The Impact of a Robotic Cat on Dementia Caregivers’ PsychosocialWork Environment – a Pilot Study

Marcus Persson, PhD, Mälardalen University, School of health, care, and social welfare

Sick leaves and mental illness among caregivers in Sweden

● Between 1999 and 2014, the long term sick-leaves for mental illness increased from 18% to the record note of 35% in Sweden. The most common mental diseases in connection to work life are stress reactions and anxiety disorders as well as depression.

● Studies show that both men and women working in professions with close contact with help-receivers in different types of welfare services have a significantly higher risk of being on sick leave for mental illness*

● Personnel working in dementia care are particularly exposed to work related problems due to high work load, understaffing, and high risks of threats and violence at work

2*Försäkringskassan 2014. Sick leaves and mental illness. A study about Swedens’ popularion 16-64 years. Social insurance report 2014:4; *Swedish Work Environment Authority. Work-related disorders 2014.

Aim of the study

● Can a social robot be used to promote the caregivers’ health and well-being by being a helpful tool in their work with the patients? ● This study explores Justocats’ potential impact on psychosocial work environment aspects*, such as: ● Work load● Working alone● Working with people (social relations) ● Risks of threats and violence, and conflicts

3*AFA Försäkring (2013) Allvarliga arbetsskador och långvarig sjukfrånvaro. www.afaforsakring.se

About the study

● The study followed three individual caregivers from the dementia care center Attendo Eskilshem for three months. The caregivers were given one robotic cat each, which was used by one of their patients. One cat stayed with the same patient the whole period of time; the patient’s had unlimited access to the cat. The caregivers had no previous experience of working with the cat

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Interviews

● Qualitative interviews were performed to capture how the participants think, feel, talk, and create meaning out of their experiences about working with Justocat ● The interviews were conducted according a semi-structured design; beginning with a series of neutral opening questions about personal background, interest, etcetera. After the initial phase of the interview, we introduced questions of more serious and possibly sensitive character, such as questions about work situation, health and illness, feelings of (mis-)recognition, and about relationships to other colleagues, managers, and clients.● The method of repeatedly interviewing the same individuals over time gave the interviewees time to reflect on issues and questions, raised by the interviewer, between each interview

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Questionnaire: themes and questions

●Personal background: number of years working, professional training, previous work places●Experiences of using technology at work: previous experiences of the cat and other technological tools at work●Thoughts about etical dilemmas using technological tools in the care of elderly people●Social relations: Questions about the role and meaning of Justocat in relationships, as a tool for communication and interaction with others●Questions about risks, threats, violence at work ●Any changes in the work rutines or relation to patient? In what way?●Any changes in patients’ behaviour? More/less physical/mental activity, more/less agitative behaviour, walking behaviours?●Any changes in work load for the caregivers? Is JustoCat function as a helper at work, and load off or another work task? Examples of situations when JustoCat helped and assisted a situation, and when it hindered and made a situation more difficult 6

● In total, nine in-depth interviews were audio recorded and transcribed● The data was thematically analyzed, involving several steps, or phases: Familiarisation with the data; coding (identify important features of the data); searching for themes (examining the significant broader patterns of meaning), reviewing them (themes are typically refined, which sometimes involves them being split, combined, or discarded), and finally defining and naming themes.● Based on how the interviewees talk about their use of JustoCat in relation to their patients, two themes emerges during the analytical process: the use of the cat as an “activator” and a “pacifier”

Thematic analysis

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Activator: in one-to-one situations

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To have something to talk about – you do not need to talk about the non existing bus or train that never arrives…You have some kind of a tool to change the monotone conversation… You talk about the cat instead and often it recalls memories. (I1)

●Listening to the caregivers’ experiences of how they use the robotic cat in their daily care of the patient, it is obvious that they use it to promote communication, i.e. to stimulate and to activate the patient to talk and to interact with the caregiver. The interviewees explains that they use the cat as a tool to recall memories and start conversations.

Activator: in group

●In social groups, the interviewees noticed that the cat could promote communication between the users, i.e. without the interference of the caregivers.

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She care so much for the cat, she tells us to be careful with it. And we can also see how the other PWDs respect that, it is her cat and they care for her…. that she should have the cat (I3)

Often when the cat is involved the patients starts talking about it. That makes you happy! The cat makes it easier to get a discussion going. (…) So it helps a lot, feels easier. (I1)

Pacifier: in one-to-one situations

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When we touch her she seems frightened, but if she has JustoCat she is more restful. When moving her, we tell her she will have the cat as soon as we have moved her to the wheel chair. In these situations it is easier, without the cat she just screams (I3)

JustoCat helps me doing a better job, especially with one PWD that hallucinates. It, JustoCat helps me to ”reach” her when she kind of loses herself in the hallucination. She becomes stiff in her body, but when having the cat in her arms the cat makes difference, she becomes relaxed. (I3)

●In one-to-one situations (between the caregivers’ and the users), the cat was used for calming and relaxing purposes when the patient was upset; as a kind of “transitional objects”

Pacifier: in group

● JustoCat is used in calming and diverting effects on the patients, e.g. stressful evenings when the caregivers work alone and are exposed to risks of conflicts and violence, e.g. trying to get all the patients to bed for the night

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IP3: The other patients are now less disturbed by her, now when she has the cat to care for. Before they got angry with her, because she disturbed them by her picking behavior.

Interviewer: How is the situation for you and your colleagues then, when she becomes anxious and the other patients get angry?

IP3: It’s stressful. For example, when we had the Lucia ceremony, it was stressing that she disturbed the others. But when we gave her the cat, she was occupied with picking on it.

Psychosocial work environment

● As Activator, JustoCat is used to stimulate the patient to engage in interaction with others (caregivers or other patients). When used in this way, the interviewed caregivers experience that the cat is contributing to their psychosocial work environment regarding factors such as working with people (social relations), and promotes a good social atmosphere in group situations. ● As pacifier, JustoCat is used to calm patients and divert negative behaviors. When used in this way, the interviewed caregivers not only feel less stressed, but also more secure, especially when working alone and are exposed to precarious situations involving potential conflicts and violence.

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Activator Pacifier

Dyad (one-to-one situations)

Triad (group situations)

Less stressful & more secure

work situation

Improved social atmosphere among patients

Less stressful & more manageable

work situation

Easier to communicate with the patient

Continuation

● The findings from this pilot study point to several potential benefits for individual caregivers when using a robotic cat in their daily care for patients, both in dyads and triads. ● Further studies are needed to evaluate the findings from this study in relation to larger samples●Plan for a larger study – involving other welfare technology that can effect psychosocial work environment – and apply for funding (2016->).

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References●AFA Insurance (2013). Allvarliga arbetsskador och långvarig sjukfrånvaro. www.afaforsakring.se

●Hofmann, Björn (2013). Ethical challenges with welfare technology: a review of the literature, Science, Engineering, Ethics, 19, 389-406.

●Kanamori, M., Suzuki, M., and Tanaka, M. (2002). Maintenance and improvement of quality of life among elderly patients using a pet-type robot, Nippon Ronen Igakkai Zasshi, Japanese journal of geriatrics, 39, 214-218.

●Libin, A., and Cohen-Mansfield, J. (2004). Therapeutic robocat for nursing home residents with dementia: Preliminary inquiry, American Journal of Alzheimer’s disease and other Dementia, 19, 111-116.

●Merton, R. K., Fiske, M., and Kendall, P. L. (1956/1990). The focused interview. A manual of problems and procedures. New York: Free Press.

●Oborn, E.; Barrett, M., and Darz, A (2011). Robots and service innovation in health care, Journal of Health Services Research & Policy, 16(1), 46-50.

●Swedish Work Environment Authority (2012). Work-related disorders 2012. Stockholm: Swedish Work Environment Authority.

●Wada, K., and Shibata, T. (2007). Living with seal robots: Its sociopsychological and physiological influences on the elderly at a care house, IEEE Transactions on Robotics, 23, 972-980.

●Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. London: SAGE Publications. 15