 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. Speakers are Hannah Vula and Anna Kopenberger. They both work on the use and development of technology in nursing. Hannah 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 the book that just came out here in 2017, 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. Thank you, Karen, for this nice introduction. Welcome to our talk. Think big or care for yourself on the obstacles to think of emergent technologies in the field of nursing science. I'm very proud to talk here on CCC. My name is Anna Kopenberger, this is Hannah Vula. And 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'm looking at how different societal agents relate themselves 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 approach us afterwards or to check out our university web pages and get in touch with us. OK, in the following 25 minutes, we will talk about the relation of nursing science and technology in order to expose it as problematic. First, I will 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, Hannah 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 will start with the first part. I want to argue that social struggles for making care work visible are a consequential requirement of conceptualize the application of different technologies in nursing science. It's like that. We cannot take it for granted to talk about care. It is thanks to the extraordinary work of feminist political activists, artists, writers, and theorists that today we are in a situation to talk about care, 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 materialists, feminists, 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 depend on each other. These emancipatory struggles have made care work visible by denaturalizing it. 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 lacks of societal appreciation. Those circumstances come, 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, xenofeminist, collective, laboria, cubonics. 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 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 automatization of certain aspects of health care. Despite a lot of controversies around this, she says the opening to automatization is a refusal to naturalize this work. OK, back to nursing science. 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-sign discipline is probably rightly accused of being pervaded by a strongly functionalist, partly mechanic, partly cybernetic paradigm. This formal and mathematical paradigm might be seen as a reflex of background against which this young and ambitious discipline has constituted itself, at least in the German context. 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 in modes of comprehension, of a fully understanding, for example, by phenomenologically reconstructing individual meaning and collective sense structures. So in comparison, medicine or nursing, medicine prefers to explain diseases by formalized events, a formalized thinking, a linear thinking, whereas nursing scientists are supposed to comprehend being healthy or being sick by mimetic faculty, by, I say, simply and plain, by feel it. That is why nursing scientists 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 in 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 entoepistemological regimes of capitalizing, rationalizing, technologizing. They kind of attack on these 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 and always mysteriously indetermined part of the human being's existence is supposed to be a crucial counterpoint of technological formations. Oh, you put it, it's really nice, thank you. So, 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 do, we are confronted with an entity that act beyond human being's 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 the 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 worse. 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 Wienerburg-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, heuristic, sorry, the cybernetic state of nature finally describes an error 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, which those objects, those spot 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 indigenous, indigenous, sorry, 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, and I will come to the end, from exactly this point, we propose to rethink the role of technology in healthcare. In nursing science, we are challenged to enlarge our methodological horizon. New forms and modes of interactions which adjust somehow point up with those environmentalizations. So, new forms and modes in these environmentalizations, modes of interaction has to be conceptualized. We might see technologically mediated relations between a patient and a nurse which allows also for well-being as for example, Jeanette Poles has put it in her book, Care at a Distance from 2012. It would be ignorant to think that phenomena like, for instance, ubiquitous computing leaves already established relations untouched. Additionally, taking relational operations of technological artifacts and human entities, not into account, would be somehow short-sighted and also anthropocentric. The new ecological paradigm, a term that also Eric Hurl has coined, seems for us to be necessarily entered also by nursing science. And in order to conceptualize healthcare as taking place in social technological environments, not at least to find the place from where also a capital valorization of healthcare 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 Hannah to show us how contemporary ecologies of care look like. 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 Osnbrück University, I experienced that all 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 this 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 demographic 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. And 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 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 VU6M100 and a prototype on the Microsoft HoloLens. And they both have in common that they should support the nurse in 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 has been done right 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 VU6 prototype, you have to measure the length and the weight 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 apple 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 or 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 attentions, 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 a 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 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 this is like our conclusion. We identified basically two obstacles to think about emerging technology in the field of nursing science right now. One is the way to think about technology these days. This is what Anna 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 with defending 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 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 which solution you want to have. So thank you for your attention. So the microphone says you can line up to the microphone so we will take questions. There might be some questions from the internet as well. And the signal engine is nodding. We'll take questions from number four and then from the signal engine. Yeah thank you for your presentation. If I get this right you said that there's 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 new caretaking technologies been introduced into nursing on the human side? 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 is also working in the field of nursing science. It was Janet Poles. Her research on telecare might be that what you're looking for. She continues a work which was started by Anne-Marie Mol which is also a quite important name in this field. And I recommend you to check this out because her research for example is this one of Janet Poles. It's kind of new 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 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 she presented in that book are not showing anything what we could what should make us step back from this. So it's more or less affirms that the well-being is secured also by this care at a distance. Is that an answer to your question? Yeah, kind of. I cannot ask another question so thank you. We'll take the question from the signal angel from the internet. Hi, okay so which parts of nursing do you think will change first and how do you think other people will adapt to that? And would it be okay to take two questions at a time? Because we have three more questions left. So for you, all right. Microphone number one. 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 research or politics, it's very difficult to reach the nurses to get a voice from them. Have your ideas also to find a solution for this? Thank you for this really, really important question because it 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 section, for example, we newly established Flegacama which is an organization form which is kind of stepped forward but it's also 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 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 take a critical stance on technology and also to develop a self-determined way and also to say we want to use it like this and not like in the other way, in a formalizing way only. So this has to be done, organization of care workers. Thank you. We're basically out of time. So do you have like two second replies to the internet question as well? 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 may happen on financial structures as well. 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. Thank you.