increased workload and those with reduced workload in negative‐pressure isolated wards.
The nurses working in general wards who had at least 3 years of clinical experience—namely, these persons had clinical experience before the COVID‐19 pandemic—also assessed changes in their psychological stress and the physical workload of working in general wards after the COVID‐19 pandemic using a 5‐point Likert scale ranging from ‘significantly decreased’ to ‘significantly increased’. Furthermore, the nurses were also asked to select the nursing domain with increased workload and those with reduced workload after the COVID‐19 pandemic.
2.4. Exposure/experience with MSRs
First of all, MSR was explained in the questionnaire, such as ‘MSR is a robot that helps healthcare staff work, and will be placed in wards that you work’. A brief explanation gave to participants whether there were some questions about MSR. Experience for MSRs was assessed.
2.5. Attitude towards MSRs
Perceived need for MSRs was assessed. Thoughts on reduced workload, delegation of duties and improved quality of nursing with the help of MSRs were evaluated on a 5‐point Likert scale ranging from 1 point for ‘strongly disagree’ to 5 points for ‘strongly agree’. Furthermore, expected benefits and disadvantages associated with the use of MSRs were evaluated using open‐ended responses. Examples of expected responses regarding the benefits of MSRs were prevention of infection owing to minimal contact with patients, improved medical service quality, reduced nursing workload, establishment of remote service and reduced hospital staff. Examples of expected responses regarding the disadvantages of MSRs were harm to patients due to malfunction of robots, reduced rapport with patients, increased nursing workload, limited environment to provide adequate nursing and increased medical cost.
2.6. Perception of MSRs
Perception of MSR availability and efficiency were evaluated by nurses using items based on Hong and Shin (2019). Availability was defined as an item that evaluates whether MSRs can actually be used in nursing tasks. On the contrary, efficiency was defined as an item how effectively nursing tasks can be helped. Questionnaires were constructed for 29 tasks in the nursing domain (Table 1). Each task was evaluated on a 5‐point Likert scale ranging from 1 point for ‘strongly disagree’ to 5 points for ‘strongly agree’. A higher score indicated a more positive perception, and 3 points was neutral. Finally, three nursing domains that most needed MSRs were selected by the participants.
2.7. Data collection
Data were collected from June to August 2021. The researchers visited the work sites, explained the purpose and method of the study to the participants and obtained written consent from each participant. The questionnaire was conducted on‐line, and a small compensation was provided in return for completing the questionnaire. The questionnaire actually used can be viewed in supplements. In the final analysis, data from a total of 282 participants were included, namely, those of 142 nurses working in negative‐pressure isolated wards and 140 nurses working in general wards.
2.8. Data analysis
SPSS 22.0 (IBM Corporation, Armonk) was used to analyse the collected data. To identify whether there is a difference between nurses in negative‐pressure isolated wards and general wards, two‐tailed tests were used with a significance level of 5%. Descriptive statistics were presented as frequency/percentage or mean/standard deviation for general characteristics, psychological stress and physical workload and attitude towards MSRs. Cronbach's α was calculated to analyse the reliability of the items on the availability and efficiency of MSRs. Independent t‐tests were conducted to compare continuous variables between the control and experimental groups. Chi‐square tests were conducted to compare categorical variables. Additionally, scatter plot was conducted by synthesizing availability and efficiency.
3. RESULTS
3.1. General characteristics of the participants
The general characteristics of the participants are shown in Table 2. The age of the participants ranged from 22 to 58 years, and the mean age was 28.96 ± 5.47 years. The mean age was significantly lower among participants working in negative‐pressure isolated wards than among those working in general wards (p = 0.023). A total of 88 participants (31.2%) had less than 3 years of clinical experience; the remaining 194 participants (68.8%) had more than 3 years of clinical experience, including more than 1 year of nursing experience before the COVID‐19 pandemic.
TABLE 2.
Characteristics of participants.
| Characteristics | Categories | Negative‐pressure isolated wards | General (non‐isolated) wards | p‐value |
|---|---|---|---|---|
| Gender | Male | 7 | 7 | 1.0 |
| Female | 135 | 133 | ||
| Mean age (years) | 28.23 ± 5.22 | 29.7 ± 5.64 | 0.023* | |
| Working place | General (non‐intensive care) unit | 100 | 90 | 0.331 |
| Intensive care unit | 42 | 50 | ||
| Working period (years) | <3 | 53 | 35 | 0.055 |
| 3 ~ 6 | 44 | 48 | ||
| 7 ~ 10 | 29 | 28 | ||
| >10 | 16 | 29 |
Statistically significant items
3.2. Work‐related psychological stress and physical workload of nurses
The mean score for nursing‐related psychological stress at the current work site was 7.18 ± 1.58 points. The mean score for psychological stress was 6.85 ± 1.66 in participants working in negative‐pressure isolated wards, which was significantly lower than the 7.52 ± 1.42 in participants working in general wards (p < 0.001). The mean score for physical workload related to nursing work at the current work site was 7.65 ± 1.48; there was no significant difference between the participant groups (Figure 1). Psychological stress associated with exposure to infectious diseases during work received a score of 3.19 ± 1.03 points out of five. The score did not differ significantly between nurses working in negative‐pressure isolated wards and those working in general wards. Physical workload of wearing protective equipment to prevent the transmission of disease received a score of 3.39 ± 1.00 points out of 5. The mean score for physical workload of wearing protective equipment was 3.54 ± 1.06 in nurses working in negative‐pressure isolated wards, which was significantly higher than the 3.24 ± 1.12 in nurses in general wards (p = 0.019).
FIGURE 1.
Score of nursing‐related psychological stress and physical workload in negative‐pressure isolated wards and general wards.
Among the nursing domain, nurses in negative‐pressure isolated wards reported the greatest psychological stress regarding communication, followed by safety management and measurement/monitoring. Similarly, nurses in general wards faced the highest level of psychological stress from communication, safety management and patient and medical record management. Among nurses working in negative‐pressure isolated wards, the greatest physical workload was associated with defecation support, transport/activity and hygiene management support. Among nurses working in general wards, the greatest physical workload was associated with transport/activity, hygiene management support and safety management (Figure 2).
FIGURE 2.
Overall distribution of (a) psychologically stressful and (b) physically burdened nursing domain. (c) Differences in stressful and burdened nursing domain depending on the type of ward.
Workload pre‐ and peri‐COVID‐19 pandemic was compared in the 194 nurses with more than 3 years of clinical experience. Among all of the domains of psychological stress (mean score 3.96 ± 1.01 out of 5), workload had increased peri‐COVID‐19 pandemic for physical workload (mean score 4.16 ± 0.79 out of 5) and administrative workload (mean score 3.92 ± 1.04 out of 5). Additionally, workload was significantly greater for nurses working in negative‐pressure isolated wards than for nurses in general wards for all domains of psychological stress (4.66 ± 0.51 vs. 3.41 ± 0.95, p < 0.001), physical workload (4.31 ± 0.66 vs. 4.04 ± 0.85, p = 0.005) and administrative workload (4.65 ± 0.57 vs. 3.35 ± 0.98, p < 0.001).
Among the nursing domain, workload had increased in the following areas peri‐COVID‐19 pandemic: transport/activity, followed by safety management and defecation support in negative‐pressure isolated wards, and counselling/education, followed by patient and medical record management, and safety management in general wards. Workload had decreased in the following areas peri‐COVID‐19 pandemic: none, followed by counselling/education and patient and medical record management in negative‐pressure isolated wards and none, followed by communication and counselling/education in general wards (Figure 3).
FIGURE 3.
Overall distribution of nursing domain with (a) increased and (b) decreased workload after pandemic. (c) Differences in nursing domain between increased and decreased workload after pandemic depending on the type of ward.
3.3. Nurses' exposure/experience with MSRs
Of the participants, 79.8% had no experience of witnessing MSRs in medical institutions being used for nursing work. A total of 19.5% of the participants had previously seen or heard of MSRs, while only 0.7% of the participants had experienced MSRs firsthand.
3.4. Nurses' attitude towards MSRs
The mean score for ‘the need for MSRs in current work sites’ was 3.66 ± 0.86 out of 5 points, indicating a positive attitude towards MSRs. The mean score for reduced nursing workload with the use of MSRs was 3.6 ± 0.92 points and was not significantly different between nurses in negative‐pressure isolated wards and those in general wards.
The mean score for delegation of nursing work to MSRs was 3.16 ± 1.07 out of 5 points. Nurses in negative‐pressure isolated wards showed a neutral attitude towards delegation of nursing work to MSRs, with a score of 3.01 ± 1.09 points. By contrast, nurses in general wards provided a relatively more positive response to delegation of nursing work to MSRs, with a score of 3.3 ± 1.03 points (p = 0.024). Additionally, the item on ‘improved nursing service with the use of MSRs’ received a mean score of 3.4 ± 1.02 out of five points. Among nurses in negative‐pressure isolated wards and general wards, the mean score for the item was 3.26 ± 1.06 and 3.54 ± 0.96 points, respectively, suggesting that nurses in general wards had a relatively more positive attitude towards the idea of improved nursing service with the use of MSRs (p = 0.023).
The most frequently cited disadvantages of MSRs included ‘harm to the patients due to malfunction of MSRs’, followed by ‘limitations in providing adequate nursing care’. By contrast, the most frequently suggested benefit of MSRs was ‘reduced nursing workload’, followed by ‘prevention of infection through minimal contact with patients’. There were no significant differences in the suggested benefits and demerits of MSRs according to the ward.
3.5. Nurses' perception of MSRs
The participants' perception of MSRs was as follows: the mean score for availability and efficiency was 3.14 ± 1.15 and 3.26 ± 1.13, respectively, out of 5 points (p < 0.001). The participants had an overall neutral to slightly positive perception of MSRs, with a relatively more positive perception of efficiency than of availability. Similarly, nurses in both negative‐pressure isolated wards and general wards had a relatively more positive perception of efficiency than of availability.
For nurses in negative‐pressure isolated wards and general wards, the mean score for perception of availability was 3.04 ± 1.27 and 3.23 ± 1.01 points, respectively (p < 0.001). The mean score for perception of efficiency was 3.18 ± 1.27 points in nurses in negative‐pressure isolated wards and 3.33 ± 0.98 points in nurses in general wards (p < 0.001). This result shows that nurses in general wards had a more positive perception of availability and efficiency of MSRs overall than did nurses in negative‐pressure isolated wards.
The nursing task with the highest perceived availability and efficiency for MSRs was alarm during monitoring, which received a score of 4.07 ± 0.70 points for availability and 3.97 ± 0.78 points for efficiency. This was followed by height and weight measurement, with a score of 3.97 ± 0.75 points for availability and 3.97 ± 0.78 points for efficiency, and vital signs measurement, with a score of 3.87 ± 0.85 points for availability and 3.90 ± 0.80 points for efficiency. This suggests that the nursing duties for which application of MSRs was viewed most positively was primarily measurement/monitoring. By contrast, nursing work that received the lowest score for MSR availability and efficiency was wound management (dressing) at 2.27 ± 0.95 and 2.47 ± 1.03 points, respectively. The nursing task that received the second‐lowest ratings for availability and efficiency of MSR use was skin management (pressure ulcer, wounds) with a score of 2.41 ± 1.07 points for availability and 2.61 ± 1.11 points for efficiency. This was followed by intestinal stoma management, with a score of 2.46 ± 0.92 for availability and 2.50 ± 1.03 for efficiency. These nursing duties were primarily related to external treatment.
Availability and efficiency of MSRs for each nursing task as rated by nurses in negative‐pressure isolated wards and general wards are shown in Table 3. The value of Cronbach's α of availability was 0.926, and efficiency was 0.946, thus the reliability of the items was excellent. For most items, nurses in general wards had a more positive perception of MSRs than did nurses in negative‐pressure isolated wards. However, nurses in negative‐pressure isolated wards had more positive perceptions than did those in general wards for items on use of MSRs for alarm during monitoring and transport of medical devices/reagents.
TABLE 3.
Participants' perception of medical serviced robots.
| Abb | Availability | General unit | p‐value | Efficiency | General unit | p‐value |
|---|---|---|---|---|---|---|
| Isolation unit | Isolation unit | |||||
| S01 | 2.83 ± 1.18 | 3.11 ± 1.00 | 0.035* | 3.01 ± 1.13 | 3.34 ± 0.93 | 0.008* |
| S02 | 2.70 ± 1.09 | 3.01 ± 0.99 | 0.013* | 2.98 ± 1.05 | 3.16 ± 0.98 | 0.142 |
| S03 | 3.82 ± 1.03 | 3.93 ± 0.62 | 0.270 | 3.92 ± 0.95 | 3.87 ± 0.60 | 0.590 |
| S04 | 3.92 ± 0.96 | 4.01 ± 0.43 | 0.301 | 3.99 ± 0.99 | 3.95 ± 0.50 | 0.700 |
| S05 | 3.13 ± 1.13 | 3.65 ± 0.72 | <0.001* | 3.36 ± 1.18 | 3.66 ± 0.75 | 0.010* |
| S06 | 4.19 ± 0.80 | 3.94 ± 0.56 | 0.003* | 4.06 ± 0.93 | 3.89 ± 0.59 | 0.066 |
| S07 | 2.92 ± 1.12 | 3.29 ± 0.82 | 0.002* | 3.08 ± 1.16 | 3.24 ± 0.90 | 0.180 |
| S08 | 2.24 ± 0.93 | 2.69 ± 0.86 | <0.001* | 2.30 ± 1.06 | 2.71 ± 0.96 | 0.001* |
| S09 | 2.91 ± 1.24 | 3.16 ± 0.98 | 0.063 | 3.17 ± 1.21 | 3.26 ± 0.94 | 0.461 |
| S10 | 2.89 ± 1.21 | 3.16 ± 0.96 | 0.038* | 3.21 ± 1.20 | 3.29 ± 0.95 | 0.564 |
| S11 | 2.38 ± 1.24 | 2.69 ± 1.03 | 0.022* | 2.65 ± 1.26 | 2.98 ± 0.99 | 0.017* |
| S12 | 2.30 ± 1.12 | 2.51 ± 1.01 | 0.098 | 2.45 ± 1.20 | 2.78 ± 0.99 | 0.013* |
| S13 | 2.56 ± 1.21 | 2.85 ± 1.05 | 0.030* | 2.82 ± 1.31 | 3.04 ± 1.03 | 0.109 |
| S14 | 2.61 ± 1.21 | 2.90 ± 1.03 | 0.032* | 2.85 ± 1.29 | 3.04 ± 1.00 | 0.182 |
| S15 | 3.18 ± 1.26 | 3.31 ± 0.96 | 0.301 | 3.25 ± 1.27 | 3.38 ± 0.97 | 0.353 |
| S16 | 2.85 ± 1.24 | 2.98 ± 1.02 | 0.351 | 3.00 ± 1.24 | 3.24 ± 1.04 | 0.075 |
| S17 | 2.98 ± 1.25 | 3.26 ± 0.93 | 0.031* | 3.15 ± 1.24 | 3.45 ± 0.93 | 0.021* |
| S18 | 3.51 ± 1.10 | 3.59 ± 0.86 | 0.543 | 3.61 ± 1.18 | 3.67 ± 0.77 | 0.581 |
| S19 | 3.51 ± 1.13 | 3.51 ± 0.93 | 0.955 | 3.50 ± 1.21 | 3.61 ± 0.85 | 0.390 |
| S20 | 3.32 ± 1.13 | 3.45 ± 0.90 | 0.275 | 3.37 ± 1.21 | 3.51 ± 0.86 | 0.259 |
| S21 | 2.08 ± 0.92 | 2.47 ± 0.94 | <0.001* | 2.31 ± 1.07 | 2.63 ± 0.97 | 0.009* |
| S22 | 3.78 ± 1.19 | 3.79 ± 0.80 | 0.973 | 3.76 ± 1.16 | 3.76 ± 0.80 | 0.975 |
| S23 | 3.87 ± 1.14 | 3.79 ± 0.76 | 0.487 | 3.85 ± 1.17 | 3.78 ± 0.82 | 0.582 |
| S24 | 2.75 ± 1.22 | 2.81 ± 1.07 | 0.658 | 2.86 ± 1.28 | 2.88 ± 1.11 | 0.892 |
| S25 | 2.78 ± 1.22 | 2.72 ± 1.07 | 0.659 | 2.92 ± 1.29 | 2.94 ± 1.02 | 0.883 |
| S26 | 2.77 ± 1.21 | 3.24 ± 0.97 | <0.001* | 2.96 ± 1.21 | 3.34 ± 1.00 | 0.004* |
| S27 | 3.19 ± 1.15 | 3.43 ± 0.91 | 0.055 | 3.50 ± 1.11 | 3.53 ± 0.86 | 0.809 |
| S28 | 3.96 ± 1.09 | 3.72 ± 0.85 | 0.043* | 4.01 ± 1.03 | 3.73 ± 0.83 | 0.013* |
| S29 | 2.44 ± 1.14 | 2.79 ± 1.06 | 0.008* | 2.59 ± 1.14 | 2.92 ± 1.11 | 0.014* |
Abbreviation: Abb, Abbreviation.
Statistically significant items
Scatter plot was conducted to compare the availability of MSRs for nursing tasks between nurses in negative‐pressure isolated wards and general wards (Figure 4). The first quadrant, which indicated high availability perceived by both groups, included tasks related to measurement/monitoring, changing bed linen, transport support and supervision of walking, counselling/education and transport of medical devices and equipment. By contrast, the third quadrant, which indicated low availability perceived by both groups, included tasks related to intestinal stoma and wound management, hygiene management support, communication and medication management. Additionally, perceived efficiency of MSRs was compared between the two groups of nurses (Figure 5). The first quadrant, which indicated high efficiency perceived by both nurse groups, included tasks related to measurement/monitoring, diet management, bathroom travelling support, transport support and supervision of walking, counselling/education and transport of medical devices and equipment. By contrast, the third quadrant, which indicated low efficiency perceived by both groups, included tasks related to intestinal stoma, skin and wound management; communication; and medication management.
FIGURE 4.
Scatter plot of availability of medical serviced robots.
FIGURE 5.
Scatter plot of efficiency of medical serviced robots.
The nursing domain that needed MSRs the most, as perceived by nurses in negative‐pressure isolated wards, were ‘transport/activity’, followed by ‘measurement/monitoring’ and ‘safety management’. By contrast, nurses in general wards perceived that ‘measurement/monitoring’ was most needed, followed by ‘transport/activity’ and ‘counselling/education’ (Figure 6).
FIGURE 6.
Distribution of answers for nursing domain that needed MSR the most. Transport/activity>Measurement/monitoring>Safety management in negative‐pressure isolated wards. Measurement/monitoring>Transport/activity>Counselling/education in general wards.
4. DISCUSSION
COVID‐19 is an infectious disease that spreads to the respiratory organs. Therefore, to prevent the transmission of COVID‐19 in hospitals, patients must be treated in negative‐pressure isolated wards (Kim, 2020). The COVID‐19 pandemic has led to many cases of infection, which has ultimately increased the demand for negative‐pressure isolated wards and the associated healthcare staff (Noh et al., 2021). In Table 2, it was confirmed that the mean age of nurses working in negative‐pressure isolated wards was statistically significantly lower, which is thought to be due to this explosive increase in patients. It is presumed that the mean age is lower than that of general wards because a lot of new Registered Nurses who have just graduated are assigned to negative‐pressure isolated wards.
The proportion of patients with severe symptoms is higher in negative‐pressure isolated wards than in general wards. As a result, healthcare staff working in negative‐pressure isolated wards are expected to have an increased workload from treating and caring for high‐risk patients and those with severe symptoms (Seo, 2021). Indeed, in a study evaluating emotional health in healthcare staff caring for COVID‐19 patients, 71.5% of healthcare staff were stressed, and the symptoms were particularly severe in nurses (Lai et al., 2020). And, among healthcare staff infected with COVID‐19, nurses who cared patients for a long time accounted for the largest proportion with 52.1% (Zheng et al., 2020). As such, nurses are at high risk of infection from caring for patients and experience more emotional and physical problems than do other healthcare staff (Lai et al., 2020; Lasalvia et al., 2021; Zheng et al., 2020). We also observed that the psychological stress and physical workload were high in nurses in negative‐pressure isolated wards. In all domains, stress and physical workload increased peri‐COVID‐19 pandemic. Similarly, nurses in general wards also experienced greater levels of psychological stress and physical workload peri‐COVID‐19 pandemic. These findings concur with those of previous studies (Bae et al., 2021; Lasalvia et al., 2021; Said & El‐Shafei, 2021). However, in this study, the level of psychological stress was higher in nurses in general wards than in those in negative‐pressure isolated wards. In previous studies, nurses in negative‐pressure isolated wards reported increased stress due to the need to wear protective equipment and increased workload associated with excessive demands of patients (Said & El‐Shafei, 2021). By contrast, other studies have reported the opposite findings—namely, that nurses in general wards experienced greater levels of stress (Bae et al., 2021; Wu et al., 2020). Bae et al. (2021) suggested that nurses in general wards had a higher level of stress due to societal differences in the spread and the countermeasure of COVID‐19. In studies that were conducted at times and in countries with relatively few COVID‐19 cases, healthcare staff in general wards had lower burnout and stress levels than did healthcare staff that provided care to patients with COVID‐19 (Bae et al., 2021; Wu et al., 2020). The current study was conducted during a period with a relatively low number of COVID‐19 cases, which may have temporarily decreased the stress of nurses in negative‐pressure isolated wards. However, following an increase in the number of patients with COVID‐19, the level of stress is likely to increase in these nurses. A previous study reported that nurses experienced burnout as the number of patients with COVID‐19 increased (Mo et al., 2020). These results show that the COVID‐19 pandemic has increased stress and physical workload in all nurses.
In this study, nurses showed generally neutral or relatively positive attitudes towards MSRs, which is consistent with attitudes observed in previous studies (Hong & Shin, 2019; Lee et al., 2018). Other studies have evaluated differences in attitudes towards MSRs according to the characteristics of nurses (Beedholm et al., 2015; Hong & Shin, 2019; Turja et al., 2018); however, few studies separated nurses according to their wards to assess attitudes towards MSRs. Our results suggest that the nurses in general wards had a more positive attitude towards delegation of nursing tasks and improvement of nursing service quality by MSRs than did nurses in negative‐pressure isolated wards. This may be related to the higher levels of stress observed in the nurses in general wards than in the nurses in negative‐pressure isolated wards.
The most commonly expected benefit of MSRs reported by the nurses in this study was reduced risk of infection from minimal contact with patients. There was no significant difference in this expectation according to ward. This finding is consistent with our intention of MSR development. Additionally, many nurses in this study expressed concerns regarding potential harm to the patients due to malfunction and limitations in providing adequate care as disadvantages of MSRs. Previous studies have also suggested that MSRs cannot be a complete alternative to nurses, and that specific measures or principles for efficient use of MSRs need to be suggested (Hong & Shin, 2019). Furthermore, to prevent accidents caused by MSRs, various scenarios should be simulated during development to prioritize the safety of patients. Indeed, many patients and healthcare staff believe that medical institutions are partially responsible for accidents caused by MSRs (Lee et al., 2022), which suggests the need for regular safety management by hospitals that use MSRs.
The nursing domain for which the most positive perception of MSRs was reported was measurement/monitoring, which was also the area that was thought to most require MSRs by the participants. Our finding supports the results of previous studies, in which measurement/monitoring‐related tasks were considered optimal for MSRs (Hong & Shin, 2019; Lee et al., 2018). Other nursing domain for which positive perceptions of MSRs reported were transport/activity and safety management. The ranking of these two domains differed from the ranking in previous studies, as well as between the groups in the current study (Hing & Shin, 2019; Lee et al., 2018). Another previous study reported results consistent with our findings (Lee et al., 2022), suggesting that measurement/monitoring, transport/activity, and safety management are important aspects of nursing that should be a focus for the development and use of MSRs in the future.
In the current study, nurses in negative‐pressure isolated wards believed that MSRs would be more useful for alarms during monitoring and transport of medical devices/reagents than did nurses in general wards. This finding may be related to the characteristics of negative‐pressure isolated wards, in which nurses have difficulty directly entering each room. Therefore, to develop MSRs for negative‐pressure isolated wards, measurement/monitoring functions, which were also considered useful in general wards, develop first with adequate alarm functions. Additionally, it would be necessary to preferentially develop functions to transport medical devices and reagents.
4.1. Limitations
A few limitations should be considered when interpreting this study's findings. First, nurses from a single hospital were recruited, and only a small number of male nurses was included in this study. Second, only two participants had experienced MSRs firsthand. Third, there is no clear consensus on the classification of nursing work areas; therefore, there may be differences between the nursing work areas classified in this study and those perceived by the nurses (Lee et al., 2018). Finally, since this study was a cross‐sectional survey, participants had to rely on perceptions and subjective memory for changes in workload pre‐ and peri‐COVID‐19 pandemic. In order to accurately confirm this point, a longitudinal study linking different time points should be conducted. However, this study is valuable as it provides basic data to inform the development of MSRs to reduce nursing workload, which has been greatly increased by the COVID‐19 pandemic.
5. CONCLUSION
In this study, the workload of both nurse groups in general wards and negative‐pressure isolated wards was found to have significantly increased following the COVID‐19 pandemic, and certain indicators of workload were higher among nurses in general wards than those in negative‐pressure isolated wards. To alleviate this, MSR may be a good option. Investigated nurses' perception of MSRs was also positive. Both nurse groups perceived that MSRs were most available and efficient for monitoring and measurements. Additionally, nurses in negative‐pressure isolated wards had more positive perceptions of the availability and efficiency of MSRs for providing alarms during monitoring and transferring medical devices and materials than did nurses in general wards. Based on these findings, these functions of MSRs should be prioritized in the development phase.
AUTHOR CONTRIBUTIONS
JHL participated in the design of the study and the statistical analysis. He performed the data collection and was the main responsible for drafting the manuscript. IHH participated in the design of the study and the funding acquisition. He commented on the drafted manuscript. JHP contributed to the data analyses and reviewed the manuscript. KK participated in the data analyses, the interpretation of data, the funding acquisition and drafting of the manuscript. JH participated in the data analyses and the validation. DHK participated in the investigation and data analysis. JIL participated in the interpretation of data and the validation. KHN participated in the interpretation of data and commented on the draft manuscript. All authors read and approved the final manuscript. All authors have agreed on the final version of the paper and meet at least one of the following criteria [based on those recommended by the ICMJE (http://www.icmje.org/recommendations/)]
FUNDING INFORMATION
This study was supported by the Technology Innovation Program of the Ministry of Trade, Industry & Energy (MOTIE), funded by the South Korea government (no. 20015052).
CONFLICT OF INTEREST STATEMENT
The authors declare that no conflict of interest exists regarding the work reported.
ETHICS STATEMENT
This study was approved by the Institutional Review Board (IRB). The specific number of the IRB was 2170‐019‐105.
ACKNOWLEDGEMENTS
We thank the Department of Biostatistics, Biomedical Research Institute, Pusan National University Hospital. A special thank you is extended to the nurses who answered the questionnaire.
Lee, J. H. , Han, I. H. , Park, J. H. , Kim, K.‐H. , Hwang, J. , Kim, D. H. , Lee, J. I. , & Nam, K. H. (2024). Nurses' perceptions of medical service robots in negative‐pressure isolated wards and in general wards: A cross‐sectional survey. Nursing Open, 11, e2175. 10.1002/nop2.2175
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.