An electronic solution to nursing shortage

The Japanese have done it again. First they gave us transistor radios, economical and effi- cient cars with front wheel drive, and par- ticipatory management. Now they have a soh- tion to the nursing shortage.

How? With robots. The Japanese, who are the world leaders in the use of robots, are proposing to use "nurse" robots in hospitals to take care of bedridden physically handicapped and aged patients. A recent report from the Japan Industrial Robot Association predicts that robots have a "great role" to play in hospi- tals. Japanese television recently showed an experimental robot for use in hospitals that responds to commands blown into tubes. When the bedridden patient blows into one of 15 tubes, the robot tilts the bed upwards. When another tube is used, the robot offers a glass of water. This robot can actually pour a drink and carry it to the patient. The Japanese are also using robots as "patients" for training doctors and other health care workers.

This report causes us to think about the pos- sibilities of robots in the operating room. At first glance, they could solve many problems. It would be good-bye scrub suit shortage. Unlike humans who must scrub, gown, and glove, robots could simply be, if you will pardon the expression, "flashed." The robots would be completely sterile and no source of contamina- tion for the patient. Robots also would dampen interpersonal conflicts. No more shouting sur- geons or Monday morning sexual innuendos; no more sassy responses.

Let's take a peek into the operating room of the future, which is staffed by advanced robots. The patient, who is human, enters the operating room suite on a stretcher that moves silently along a monorail. A robot with a cap to indicate it is a nurse hands the patient a small device that looks like a calculator. On it is an outline of a human shape, which has buttons at various critical locations.

"Please select your operation," instructs the nurse gently. "If you have heart trouble, press the button that says 'heart'.''

"Actually, it's my back," the patient re- sponds.

"Press 'back','' the nurse says soothingly. The patient presses the back button and

finds himself moving smoothly and silently along the monorail into a room marked "back."

"I am Dr 0 Mi Aching Back," announces a commanding voice at his side. "We will find out what is wrong with your back and fix it," says the doctor confidently. "While my aide does the diagnostic testing, I will prepare myself for the operation." With this, it presses several buttons and disappears into a large steam sterilizer.

The aide then focuses an imaging device on the patient's back, asking him to pinpoint the source of his discomfort. An image appears on the screen above the OR table, and the doctor emerges from the sterilizer and examines the screen. "It is clear," it says, "that you need operation 627. Please sign this consent form."

As soon as the patient does this, a mask for the anesthetic gases descends from the ceil- ing and the patient is soon unconscious. In this OR, anesthesia is administered completely au- tomatically with sensitive monitoring instru- ments measuring the vital signs and adjusting

636 AORN Journal, March 1982, Val 35, No 4

the amount of anesthetic delivered as well as the need for any other drugs. This, of course, eliminates the need for an anesthetist.

Having inserted the program for operation 627, the surgeon progresses with great accuracy and speed. Its hand is steady, and it follows the many complicated steps in the pro- cedure without error. The scrub nurse has been programmed to pick up the instruments and to hand them to the physician in the se- quence in which they will be needed. This robot has four hands so it can hold retractors as well as pass instruments, eliminating the need for a first assistant.

When the operation is finished, the patient is transferred on the monorail to the post- anesthetic room, where monitoring of his vital signs continues. Postan est het ic robot nurses check the monitoring and give care as re- quired. For example, if the patient's tempera- ture drops below a certain point, the robot will place a blanket on him. The monitors control when the patient is returned to his room. When they give the "okay," the stretcher moves along the monorail toward the exit, but it stops at the door.

"Please place credit card-VISA, Master- Card, or American Express are acceptable-in slot to pay for operation." Groping in the folds of his gown, the patient finds the right credit card

and inserts it in the slot. The computer rapidly prints out his four-foot bill and automatically bills the charges to his American Express account.

The stretcher moves on. "Thank you, come again. Have a nice day," says the robot.

I could be wrong, but I think robots will have limited use in direct patient care in hospitals. The elderly or bedridden patient who wants a glass of water also wants some attention and some human contact. The patient who comes to surgery wants not just efficient care, but the touch of humanity.

After all, a robot cannot be programmed to laugh or shed a tear.

Elinor S Schrader Editor

638 AORN Journal, March 1982, Vol35 , No 4