Editorial

This issue of JRN coincides with celebrations to mark the 70th birthday of the National Health Service (NHS) in the UK. The NHS is often described as one of the UK’s ‘national treasures’– not only because of its everyday impact on so many people but also because of its durability and global influence on care, research, education, policy and public health. The NHS has overcome many challenges since its inception and, as I write this editorial in its birthday month of July, it seems right and fair to celebrate its achievements and build on these to ensure it flourishes rather than simply survives in the next decades of its life. Its contributions range from colossal health and technical innovations (see Moberly, 2018 for examples) to the ‘little things’ that health-care staff and volunteers do every day to make life better for patients and their families/ carers (e.g. Smith (2011); Health Foundation (2018)). None should be taken for granted.

Now the NHS has reached this point many people are asking what future decades will bring. These conversations mostly revolve around resources – especially staffing and finance - but there are many other things that make a healthcare system work, and they, for me, focus on how and why individual care is given as it is. Over the last few weeks two things have made me think more than usual about how care-giving could alter – and how this might affect the future of the largest workforce in the NHS who provide everyday care, nurses. The first came as I flicked through the weekend papers and stumbled across references to Christie Watson’s new book “The Language of Kindness: A Nurse’s Story” (2018): when I read it it reminded me of the little things that have an impact on care, and the other was listening to a couple of radio programmes about artificial intelligence. The two became entwined as I thought about what would be needed to create kind, effective and efficient robot ‘nurses’ and how that might develop as a result. Whilst a somewhat surreal thought it may not be too far from reality.

Robot ‘nurses’ are no longer a thing of the future – they are here already in some countries such as Japan, the USA and Canada where they are being used for specific technical/mechanical tasks (e.g. lifting, delivering food, taking vital signs) often as an adjunct to human, qualified nurses (http://theconversation.com/nurses-of-the-future-must-embrace-high-tech-86042 & https://nurse.org/articles/nurse-robots-friend-or-foe/). Creating and using robot nurses is contentious (Gelinas, 2017) and there are many practical and ethical reasons why people decry such innovations but nurses must not shy away from influencing such developments if we are to be confident that they will provide what is needed. What interested me was whether it was possible to program such robots to be kind, to know the ‘little things’ that are needed, and integrate them into the performance of their tasks. Of course, a robot could be programmed to perform tasks such as delivering tea or washing hair – the added touches that are often described as bringing comfort to patients, but can a robot do this with the intuitive kindness that a human can bring to such interactions? Could they get things to be ‘just right’ for the person they interacted with, for example the right quality of a touch; the carefully selected comforting words; or the recognition that silence rather than talk is best. I’d always dismissed this possibility but the radio programmes I heard made me wonder if such things might be possible. The presenters described how robots have already been programmed, following analyses of humans’ best behaviours, to recognise desired interpersonal characteristics in job applicants’ video-recorded interviews, including clues from body language and intonation. If robots can be enabled to recognise these sorts of interpersonal characteristics could they also recognise features of kindness and compassion? And, if they could recognise such features could they, one day, also be programmed to reproduce them in the form of individualised interactions? Are we coming to the time when the near-affectionate individualised relationship the film ‘Robot and Frank’ portrays between a ‘carer’ robot and a man with dementia is not just fiction? If this is feasible then nurses need to get involved in the creation of robot nurses to ensure that only the best care is mimicked and any risk of programming poor(er) care is eliminated. JRN is just about to release a call for papers focusing on Design, Technology and Innovation in nursing and we hope readers will join this debate by sharing their experiences, research, evaluations and designs in this special edition (http://journals.sagepub.com/home/jrn).

The currrent edition of JRN brings together a selection of work focused largely on managing risk – a nursing role where one could indeed envisage artificial intelligence, if not actual robots, playing a part, but – as the authors surely demonstrate, never the whole role. Their papers focus on preventing harm through pressure injury assessment (Mordiffi et al.), central venous catheter infection prevention (Aloush) and increasing knowledge for people with diabetes (Hadi Sulistyo et al.); and promoting nurses’ abilities to manage care better by focusing on empathic behaviours (Ashouri et al.) and social capital (Vagharseyyedin et al.). The edition concludes with a student nurse’s perspective of a research internship she undertook and the learning she gained from this unusual experience (Allman) – its inclusion emphasises the need for nurses to develop through taking risks and opportunities themselves.

Whilst the robot nurse might be programmed to help with many of the things discussed in this edition I still doubt that it could do so without intuitive insights into the complexities of human beings and the organisational systems they create and work in. Nurses will always need to rely on such insights to ensure that harm is avoided and people are kept safe and nurtured. These are vital dimensions of patient/ family care and staff management that require a deeply human understanding. For that reason, if no other, a nurse’s everyday work should never come under the mandate of an automaton, regardless of its intelligence.