{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:12Z","timestamp":1785545052233,"version":"3.56.0"},"reference-count":61,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Robotic technology has the potential to assist nurses, but the complexity and unpredictability of health care environments cannot be replicated in a laboratory setting. Furthermore, there is a lack of experiential evidence that robotic technology will meaningfully impact nursing. Collaborative development of technology and real-world usability studies offers the ability to address problems early in the design process when functional changes can be implemented.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The purpose of this study was to use an observational study and systematically evaluate the work system of inpatient nurses to identify barriers to the integration of robotic technology. The objectives are to use an observational study of active hospital units to gain a deeper understanding of nursing tasks, workflow, and the health care setting; identify barriers to the integration of robotic technology using the people, environment, tools, and tasks (PETT) scan from the Systems Engineering Initiative for Patient Safety framework; and synthesize the work system components of the PETT scan into themes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We used the practice-oriented model of the Systems Engineering Initiative for Patient Safety, the PETT scan, to identify barriers for robotic technology use and innovation. A convenience sample of nursing staff was observed as they worked. Units included the emergency department, medical and surgical intensive care unit, preop or postanesthesia care unit, and general medical-surgical floor. The total number of observation hours per unit was based on data saturation, which occurred at variable times during the day shift, and was arranged with unit management. A total of 53 hours across 16 sessions were recorded. Multiple rounds of inductive and deductive coding were conducted. Briefly, a 3-phase iterative data analysis process was used\u2014initial inductive content analysis, a deductive phase to organize emergent categories into a PETT scan, and finalization of the PETT scan with the identification of overarching themes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Observations across all units yielded a broad set of barriers to integrating robotic and other health care technologies. Using the PETT scan, 78 barriers were identified and were summarized into 20 themes with supporting subthemes and exemplars.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n By systematically observing nursing workflows and synthesizing barriers into themes, this study provides new insight into the conditions that enable or constrain robotic integration. Findings suggest that robotic technologies are presently best suited for auxiliary and background roles. Broader integration into patient care workflows will depend on designs that align with clinical workflows, support interoperability and robustness, and address ethical, accountability, and coordination challenges inherent in nursing care, as well as maintained organizational support.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/89409","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T17:40:05Z","timestamp":1777570805000},"page":"e89409-e89409","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Nursing Work Systems and Identifying Barriers for Robotic Technology Integration: Observational Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3351-8882","authenticated-orcid":false,"given":"Gina L","family":"Georgadarellis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3287-3802","authenticated-orcid":false,"given":"Ellen","family":"Benjamin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0052-7801","authenticated-orcid":false,"given":"Shannon C","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2753-2683","authenticated-orcid":false,"given":"Cidalia J","family":"Vital","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6290-9805","authenticated-orcid":false,"given":"Frank C","family":"Sup IV","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1038\/s41514-024-00148-2","article-title":"Healthcare on the brink: navigating the challenges of an aging society in the United States","volume":"10","author":"Jones","journal-title":"NPJ Aging"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1002\/nop2.942","article-title":"The impact of \u201cmissed nursing care\u201d or \u201ccare not done\u201d on adults in health care: a rapid review for the Consensus Development Project","volume":"9","author":"Willis","journal-title":"Nurs Open"},{"issue":"8","key":"R3","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.11124\/JBIES-23-00367","article-title":"Nurses\u2019 perceptions of reasons for missed nursing care in hospitals: a qualitative systematic review protocol","volume":"22","author":"Ellehave","journal-title":"JBI Evid Synth"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.ijnurstu.2015.02.012","article-title":"Unfinished nursing care, missed care, and implicitly rationed care: State of the Science review","volume":"52","author":"Jones","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1111\/inr.13096","article-title":"Global reasons for missed nursing care: a systematic review and meta-analysis","volume":"72","author":"Gong","journal-title":"Int Nurs Rev"},{"issue":"7","key":"R6","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.1111\/jonm.12835","article-title":"Developing policies and actions in response to missed nursing care: a consensus process","volume":"27","author":"Palese","journal-title":"J Nurs Manag"},{"key":"R7","unstructured":"Ball JE Griffiths P . Missed nursing care: a key measure for patient safety. Agency for Healthcare Research and Quality | PSNet Internet. 2018. URL: https:\/\/psnet.ahrq.gov\/perspective\/missed-nursing-care-key-measure-patient-safety [Accessed 09-12-2025]"},{"issue":"60","key":"R8","doi-asserted-by":"publisher","DOI":"10.1126\/scirobotics.abi8017","article-title":"A decade retrospective of medical robotics research from 2010 to 2020","volume":"6","author":"Dupont","journal-title":"Sci Robot"},{"issue":"1-2","key":"R9","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1080\/24725838.2024.2323061","article-title":"Nursing perceptions of robotic technology in healthcare: a pretest-posttest survey analysis using an educational video","volume":"12","author":"Georgadarellis","journal-title":"IISE Trans Occup Ergon Hum Factors"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","DOI":"10.4293\/JSLS.2018.00039","article-title":"Origins of robotic surgery: from skepticism to standard of care","volume":"22","author":"George","journal-title":"JSLS"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.bioeng.1.1.211","article-title":"Robotics for surgery","volume":"1","author":"Howe","journal-title":"Annu Rev Biomed Eng"},{"issue":"2","key":"R12","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1109\/10.1354","article-title":"A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery","volume":"35","author":"Kwoh","journal-title":"IEEE Trans Biomed Eng"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01102-y","article-title":"Levels of autonomy in FDA-cleared surgical robots: a systematic review","volume":"7","author":"Lee","journal-title":"NPJ Digit Med"},{"issue":"2 Suppl","key":"R14","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1016\/j.ygyno.2009.02.002","article-title":"Emergence of robotic assisted surgery in gynecologic oncology: American perspective","volume":"114","author":"Mendivil","journal-title":"Gynecol Oncol"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2024.100451","article-title":"Automated dispensing cabinets and their impact on the rate of omitted and delayed doses: a systematic review","volume":"14","author":"Jeffrey","journal-title":"Explor Res Clin Soc Pharm"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-023-01953-0","article-title":"Reducing medication errors by adopting automatic dispensing cabinets in critical care units","volume":"47","author":"Tu","journal-title":"J Med Syst"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-020-00420-2","article-title":"Nurses\u2019 perceptions of automated dispensing cabinets - an observational study and an online survey","volume":"19","author":"Mets\u00e4muuronen","journal-title":"BMC Nurs"},{"issue":"5","key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/33380","article-title":"Use of robots in critical care: systematic review","volume":"24","author":"Teng","journal-title":"J Med Internet Res"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","first-page":"77","DOI":"10.2146\/ajhp100012","article-title":"Use of pharmacy delivery robots in intensive care units","volume":"68","author":"Summerfield","journal-title":"Am J Health Syst Pharm"},{"key":"R20","unstructured":"Moxi--Diligent Robotics. URL: https:\/\/www.diligentrobots.com\/moxi\/ [Accessed 25-11-2025]"},{"key":"R21","unstructured":"Tietze M McBride S . Robotics and the impact on nursing practice case study and pilot site analyses. American Nurses Association; 2020. URL: https:\/\/anaprodsite2.nursingworld.org\/globalassets\/innovation\/robotics-and-the-impact-on-nursing-practice_print_12-2-2020-pdf-1.pdf [Accessed 20-04-2023]"},{"key":"R22","unstructured":"Marshall D . Using our moxi: implementing robotics to remove staff delivery tasks. American Organization for Nursing Leadership; 2022. URL: https:\/\/www.aonl.org\/system\/files\/media\/file\/2022\/02\/Voice_1-22_Robotics.pdf [Accessed 05-09-2025]"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-02842-2","article-title":"Utilisation of robots in nursing practice: an umbrella review","volume":"24","author":"Adeyemo","journal-title":"BMC Nurs"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/72674","article-title":"Opportunities, challenges, and future directions for the integration of automation in nursing practice: discursive study","volume":"8","author":"Pepito","journal-title":"JMIR Nurs"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.3389\/frobt.2024.1398140","article-title":"A systematic review of collaborative robots for nurses: where are we now, and where is the evidence?","volume":"11","author":"Babalola","journal-title":"Front Robot AI"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.3233\/SHTI250337","article-title":"Usability and UX in healthcare: exploring current practices and future directions","volume":"327","author":"Marcilly","journal-title":"Stud Health Technol Inform"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2025.3578870","article-title":"Taxonomic robot identifiers: toward general classification and oversight for autonomous systems","volume":"13","author":"Isaka","journal-title":"IEEE Access"},{"key":"R28","unstructured":"U.S. Food & Drug Administration. How to determine if your product is a medical device. 2022. URL: https:\/\/www.fda.gov\/medical-devices\/classify-your-medical-device\/how-determine-if-your-product-medical-device [Accessed 25-01-2024]"},{"issue":"2","key":"R29","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1017\/S0269888998002033","article-title":"On autonomous robots","volume":"13","author":"Bekey","journal-title":"Knowl Eng Rev"},{"issue":"4","key":"R30","doi-asserted-by":"publisher","DOI":"10.1126\/scirobotics.aam8638","article-title":"Medical robotics-regulatory, ethical, and legal considerations for increasing levels of autonomy","volume":"2","author":"Yang","journal-title":"Sci Robot"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.apergo.2013.04.023","article-title":"Human factors systems approach to healthcare quality and patient safety","volume":"45","author":"Carayon","journal-title":"Appl Ergon"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/0169-8141(89)90051-6","article-title":"A balance theory of job design for stress reduction","volume":"4","author":"Smith","journal-title":"Int J Ind Ergon"},{"issue":"6","key":"R33","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/s0003-6870(00)00040-5","article-title":"Work organization and ergonomics","volume":"31","author":"Carayon","journal-title":"Appl Ergon"},{"issue":"12","key":"R34","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/JAMA.1988.03410120089033","article-title":"The quality of care. How can it be assessed?","volume":"260","author":"Donabedian","journal-title":"JAMA"},{"issue":"Suppl 1","key":"R35","doi-asserted-by":"publisher","first-page":"i50","DOI":"10.1136\/qshc.2005.015842","article-title":"Work system design for patient safety: the SEIPS model","volume":"15 Suppl 1","author":"Carayon","journal-title":"Qual Saf Health Care"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/60176","article-title":"Work systems analysis of emergency nurse patient flow management using the systems engineering initiative for patient safety model: applying findings from a grounded theory study","volume":"11","author":"Benjamin","journal-title":"JMIR Hum Factors"},{"issue":"11","key":"R37","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1136\/bmjqs-2020-012538","article-title":"SEIPS 101 and seven simple SEIPS tools","volume":"30","author":"Holden","journal-title":"BMJ Qual Saf"},{"issue":"9","key":"R38","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations","volume":"89","author":"O\u2019Brien","journal-title":"Acad Med"},{"key":"R39","unstructured":"O\u2019Brien BC Harris IB Beckman TJ Reed DA Cook DA . The SRQR reporting checklist. In: Harwood J Albury C de BJ Schl\u00fcssel M Collins G , editors. The EQUATOR Network Reporting Guideline Platform. 2025. URL: https:\/\/resources.equator-network.org\/reporting-guidelines\/srqr\/srqr-checklist.docx [Accessed 17-03-2026]"},{"issue":"4","key":"R40","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization","volume":"52","author":"Saunders","journal-title":"Qual Quant"},{"issue":"9","key":"R41","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","journal-title":"Qual Health Res"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2023.104105","article-title":"Work system barriers and facilitators of a team health information technology","volume":"113","author":"Hose","journal-title":"Appl Ergon"},{"key":"R43","unstructured":"Lincoln YS Guba EG . Naturalistic Inquiry. SAGE Publications Inc; 1985. ISBN: 9780803924314"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/39786","article-title":"Intelligent physical robots in health care: systematic literature review","volume":"25","author":"Huang","journal-title":"J Med Internet Res"},{"key":"R45","doi-asserted-by":"crossref","unstructured":"Barajas NC Rouchitsas A Broo DG . Examining human\u2013robot interactions: design guidelines for trust and acceptance. In: Malakhatka E Wiberg M , editors. Human-Technology Interaction: Interdisciplinary Approaches and Perspectives. Springer Nature Switzerland; 2025:117-137. [doi: 10.1007\/978-3-031-78357-9_4]","DOI":"10.1007\/978-3-031-78357-9_4"},{"issue":"8","key":"R46","doi-asserted-by":"publisher","first-page":"316","DOI":"10.3390\/technologies13080316","article-title":"A systematic approach for robotic system development","volume":"13","author":"Leone","journal-title":"Technologies (Basel)"},{"issue":"12","key":"R47","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1007\/s12369-023-01027-8","article-title":"A taxonomy of factors influencing perceived safety in human\u2013robot interaction","volume":"15","author":"Akalin","journal-title":"Int J of Soc Robotics"},{"issue":"4","key":"R48","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.1801","article-title":"A research review on clinical needs, technical requirements, and normativity in the design of surgical robots","volume":"13","author":"D\u00edaz","journal-title":"Int J Med Robot"},{"issue":"5","key":"R49","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.outlook.2007.04.003","article-title":"A model of nursing as a complex adaptive system","volume":"55","author":"Chaffee","journal-title":"Nurs Outlook"},{"issue":"1","key":"R50","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-02981-6","article-title":"Empowering nurse leaders: leveraging financial management practices to foster sustainable healthcare - a mixed-methods study","volume":"24","author":"Ismail","journal-title":"BMC Nurs"},{"issue":"3","key":"R51","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.outlook.2022.01.002","article-title":"Exploring the turbulent nature of nurses\u2019 workflow","volume":"70","author":"Jennings","journal-title":"Nurs Outlook"},{"issue":"4","key":"R52","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1177\/09514848231218617","article-title":"A multi-dimensional study of organisational boundaries and silos in the healthcare sector","volume":"37","author":"Pedersen","journal-title":"Health Serv Manage Res"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1097\/00004010-200101000-00006","article-title":"Managing the care of health and the cure of disease--part I: differentiation","volume":"26","author":"Glouberman","journal-title":"Health Care Manage Rev"},{"issue":"2","key":"R54","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.healthpol.2018.09.018","article-title":"Enabling health technology innovation in Canada: barriers and facilitators in policy and regulatory processes","volume":"123","author":"MacNeil","journal-title":"Health Policy"},{"key":"R55","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnsa.2023.100170","article-title":"Enabling nurses\u2019 engagement in the design of healthcare technology - core competencies and requirements: a qualitative study","volume":"6","author":"van Houwelingen","journal-title":"Int J Nurs Stud Adv"},{"issue":"1","key":"R56","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-024-02311-2","article-title":"Bottleneck factors impacting nurses\u2019 workflow and the opportunity to prioritize improvement efforts: factor analysis","volume":"23","author":"Al Moteri","journal-title":"BMC Nurs"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.1177\/23779608251328278","article-title":"Time wasters facing nurses during work in hospital departments","volume":"11","author":"Qtait","journal-title":"SAGE Open Nurs"},{"key":"R58","doi-asserted-by":"publisher","DOI":"10.1177\/20556683231180189","article-title":"Impacts of technology use on the workload of registered nurses: a scoping review","volume":"10","author":"Mohammadnejad","journal-title":"J Rehabil Assist Technol Eng"},{"issue":"2","key":"R59","doi-asserted-by":"publisher","DOI":"10.57239\/PJLSS-2024-22.2.00643","article-title":"The impact of AI on nursing workload and stress levels in critical care settings","volume":"22","author":"Alnawafleh","journal-title":"Pakjlifesocsci"},{"issue":"4","key":"R60","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.bpsc.2025.01.012","article-title":"From confound to clinical tool: mindfulness and the observer effect in research and therapy","volume":"10","author":"Bauer","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"issue":"1","key":"R61","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-025-01274-0","article-title":"A real-time communication and information system for triage, positioning, and documentation (TriPoD) in mass-casualty incidents: a qualitative observational study","volume":"25","author":"Lindstr\u00f6m","journal-title":"BMC Emerg Med"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e89409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:24:39Z","timestamp":1785536679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e89409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":61,"URL":"https:\/\/doi.org\/10.2196\/89409","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]},"article-number":"v28i1e89409"}}