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