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Karen: Thank you all for coming. We are about to start the next talk. Think big or
care for yourself on the obstacles to think of emergent technologies in the
field of nursing science. Our speakers are Hanna Wüller and Anne Koppenburger. They
both work on the use and development of technology in nursing. Hanna is examining
which parts of nursing should be supported by technological solutions. She does
research on augmented reality used in nursing. Anna works on feminist science
and technological studies, as well as critique of the political economy. She is
the editor of a book that just came out here in 2017: The Cybernetic Capitalism
Revolution - The Emancipatory Perspective in technological change. I hope you will
listen to their talk with great interest. There is translations into English and
German on the website that you can find on the site. Enjoy the talk.
*applause*
Thank you, Karen, for this nice introduction. Welcome to our talk: Think
big or care for yourself. On the obstacles to think of emerging technologies in the
field of nursing science. We're very proud to talk here on CCC. My name is Anne
Koppenburger. This is Hanna Wüller. Let me shortly say something about the
perspective that I will take in this talk. As I did in the book that was just showed,
I will do it again to give you time, maybe to write it down or something. I'm
interested in the understanding of technologies, especially in the
understandings of technological change. I am looking at how different societal
agents relate themself within this change. And in that book, we did it with some
different agents like DIY technology friendly initiatives, industrial players
or trade unions. Today, we want to talk about care and the relation to technology.
And we will do this in three steps. And I should say that it will take around 25
minutes, then we will have five minutes left. We would be happy to get one or two
questions from the audience. But however, for those of you who will not get the
possibility to talk to us or to contribute something to our talk, please feel free to
reproach us afterwards or to check out our university web pages and get in touch with
us. OK, the following 25 minutes we will talk about the relation of nursing,
science and technology in order to expose it as problematic. First, I would talk
about nursing science and what we actually talk about when we say nursing science,
and I will link this to the question of what we mean when we talk in nursing
science about technology. Afterwards, Hanna will introduce you in a current
research project on augmented reality. She will talk about what is going on right now
in this field of research. OK. I would start with the first part. I want to argue
that social struggles for making care work visible are a consequential requirement to
conceptualize the application of different technologies and nursing science. It's
like that: You cannot take it for granted to talk about care. It is thanks to the
extraordinary work of feminist political activists, artist, writers and theorists
that today we are in the situation to talk about care work as a structured and
structuring activity at all. I mean, to talk about care apart from it as being a
labor of love. It was embedded in the new left social movements in the 1960s and
some countries around the world that materialist feminist were struggling to
expose care work as a notable part of social reproduction. In these efforts, the
relation between productive labor and reproductive labor has been exposed as
interdependent, as dependent on each other. And this emancipatory struggles
have made care work visible by the naturalizing as care work has been
revealed as an essential precondition of a bourgeois society's capitalist production.
However, being visible, of course, is not the same as being recognized and still
today care work lags of societal appreciation. Those circumstances comes,
for example, with low wages and poor working conditions. Who wants to learn
more about the ongoing struggle is recommended to check out, for instance,
the work of Helen Hester. She's a member of the technology-friendly xeno-feminist
collective Laboria Cuboniks. She's an associate professor for media and
communication at the University of West London, and she emphasizes on the task to
continue the discussion of making care work visible. Visible as a part - as a
notable part - of social reproduction, she proposes to rethink living arrangements,
living standards and the role of domestic technology. Therefore, she opens up a
discussion on automatisation of certain aspects of health care. Despite a lot of
controversies around this, she says the opening to automatisation is a refusal to
naturalize this work. OK, back to nursing science. Yeah, we can see how these
social, political, economic movements that I just have mentioned, those emancipatory
struggles, they obviously affect the theoretical horizon of nursing science,
which in turn influences the conceptualization of technology and care
work settings. Speaking for a German context of nursing science, contemporary
nursing scientists, they are still overwhelmingly busy with the
professionalization of health care. They are partly still engaged in establishing
nursing science as a scientific discipline that describes and develops reasonable
caring practice on the basis of independent nursing research.
Distinguishing nursing science as independent from medicine is seen as a
cornerstone in these struggles. Medicine as a life science discipline is probably
rightly accused of being pervaded by strongly functionalist, partly mechanic,
partly cybernetic paradigm. This formal and mathematical paradigm might be seen as
a reflexive background against which this young and ambitious discipline has
constituted itself, at least in the German context. Oh, sorry. By drawing on critical
theories, nursing scientists rejected a purely medical approach to bodily
processes, which often those medical approaches, they often comes in
explanatory modes of, for example, quantifying rationalizing technologizing.
Nursing practice, in contrast, is supposed to approach human beings' experiences of
health and sickness and modes of comprehension of a fully understanding,
for example, by phenomenologically reconstructing individual meaning and
collective sense structures. So in comparison, medicine and nursing, medicine
prefers to explain diseases by formalize events, a formalized thinking, a linear
thinking. Whereas nursing science is supposed to comprehend being healthy or
being sick by mimetic faculty, by, I say, simply and playing, by feel it. That is
why nursing sciences draw on highly controversial constructs like intuition or
implicit knowledge. Here, we still witness the movement of making visible what was
made invisible before socially, politically, theoretically. Exactly at
this point, we find a particular strong rejection of different technologies and
care work by nursing scientists. Since technology, especially information
technology, are conceived as means of explanation, these technologies are
identified with the formalistic paradigm that supposedly cannot comprehend the
implicit part of human beings' experience. Here, the different struggles that I have
mentioned meet each other. They both are targeting at onto-epistemological regimes
of capitalizing, rationalizing technologizing. They kind of attack on
this processes just in order, which is an important work also to include the
excluded, to qualify the quantified, and also to de-technologize the technologized.
So just to sum up this first part, it is important to keep in mind that both the
histories of feminists efforts to make care work visible and the academic
struggle of establishing nursing science as a scientific discipline, they are both
interlinked. They go parallel in their ambition to emancipate themselves from
formalizing, thinking and acting. They also share basic parts of their
theoretical foundation. As a result, an always mysteriously indetermined part of
the human being's existence is supposed to be a crucial counterpoint of technological
formations. *mumbles*
But the question, of course, is what are
those or these technological formations and how to situate nursing practices
within them. So for this, let me tell you what technology means when we as a nursing
science talk about it. So technology - What do we talk about it? I already said
that the human being is depicted in different critical theories as the
counterpart of technology. It is this image, actually, what right now seems to
be increasingly challenged. For example, when we think of technological operations
on micro-temporal levels as sensor technologies too, we are confronted with
an entity that act beyond human beings' sensational perception. When we first
think of technology's power to control us, meaning the regulating sense of control,
then we cannot but conclude that it's not just a human being's action that makes
sense to us. The existence and operations of contemporary smart objects are
increasingly unraveling the image of the human as an exceptional sense maker. This
is the technological condition that for some decades now challenges particularly
the humanities to come to grasp with. And it was Erich Hörl who described this
ongoing basically technologically influenced displacement of sense as a
representational sense. He - Erich Hörl - is a professor of media philosophy at
Lüneburg Leuphana university in Germany. He has claimed that after an organic and
after a mechanical state of nature, we were entering a cybernetic state of nature
by the end of the 18th century. As a heuristic, the cybernetic state of nature
finally describes an era where objects in different disciplines - academic
disciplines - and theories are increasingly exposed as active,
intelligent and communicating. A growing object-orientation proves the
environmentalization of agency, as well as even environmentalized ways of being. As a
reminder, I should shortly say that against this - this environmentalization
of agency with those objects in our environment are just an example of this
environmentalization - against this background, the hermeneutic tradition of
critical theories that I mentioned - for them, objects are merely conceived as
means which the human subject intentionally uses to transform its
reality. That means in those critical theories, human beings' tool use is
conceptualized as a mean that serves certain ends. Of course, only the humans
set up those ends. Tools are used in order to supplement and to cope with the
indigence and neediness of human beings. It is in this way that technological
artifacts are always conceived as the other side, the outside of the human. So,
and exactly from this point - I will come to my end, to the end - and from exactly
this point, we propose to rethink the role of technology in health care and nursing
science via a challenge to enlarge our methodological horizon, new forms and
modes of interactions, which I just somehow point up as those
environmentalizations, so new forms and modes and this environmentalizations,
modes of interaction has to be conceptualized. We might see
technologically mediated relations between a patient and a nurse, which allows also
for wellbeing, as, for example, Jeannette Pols has put it in her book Care at a
Distance from 2012. It would be ignorant to think that phenomenons like, for
instance, ubiquitous computing leave already established relations untouched.
Additionally, taking relational operations of technological artifacts and human
entities not into account would be somehow shortsighted and also anthropocentric. The
new ecological paradigm, a term that also Erich Hörl has coined, seems for us to be
necessarily entered also by nudging science in order to conceptualize health
care as taking place in social technological environments, not at least
to find a place from where also a capital valuarization of health care and
everything might be rejected, a place where technological systems might be
conversed and used in an emancipatory and self-determined way. So here I'd like to
finish and ask Hanna to show us how contemporary ecologies of care would look
like. Hanna: Now we get to the second part of
the presentation, which is quite different from the first one because the first one
was how we could think about technology and what's going on in nursing science.
And when I came to Osnabrück University, I experienced that - oh, technology, you
should be careful. And before this, I studied business computer science, and I
was just not used to the thinking. So it strikes me a lot. And now I'm working in a
research project where these both sides are struggling all the time. So it's like,
be careful and try to think about how to conceptualize technology and how this can
change nursing and the daily work of nurses, and at the same time, it's like
you have this research project and you have kind of the goal of creating
prototypes and evaluating them, and doing practical research, empirical research,
and bringing the technology into the practice and look how it's going to work.
So kind of the argumentation to do this is the demographical change. People claim
that this change - people are getting older and there will be not enough carers
- that could be solved by a technological solution. Just yesterday, in the talk
about China's social credit system, we also heard just technological solutions
for social problems that may be not the best solution, not the best way to do it.
But we still do take a look at how could augmented reality in nursing look like. An
augmented reality, I think the most of you may know, it's like displaying virtual
objects into the reality - this is one of the marketing pictures. They promise you a
lot of things are possible and augmented reality can be really useful in a lot of
fields, you can community communicate with your colleague, you are in a different
room and still work on the same virtual artifacts. But we have the question - what
can be into that for nursing? So we took some workshops with nurses and nursing
managers, and we came up with a lot of use cases and currently we are examining two
prototypes. One is on wound care management. We have this with different
devices as well. We are trying - evaluating a prototype on the Vuzix M100
and a prototype on the Microsoft HoloLens. And they both have in common that they
should support the nurse and doing the documentation for the wound. So the nurse
can do the documentation while caring for the patient. That means the interaction
between the nurse and the patient may change here, but it could be possible to
save some time. And it also could enhance the quality of the documentation because
the documentation is being done by the time the nurse is there and has to see the
wound. This is what both prototypes have in common. The HoloLens prototype allows
to support the measuring of the wound as well. With the Vuzix prototype, you have
to measure the length and the width of the wound on your own, and then you can use
voice commands to put it into the documentation. With the HoloLens
prototype, this is what you see right here when you look through the glass, you get
this image and you can make a point on the edge of the wound and a point on the upper
side edge, and the measurement is done automatically. So the number you see is
the measured number, and the blue dots are the edges of the wound. Actually, this
prototype cannot detect the edges of the wound automatically, but this could be
under further consideration. And the second prototype we are actually
evaluating is on drug management. So I will show you a short video (if it's going
to work). Yeah,here you can see 10 dispensers, so dispensers for medication
for 10 patients at the same time. It's like for morning, midday, noon and
evening, or evening and night, I'm sorry. And you can put the pill into the right
box by the app showing you how to do it. If you can see here on the smartphone, the
app shows you how many pills you have to put into one box and you have to scan the
medication first, and if you scan the wrong one, you get this sign that it's the
wrong one. So you have some way of error prevention integrated as well. For this
prototype, you could also think of a lot of attention, like it could get the
information which medication has to be taken automatically, or it could detect if
the pill is taken into the right box. But this is actually not what we have right
now. Yeah. So it looks a bit less fancy than the picture from the advertisements,
but maybe it can save nurses some time and maybe it can do some error correctness.
And for these prototypes and some more which are currently evaluated by other
researchers or which have been evaluated, there are still a lot of challenges like
technical challenges and the challenge how to deal with the small display size and
short battery life, for sure. And it can be easy to focus in these details and
forget the big picture, forget what - how can we think technology? How can we think
the interaction of the technology and the humans? And what will this do with us? So
this is part of what the research funding policy could lead us to do. I still think
it's very interesting and maybe there will be some good things to do with this
technology, and this technology can enable us to change the structure of care work.
But it cannot be. We shouldn't forget everything else. So that's like our
conclusion. We identified basically two obstacles to think about emergent
technology in the field of nursing science right now. One is the way to think about
technology these days. This is what Hanna explained. We had to struggle in nursing
science to establish this discipline, and there had to be good arguments and the
struggle is still going on. So a lot of nursing science are still busy defending
with nursing from medicine. And sometimes this is kind of projected on defending
nursing from technology because technology is also perceived to be naturalistic,
binary, and doesn't feel the differences in the touch or doesn't get all the small
things. And yeah, the second thing is the research funding policy, which should lead
you to develop technological solutions, but in the best, you know, the solution
before you really had the question, because this is how you try to - how you
argument that you need some money to do something for this, you know, you know,
which solution you want to have. So thank you for your attention.
*applause*
Herald: We have about 5 Minutes for Q&As, so there are microphones *unintelligible*
microphones, we'll take some questions from listeners as well, *unintelligible*
and the signal angel is 'Naughty'. We'll take questions from microphone number 4
and then the signal angel. Audience member: Thank you for your
presentation. If I get this right, you said that there is a big research gap of
how new technologies influence the relationships between caretakers and the
persons who are being taken care of, who need help. And is there some research
going on about this? Like what effects have you - caretaking technology
introduced into nursing, yeah, on the human side?
Anne: Should I answer to this? Yeah, I will answer to this question. Thank you
for this. I mentioned in the last part a Dutch anthropologist who was also working
in the field of nursing science. It was Jeanette Pols. Her research on Telecare
might be that what you're looking for. She is - to continue the work, which was
started by Annemarie Mol, which is also quite important name in this field, and I
recommend you to check this out because her research, for example, is one of Janet
Pol reports. It's just, it's kind of new, and in the German context of nursing
science, it is not really recognized, especially not in this hermeneutical
tradition of nursing science that we refer to that we also work with. But as far as I
can tell from her research, there is the idea of new modes of interaction and that
the well-being, for example, of oncological patients that are cared at a
distance by a telecare technology or by certain interactive technologies, that
those well-being is always a question of how you measure well-being. I know, and
she also knows this problem. But her first research results, which are presented in
that book, are not showing anything what we could - what should make us step back
from this. So it more or less affirms that the well-being is like secured also by
this care at a distance. Is that an answer to your question?
Audience member: Yeah, kind of. I cannot ask another question, so thank you.
Herald: We'll take the question from the signal angel from the internet.
Signal Angel: Hi. OK, so which parts of nursing do you think will change first and
how do you think elder people will adapt to that?
Herald: And would it be OK to take two questions at a time, because we have three
more questions left? *people talking over each other*
Herald: Microphone number one. Audience meber: Uh, hello. Thank you for
your talk. I'm a nurse and I see the problem - I think technology is very
important in nursing, but I see the problem in the network between the nurses.
When you make the research of politics, it's very difficult to reach the nurses to
get a voice from them. Have you ideas also to find a solution for this?
Anne: Should I answer? Shall I answer this? Thank you for this really, really
important question because that is kind of a basic problem that we see in that field
of nursing science that is somehow even kind of divided - we have nursing science
and we have nursing practice, even though our association is based on both. But the
degree of organization and caring practice is extremely low, which makes it really
hard to reach them - to reach out to them. As you said, we can see in the Lower
Saxony, for example, a newly established Pflegekammer come out, which is an
organization form which is kind of step forward, but it's also like controversial
because of this centralistic structure. I guess there's a lot of work to be done,
organizing work, and we can learn, for example, from examples from Switzerland.
They are kind of better organized. Yeah, you're right with that hint that
this should happen on the same time, this question of organization to be really in
the position to have a - to take a critical stance on technology and also to
develop a self-determined way in order to say we want to use it like this and not
like in another way, in a, like, in a formalizing way only. So it just has to be
done. Organization of care workers. Thank you. Thank you.
Herald: We were basically out of time. So do you have like two second replies to the
internet question as well? Hanna: Yes. I think it's really difficult
to answer how part of nursing is changing first. There's a lot of change going on in
doing the documentation, like on computers and not on paper. And there's a lot of
change. And what else is going on will - may happen on financial structures as
well. Herald: Excellent. Thank you very much for
both the presentation and the questions. For the two questions that weren't able to
be asked over the microphones, I'm sure you can find Hannah and Anna just next to
the stage after the talk. Thank you very much.
Hanna: Thank you.
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