Principal findings concerning the developed service robot
In summary, the study indicates a positive reception of the robot with high usability, perceived usefulness, rather low skepticism, and a strong intention to use it. Although there is a need to optimize accessibility, this aspect does not seem to significantly detract from the overall positive evaluation of the robot. The data indicates that the robot was well-received and deemed as a potentially valuable system by the majority of the participants. In detail, the results of the descriptive analysis can be interpreted as follows.
Starting with usability, the median score of 20.0 out of a possible 21 shows that the participants rated the robot's usability very highly. This near-maximum median value suggests that the robot is generally perceived as easy to use. Moreover, the narrow interquartile range (IQR) of 3.0 indicates a strong consensus among the participants. In terms of usefulness, on a scale up to 28, the median is 21.0, which can also be considered a high value. It indicates that the participants found the robot quite useful and relevant to their duties. However, the moderate IQR of 8.0 suggests that there is some variation in opinions. Although the participants agreed on the usefulness, there are differences in extent. Looking at skepticism, the median score is 10.5, which is towards the lower end of the scale. This indicates that the nurses tend to be less skeptical about the robot. The moderate IQR of 5.0 suggests that there is some variation in skepticism levels, nevertheless, with a middle 50% range of opinion covering the lower half of the scale. For accessibility, the median score is 10.0 on a slightly reduced scale of 3 to 21. This places the median near the middle of the scale and reflects a moderate level of accessibility, with participants seeing some barriers and limitations to access. The IQR of 5.0 again reflects a range of opinions, which, however, differ only slightly from one another. The intention to use scale shows a median score of 224.5 out of a possible 300. This reflects a high score and signifies a strong overall intention among the participants to use the robot. Although the IQR is quite large, pointing to considerable variability in individual willingness to use the robot in practice, it still confirms the strong intention, as 75% of participants scored above the midpoint of the scale.
Principal findings concerning the identified dependencies and influencing factors
The strong positive correlation we have identified between usability and the intention to use aligns with existing research, since usability continues to be highlighted as a critical determinant of technology adoption in healthcare [56]. Studies affirm that the ease of use of robots significantly affects their acceptance among nursing staff, as professionals prioritize technologies that seamlessly integrate into their workflow without introducing complexities [3]. Moreover, a survey on robotics in healthcare noted that robots that are difficult to use are likely to be abandoned or rejected by healthcare staff [57]. In contexts where nurses are already under time pressure, the usability of technology becomes crucial to its success. The factor is vital because it affects the overall efficiency of nursing tasks and the willingness of staff to engage with technology regularly. A high degree of usability ensures that nursing staff can adopt robots with minimal disruption to their workflows.
The strong positive correlation between the perceived usefulness and the intention to use the developed robot also aligns with recent discussions in the literature. In nursing, this relationship is critical as nursing staff must expect clear benefits to patient care and workflow efficiency to adopt new technologies [58]. Robots that can demonstrably reduce workload and improve quality of care are more likely to be embraced. Furthermore, the research underscores the importance of demonstrating the practical benefits of robots in real-world healthcare settings to ensure their integration and sustained use [28]. Given the strong correlation identified, we support that demonstrating a robot's usefulness through case studies or pilot testing in real-world settings could further encourage its integration into nursing practices.
Additionally, the strong negative correlation between skepticism and the intention to use we have identified in our study supports previous findings. Skepticism about robotics in nursing can be a significant barrier, with concerns often relating to patient safety, job security, the reliability of the systems and data security. Current literature suggests that regulatory frameworks and robust training programs are essential to overcome these hurdles [32]. Addressing these concerns through transparent communication about the capabilities and limitations of robotic systems, pilot studies, and involving nurses in the development process can further mitigate barriers [28]. Against this backdrop, demonstrating the reliability and safety of these systems, as well as emphasizing their role as a supplement rather than a replacement for human care, is essential for acceptance among nursing staff.
The strong positive correlation between the perceived accessibility of the robot and the intention to use it is particularly revealing. It suggests that beyond the usability and usefulness of the robot, its acceptance may also hinge significantly on how accessible it is in terms of cost and availability. Our results suggest that if nursing staff perceive the robot as financially affordable and readily available, they are more likely to consider using it. This implies that strategies to make these robots more affordable, such as subsidies, leasing options, or demonstrating long-term cost savings, could enhance their uptake. This aligns with previous research, indicating that for robotics to be widely adopted in nursing, they must be affordable and readily available to healthcare facilities. This includes addressing upfront costs and long-term maintenance, which can be barriers to technology adoption [28]. Thus, making robotic technologies economically accessible and proving their cost-effectiveness are vital steps to ensure wider acceptance and integration into daily nursing operations.
To summarize, it can be stated that a key prerequisite for the successful diffusion of robotics in the nursing sector is to demonstrate that the technical capabilities, potential application areas, and human-robot collaboration approaches are in line with the professional ethical values and standards of care work. Thus, there is currently a great need for structured and targeted orientation measures to impart knowledge and skills aimed at promoting positive attitudes and realistic expectations regarding the potential of care robots [25].
Against this background, the role of the general attitudes towards robots in connection with the evaluation of the service robot under study is discussed below. The distinction between positive and negative attitudes towards robots on a personal and social level based on the GAToRS made it possible to take a differentiated look at the general attitude towards robots in the sample. For the scale Personal Level Positive Attitude (P+) we found a slightly positive personal attitude towards robots with little variability in the opinions. This rather positive attitude towards robots on a personal level is also supported by the results on the Personal Level Negative Attitude (P-) scale, indicating a minor negative personal attitude towards robots on average, with a small range of opinions at the lower end of the scale. Concerning positive attitudes at a Societal Level (S+), the results show on average a rather positive perception of the impact of robots on society. Once again, there is little variability in the participants' perceptions, which indicates that the positive views are fairly aligned. At the same time, however, the results on the Negative Attitude Societal Level (S-) scale show a slightly negative perception of the social impact of robots on average. In addition, there is a greater variability in the participants' attitudes, indicating a greater divergence in the perception of negative societal impacts. Overall, the results at the societal level show an ambivalent attitude towards the impact of robot use on society.
In addition to the general examination of the attitudes towards robots in the sample, our study also examined their relation to the evaluation of the robot within the dimensions of usability, usefulness, skepticism, accessibility, and intention to use. Significant correlations between the general attitude towards robots and the robot evaluation were found for the dimensions Personal Level Positive Attitude (P+), Personal Level Negative Attitude (P-), and Negative Attitude Societal Level (S-). On a personally positive level (P+), our results show that the higher the positive views towards robots, the higher the usefulness, accessibility, and intention to use were rated. Furthermore, the findings indicate that the higher the negative attitudes on a personal level (P-), the more the use of robots is seen as risky, dangerous, and detrimental. Finally, for negative expectations of the social influence of robots (S-), the results show that greater reservations are associated with a lower rating of usefulness, higher concerns about the risks and disadvantages of using the robot, and limited accessibility.
The overall positive attitude towards robots in our sample is consistent with the findings of Papadopolous et al. [59], who found in a systematic review that views and attitudes were generally more positive than negative across all studies. At the same time, however, the authors also point to various influencing factors such as type of exposure, observed robot capabilities, usefulness, and potential role of the robot. In addition, the belief in reliability and trustworthiness, as well as performance expectations, were particularly responsible for a positive perception of usefulness and intention to use [59], which is comparable to the scope of both positive attitude dimensions on the personal and societal level of the GAToRS [51].
In addition, the ambivalence observed in the results from the attitudes on the societal dimensions of the GAToRS as well as the significant correlations of negative attitudinal dimensions with usefulness, skepticism, and accessibility can also be interpreted in line with current research findings. For example, Turja et al. [49] emphasize the importance of compatibility between personal values and robot use as a significant influencing factor for the perceived usefulness and intention to use. On the one hand, these personal values include professional ethical standards of human-centered care work such as integrity (patient safety), dignity, respectfulness, and trustworthiness. On the other hand, the fear of technological unemployment plays a particularly important role [49]. In addition, based on an integrative review, Servaty et al. [28] identify ethical issues concerning the fear of a decrease in social contact and interactions, stigmatization of patients, dehumanization, and privacy issues as further acceptance barriers for the use of robotic systems in nursing. Therefore, uncertainties regarding the appropriateness of robot use in care situations correlate with a negative perception of the usefulness of robot assistance [60].
To increase perceived usefulness and the intention to use, several studies emphasize the need for appropriate experience and training opportunities for the different target groups of nursing staff [49, 59]. Beyond this, the results of Klebbe et al. [29] suggest that surveying the attitudes and acceptance of nursing staff should play a vital role in the implementation process of robotic systems for nursing to identify barriers to acceptance at an early stage and take appropriate measures to reduce them.
The following section discusses the findings on the role of robotic experience in light of the fact that no statistically significant differences in the evaluation of the developed robot were found between the two groups of participants with and without previous robotic experience. This result is in contrast to several other studies in which previous experience with robotics was found to be a relevant influencing factor for acceptance. In an analysis of the relationship between robot acceptance and experience with robots, Turja et al. [46] concluded that healthcare professionals have little robotics experience and tend to have a more negative attitude towards robotics than the general public. At the same time, however, the authors found that previous experience with robots in the sample of healthcare professionals was consistently associated with higher robot acceptance in general and in the workplace. Moreover, the importance of practical experience with robotics in the workplace was demonstrated by Melkas et al. [33]. The authors found that the various types of prejudice generally decreased after gaining personal experiences of using the robot under study with clients. Nursing staff who were initially skeptical changed their attitude after gaining their own experience with the robot and seeing the positive reactions of elderly clients. Additionally, the authors conclude that to fully grasp the potential of a robot, employees must receive appropriate orientation. In view of these findings, different explanations for our study results can be considered. One explanation could be that our sample has a generally positive attitude towards and a high willingness to use robotics, which is supported by the results of the GAToRS. It is also conceivable that the selected application scenarios are generally highly agreed upon by the target group of nursing staff [29, 46, 59] so that the influence of experience can be mitigated.
Limitations
Although the sample size of n = 30 is sufficient for initial investigations, it limits the generalizability of the results. Additionally, the sample size and the use of non-parametric tests, appropriate given the data distribution, may affect the likelihood of detecting an effect, if one exists. Nevertheless, as significant results were obtained, it can be concluded that there are several effects strong enough to be detected even in a limited sample. However, the applicability of the results is confined to robots and scenarios similar to those examined in this study, suggesting that the findings may not be universally applicable to different systems or contexts without additional comparative analysis. Moreover, the sample’s largely positive attitude towards the research object could have introduced bias, highlighting the need for studies involving more heterogeneous participant attitudes to ensure the robustness of the findings. Lastly, while the laboratory setting allowed for a controlled and comparable study procedure for each participant, it may not have accurately reflected the actual conditions of daily nursing practice. In summary, the results of our study should be verified in a large-scale field test over a longer period of time with a diverse sample of nursing staff.