Technological advancements have led to the use of robots as prospective partners to complement understaffing and deliver effective care to patients. This article discusses relevant concepts on robots from the perspective of nursing theories and robotics in nursing and examines the distinctions between human beings and healthcare robots as partners and robot development examples and challenges. Robotics in nursing is an interdisciplinary discipline that studies methodologies, technologies, and ethics for developing robots that support and collaborate with physicians, nurses, and other healthcare workers in practice. Robotics in nursing is geared toward learning the knowledge of robots for better nursing care, and for this purpose, it is also to propose the necessary robots and develop them in collaboration with engineers. Two points were highlighted regarding the use of robots in health care practice: issues of replacing humans because of human resource understaffing and concerns about robot capabilities to engage in nursing practice grounded in caring science. This article stresses that technology and artificial intelligence are useful and practical for patients. However, further research is required that considers what robotics in nursing means and the use of robotics in nursing.

Japan's declining birth rate and increasing aging population prompted intercessory efforts towards robot technologies in nursing practice for theelderly. Today, technological companies are developing robots that meet universal health care technology demands. While human caring focus on human-to-human relationships,but between humans and nonhumans, e.g. Humanoid Nursing Robot (HNRs)-to-human relationships, caring practices have not been forthcoming. When HNRs can support patients independently, capabilities much like being human will be required, including intelligence and skill competencies. Currently, Tanioka's research group is conducting clinical trials of humanoid robots equipped with applications using Pepper (manufactured by SOFTBANK CORPORATION), towards elderly care and rehabilitation at the Mifune Hospital, Kagawa prefecture. Care Prevention Gymnastics Exercises (Pepper-CPGE) was madeby Xing Company, Japan. Therefore, this paper aims to describe the clinical trial outcomes based on the Transactive Relationship Theory of Nursing (TRETON) (Tanioka, 2017) emphasizing nursing engagement processes between HNRs and human persons. Observable effects include positive changes in relationships of patients, humanoid robots and healthcare providers. Emphasizing ethical concerns and human person safety as critical factors of care, and fears for divergent robot use are observed. Cooperative undertakings with various interdisciplinary activities mark the visioning of Japanese human caring ideas for an aging society. J. Med. Invest. 66 : 19-23, February, 2019

Background: Precise nursing actions assure quality human health care. However, such actions are often identified as low-level health care work thereby delegated as tasks that only need completion. With the Japanese elderly population increasing at a phenomenal rate, these types of nursing actions are critically demanded. As a health care practice problem leading to labor shortages in health care settings specifically among nurses and direct health caregivers, Japan has made a national commitment focused on developing healthcare robots to respond to the nursing care demands of the older adult population. Transactive relationships are necessary in human and robot nurse-patient interactions. How will human persons and humanoid nursing robots (HNRs) relate with each other? Research on robots assisting patient care is needed to reduce human-dependent activities thereby sanctioning human nurses’ focus on direct human caring relationships. Aim: The purpose of this paper is to describe the development of the Transactive Relationship Theory of Nursing (TRETON) for nursing engagements between HNRs and human persons. Methods: Theory development and Systematic Review of Literature focused on the phenomenon of healthcare engagements, humanoid robots, and nursing practice. Specifically, the metaparadigms of Nursing provided the procedural theoretical structures. Results/Findings: The TRETON is the product of theory development. Nursing encounters between humanoid nursing robots and human persons in transactive interactions were described within the metaparadigms of person, nursing, environment, and health. Conclusion: The TRETON is a middle-range theory of nursing guiding nursing practice focused on the relationship between human persons and humanoid nursing robots. It endorses two critical nursing questions, i.e., if the nature of HNRs is to assume human caring practices to promote human health and well-being, will this nature matter to nursing care of human persons? What will engender the nature of the transaction between human persons and HNRs in 21st century ontology of nursing?

Although progress is being made in affective computing, issues remain in enabling the effective expression of compassionate communication by healthcare robots. Identifying, describing and reconciling these concerns are important in order to provide quality contemporary healthcare for older adults with dementia. The purpose of this case study was to explore the development issues of healthcare robots in expressing compassionate communication for older adults with dementia. An exploratory descriptive case study was conducted with the Pepper robot and older adults with dementia using high-tech digital cameras to document significant communication proceedings that occurred during the activities. Data were collected in December 2020. The application program for an intentional conversation using Pepper was jointly developed by Tanioka’s team and the Xing Company, allowing Pepper’s words and head movements to be remotely controlled. The analysis of the results revealed four development issues, namely, (1) accurate sensing behavior for “listening” to voices appropriately and accurately interacting with subjects; (2) inefficiency in “listening” and “gaze” activities; (3) fidelity of behavioral responses; and (4) deficiency in natural language processing AI development, i.e., the ability to respond actively to situations that were not pre-programmed by the developer. Conversational engagements between the Pepper robot and patients with dementia illustrated a practical usage of technologies with artificial intelligence and natural language processing. The development issues found in this study require reconciliation in order to enhance the potential for healthcare robot engagement in compassionate communication in the care of older adults with dementia.