Report calls on nurses and patients to participate in design of AI-powered technologies in health care

Tracie Risling and Richard Booth, PhD-prepared associate professors of nursing in Saskatchewan and London, Ontario, respectively, have both done substantive research on different types of health technologies powered by artificial intelligence (AI). The two RN experts have spent the last year co-chairing an innovative project that – on Oct. 21 – brought together a collection of great minds in nursing informatics, clinical practice, administration, education, research and policy to engage in conversations about how nurses can safeguard person- and family-centred compassionate care in an age of AI. It’s a conversation that has really taken off in light of a global pandemic that experts agree has catapulted discussions of digital health technologies into the everyday conversations of people around the world and around the dinner table as they seek to find new ways to access care and support for themselves and their loved ones.

“I know the COVID fatigue is real,” Risling says, but “…on the technology side of things, the arrival of this virus did more to accelerate the advancement of digital health solutions than years of advocacy and research. The pandemic necessitated the rapid expansion of telehealth, virtual care and other solutions to connect patients and practitioners.” This acceleration now means people from all walks of life expect that the provision of care supported by AI-powered technologies is just as important as the compassionate nursing care they have always expected.

Risling and Booth each provided compelling presentations at an Oct. 21 virtual symposium co-hosted by RNAO and AMS Healthcare. The two organizations partnered a year ago to produce a report on emerging trends in AI health technologies (AIHT). The report, which was released at the symposium, explores how trends in AIHTs can potentially transform the roles and functions of nurses, and how AIHTs influence the nurse-patient relationship, specifically as it relates to compassionate care. Entitled Nursing and Compassionate Care in the Age of Artificial Intelligence, the report is an urgent call for the nursing profession to engage in shaping this emerging future. Its findings formed the basis for discussions at the virtual event.


“Canada is investing funds into this field of work (see sidebar) and as nurses we have the responsibility to lead – anchored in person-centred values, backed by evidence, and with our characteristic courage – and ask the tough questions as AIHTs are developed,” RNAO CEO Dr. Doris Grinspun said in her opening remarks at the event. “Which technologies will open access to health services instead of deepening health inequities for people, communities and society? Will these technologies enhance clinical care, and person- and family-centred compassionate care? Our partnership with AMS is only the beginning of this journey to find answers to these and other questions about the interface between AIHTs and nursing care in all its dimensions. Today, we launch the report and begin these vital conversations.” The federal government launched a $125 million Pan-Canadian AI strategy in 2017, becoming the first country in the world to announce a national strategy to advance AI research and innovation in a number of areas, including health.

“By joining this symposium, you really understand the relevance of this report,” AMS CEO Gail Paech said as the event got underway with more than 300 participants. “Offering compassionate, person- and family-centred nursing care while also using AIHTs requires strong, proactive nursing leaders at the ready, from the boardrooms of health care to the frontlines of clinical practice. Nurses must ensure that as new technologies expand and grow, compassionate care remains at the core of everyday nursing practice.”

“Really, the world is our oyster at this point,” Booth says. “If we sit on the sidelines, someone else is going to do this for us. It’s really up to us to steward what we want to see happen in the next 20 years. What this allows us to do is help evolve things that are tenets of the profession that we want to hold on to…either because they’re human or because they’re so core to nursing that if we let go, we’ll be essentially diluting the profession of the future.”

A call to act now

Nursing and Compassionate Care in the Age of Artificial Intelligence contains 15 recommendations. Among those are eight that require immediate action:

1. Create forums for open dialogue between nurses and patients to raise awareness of the patient-nursing-AIHT interface; gain patients’ and nurses’ perspectives; and foster understanding of the roles and responsibilities of nursing in shaping effective, meaningful and ethical utilization of relevant AIHTs and timely outcome evaluation.

2. Explore the impact of AI on patients, families, caregivers and nurses and their perception of the delivery of person- and family-centred compassionate care augmented by AIHTs.
3. Identify evidence-based best practices to guide ethical implementation of appropriate AIHTs across the care continuum to enhance person-centred, compassionate nursing care.
4. Identify new care delivery models, responsibilities and competencies for nurses in all roles and sectors to support the interface between nursing science, person- and family-centred compassionate care and AI.
5. Conduct a thorough review and reform of nursing curricula to ensure congruency of the nursing role with present needs and future demands of emerging AIHTs.
6. Develop a strategic plan to build capacity for basic informatics skills and data/digital literacy in the existing and future nursing workforce.
7. Implement new and revised professional codes of ethics and standards of practice that articulate nurses’ responsibilities and accountabilities in relation to the use of AIHTs.
8. Prioritize rigorous, nurse-led interprofessional research to inform policies and procedures to support the co-design, development, implementation and evaluation of AIHTs in nursing.

Read the full report, including the remaining seven recommendations HERE. According to Risling, there were two key takeaways from the October event:

“We must acknowledge that technology isn’t just coming…it’s already here,” she noted as the first. There are several applications of AI predictive analytics already being used in nursing in Canada. For example, a few hospitals are using these technologies to reduce falls and fall-related injuries by alerting nurses, via mobile devices, of patients’ fall-risk scores, enabling them to intervene proactively. “We really need to position nursing for further evolution and the application of this technology into health care,” Risling said.

The second takeaway: “We must realize that what this AI future will NOT do is change what makes us nurses. Technology, even powered by AI, is not a replacement for (nurses).”

“We at RNAO believe that nurses have a shared responsibility to assess the health, ethical and cost-benefits of AIHTs, and to effectively integrate those that are deemed beneficial to patients, communities and health-system outcomes,” says Rita Wilson, RNAO’s eHealth project manager and lead staff for this RNAO-AMS partnership. “We must proactively engage this emerging future through strong nursing leadership in education, administration, practice, policy and research. Such leadership will advance well-informed and ethical discussions and influence decisions about the effective and meaningful utilization of relevant AIHTs.”

While the technicalities of AI are complex, Risling says the drivers of it are much more familiar to nurses: “Digital health literacy, data literacy, machine learning – these key concepts are our roadmap to being informed advocates for this technology. Although all nurses may not have had the opportunity to realize it, this journey has already begun. We have a moment here where decisive and bold action will influence our direction.”

In his concurrent session about engaging nursing students in building AIHTs of the future, Booth talked about how nursing educators need to step back from their bubble and look at education strategies in light of all the different technological advancements that are happening in the world around us. In surveys with his students, he has found a real dichotomy between students knowing technology is the future, but not wanting to embrace it in such a way that it changes how and what they want to learn about nursing as a profession. This will be a real challenge for educators moving forward, he suggests. Fortunately, Booth has also found most students recognize that technology will be part of their role as nurses, but they know how important it is to have the human aspects in nursing that cannot be replaced.

Nursing and Compassionate Care in the Age of Artificial Intelligence offers 15 recommendations that aim to do two things: support efforts to prepare nurses and nursing students to leverage AIHTs to augment the patient experience while ensuring the delivery of high-quality, clinical, person-centred compassionate nursing care; and facilitate the successful interface of relevant emerging AIHTs within the nursing profession. Among these recommendations are eight (see sidebar) that serve as a call for immediate action to establish a strong foundation upon which the remaining recommendations will be built.

“When you’re thinking about your personal action moment, I’m going to say there’s a recommendation here for everyone,” Risling says. Maybe you’re interested in evidence-based best practice, you’re a policy maker, a creator of care delivery models, or you’re excited to see nursing curricula embrace the critical importance of digital health technology, she suggests. Maybe you’re a strategic planner or someone who realizes that when we get to 2030, the changes that AI and these types of technologies have brought to health care are going to need to be reflected in our professional codes of ethics and our standards of practice. Maybe you’re a researcher and you’re ready to jump in with more multi-disciplinary research really promoting co-design and development.

Whatever your interest or specialty, “…let me encourage all of us to start by stepping out of line, if for no other reasons than to improve our view of what’s coming,” Risling says. She further suggests that, in addition to the need to stay informed and on top of developments, there’s also the need to seek out information and professional development opportunities to better prepare “…for the moment we will need to speak out and advocate that others learn and engage in this area and to promote the need for further AI advances…and to clearly articulate that involving compassionate care in an AI-powered health-care system requires nursing expertise and direction.”

Learn more by watching the archived recordings of the October symposium and reading the full report.

Kimberley Kearsey is managing editor for RNAO.