Designing Nursing Robots with Empathy:
A User-Centered,
Qualitative Research Approach
Takeo Ainoya
Graduate School of Design
Tokyo University of Technology
Kamata Tokyoainoyatk@stf.teu.ac.jp

Keiko Kasamatsu
Graduate School of Systems
Department of Industrial Art
Tokyo Metropolitan University
hino tokyo
kasamatu@tmu.ac.jp

Fuko Oura
Graduate School of Systems
Department of Industrial Art
Tokyo Metropolitan University
hino tokyo
fu.a7te@gmail.com

Kiyoshi Naemura
School of Health Sciences
Tokyo University of Technology
Kamata Tokyo
nae@stf.teu.ac.jp

Yumiko Miyakubi
School of Health Sciences
Tokyo University of Technology
Kamata Tokyo
miyakubiy@stf.teu.ac.jp

Shino Suefusa
Graduate School of Design
Tokyo University of Technology
Kamata Tokyo
suefusa@stf.teu.ac.jp

Abstract—Pediatric intravenous (IV) self-removal is acommon and disruptive problem that can lead to treatment
delays and increased workload for nurses. To inform the designof empathetic nursing robots and lay the foundation for acreativity generation system, this qualitative study explorednurses' experiences with pediatric IV self-removal. Semistructured interviews were conducted with five pediatric nurses
and analyzed using the Modified Grounded Theory Approach.
Key findings included factors contributing to IV self-removal,
nurses' coping strategies and challenges, and differences
between medical and nursing approaches. User experience (UX)
and customer journey mapping visualized the patient
experience and opportunities for robot interventions. Building
on prior research in design thinking and collaborative
creativity, this study highlights the value of a patient-centered,empathy-driven approach and proposes strategies for
integrating user insights and fostering interdisciplinary
creativity in developing nursing robots. The results provide aframework for advancing nursing robotics through usercentered design and promoting more holistic, innovative
solutions to complex healthcare challenges.
Keywords — design thinking, co-creation, team creativity,
UX-based workshop, prototyping

I. INTRODUCTION
Pediatric IV self-removal is a prevalent and challenging
problem in hospital care, leading to treatment interruptions,increased risk of complications, and added workload fornurses. As nursing robots are increasingly explored as
potential solutions to support nursing care, it is crucial tounderstand the unique needs and experiences of pediatricpatients and nurses in this context. However, current nursing
robot development often faces challenges in effectively
incorporating user perspectives and fostering creative, patientcentered solutions.[1][2]The authors have previously conducted research on cognitive
sharing and creative ideation in product development projects.
The "KADEN Project" (Kasamatsu & Ainoya, 2015) [3][4]employed a design process that emphasized the use of image
sketches and collages to share mental models and foster

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creativity among design and engineering students. Anotherstudy (Ainoya, 2014) [5] proposed a hierarchical model ofconcept for creative conflict resolution in manufacturing,highlighting the importance of understanding and sharing the
cognitive characteristics of individual team members. Thesestudies suggest that visualizing ideas through sketches basedon imagination and mental imagery can facilitate effective
communicationandcreativeproblem-solvinginmultidisciplinary teams.
Building upon these insights, the current study aims toaddress the challenges of pediatric IV self-removal by
conducting a qualitative investigation of nurses' experiences
and perspectives and applying the principles of cognitive
sharing and creative ideation to the design of empathetic
nursing robots. Additionally, this research introduces thenovel approach of UX mapping to capture and integrate user
perspectives throughout the design process. By combining
these strategies, we seek to contribute new knowledge andmethodologies for fostering innovation and collaboration in
the development of user-centered healthcare technologies.
The main objectives of this study are:
1. To explore pediatric nurses' experiences, challenges,
and coping strategies related to IV self-removal incidents.
2. To identify key factors contributing to IV self-removaland opportunities for nursing robot interventions through UX
mapping and customer journey mapping.
3. To examine the differences between medical andnursing approaches to IV management and highlight theimportance of an empathy-driven, patient-centered approachin nursing robot design.
4. To lay the foundation for a creativity generation andsharing system that integrates user insights, interdisciplinary
collaboration, and creative ideation techniques to foster
innovation in nursing robotics.

II. BACKGROUND
Pediatric IV self-removal and its impact

Intravenous (IV) therapy is a common and essential part ofpediatric medical care. However, the self-removal of IV lines
by pediatric patients is a frequent and significant problem inclinical settings. This not only disrupts the treatment process
but also poses risks such as bleeding, infection, and damage toblood vessels. Moreover, it increases the workload of nurses
who need to re-insert the IV lines and closely monitor thepatients.
Current state and challenges in nursing robot development
Robotics technology has been increasingly explored as apotential solution to various challenges in nursing care,including reducing nurses' physical burden, enhancing
efficiency, and improving patient outcomes. However, thedevelopment of nursing robots faces several obstacles. One
major challenge is the lack of effective communication andshared understanding among the diverse stakeholders
involved, such as nurses, patients, engineers, and designers.
This often results in a mismatch between the developed robots
and the actual needs and preferences of end-users.

Prior research on creativity generation and sharing systems.
To address the challenges mentioned above, there has been
growing interest in the development of creativity generationand sharing systems in various fields, including healthcare.
These systems aim to facilitate the creative process byproviding tools and platforms for ideation, collaboration, andknowledge sharing among diverse participants. In the context
of nursing robot development, such systems could potentiallyenable nurses, patients, and other stakeholders to actively
contribute their insights and ideas, leading to more usercentered and innovative solutions. However, research on theapplication of creativity generation and sharing systems innursing robotics is still limited, highlighting the need forfurther exploration.
III. METHODS（FIG.1）
Nursing Staff Interviews
We conducted semi-structured interviews with pediatricnurses to gain insights into their experiences and challenges inmanaging IV therapy for children, particularly focusing on theissue of IV self-removal.
Participant Selection and Sample Size:
Participants were recruited based on the following criteria:- Registered nurses with current or recent experience working
in pediatric wards

The interviews were conducted by a main interviewer, with
two observers present. Each interview lasted approximately
30 minutes and was conducted either face-to-face (for 2
participants) or online via Zoom (for 3 participants). Theinterviews were recorded using a voice recorder and video
camera (for face-to-face interviews) or Zoom's recording
function (for online interviews).
The semi-structured interview guide included the following
key questions:
1. Challenges and difficulties faced in managing IV therapy
for pediatric patients
2. Successful strategies or techniques used in managing IV
therapy for pediatric patients
3. Communication approaches used when explaining andsetting up IV therapy for children
4. Children's reactions and responses to IV therapy
5. Experiences with children who could tolerate IV therapy
6. Experiences with children who could not tolerate IV
therapy
Qualitative Data Analysis using M-GTA
The interview data was analyzed using the Modified
Grounded Theory Approach (M-GTA), a qualitative data
analysis method that aims to generate a substantive theory
grounded in the data.
Transcription and Coding:
The recorded interviews were transcribed verbatim andimported into the qualitative data analysis software
MAXQDA. The data was then coded by the researchers,
focusing on identifying the situations and experiences
described by the participants in relation to the three mainstakeholders (nurses, patients, and doctors) and the timeline of
IV management tasks. ( Error! Reference source notfound.).
Constant Comparative Analysis and Category Generation:
Through a process of constant comparative analysis, the coded
data was organized into categories and subcategories. This
involved comparing the coded data, identifying patterns andrelationships, and refining the categories until a coherent andcomprehensive understanding of the phenomenon wasachieved.

- Experience in managing IV therapy for pediatric patients- Willingness to share their experiences and insights
A total of five nurses were interviewed, which was determined
to be sufficient for reaching theoretical saturation.
Semi-structured Interview Process:Fig.1 Conceptual diagram of the study

IV. RESULTS
Key Findings from Nursing Staff Interviews
Factors and Impacts of Pediatric IV Self-Removal:
The interviews revealed that children's developmental level
and individual characteristics significantly influence theirunderstanding of and response to IV therapy, which in turnaffects nurses' approach to managing IV self-removal.
Several common factors were identified:- If children understand what an IV is, they are less likely todeliberately remove it or show resistance- When children are aware of the IV but still attempt to remove
it or show concern, there may be some underlying issues with
the IV that require nursing intervention- Some children may touch or attempt to remove the IV out of
curiosity or discomfort, even if they understand its purpose- When children lack understanding of the IV's meaning, they
may touch or attempt to remove it due to curiosity, discomfort,or pain- Children who don't understand the IV's purpose may also
have emotional reactions and attempt to remove it, in whichcase mild restraints may need to be consideredwhen determining the appropriate intervention. Thissignificantly expands the scope of the assessment domain.
Nurses' choice of intervention is heavily influenced by theirprevious experiences. There is a growing need to explore ways
to convert these experiences into shareable knowledge.
Application of Previous Research Insights:
The findings of this study align with the principles ofcognitive sharing and creative ideation explored in the authors'previous research (Kasamatsu & Ainoya, 2015; Ainoya,2014). The use of UX mapping and customer journey mapping
to visualize and share user experiences and perspectives
reflects the importance of creating a shared understanding
among team members with diverse expertise[6]. The richqualitative data gathered from nurse interviews serves as avaluable resource for stimulating imagination and creative
problem-solving, similar to the role of image sketches andcollages in the "KADEN Project."
Furthermore, the emphasis on understanding the cognitive
characteristics and concerns of different stakeholders(patients, nurses, doctors) in the IV self-removal context
mirrors the hierarchical model of concept proposed by Ainoya(2014). By recognizing and integrating these diverse
perspectives, the current study lays the groundwork for more
effective collaboration and creative conflict resolution in thedevelopment of nursing robots. (fig.３)(fig.2)

Fig 3. Stakeholders and their respective UX in nursing

V. DISCUSSION
Implications for Nursing Robot DesignFig 2. Patient UX from interviews with nursing staff

Essential Functions and Characteristics of Nursing Robots
Derived from IV Self-Removal Cases:

Nurses' Coping Strategies and Challenges:- Need for real-time monitoring and early detection of patient
discomfort or distress

Nurses' interventions for managing IV self-removal are
typically directed by physicians' orders. However, if
physicians were more aware of patients' characteristics,
cognition, and reactions, they could select interventions that
better account for these factors. Currently, interventions areoften chosen based on the medical objective and available
hospital supplies, making it difficult for nurses to contributeto the selection process.
In addition to the child's medical condition, nurses must also
consider the child's developmental level and conscious state- Importance of providing timely and appropriate
interventions to prevent self-removal attempts- Potential for robots to offer personalized distraction andcomfort measures based on individual patient preferences andcharacteristics- Necessity of clear and age-appropriate communication
capabilities to educate and reassure patients about IV therapy

Importance of Empathetic Robot Design
and Specific Strategies:- Acknowledging the small sample size and limited diversityof participants, which may affect the generalizability offindings- Incorporating features that convey empathy, such as softand comforting voice tones, gentle movements, and soothingvisual displays- Recognizing the focus on a specific patient population andcare setting, which may limit the applicability of insights toother contexts- Designing robots with a friendly and non-threatening
appearance to reduce patient anxiety and promote trust- Discussing potential biases or limitations associated with
the qualitative research methods employed, such as theinfluence of researcher subjectivity- Enabling robots to recognize and respond appropriately topatient emotions through advanced sensing and AI
technologies- Involving nurses, patients, and families in the design
process to ensure that robots align with their needs andpreferences
Foundation for Building a Creativity Generationand Sharing System

Importance of Diverse Perspectives and Insights Gained
from Interview Results:- Highlighting the value of incorporating multiple
viewpoints, including those of nurses, patients, and families,in the development of nursing robots- Emphasizing the need for a holistic understanding of thepatient experience, beyond just the technical aspects of IV
management- Recognizing the potential for qualitative research to
uncover unique insights and drive innovative robot design
Potential for Creativity Generation through Collaboration
among Nurses, Engineers, and Designers:- Discussing the benefits of interdisciplinary collaboration in
fostering creative solutions to complex healthcare challenges- Proposing a framework for facilitating effective
communication and knowledge sharing among team memberswith diverse backgrounds- Investigate projects to develop nursing robots using
interdisciplinary collaboration.

Future Research Plans:- Proposing future studies that build upon the current findings
and address the identified limitations, such as conducting
larger-scale and more diverse investigations- Exploring opportunities to apply the research methodology
and insights to other nursing care scenarios beyond IV
management- Outlining plans for the development and testing of acreativity generation and sharing system based on the lessons
learned from this study
Contribution to Nursing Robotics Research:
This study makes several notable contributions to the fieldof nursing robotics research. First, it provides a detailed
qualitative exploration of the challenges and opportunities
surrounding pediatric IV self-removal, an area that hasreceived limited attention in the context of nursing robot
development. Second, it introduces the application of UX
mapping and customer journey mapping techniques to thedesign of nursing robots, demonstrating how these tools canhelp to capture and integrate user perspectives throughout thedesign process. Third, by building upon previous research on
cognitive sharing and creative ideation in productdevelopment, this study offers new insights and strategies forfostering interdisciplinary collaboration and innovation innursing robot design. The proposed methodology, which
combines user-centered design principles, creative ideation
techniques, and cognitive sharing strategies, represents a
novel and promising approach to addressing the complex
challenges of developing empathetic and effective nursing
robots. （fig.4）

Plans for Future Ideation Workshops:- Outlining the objectives and expected outcomes of the
proposed workshops, such as generating novel robot designconcepts and identifying key research priorities- Describing the planned participants, format, and activitiesof the workshops, with a focus on promoting creativity andcollaboration- Plan workshop participants, formats, and activities with afocus on promoting creativity and collaboration
Fig 4. The potential of empathic caregiving robots throughpsychological care
Limitations and Future Directions
Limitations of the Current Study:

Finally, by emphasizing the importance of a patientcentered, empathy-driven approach and highlighting thedifferences between medical and nursing perspectives, thisstudy contributes to a broader shift in nursing robotics
research towards more holistic, user-centered solutions. The
findings and methodological framework presented here caninform future research and development efforts aimed atcreating nursing robots that truly meet the needs andpreferences of patients and healthcare providers.

VI. CONCLUSION
Summary of Main Findings and Contributions:This study provides valuable insights into the challenges andopportunities associated with pediatric IV self-removal, as
well as the potential for nursing robots to address this issue.
Through qualitative interviews with experienced nurses andthe development of a comprehensive UX map and customer
journey map, we have identified key factors contributing to IV
self-removal, the impact of this problem on patients andhealthcare providers, and the essential functions andcharacteristics that nursing robots should possess toeffectively prevent and manage these incidents.
Moreover, our research highlights the importance of
empathetic design in nursing robotics and proposes specificstrategies for incorporating empathy-driven features andinteraction modalities. By adopting a user-centered approach,grounded in the real-world experiences and perspectives ofnurses and patients, we have laid the foundation fordeveloping nursing robots that are not only functionallyeffective but also emotionally attuned to the needs of theirusers.
Importance of Patient-Centered Approach and Creativity in
Nursing Robot Development:
A central theme emerging from this study is the critical roleof patient-centered design in the development of successful
nursing robots. By leveraging UX mapping and customer
journey mapping techniques, we have demonstrated how thesetools can help to capture the rich and nuanced aspects of thepatient experience and translate these insights into actionable
design requirements and innovation opportunities.
Furthermore, our findings underscore the significance of
creativity and interdisciplinary collaboration in the nursing
robot development process. By bringing together the diverse
perspectives and expertise of nurses, engineers, designers, andother stakeholders, we can foster a more holistic andinnovative approach to problem-solving and generate novel
solutions that transcend the limitations of traditional,
technology-driven design paradigms.

Future Directions for Research on Creativity Generation andSharing System:
Building upon the insights and methodologies developed inthis study, we propose several directions for future research
aimed at promoting creativity and knowledge sharing in
nursing robot design. These include:
1.Conducting larger-scale, multi-site studies to validate andextend the findings of the current investigation, and to explore
the generalizability of the UX mapping and customer journey
mapping approaches to other healthcare contexts and user
populations.
2. Developing and testing a formalized creativity generationand sharing system that integrates the principles andtechniques of user-centered design, interdisciplinary
collaboration, and participatory innovation. This system could
include tools, platforms, and processes for capturing andanalyzing user insights, facilitating creative ideation, andsupporting the co-creation of nursing robot solutions.
3. Evaluating the impact of the creativity generation andsharing system on the quality, acceptability, and effectivenessof nursing robot designs, as well as on the satisfaction andwell-being of patients, nurses, and other healthcare
stakeholders.
By pursuing these research directions, we can continue toadvance the field of nursing robotics and contribute to thedevelopment of more user-centered, empathetic, andinnovative technologies that enhance the quality and safety ofpatient care.
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