34C3 - Think big or care for yourself

*33C3 preroll music*

Karen: Thank you all for coming. We are
about to start the next talk. Think big or

care for yourself on the obstacles to
think of emergent technologies in the

field of nursing science. Our speakers are
Hanna Wüller and Anne Koppenburger. They

both work on the use and development of
technology in nursing. Hanna is examining

which parts of nursing should be supported
by technological solutions. She does

research on augmented reality used in
nursing. Anna works on feminist science

and technological studies, as well as
critique of the political economy. She is

the editor of a book that just came out
here in 2017: The Cybernetic Capitalism

Revolution - The Emancipatory Perspective
in technological change. I hope you will

listen to their talk with great interest.
There is translations into English and

German on the website that you can find on
the site. Enjoy the talk.

*applause*

Thank you, Karen, for this nice
introduction. Welcome to our talk: Think

big or care for yourself. On the obstacles
to think of emerging technologies in the

field of nursing science. We're very proud
to talk here on CCC. My name is Anne

Koppenburger. This is Hanna Wüller. Let me
shortly say something about the

perspective that I will take in this talk.
As I did in the book that was just showed,

I will do it again to give you time, maybe
to write it down or something. I'm

interested in the understanding of
technologies, especially in the

understandings of technological change. I
am looking at how different societal

agents relate themself within this change.
And in that book, we did it with some

different agents like DIY technology
friendly initiatives, industrial players

or trade unions. Today, we want to talk
about care and the relation to technology.

And we will do this in three steps. And I
should say that it will take around 25

minutes, then we will have five minutes
left. We would be happy to get one or two

questions from the audience. But however,
for those of you who will not get the

possibility to talk to us or to contribute
something to our talk, please feel free to

reproach us afterwards or to check out our
university web pages and get in touch with

us. OK, the following 25 minutes we will
talk about the relation of nursing,

science and technology in order to expose
it as problematic. First, I would talk

about nursing science and what we actually
talk about when we say nursing science,

and I will link this to the question of
what we mean when we talk in nursing

science about technology. Afterwards,
Hanna will introduce you in a current

research project on augmented reality. She
will talk about what is going on right now

in this field of research. OK. I would
start with the first part. I want to argue

that social struggles for making care work
visible are a consequential requirement to

conceptualize the application of different
technologies and nursing science. It's

like that: You cannot take it for granted
to talk about care. It is thanks to the

extraordinary work of feminist political
activists, artist, writers and theorists

that today we are in the situation to talk
about care work as a structured and

structuring activity at all. I mean, to
talk about care apart from it as being a

labor of love. It was embedded in the new
left social movements in the 1960s and

some countries around the world that
materialist feminist were struggling to

expose care work as a notable part of
social reproduction. In these efforts, the

relation between productive labor and
reproductive labor has been exposed as

interdependent, as dependent on each
other. And this emancipatory struggles

have made care work visible by the
naturalizing as care work has been

revealed as an essential precondition of a
bourgeois society's capitalist production.

However, being visible, of course, is not
the same as being recognized and still

today care work lags of societal
appreciation. Those circumstances comes,

for example, with low wages and poor
working conditions. Who wants to learn

more about the ongoing struggle is
recommended to check out, for instance,

the work of Helen Hester. She's a member
of the technology-friendly xeno-feminist

collective Laboria Cuboniks. She's an
associate professor for media and

communication at the University of West
London, and she emphasizes on the task to

continue the discussion of making care
work visible. Visible as a part - as a

notable part - of social reproduction, she
proposes to rethink living arrangements,

living standards and the role of domestic
technology. Therefore, she opens up a

discussion on automatisation of certain
aspects of health care. Despite a lot of

controversies around this, she says the
opening to automatisation is a refusal to

naturalize this work. OK, back to nursing
science. Yeah, we can see how these

social, political, economic movements that
I just have mentioned, those emancipatory

struggles, they obviously affect the
theoretical horizon of nursing science,

which in turn influences the
conceptualization of technology and care

work settings. Speaking for a German
context of nursing science, contemporary

nursing scientists, they are still
overwhelmingly busy with the

professionalization of health care. They
are partly still engaged in establishing

nursing science as a scientific discipline
that describes and develops reasonable

caring practice on the basis of
independent nursing research.

Distinguishing nursing science as
independent from medicine is seen as a

cornerstone in these struggles. Medicine
as a life science discipline is probably

rightly accused of being pervaded by
strongly functionalist, partly mechanic,

partly cybernetic paradigm. This formal
and mathematical paradigm might be seen as

a reflexive background against which this
young and ambitious discipline has

constituted itself, at least in the German
context. Oh, sorry. By drawing on critical

theories, nursing scientists rejected a
purely medical approach to bodily

processes, which often those medical
approaches, they often comes in

explanatory modes of, for example,
quantifying rationalizing technologizing.

Nursing practice, in contrast, is supposed
to approach human beings' experiences of

health and sickness and modes of
comprehension of a fully understanding,

for example, by phenomenologically
reconstructing individual meaning and

collective sense structures. So in
comparison, medicine and nursing, medicine

prefers to explain diseases by formalize
events, a formalized thinking, a linear

thinking. Whereas nursing science is
supposed to comprehend being healthy or

being sick by mimetic faculty, by, I say,
simply and playing, by feel it. That is

why nursing sciences draw on highly
controversial constructs like intuition or

implicit knowledge. Here, we still witness
the movement of making visible what was

made invisible before socially,
politically, theoretically. Exactly at

this point, we find a particular strong
rejection of different technologies and

care work by nursing scientists. Since
technology, especially information

technology, are conceived as means of
explanation, these technologies are

identified with the formalistic paradigm
that supposedly cannot comprehend the

implicit part of human beings' experience.
Here, the different struggles that I have

mentioned meet each other. They both are
targeting at onto-epistemological regimes

of capitalizing, rationalizing
technologizing. They kind of attack on

this processes just in order, which is an
important work also to include the

excluded, to qualify the quantified, and
also to de-technologize the technologized.

So just to sum up this first part, it is
important to keep in mind that both the

histories of feminists efforts to make
care work visible and the academic

struggle of establishing nursing science
as a scientific discipline, they are both

interlinked. They go parallel in their
ambition to emancipate themselves from

formalizing, thinking and acting. They
also share basic parts of their

theoretical foundation. As a result, an
always mysteriously indetermined part of

the human being's existence is supposed to
be a crucial counterpoint of technological

formations.
*mumbles*

But the question, of course, is what are

those or these technological formations
and how to situate nursing practices

within them. So for this, let me tell you
what technology means when we as a nursing

science talk about it. So technology -
What do we talk about it? I already said

that the human being is depicted in
different critical theories as the

counterpart of technology. It is this
image, actually, what right now seems to

be increasingly challenged. For example,
when we think of technological operations

on micro-temporal levels as sensor
technologies too, we are confronted with

an entity that act beyond human beings'
sensational perception. When we first

think of technology's power to control us,
meaning the regulating sense of control,

then we cannot but conclude that it's not
just a human being's action that makes

sense to us. The existence and operations
of contemporary smart objects are

increasingly unraveling the image of the
human as an exceptional sense maker. This

is the technological condition that for
some decades now challenges particularly

the humanities to come to grasp with. And
it was Erich Hörl who described this

ongoing basically technologically
influenced displacement of sense as a

representational sense. He - Erich Hörl -
is a professor of media philosophy at

Lüneburg Leuphana university in Germany.
He has claimed that after an organic and

after a mechanical state of nature, we
were entering a cybernetic state of nature

by the end of the 18th century. As a
heuristic, the cybernetic state of nature

finally describes an era where objects in
different disciplines - academic

disciplines - and theories are
increasingly exposed as active,

intelligent and communicating. A growing
object-orientation proves the

environmentalization of agency, as well as
even environmentalized ways of being. As a

reminder, I should shortly say that
against this - this environmentalization

of agency with those objects in our
environment are just an example of this

environmentalization - against this
background, the hermeneutic tradition of

critical theories that I mentioned - for
them, objects are merely conceived as

means which the human subject
intentionally uses to transform its

reality. That means in those critical
theories, human beings' tool use is

conceptualized as a mean that serves
certain ends. Of course, only the humans

set up those ends. Tools are used in order
to supplement and to cope with the

indigence and neediness of human beings.
It is in this way that technological

artifacts are always conceived as the
other side, the outside of the human. So,

and exactly from this point - I will come
to my end, to the end - and from exactly

this point, we propose to rethink the role
of technology in health care and nursing

science via a challenge to enlarge our
methodological horizon, new forms and

modes of interactions, which I just
somehow point up as those

environmentalizations, so new forms and
modes and this environmentalizations,

modes of interaction has to be
conceptualized. We might see

technologically mediated relations between
a patient and a nurse, which allows also

for wellbeing, as, for example, Jeannette
Pols has put it in her book Care at a

Distance from 2012. It would be ignorant
to think that phenomenons like, for

instance, ubiquitous computing leave
already established relations untouched.

Additionally, taking relational operations
of technological artifacts and human

entities not into account would be somehow
shortsighted and also anthropocentric. The

new ecological paradigm, a term that also
Erich Hörl has coined, seems for us to be

necessarily entered also by nudging
science in order to conceptualize health

care as taking place in social
technological environments, not at least

to find a place from where also a capital
valuarization of health care and

everything might be rejected, a place
where technological systems might be

conversed and used in an emancipatory and
self-determined way. So here I'd like to

finish and ask Hanna to show us how
contemporary ecologies of care would look

like.
Hanna: Now we get to the second part of

the presentation, which is quite different
from the first one because the first one

was how we could think about technology
and what's going on in nursing science.

And when I came to Osnabrück University, I
experienced that - oh, technology, you

should be careful. And before this, I
studied business computer science, and I

was just not used to the thinking. So it
strikes me a lot. And now I'm working in a

research project where these both sides
are struggling all the time. So it's like,

be careful and try to think about how to
conceptualize technology and how this can

change nursing and the daily work of
nurses, and at the same time, it's like

you have this research project and you
have kind of the goal of creating

prototypes and evaluating them, and doing
practical research, empirical research,

and bringing the technology into the
practice and look how it's going to work.

So kind of the argumentation to do this is
the demographical change. People claim

that this change - people are getting
older and there will be not enough carers

- that could be solved by a technological
solution. Just yesterday, in the talk

about China's social credit system, we
also heard just technological solutions

for social problems that may be not the
best solution, not the best way to do it.

But we still do take a look at how could
augmented reality in nursing look like. An

augmented reality, I think the most of you
may know, it's like displaying virtual

objects into the reality - this is one of
the marketing pictures. They promise you a

lot of things are possible and augmented
reality can be really useful in a lot of

fields, you can community communicate with
your colleague, you are in a different

room and still work on the same virtual
artifacts. But we have the question - what

can be into that for nursing? So we took
some workshops with nurses and nursing

managers, and we came up with a lot of use
cases and currently we are examining two

prototypes. One is on wound care
management. We have this with different

devices as well. We are trying -
evaluating a prototype on the Vuzix M100

and a prototype on the Microsoft HoloLens.
And they both have in common that they

should support the nurse and doing the
documentation for the wound. So the nurse

can do the documentation while caring for
the patient. That means the interaction

between the nurse and the patient may
change here, but it could be possible to

save some time. And it also could enhance
the quality of the documentation because

the documentation is being done by the
time the nurse is there and has to see the

wound. This is what both prototypes have
in common. The HoloLens prototype allows

to support the measuring of the wound as
well. With the Vuzix prototype, you have

to measure the length and the width of the
wound on your own, and then you can use

voice commands to put it into the
documentation. With the HoloLens

prototype, this is what you see right here
when you look through the glass, you get

this image and you can make a point on the
edge of the wound and a point on the upper

side edge, and the measurement is done
automatically. So the number you see is

the measured number, and the blue dots are
the edges of the wound. Actually, this

prototype cannot detect the edges of the
wound automatically, but this could be

under further consideration. And the
second prototype we are actually

evaluating is on drug management. So I
will show you a short video (if it's going

to work). Yeah,here you can see 10
dispensers, so dispensers for medication

for 10 patients at the same time. It's
like for morning, midday, noon and

evening, or evening and night, I'm sorry.
And you can put the pill into the right

box by the app showing you how to do it.
If you can see here on the smartphone, the

app shows you how many pills you have to
put into one box and you have to scan the

medication first, and if you scan the
wrong one, you get this sign that it's the

wrong one. So you have some way of error
prevention integrated as well. For this

prototype, you could also think of a lot
of attention, like it could get the

information which medication has to be
taken automatically, or it could detect if

the pill is taken into the right box. But
this is actually not what we have right

now. Yeah. So it looks a bit less fancy
than the picture from the advertisements,

but maybe it can save nurses some time and
maybe it can do some error correctness.

And for these prototypes and some more
which are currently evaluated by other

researchers or which have been evaluated,
there are still a lot of challenges like

technical challenges and the challenge how
to deal with the small display size and

short battery life, for sure. And it can
be easy to focus in these details and

forget the big picture, forget what - how
can we think technology? How can we think

the interaction of the technology and the
humans? And what will this do with us? So

this is part of what the research funding
policy could lead us to do. I still think

it's very interesting and maybe there will
be some good things to do with this

technology, and this technology can enable
us to change the structure of care work.

But it cannot be. We shouldn't forget
everything else. So that's like our

conclusion. We identified basically two
obstacles to think about emergent

technology in the field of nursing science
right now. One is the way to think about

technology these days. This is what Hanna
explained. We had to struggle in nursing

science to establish this discipline, and
there had to be good arguments and the

struggle is still going on. So a lot of
nursing science are still busy defending

with nursing from medicine. And sometimes
this is kind of projected on defending

nursing from technology because technology
is also perceived to be naturalistic,

binary, and doesn't feel the differences
in the touch or doesn't get all the small

things. And yeah, the second thing is the
research funding policy, which should lead

you to develop technological solutions,
but in the best, you know, the solution

before you really had the question,
because this is how you try to - how you

argument that you need some money to do
something for this, you know, you know,

which solution you want to have. So thank
you for your attention.

*applause*

Herald: We have about 5 Minutes for Q&As,
so there are microphones *unintelligible*

microphones, we'll take some questions
from listeners as well, *unintelligible*

and the signal angel is 'Naughty'. We'll
take questions from microphone number 4

and then the signal angel.
Audience member: Thank you for your

presentation. If I get this right, you
said that there is a big research gap of

how new technologies influence the
relationships between caretakers and the

persons who are being taken care of, who
need help. And is there some research

going on about this? Like what effects
have you - caretaking technology

introduced into nursing, yeah, on the
human side?

Anne: Should I answer to this? Yeah, I
will answer to this question. Thank you

for this. I mentioned in the last part a
Dutch anthropologist who was also working

in the field of nursing science. It was
Jeanette Pols. Her research on Telecare

might be that what you're looking for. She
is - to continue the work, which was

started by Annemarie Mol, which is also
quite important name in this field, and I

recommend you to check this out because
her research, for example, is one of Janet

Pol reports. It's just, it's kind of new,
and in the German context of nursing

science, it is not really recognized,
especially not in this hermeneutical

tradition of nursing science that we refer
to that we also work with. But as far as I

can tell from her research, there is the
idea of new modes of interaction and that

the well-being, for example, of
oncological patients that are cared at a

distance by a telecare technology or by
certain interactive technologies, that

those well-being is always a question of
how you measure well-being. I know, and

she also knows this problem. But her first
research results, which are presented in

that book, are not showing anything what
we could - what should make us step back

from this. So it more or less affirms that
the well-being is like secured also by

this care at a distance. Is that an answer
to your question?

Audience member: Yeah, kind of. I cannot
ask another question, so thank you.

Herald: We'll take the question from the
signal angel from the internet.

Signal Angel: Hi. OK, so which parts of
nursing do you think will change first and

how do you think elder people will adapt
to that?

Herald: And would it be OK to take two
questions at a time, because we have three

more questions left?
*people talking over each other*

Herald: Microphone number one.
Audience meber: Uh, hello. Thank you for

your talk. I'm a nurse and I see the
problem - I think technology is very

important in nursing, but I see the
problem in the network between the nurses.

When you make the research of politics,
it's very difficult to reach the nurses to

get a voice from them. Have you ideas also
to find a solution for this?

Anne: Should I answer? Shall I answer
this? Thank you for this really, really

important question because that is kind of
a basic problem that we see in that field

of nursing science that is somehow even
kind of divided - we have nursing science

and we have nursing practice, even though
our association is based on both. But the

degree of organization and caring practice
is extremely low, which makes it really

hard to reach them - to reach out to them.
As you said, we can see in the Lower

Saxony, for example, a newly established
Pflegekammer come out, which is an

organization form which is kind of step
forward, but it's also like controversial

because of this centralistic structure. I
guess there's a lot of work to be done,

organizing work, and we can learn, for
example, from examples from Switzerland.

They are kind of better organized.
Yeah, you're right with that hint that

this should happen on the same time, this
question of organization to be really in

the position to have a - to take a
critical stance on technology and also to

develop a self-determined way in order to
say we want to use it like this and not

like in another way, in a, like, in a
formalizing way only. So it just has to be

done. Organization of care workers. Thank
you. Thank you.

Herald: We were basically out of time. So
do you have like two second replies to the

internet question as well?
Hanna: Yes. I think it's really difficult

to answer how part of nursing is changing
first. There's a lot of change going on in

doing the documentation, like on computers
and not on paper. And there's a lot of

change. And what else is going on will -
may happen on financial structures as

well.
Herald: Excellent. Thank you very much for

both the presentation and the questions.
For the two questions that weren't able to

be asked over the microphones, I'm sure
you can find Hannah and Anna just next to

the stage after the talk. Thank you very
much.

Hanna: Thank you.

*postroll music*