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33C3 preroll music
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Karen: Thank you all for coming. We are[br]about to start the next talk. Think big or
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care for yourself on the obstacles to[br]think of emergent technologies in the
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field of nursing science. Our speakers are[br]Hanna Wüller and Anne Koppenburger. They
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both work on the use and development of[br]technology in nursing. Hanna is examining
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which parts of nursing should be supported[br]by technological solutions. She does
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research on augmented reality used in[br]nursing. Anna works on feminist science
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and technological studies, as well as[br]critique of the political economy. She is
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the editor of a book that just came out[br]here in 2017: The Cybernetic Capitalism
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Revolution - The Emancipatory Perspective[br]in technological change. I hope you will
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listen to their talk with great interest.[br]There is translations into English and
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German on the website that you can find on[br]the site. Enjoy the talk.
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applause
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Thank you, Karen, for this nice[br]introduction. Welcome to our talk: Think
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big or care for yourself. On the obstacles[br]to think of emerging technologies in the
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field of nursing science. We're very proud[br]to talk here on CCC. My name is Anne
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Koppenburger. This is Hanna Wüller. Let me[br]shortly say something about the
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perspective that I will take in this talk.[br]As I did in the book that was just showed,
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I will do it again to give you time, maybe[br]to write it down or something. I'm
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interested in the understanding of[br]technologies, especially in the
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understandings of technological change. I[br]am looking at how different societal
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agents relate themself within this change.[br]And in that book, we did it with some
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different agents like DIY technology[br]friendly initiatives, industrial players
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or trade unions. Today, we want to talk[br]about care and the relation to technology.
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And we will do this in three steps. And I[br]should say that it will take around 25
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minutes, then we will have five minutes[br]left. We would be happy to get one or two
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questions from the audience. But however,[br]for those of you who will not get the
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possibility to talk to us or to contribute[br]something to our talk, please feel free to
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reproach us afterwards or to check out our[br]university web pages and get in touch with
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us. OK, the following 25 minutes we will[br]talk about the relation of nursing,
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science and technology in order to expose[br]it as problematic. First, I would talk
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about nursing science and what we actually[br]talk about when we say nursing science,
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and I will link this to the question of[br]what we mean when we talk in nursing
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science about technology. Afterwards,[br]Hanna will introduce you in a current
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research project on augmented reality. She[br]will talk about what is going on right now
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in this field of research. OK. I would[br]start with the first part. I want to argue
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that social struggles for making care work[br]visible are a consequential requirement to
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conceptualize the application of different[br]technologies and nursing science. It's
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like that: You cannot take it for granted[br]to talk about care. It is thanks to the
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extraordinary work of feminist political[br]activists, artist, writers and theorists
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that today we are in the situation to talk[br]about care work as a structured and
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structuring activity at all. I mean, to[br]talk about care apart from it as being a
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labor of love. It was embedded in the new[br]left social movements in the 1960s and
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some countries around the world that[br]materialist feminist were struggling to
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expose care work as a notable part of[br]social reproduction. In these efforts, the
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relation between productive labor and[br]reproductive labor has been exposed as
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interdependent, as dependent on each[br]other. And this emancipatory struggles
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have made care work visible by the[br]naturalizing as care work has been
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revealed as an essential precondition of a[br]bourgeois society's capitalist production.
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However, being visible, of course, is not[br]the same as being recognized and still
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today care work lags of societal[br]appreciation. Those circumstances comes,
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for example, with low wages and poor[br]working conditions. Who wants to learn
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more about the ongoing struggle is[br]recommended to check out, for instance,
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the work of Helen Hester. She's a member[br]of the technology-friendly xeno-feminist
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collective Laboria Cuboniks. She's an[br]associate professor for media and
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communication at the University of West[br]London, and she emphasizes on the task to
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continue the discussion of making care[br]work visible. Visible as a part - as a
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notable part - of social reproduction, she[br]proposes to rethink living arrangements,
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living standards and the role of domestic[br]technology. Therefore, she opens up a
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discussion on automatisation of certain[br]aspects of health care. Despite a lot of
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controversies around this, she says the[br]opening to automatisation is a refusal to
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naturalize this work. OK, back to nursing[br]science. Yeah, we can see how these
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social, political, economic movements that[br]I just have mentioned, those emancipatory
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struggles, they obviously affect the[br]theoretical horizon of nursing science,
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which in turn influences the[br]conceptualization of technology and care
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work settings. Speaking for a German[br]context of nursing science, contemporary
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nursing scientists, they are still[br]overwhelmingly busy with the
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professionalization of health care. They[br]are partly still engaged in establishing
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nursing science as a scientific discipline[br]that describes and develops reasonable
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caring practice on the basis of[br]independent nursing research.
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Distinguishing nursing science as[br]independent from medicine is seen as a
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cornerstone in these struggles. Medicine[br]as a life science discipline is probably
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rightly accused of being pervaded by[br]strongly functionalist, partly mechanic,
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partly cybernetic paradigm. This formal[br]and mathematical paradigm might be seen as
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a reflexive background against which this[br]young and ambitious discipline has
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constituted itself, at least in the German[br]context. Oh, sorry. By drawing on critical
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theories, nursing scientists rejected a[br]purely medical approach to bodily
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processes, which often those medical[br]approaches, they often comes in
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explanatory modes of, for example,[br]quantifying rationalizing technologizing.
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Nursing practice, in contrast, is supposed[br]to approach human beings' experiences of
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health and sickness and modes of[br]comprehension of a fully understanding,
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for example, by phenomenologically[br]reconstructing individual meaning and
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collective sense structures. So in[br]comparison, medicine and nursing, medicine
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prefers to explain diseases by formalize[br]events, a formalized thinking, a linear
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thinking. Whereas nursing science is[br]supposed to comprehend being healthy or
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being sick by mimetic faculty, by, I say,[br]simply and playing, by feel it. That is
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why nursing sciences draw on highly[br]controversial constructs like intuition or
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implicit knowledge. Here, we still witness[br]the movement of making visible what was
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made invisible before socially,[br]politically, theoretically. Exactly at
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this point, we find a particular strong[br]rejection of different technologies and
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care work by nursing scientists. Since[br]technology, especially information
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technology, are conceived as means of[br]explanation, these technologies are
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identified with the formalistic paradigm[br]that supposedly cannot comprehend the
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implicit part of human beings' experience.[br]Here, the different struggles that I have
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mentioned meet each other. They both are[br]targeting at onto-epistemological regimes
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of capitalizing, rationalizing[br]technologizing. They kind of attack on
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this processes just in order, which is an[br]important work also to include the
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excluded, to qualify the quantified, and[br]also to de-technologize the technologized.
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So just to sum up this first part, it is[br]important to keep in mind that both the
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histories of feminists efforts to make[br]care work visible and the academic
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struggle of establishing nursing science[br]as a scientific discipline, they are both
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interlinked. They go parallel in their[br]ambition to emancipate themselves from
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formalizing, thinking and acting. They[br]also share basic parts of their
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theoretical foundation. As a result, an[br]always mysteriously indetermined part of
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the human being's existence is supposed to[br]be a crucial counterpoint of technological
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formations.[br]mumbles
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But the question, of course, is what are
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those or these technological formations[br]and how to situate nursing practices
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within them. So for this, let me tell you[br]what technology means when we as a nursing
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science talk about it. So technology -[br]What do we talk about it? I already said
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that the human being is depicted in[br]different critical theories as the
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counterpart of technology. It is this[br]image, actually, what right now seems to
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be increasingly challenged. For example,[br]when we think of technological operations
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on micro-temporal levels as sensor[br]technologies too, we are confronted with
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an entity that act beyond human beings'[br]sensational perception. When we first
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think of technology's power to control us,[br]meaning the regulating sense of control,
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then we cannot but conclude that it's not[br]just a human being's action that makes
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sense to us. The existence and operations[br]of contemporary smart objects are
0:12:08.824,0:12:14.748
increasingly unraveling the image of the[br]human as an exceptional sense maker. This
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is the technological condition that for[br]some decades now challenges particularly
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the humanities to come to grasp with. And[br]it was Erich Hörl who described this
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ongoing basically technologically[br]influenced displacement of sense as a
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representational sense. He - Erich Hörl -[br]is a professor of media philosophy at
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Lüneburg Leuphana university in Germany.[br]He has claimed that after an organic and
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after a mechanical state of nature, we[br]were entering a cybernetic state of nature
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by the end of the 18th century. As a[br]heuristic, the cybernetic state of nature
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finally describes an era where objects in[br]different disciplines - academic
0:13:03.971,0:13:09.447
disciplines - and theories are[br]increasingly exposed as active,
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intelligent and communicating. A growing[br]object-orientation proves the
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environmentalization of agency, as well as[br]even environmentalized ways of being. As a
0:13:24.436,0:13:31.964
reminder, I should shortly say that[br]against this - this environmentalization
0:13:31.964,0:13:38.144
of agency with those objects in our[br]environment are just an example of this
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environmentalization - against this[br]background, the hermeneutic tradition of
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critical theories that I mentioned - for[br]them, objects are merely conceived as
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means which the human subject[br]intentionally uses to transform its
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reality. That means in those critical[br]theories, human beings' tool use is
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conceptualized as a mean that serves[br]certain ends. Of course, only the humans
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set up those ends. Tools are used in order[br]to supplement and to cope with the
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indigence and neediness of human beings.[br]It is in this way that technological
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artifacts are always conceived as the[br]other side, the outside of the human. So,
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and exactly from this point - I will come[br]to my end, to the end - and from exactly
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this point, we propose to rethink the role[br]of technology in health care and nursing
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science via a challenge to enlarge our[br]methodological horizon, new forms and
0:14:44.695,0:14:50.460
modes of interactions, which I just[br]somehow point up as those
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environmentalizations, so new forms and[br]modes and this environmentalizations,
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modes of interaction has to be[br]conceptualized. We might see
0:14:58.680,0:15:04.380
technologically mediated relations between[br]a patient and a nurse, which allows also
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for wellbeing, as, for example, Jeannette[br]Pols has put it in her book Care at a
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Distance from 2012. It would be ignorant[br]to think that phenomenons like, for
0:15:14.520,0:15:20.280
instance, ubiquitous computing leave[br]already established relations untouched.
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Additionally, taking relational operations[br]of technological artifacts and human
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entities not into account would be somehow[br]shortsighted and also anthropocentric. The
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new ecological paradigm, a term that also[br]Erich Hörl has coined, seems for us to be
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necessarily entered also by nudging[br]science in order to conceptualize health
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care as taking place in social[br]technological environments, not at least
0:15:47.760,0:15:53.160
to find a place from where also a capital[br]valuarization of health care and
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everything might be rejected, a place[br]where technological systems might be
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conversed and used in an emancipatory and[br]self-determined way. So here I'd like to
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finish and ask Hanna to show us how[br]contemporary ecologies of care would look
0:16:09.600,0:16:13.080
like.[br]Hanna: Now we get to the second part of
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the presentation, which is quite different[br]from the first one because the first one
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was how we could think about technology[br]and what's going on in nursing science.
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And when I came to Osnabrück University, I[br]experienced that - oh, technology, you
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should be careful. And before this, I[br]studied business computer science, and I
0:16:37.620,0:16:44.160
was just not used to the thinking. So it[br]strikes me a lot. And now I'm working in a
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research project where these both sides[br]are struggling all the time. So it's like,
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be careful and try to think about how to[br]conceptualize technology and how this can
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change nursing and the daily work of[br]nurses, and at the same time, it's like
0:17:05.520,0:17:12.060
you have this research project and you[br]have kind of the goal of creating
0:17:12.060,0:17:17.880
prototypes and evaluating them, and doing[br]practical research, empirical research,
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and bringing the technology into the[br]practice and look how it's going to work.
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So kind of the argumentation to do this is[br]the demographical change. People claim
0:17:30.180,0:17:37.140
that this change - people are getting[br]older and there will be not enough carers
0:17:37.140,0:17:44.760
- that could be solved by a technological[br]solution. Just yesterday, in the talk
0:17:44.760,0:17:50.100
about China's social credit system, we[br]also heard just technological solutions
0:17:50.100,0:17:54.780
for social problems that may be not the[br]best solution, not the best way to do it.
0:17:56.460,0:18:04.860
But we still do take a look at how could[br]augmented reality in nursing look like. An
0:18:04.860,0:18:10.260
augmented reality, I think the most of you[br]may know, it's like displaying virtual
0:18:10.260,0:18:17.040
objects into the reality - this is one of[br]the marketing pictures. They promise you a
0:18:17.040,0:18:22.380
lot of things are possible and augmented[br]reality can be really useful in a lot of
0:18:22.380,0:18:26.820
fields, you can community communicate with[br]your colleague, you are in a different
0:18:26.820,0:18:35.460
room and still work on the same virtual[br]artifacts. But we have the question - what
0:18:35.460,0:18:44.820
can be into that for nursing? So we took[br]some workshops with nurses and nursing
0:18:44.820,0:18:53.040
managers, and we came up with a lot of use[br]cases and currently we are examining two
0:18:53.040,0:19:02.520
prototypes. One is on wound care[br]management. We have this with different
0:19:02.520,0:19:11.040
devices as well. We are trying -[br]evaluating a prototype on the Vuzix M100
0:19:11.040,0:19:16.380
and a prototype on the Microsoft HoloLens.[br]And they both have in common that they
0:19:16.380,0:19:22.860
should support the nurse and doing the[br]documentation for the wound. So the nurse
0:19:22.860,0:19:28.740
can do the documentation while caring for[br]the patient. That means the interaction
0:19:28.740,0:19:33.600
between the nurse and the patient may[br]change here, but it could be possible to
0:19:33.600,0:19:40.560
save some time. And it also could enhance[br]the quality of the documentation because
0:19:40.560,0:19:46.860
the documentation is being done by the[br]time the nurse is there and has to see the
0:19:46.860,0:19:53.700
wound. This is what both prototypes have[br]in common. The HoloLens prototype allows
0:19:53.700,0:20:01.440
to support the measuring of the wound as[br]well. With the Vuzix prototype, you have
0:20:01.440,0:20:07.560
to measure the length and the width of the[br]wound on your own, and then you can use
0:20:07.560,0:20:12.540
voice commands to put it into the[br]documentation. With the HoloLens
0:20:12.540,0:20:19.140
prototype, this is what you see right here[br]when you look through the glass, you get
0:20:19.140,0:20:25.800
this image and you can make a point on the[br]edge of the wound and a point on the upper
0:20:25.800,0:20:32.220
side edge, and the measurement is done[br]automatically. So the number you see is
0:20:32.220,0:20:38.820
the measured number, and the blue dots are[br]the edges of the wound. Actually, this
0:20:38.820,0:20:44.760
prototype cannot detect the edges of the[br]wound automatically, but this could be
0:20:44.760,0:20:50.640
under further consideration. And the[br]second prototype we are actually
0:20:50.640,0:21:02.400
evaluating is on drug management. So I[br]will show you a short video (if it's going
0:21:02.400,0:21:11.460
to work). Yeah,here you can see 10[br]dispensers, so dispensers for medication
0:21:11.460,0:21:19.500
for 10 patients at the same time. It's[br]like for morning, midday, noon and
0:21:19.500,0:21:28.320
evening, or evening and night, I'm sorry.[br]And you can put the pill into the right
0:21:28.320,0:21:37.620
box by the app showing you how to do it.[br]If you can see here on the smartphone, the
0:21:37.620,0:21:45.240
app shows you how many pills you have to[br]put into one box and you have to scan the
0:21:45.240,0:21:50.940
medication first, and if you scan the[br]wrong one, you get this sign that it's the
0:21:50.940,0:21:58.860
wrong one. So you have some way of error[br]prevention integrated as well. For this
0:21:58.860,0:22:04.560
prototype, you could also think of a lot[br]of attention, like it could get the
0:22:04.560,0:22:10.260
information which medication has to be[br]taken automatically, or it could detect if
0:22:10.260,0:22:17.160
the pill is taken into the right box. But[br]this is actually not what we have right
0:22:17.160,0:22:26.760
now. Yeah. So it looks a bit less fancy[br]than the picture from the advertisements,
0:22:26.760,0:22:33.180
but maybe it can save nurses some time and[br]maybe it can do some error correctness.
0:22:33.180,0:22:40.740
And for these prototypes and some more[br]which are currently evaluated by other
0:22:40.740,0:22:46.020
researchers or which have been evaluated,[br]there are still a lot of challenges like
0:22:46.020,0:22:52.620
technical challenges and the challenge how[br]to deal with the small display size and
0:22:52.620,0:23:02.580
short battery life, for sure. And it can[br]be easy to focus in these details and
0:23:03.240,0:23:10.500
forget the big picture, forget what - how[br]can we think technology? How can we think
0:23:11.820,0:23:19.260
the interaction of the technology and the[br]humans? And what will this do with us? So
0:23:19.260,0:23:27.780
this is part of what the research funding[br]policy could lead us to do. I still think
0:23:27.780,0:23:33.120
it's very interesting and maybe there will[br]be some good things to do with this
0:23:33.120,0:23:39.180
technology, and this technology can enable[br]us to change the structure of care work.
0:23:40.800,0:23:49.080
But it cannot be. We shouldn't forget[br]everything else. So that's like our
0:23:49.080,0:23:55.200
conclusion. We identified basically two[br]obstacles to think about emergent
0:23:55.200,0:24:00.420
technology in the field of nursing science[br]right now. One is the way to think about
0:24:00.420,0:24:09.540
technology these days. This is what Hanna[br]explained. We had to struggle in nursing
0:24:09.540,0:24:16.680
science to establish this discipline, and[br]there had to be good arguments and the
0:24:16.680,0:24:22.470
struggle is still going on. So a lot of[br]nursing science are still busy defending
0:24:22.470,0:24:28.740
with nursing from medicine. And sometimes[br]this is kind of projected on defending
0:24:28.740,0:24:34.200
nursing from technology because technology[br]is also perceived to be naturalistic,
0:24:34.200,0:24:43.260
binary, and doesn't feel the differences[br]in the touch or doesn't get all the small
0:24:43.260,0:24:49.860
things. And yeah, the second thing is the[br]research funding policy, which should lead
0:24:49.860,0:24:58.020
you to develop technological solutions,[br]but in the best, you know, the solution
0:24:58.020,0:25:08.760
before you really had the question,[br]because this is how you try to - how you
0:25:08.760,0:25:15.060
argument that you need some money to do[br]something for this, you know, you know,
0:25:15.060,0:25:21.720
which solution you want to have. So thank[br]you for your attention.
0:25:31.740,0:25:43.428
applause
0:25:43.428,0:25:45.571
Herald: We have about 5 Minutes for Q&As,[br]so there are microphones unintelligible
0:25:45.571,0:25:45.653
microphones, we'll take some questions[br]from listeners as well, unintelligible
0:25:45.653,0:25:45.736
and the signal angel is 'Naughty'. We'll[br]take questions from microphone number 4
0:25:45.736,0:25:47.040
and then the signal angel.[br]Audience member: Thank you for your
0:25:47.040,0:25:58.140
presentation. If I get this right, you[br]said that there is a big research gap of
0:25:58.140,0:26:04.860
how new technologies influence the[br]relationships between caretakers and the
0:26:04.860,0:26:12.060
persons who are being taken care of, who[br]need help. And is there some research
0:26:12.060,0:26:20.220
going on about this? Like what effects[br]have you - caretaking technology
0:26:20.220,0:26:25.080
introduced into nursing, yeah, on the[br]human side?
0:26:25.080,0:26:30.600
Anne: Should I answer to this? Yeah, I[br]will answer to this question. Thank you
0:26:30.600,0:26:41.940
for this. I mentioned in the last part a[br]Dutch anthropologist who was also working
0:26:41.940,0:26:49.020
in the field of nursing science. It was[br]Jeanette Pols. Her research on Telecare
0:26:50.160,0:26:57.227
might be that what you're looking for. She[br]is - to continue the work, which was
0:26:57.227,0:27:06.518
started by Annemarie Mol, which is also[br]quite important name in this field, and I
0:27:06.518,0:27:12.732
recommend you to check this out because[br]her research, for example, is one of Janet
0:27:12.732,0:27:19.957
Pol reports. It's just, it's kind of new,[br]and in the German context of nursing
0:27:19.957,0:27:25.952
science, it is not really recognized,[br]especially not in this hermeneutical
0:27:25.952,0:27:33.910
tradition of nursing science that we refer[br]to that we also work with. But as far as I
0:27:33.910,0:27:43.835
can tell from her research, there is the[br]idea of new modes of interaction and that
0:27:43.835,0:27:50.529
the well-being, for example, of[br]oncological patients that are cared at a
0:27:50.529,0:27:57.643
distance by a telecare technology or by[br]certain interactive technologies, that
0:27:57.643,0:28:04.404
those well-being is always a question of[br]how you measure well-being. I know, and
0:28:04.404,0:28:09.780
she also knows this problem. But her first[br]research results, which are presented in
0:28:09.780,0:28:16.723
that book, are not showing anything what[br]we could - what should make us step back
0:28:16.723,0:28:24.315
from this. So it more or less affirms that[br]the well-being is like secured also by
0:28:24.315,0:28:30.508
this care at a distance. Is that an answer[br]to your question?
0:28:30.508,0:28:35.528
Audience member: Yeah, kind of. I cannot[br]ask another question, so thank you.
0:28:35.528,0:28:39.341
Herald: We'll take the question from the[br]signal angel from the internet.
0:28:39.341,0:28:44.076
Signal Angel: Hi. OK, so which parts of[br]nursing do you think will change first and
0:28:44.076,0:28:47.334
how do you think elder people will adapt[br]to that?
0:28:47.334,0:28:52.151
Herald: And would it be OK to take two[br]questions at a time, because we have three
0:28:52.151,0:28:54.958
more questions left?[br]people talking over each other
0:28:54.958,0:29:01.436
Herald: Microphone number one.[br]Audience meber: Uh, hello. Thank you for
0:29:01.436,0:29:07.677
your talk. I'm a nurse and I see the[br]problem - I think technology is very
0:29:07.677,0:29:11.995
important in nursing, but I see the[br]problem in the network between the nurses.
0:29:11.995,0:29:17.490
When you make the research of politics,[br]it's very difficult to reach the nurses to
0:29:17.490,0:29:22.776
get a voice from them. Have you ideas also[br]to find a solution for this?
0:29:22.776,0:29:26.260
Anne: Should I answer? Shall I answer[br]this? Thank you for this really, really
0:29:26.260,0:29:37.389
important question because that is kind of[br]a basic problem that we see in that field
0:29:37.389,0:29:45.720
of nursing science that is somehow even[br]kind of divided - we have nursing science
0:29:45.720,0:29:52.864
and we have nursing practice, even though[br]our association is based on both. But the
0:29:52.864,0:30:01.093
degree of organization and caring practice[br]is extremely low, which makes it really
0:30:01.093,0:30:10.007
hard to reach them - to reach out to them.[br]As you said, we can see in the Lower
0:30:10.007,0:30:18.230
Saxony, for example, a newly established[br]Pflegekammer come out, which is an
0:30:18.230,0:30:25.770
organization form which is kind of step[br]forward, but it's also like controversial
0:30:25.770,0:30:33.520
because of this centralistic structure. I[br]guess there's a lot of work to be done,
0:30:33.520,0:30:40.070
organizing work, and we can learn, for[br]example, from examples from Switzerland.
0:30:40.070,0:30:46.829
They are kind of better organized.[br]Yeah, you're right with that hint that
0:30:46.829,0:30:58.944
this should happen on the same time, this[br]question of organization to be really in
0:30:58.944,0:31:06.630
the position to have a - to take a[br]critical stance on technology and also to
0:31:06.630,0:31:12.361
develop a self-determined way in order to[br]say we want to use it like this and not
0:31:12.361,0:31:18.131
like in another way, in a, like, in a[br]formalizing way only. So it just has to be
0:31:18.131,0:31:22.729
done. Organization of care workers. Thank[br]you. Thank you.
0:31:22.729,0:31:28.055
Herald: We were basically out of time. So[br]do you have like two second replies to the
0:31:28.055,0:31:33.210
internet question as well?[br]Hanna: Yes. I think it's really difficult
0:31:33.210,0:31:40.680
to answer how part of nursing is changing[br]first. There's a lot of change going on in
0:31:40.680,0:31:48.825
doing the documentation, like on computers[br]and not on paper. And there's a lot of
0:31:48.825,0:31:55.803
change. And what else is going on will -[br]may happen on financial structures as
0:31:55.803,0:31:58.036
well.[br]Herald: Excellent. Thank you very much for
0:31:58.036,0:32:01.497
both the presentation and the questions.[br]For the two questions that weren't able to
0:32:01.497,0:32:05.399
be asked over the microphones, I'm sure[br]you can find Hannah and Anna just next to
0:32:05.399,0:32:08.053
the stage after the talk. Thank you very[br]much.
0:32:08.053,0:32:18.790
Hanna: Thank you.
0:32:18.790,0:32:22.260
postroll music
0:32:22.260,0:32:33.000
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