Journal of Robotic Surgery (2023) 17:1847–1855

https://doi.org/10.1007/s11701-023-01592-0

CORRESPONDENCE

Can artificial intelligence and robotic nurses replace operating room

nurses? The quasi‑experimental research
Eda Ergin1 · Duygu Karaarslan2 · Seda Şahan1 · Ümran Bingöl3

Received: 29 November 2022 / Accepted: 26 March 2023 / Published online: 31 March 2023
© The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2023

Abstract
Operating room nurses, who have an important place in the professional healthcare team, should be able to use technology
effectively and adapt to innovations. This study is expected to shed light on how effective the development of robotic tech-
nologies and artificial intelligence and their integration into operating room nursing will be in fulfilling the requirements of
contemporary nursing philosophy. This study was designed as a single group pre- and post-test quasi-experimental study. The
quasi-experimental (pretest–posttest) research design was utilized to conduct the study in a Training and Research Hospital
in Western Turkey. The nurses (n = 35) working in the operating room of the aforementioned hospital were included in the
study. In this study, we aimed to determine whether operating room nurses experienced anxiety due to the use of artificial
intelligence and robotic nurses, and the effectiveness of the training given to them in order to raise their awareness. The
following three tools were used for data collection: The Nurses’ Descriptive Characteristics Form, Artificial Intelligence
Knowledge Questionnaire, and Artificial Intelligence Anxiety Scale. Data extraction and analysis were performed in a nar-
rative and tabular way. According to this study, the training given to the operating room nurses significantly increased their
knowledge levels about artificial intelligence and robotic nurses, and increased their artificial intelligence- and robotic nurse-
related anxiety significantly (p < 0.05). The participating operating room nurses experienced limitations regarding current
information, training programs and learning opportunities on robotic surgery. We recommend that the operating room nurses
should be provided with trainings on artificial intelligence technologies and robotic nurses, and that they should be enabled
to use these information technologies regarding future technologies actively.

Keywords Artificial intelligence · Robotic nurses · Operating room nurses · Operating rooms

Introduction

The fourth industrial revolution revolutionizes service areas

by affecting the world economy and all sectors. It also has
* Eda Ergin contributed to the development of the concept of health 4.0
eda.ergin@bakircay.edu.tr and to the acceleration of digitalization in health by creat-
Duygu Karaarslan ing significant effects on the health sector [1]. Human–robot
duygukrrsln@gmail.com cooperation, which is one of the most prominent develop-
Seda Şahan ments of Industry 4.0, is used in various business areas, and
seda.sahan@bakircay.edu.tr its use in the health sector is becoming increasingly common
Ümran Bingöl [2].
umran.bingol@bakircay.edu.tr Operating rooms are special hospital departments where
surgical interventions are performed, and sterility is highly
1
Health Sciences Faculty, Nursing Department, Izmir important. Operating rooms, which have a multidiscipli-
Bakircay University, Menemen, 35100 İzmir, Turkey
nary team whose members are surgeons, anesthesiologists,
2
Health Sciences Faculty, Nursing Department, Manisa Celal nurses, technicians and pharmacists, serve patients with new
Bayar Unıversity, Manisa, Turkey
approaches thanks to the development of information tech-
3
İzmir Bakircay Universitesi Cigli Training and Research nologies [3]. Robot technologies integrated with artificial
Hospital, İzmir, Turkey

13
Vol.:(0123456789)
1848
intelligence are advancing day by day. In the last few years,
robot-assisted surgery has gained importance. Safety, posi-
tive improvements, and reducing the possibility of infection
during surgical procedures have come to the forefront, which
has made the use of robot-assisted surgery more attractive
in hospitals. Robots play a supporting role both in surgical
procedures and in the operating room [4]. Nurses should be
knowledgeable about both these technologies and the prepa-
ration process well if they are to provide care for the patient
in surgeries performed with these technologies. Nurses are
expected to improve themselves and keep their skills up to
date on this constantly developing technology. Thus, nurses
are expected to adapt to the change and transformation in
order to meet the needs of the changing world.
Background/literature
One of the important factors shaping the modern world is
the developments in the field of technology. These develop-
ments, in parallel with rapid changes, have encouraged the
use of innovative technologies in all fields including the field
of health [5]. Thanks to the effect of globalization, a new
period called the “digital revolution” has been started in the
world. In this period, ‘unmanned production’ came to the
fore and it became possible for robots equipped with human-
specific features and strengthened with artificial intelligence
to provide services [2]. The World Health Organization
(WHO) defined the concept of “digital health” which came
to the fore in its global strategy report on digital health as
“the adoption of digital technologies to develop and improve
health” [6]. It includes digital health, clinical information
systems, mobile health, wearable health technologies, robot
nurses and artificial intelligence applications [1]. Rapid
developments in technology, especially in the fields of arti-
ficial intelligence and robotics, help the complement of both
the health sector and all other sectors [7]. Imagining the
health care provided by robots seemed completely unrealis-
tic until the 2000s; however, today, in some countries such
as Japan, nursing care is provided by assistive robots to a
great extent [8]. It is of great importance for health institu-
tions to follow and use technological developments in order
to provide services in accordance with the right to receive
quality health care [2]. Japan, one of the leading countries in
robotic technologies, which spent 16.7 billion Japanese Yen
for projects on nursing care robots in 2015 is now planning
to increase this figure to 404.3 billion Japanese Yen by 2035
[2]. This revolution in the provision of care, which continues
in many countries and is targeted to be used and realized
globally in the near future, has significantly progressed after
the outbreak of the COVID-19 pandemic [8].
Artificial intelligence and robot technologies in the
field of health are used in early diagnosis, decision mak-
ing, research, treatment, education, and maintenance of
13
Journal of Robotic Surgery (2023) 17:1847–1855
health [5]. Within this context, the surgical robot called “Da
Vinci” [9] reduces the responsibility of nurses by minimiz-
ing possible errors that are likely to occur in the operat-
ing room. Assistive robots named “Jibo”, “Pepper”, “Paro”
and “Buddy” are used to support patients such as autistic
children, the disabled and older adults in their treatment,
care and rehabilitation processes [5, 10, 11]. Robots named
“SAM” are among the robots that evaluate the patient for the
risk of falling. The Robotic IV Automation (RIVA) system
which ensures patient safety and cost-effectiveness in drug
use and minimizes errors, ensures that drugs and perfusions
to be administered intravenously are prepared at the right
dose. Robot “Sophia” is one of the best examples of this
system. Sophia, which has voice recognition technology, can
speak and can recognize faces, is used in health services [5,
10, 11]. In the literature, it is stated that robots can improve
the mood of patients and alleviate their pain, which enables
nurses to spend more time with patients, and increases their
interaction with patients [9, 12].
Nursing is an applied discipline which renews itself in
parallel with scientific, technological, socio-cultural changes
away from traditional perceptions and deals with the health
of the individual, family and society in the world [13]. In
the twenty-first century, the widespread use of smartphones,
virtual reality experiences, development of robot technol-
ogy and artificial intelligence prepare nursing practices for
a transformational structure [10, 11]. Accordingly, nurses’
roles, faced with important technical developments in prac-
tice environments, are developing rapidly [14]. In particular,
the use of artificial intelligence and robotic technologies is
accepted as the onset of the transformation in nursing ser-
vices to improve the way of care. Thus, it is predicted that
nurses’ workload will be reduced by integrating robot tech-
nologies and artificial intelligence into nursing services [5].
When the use of robots in institutional settings becomes a
common practice, it will have a major effect on healthcare,
nursing profession, and nursing studies in general [15].
One of the critically important units in hospitals where
high-tech tools and equipment are used and various tech-
niques are applied in the light of renewed information is
operating rooms. One of the areas affected most by this
constantly developing technology age is the health sector
especially the field of surgery addition to [16]. The operating
room is an area where very complex processes are applied
due to rapid technological developments such as robotic
surgery, artificial intelligence, simulation, and minimally
invasive techniques [17]. Operating room nurses, who are
part of the operating room team and serve patients with new
approaches in parallel with the development of information
technologies, use many information technologies while they
work [3]. In particular, operating room nurses continue to
follow the evolving and changing surgical skills and knowl-
edge necessary for patient safety and quality of care [14].
Journal of Robotic Surgery (2023) 17:1847–1855
The use of robots in operating rooms makes surgery
easier and clearer for nurses. This method also helps them
gain experience about new technologies and professional
roles. Nurses can create a new field as clinical specialists
and expand their roles as professionals [18]. Adoption of
a developing technology is only possible with nurses who
are interested in this field. It is important to determine how
nurses perceive developments in technology and robotic
surgery in order for them to be well prepared for and to
keep up with developing and changing technologies [16]. In
their study conducted to determine nurses’ views on robotic
surgery, Alcan et al. [18] found that of the nurses, 90.6%
(n = 259) had heard the term robotic surgery before, that
34.6% (n = 99) were knowledgeable enough about robotic
surgery, and that of the nurses who were knowledgeable,
36.7% (n = 95) received information from the internet. In
their study, Kang et al. [14] stated that nurses working in
robotic surgery in Korea were proud of working in a team
that used the latest surgical technology. The use of robotic
surgery have several advantages: ıt makes it possible to
reach small incision areas, leads to fewer complications in
the postoperative period, allows early mobilization, short-
ens the length of hospitalization and requires fewer person-
nel in the surgical team [16]. Badilla-Solórzano et al. [4]
conducted a study on robotic operating room nurses based
on deep learning for instrument detection under conditions
similar to those of an actual operating room. In their study,
they uncovered an example of a scrub nurse responsible for
handing in surgical instruments to the physician who per-
forms the surgery and getting them back after use. In one
of their best-known studies called “Gestonurse” Jacob et al.
[19] concluded that the robotic nurse performed 97% of the
hand movements correctly and that it was suitable for uncon-
trolled environments such as the operating room.
In a similar study, Nakano and Nagamune [20] performed
a study on a robotic scrub nurse to assist operating room
nurses for orthopedic surgeries. In their study, in which they
set out by considering the needs of operating room nurses
in Japan, they developed a detection system for instruments
used in orthopedic surgery using the modeling method. Con-
sequently, the “Faster Region-Based Convolutional Neural
Network” system was accepted as suitable for the detection
of surgical instruments [20].
Our review of the current literature demonstrated that the
number of studies in which the thoughts and experiences of
operating room nurses in the field of artificial intelligence
and robotic surgery are investigated is very few if any. The
spread of artificial intelligence and robots in the future will
bring about new approaches and applications in the field
of operating room nursing. Therefore, it becomes essential
to determine the opinions of all nurses, especially those of
operating room nurses, in order to enable them to adapt to
the rapidly developing robot nurses and artificial intelligence
1849
technology. Therefore, the present study was aimed at deter-
mining the opinions of operating room nurses about robot
nurses and artificial intelligence, and contributing to the
literature on this issue. This study aims to determine the
effect of training given to operating room nurses for artificial
intelligence and robot nurses on the level of awareness and
anxiety of nurses about artificial intelligence.
Methods
In the present study, it was aimed to determine operating
room nurses’ artificial intelligence- and robotic nurses-
related concerns and to raise their awareness. The research
questions were as follows:
H1 The training given to the operating room nurses for
artificial intelligence and robot nurses affects increasing the
awareness level of nurses toward artificial intelligence.
H2 The training given to the operating room nurses for arti-
ficial intelligence and robot nurses affects reducing the anxi-
ety level of nurses toward artificial intelligence.
Design
The present study has a single group pre- and post-test quasi-
experimental design. The study data were collected from the
operating room nurses working in aTraining and Research
Hospital located in the west of Turkey between May 27,
2022 and June 24, 2022.
Participants
Forty-seven (N:47) nurses working in the operating room in
a Training and Research Hospital in western Turkey com-
prised the study population. Of them, 12 were excluded from
the study during the data collection phase. Twelve nurses
were not included in the study because a pilot study was con-
ducted with 10 nurses, and 2 nurses wanted to be excluded
because they were on duty. The remaining 35 nurses were
considered enough for the study sample because the number
of the nurses to be included in the sample was calculated
as 33 using the Open Epi Info Statcalc ­program™ (power:
0.50, confidence level: 80%, possibility of losses to follow-
up: 5%).
Inclusion criteria for the study
Being an operating room nurse,
Not having received training on artificial intelligence
before,
Not being on leave during the planned date of the work,
13
1850
Agreeing to participate in the research.
Exclusion criteria from the study
Refusal to participate in the research.
Data collection and measures
The study data were collected using the Nurses’ Descrip-
tive Characteristics Form, Artificial Intelligence Knowledge
Questionnaire, and Artificial Intelligence Anxiety Scale.
Nurses’ descriptive characteristics form
The form developed by the researchers in line with the lit-
erature [5, 11, 21, 22] includes nine items. While five of
the items question the participants’ demographic and job-
related characteristics such as sex, age, length of service in
the profession, length of service in the operating room and
job satisfaction, four items question their views of artificial
intelligence.
Artificial intelligence knowledge questionnaire
The 20-item form was created by the researchers in line with
the literature [9, 23] to measure the participating nurses’
level of knowledge related to artificial intelligence and
robotic nurses. The correct answer to each question was
evaluated as “5” points and the wrong answer as “0” points.
The highest and lowest possible scores to be obtained from
the questionnaire are “100” and “0”, respectively. The higher
the score obtained from the questionnaire is, the higher the
nurses’ level of knowledge of artificial intelligence and
robotic nurses is. Before Artificial Intelligence Knowledge
Questionnaire was administered, the questions in it were
analyzed by ten faculty members, and then its content valid-
ity index was calculated. In the percentage analysis, 80%
of the questions should be rated as “appropriate” or “very
appropriate” [24] According to the analysis of the faculty
members, the content validity index score was determined
as 0.98. The 20-question Artificial Intelligence Knowledge
Questionnaire determined as appropriate was administered
to 5 surgical nurses to evaluate its comprehensibility and
their feedback was obtained.
Pilot study
A pilot study was conducted with ten operating room
nurses to test the clarity of the questions in the informa-
tion form and the time to solve the questions. After the
pilot application, the nurses stated that the questions were
clear and understandable. In addition, the time to solve the
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Journal of Robotic Surgery (2023) 17:1847–1855
questions was 15 min. Since there was no negative feed-
back from the nurses, the information form still needed
to be changed. The ten nurses who were piloted were not
included in the sample.
Artificial intelligence anxiety scale
The “Artificial Intelligence Anxiety Scale” developed by
Wang and Wang [25] was adapted into Turkish by Akkaya
and Özkan [26]. The scale consists of 16 items and the
following 4 subscales: “Learning” (items 1,2,3,4,5), “Job
Replacement” (items 6,7,8,9), “Sociotechnical Blindness”
(items 10,11,12,13) and “Artificial Intelligence Configura-
tion” (items 14, 15, 16). The Cronbach’s Alpha value for
the overall scale was 0.937 in Akkaya and Özkan’s study
[26] and 0.942 in this study.
The implementation of the present study
The researchers planned to give training to the operating
room nurses participating in the study on the day (Friday)
allocated to the in-service training given every week. First,
the purpose of the study was explained to the operating
room nurses. Then, those who volunteered to participate
in the study were asked to sign the consent form. The
participating operating room nurses were asked to use
pseudonyms when they filled in the Nurses’ Descriptive
Characteristics Form, Artificial Intelligence Knowledge
Questionnaire, and Artificial Intelligence Anxiety Scale.
All the operating room nurses participating in the study
were given 45 min of training on ‘artificial intelligence
technologies and robotic nurses’.
The content of the training was as follows: definition
of artificial intelligence, the emergence of artificial intel-
ligence concept, the place of artificial intelligence in
scientific taxonomy, artificial intelligence technologies,
artificial intelligence applications in daily life, artificial
intelligence, robots and nurses in health and nursing,
robots in surgery, examples of robotic nurses and robot
samples that can replace scrub and circulating nurses in
the future. Immediately after the training, all the operating
room nurses participating in the study were asked to fill
in the “Artificial Intelligence Anxiety Scale” again. Three
weeks after they were given the training, all the operating
room nurses participating in the study were asked to fill
in the “Artificial Intelligence Knowledge Questionnaire”
using their pseudonyms.
Journal of Robotic Surgery (2023) 17:1847–1855 1851

Table 1  Demographic n % Results

characteristics of nurses
Gender
The mean “age” of the operating room nurses participat-
Women 31 88.6
ing in the study was 42.65 (± 7.28) years. Of them, 88.6%
Men 4 11.4
(n = 31) were “women”, 80% (n = 28) had the “undergradu-
Education
ate degree”, and 48.6% (n = 17) had a length of service in the
Associate degree 5 14.3
operating room ranging between 1 and 10 years (Table 1).
Bachelor’s degree 28 80.0
When the operating room nurses participating in the
Master’s degree 2 5.7
study were asked about their opinions of artificial intelli-
Length of service in the oper-
gence and robotic nurses, of them, 75.4% (n = 29) stated
ating room
that they had heard the concept of “artificial intelligence
1–10 years 17 48.6
and robotic nurses” before, 71.4% (n = 25) said that they did
11–20 years 10 28.6
not think that robots would replace nurses, 77.1% (n = 27)
21–30 years 6 17.3
thought that robots would benefit the nursing profession, and
≥ 31 years 2 5.8
80% (n = 28) stated that robots would reduce the workload
Total 35 100
of nurses (Table 2).
There was a significant difference between the mean pre-

Table 2  Operating room Items Yes No

nurses’ opinions on artificial
intelligence and robotic nurses n % n %
(n = 35)
Have you ever heard of the concepts of artificial intelligence and robotic nursing? 29 75.4 9 23.7
Do you think robots with artificial intelligence will replace nurses? 10 28.6 25 71.4
Do you think robots with artificial intelligence will benefit the nursing profession? 27 77.1 8 22.9
Do you think artificial intelligence and robotic nursing applications will reduce the 28 80.0 7 20.0
workload of nurses?

Data analysis test and posttest scores the participants obtained from the
Artificial Intelligence Knowledge Questionnaire (t = 2.497,
Statistical analysis of the data was performed with IBM
p = 0.018). The mean scores the participants obtained from
SPSS 22.0 package program in Windows 10 on the com-
the Artificial Intelligence Knowledge Questionnaire before
puter. The variables were summarized in terms of the fol-
and after the training were 68.00 ± 11.38 and 73.74 ± 8.96,
lowing values: unit number (n), percentage (%), arithmetic
respectively.
mean (x̄ ), and standard deviation (SD). The Levene test
There was a significant difference between the mean pre-
was used to check whether the variances were homogene-
test and posttest scores the participants obtained from the
ous and Shapiro–Wilk test was used to test the normality
Artificial Intelligence Anxiety Scale (t = 2.392, p = 0.022).
of the data. In all the data, α error level p < 0.05 was con-
The mean scores the participants obtained from the Artificial
sidered statistically significant.
Intelligence Anxiety Scale before and after the training were
46.14 ± 11.79 and 51.20 ± 11.45, respectively.
There was a significant difference between the mean
Ethics pretest and posttest scores the participants obtained from
the Job Replacement Subscale of the Artificial Intelligence
The research was approved by the Ethics Committee of
Anxiety Scale (t = 2.376, p = 0.023), and the post-test scores
the Faculty (Approval date: April 29, 2022, Approval No:
were 1.57 points higher than the pre-test scores.
590/570). Before the study was conducted, permission was
There was a significant difference between the mean pre-
obtained from the administration of the hospital where the
test and post-test scores the participants obtained from the
study was to be conducted (Approval No: 11.05.2022). It
Artificial Intelligence Configuration Subscale of the Arti-
was ensured that the study conformed to the principles
ficial Intelligence Anxiety Scale (t = 2.793, p = 0.009) and
stated in the Declaration of Helsinki. The written consent
the posttest scores were 1.48 points higher than the pretest
was obtained from the operating room nurses who volun-
scores (Table 3).
teered to participate in the study.

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1852 Journal of Robotic Surgery (2023) 17:1847–1855

Table 3  Comparison of the mean scores obtained by the operating room nurses from the artificial intelligence knowledge questionnaire (AIKQ)
and Artificial intelligence anxiety scale (AIAS) (n = 35)
Pretest Posttest t p

X ± SD Median (bottom-top) X ± SD Median (bottom-top)

AIKQ 68.0 ± 11.38 70.0 (35–90) 73.74 ± 8.96 75.0 (50–90) 2.497 0.018
AIAS total 46.14 ± 11.79 44.00 (32–78) 51.20 ± 11.45 55.0 (32–80) 2.392 0.022
Learning subscale 12.28 ± 4.73 11.0 (5–23) 13.42 ± 4.78 13.0 (5–25) 1.445 0.158
Job replacement subscale 12.28 ± 3.76 12.0 (7–20) 13.85 ± 3.43 14.0 (8–20) 2.376 0.023
Sociotechnical blindness subscale 13.25 ± 3.04 13.0 (8–20) 14.11 ± 3.21 15.0 (8–20) 1.493 0.145
Artificial intelligence configuration subscale 8.31 ± 2.86 9.0 (3–15) 9.8 ± 2.76 10.0(6–15) 2.793 0.009

t Independent T Test
Bold value represents p < 0.05

A comparison was made between the mean scores of Table 4  Comparison of pre- and post-training scores obtained from
the Artificial Intelligence Anxiety Scale before and after the Artificial Intelligence Anxiety Scale (AIAS) by the Operat-
ing Room Nurses According to their Demographic Characteristics
the training of the operating room nurses. According to the
(n = 35)
results of the analysis, it was determined that there was no
significant difference between gender and artificial intelli- Artificial intelligence anxiety scale
gence anxiety scale pre-test (U = 41.00, p = 0.27) and post- Pretest Posttest
test mean scores (U = 55.00, p = 0.71). Median X ± SD Median
X ± SD
When the education level and the Artificial Intelligence
Anxiety Scale mean scores were compared, it was found that Gender
there was no significant difference between the education Women 46.80 ± 11.72 4.0 51.65 ± 11.61 5.0
level and the Artificial Intelligence Anxiety Scale pre-test Men 41 ± 12.71 5.0 48 ± 10.98 8.0
(F = 0.286, p = 0.75) and post-test mean scores (F = 0.101, U = 41.00 U = 55.00
p = 0.90). p = 0.27 p = 0.71
When the length of service in the operating room and Education
the Artificial Intelligence Anxiety Scale mean scores were Associate degree 42.40 ± 11.61 8.0 49.20 ± 11.88 8.0
compared, it was found that there was no significant differ- Bachelor’s 46.82 ± 11.89 4.0 51.42 ± 11.75 5.0
degree
ence between the length of service in the operating room and
Master’s degree 46.0 ± 11.97 6.0 53.0 ± 12.75 3.0
the Artificial Intelligence Anxiety Scale pre-test (F = 0.727,
F = 0.286 F = 0.101
p = 0.74) and post-test mean scores (F = 1.547, p = 0.19) p = 0.75 p = 0.90
(Table 4). Length of service in the operating room
1–10 years 41.30 ± 10.24 38.0 47.53 ± 11.25 46.0
11–20 years 45.10 ± 9.38 43.0 57.50 ± 11.20 55.0
Discussion 21–30 years 49.90 ± 11.32 8.0 47.63 ± 11.52 46.0
≥ 31 years 0.30 ± 9.50 40.0 46.0 ± 10.25 46.0
Discussing the opinions of operating room nurses F = 0.727 F = 1.547
on artificial intelligence and robot nurses p = 0.74 p = 0.19

U Mann Whitney U Test, F One Way ANOVA Test

It is expected that artificial intelligence will have a signifi-
cant impact on professions in the next few decades and per-
haps that it will even threaten the existence of many profes-
sional fields, especially that of professions in the fields of
law and medicine [27]. In this study, the majority of the
participating nurses (n = 25) stated that they did not think
that robots would replace nurses. In the literature, there
is a consensus among authors that artificial intelligence
robots will not directly replace nurses in the near future
[22, 28–32]. However, contrary to this study results, in their
study, Abdullah and Fakieh [23] investigated the perceptions
and attitudes of healthcare professionals toward the appli-
cation of artificial intelligence technologies in healthcare
institutions in Saudi Arabia, and they reported that most
of the participants were worried that artificial intelligence
would replace them.
In this study, more than half of the participating operating
room nurses stated that robots would reduce their workload.
Consistent with the results of this study, in Ergin et al.’s
[22] study involving nurse managers more than half of them

13
Journal of Robotic Surgery (2023) 17:1847–1855
thought that robotic nurses would benefit the nursing profes-
sion. In Alcan et al.’s [18] study conducted to determine the
views of nurses on robotic surgery, 68.9% of the 286 nurses
stated that they would prefer robotic surgery if they were to
undergo surgery in the future. In the literature, it has been
reported that the use of robots to assist nurses will contrib-
ute to meeting the needs of patients in a timely manner and
enriching the nurse-patient relationship [30, 33, 34].
Adoption of a developing technology is only possible
with nurses who are interested in this field [35]. In this
study, the majority of nurses had heard of the concept of
artificial intelligence and robotic nursing before. In stud-
ies conducted with university students, it was determined
that the students were knowledgeable about the concept of
artificial intelligence, consistent with this study [21, 36, 37].
In the study conducted by Mehdipour [38], it was revealed
that the artificial intelligence system skills of nurses are
“very low”, but their awareness and knowledge levels about
artificial intelligence applications are “high”. In the study
conducted by Porto and Çatal [16], it was determined that
almost all of the 114 operating room nurses had positive
opinions about robotic surgery. Almost all of the operat-
ing room nurses working in the robotic team believed that
robotic technology was essential and were proud to work in
the robotic team. Kang et al. [14] obtained results in support
of this study in their study. They said that the operating room
nurses are proud to work in a team that uses the latest surgi-
cal technology despite their hard work. Porto and Çatal [16]
also found that operating room nurses with robotic surgery
experience had a “higher level” of individual innovativeness,
and trained nurses had a significantly better fit.
Comparison of pre‑ and post‑training artificial
intelligence knowledge test and artificial
intelligence anxiety scale scores of operating room
nurses
Robotic operating room nurses have the potential to be
an attractive solution for the operating room [4]. This
study is the first one conducted both in our country and in
other countries in which the participating operating room
nurses’ levels of knowledge on the subject were investi-
gated by providing training on artificial intelligence and
robotic nurses for them. The mean scores the participants
obtained from the Artificial Intelligence Knowledge Ques-
tionnaire before and after the training were 68.00 ± 11.38
and 73.74 ± 8.96 out of 100, respectively. There was a
significant difference between the two scores (p < 0.05).
The results of this study demonstrated that there was a
significant difference between the mean scores the operat-
ing room nurses obtained from the Artificial Intelligence
Knowledge Questionnaire before and after the training
given to them on artificial intelligence and robotic nurses
1853
(p = 0.018), and that the mean post-training score was 5.74
points higher than the mean pretest score. As a result of
the research, “The training given to the operating room
nurses for artificial intelligence and robot nurses affects
increasing the awareness level of nurses toward artificial
intelligence.” (H1) was supported by the hypothesis. This
result shows that after the training, the participants’ knowl-
edge levels of artificial intelligence and robotic nurses
increased. The participating operating room nurses expe-
rienced limitations regarding current information, training
programs and learning opportunities on robotic surgery.
This shows that nurses need well-designed training pro-
grams on robotic surgery. If their educational needs are
met, nurses can contribute to the improvement of patient
safety and quality of care.
Significant advances in studies on artificial intelligence
in recent years have led to the proliferation of technologies
that significantly affect our daily lives. Healthcare profes-
sionals are expected to learn how to take advantage of this
technology and to struggle to improve patient care without
being unduly afraid of developments in artificial intelli-
gence [39]. This study results demonstrated that after the
training given to them, the participating operating room
nurses had a moderate level of anxiety about the use of
artificial intelligence and robotic nurses in the operating
room, and that their anxiety levels increased significantly
(p < 0.05). As a result of the research, “The training given
to the operating room nurses for artificial intelligence and
robot nurses affects reducing the anxiety level of nurses
toward artificial intelligence.” It is seen that it does not
support the (H2) hypothesis. Badilla-Solórzano et al. [4]
conducted a study on robotic operating room nurses based
on deep learning for instrument detection under condi-
tions similar to those of an actual operating room. In a
similar study, Nakano, and Nagamune [20] performed a
study on a robotic scrub nurse to assist operating room
nurses. In the light of these developments, we can say that
the increase observed in the artificial intelligence anxiety
levels of the operating room nurses participating in this
study after the training given to them is an expected result.
In their study, Nasreldin Othman et al. [40] investigated
the anxiety levels of 150 nurses about establishing part-
nerships with artificial intelligence during nursing care
before and after the training. Contrary to this study find-
ings, they determined that the nurses’ artificial intelligence
anxiety levels decreased significantly after the training. In
the study of Porto and Çatal [16], 35.8% of the operating
room nurses stated that they received training before join-
ing the robotic surgery team and were significantly better
adapted. In a study conducted with operating room nurses
working with robotic surgery in Istanbul, they stated that
they were uncomfortable with the lack of knowledge on
this subject [41]. These nurses stated that any technical
13
1854 Journal of Robotic Surgery (2023) 17:1847–1855

problem with the robot added to their lack of technical
knowledge, causing them to worry during the operation
and about harming the patient.
Comparison of pre‑ and post‑training artificial
intelligence anxiety scale scores according
to the demographic characteristics of operating
room nurses
not compared with other institutions is one of the study’s
limitations.
The fact that more than 88.6% of the operating room
nurses participating in the study were “female” nurses may
have caused biased results. With the variables used in this
study, conducting studies involving more than one hospital
and with a larger sample size is recommended.

It was found that there was no significant difference between

Conclusions
the pre-training artificial intelligence anxiety scale mean
scores of artificial intelligence and robot nurses given to
In conclusion, we determined that the participating operat-
the operating room nurses and their sociodemographic
ing room nurses’ level of knowledge of artificial intelligence
characteristics. Pre-training artificial intelligence anxiety
and robotic nurses was moderate, and that their knowledge
scores of women were found to be higher and moderate
level increased after the training. In line with these results,
than men. After the application, it was determined that the
we recommend that the operating room nurses, other team
rate of women having a moderate level of anxiety increased
members and patients should be supported with trainings
slightly and their anxiety level was higher than that of male
given on artificial intelligence technologies and robotic
nurses, and there was no significant difference between the
nurses, that patient and employee safety regarding future
two after the application. Nasreldin Othman et al. [40], it
technologies should be enhanced, and that nurses should
was concluded that gender did not make a significant dif-
actively use these information technologies to ensure cost-
ference in anxiety in their study in which they examined the
effectiveness, appropriate team communication and effective
levels of artificial intelligence anxiety before and after the
use of the operating room.
training given to artificial intelligence during nursing care.
As a result of the study, it was recommended to apply
Pintos de Santos et al. [42] reported that men have a more
continuing education sessions to the operating room nurses
positive attitude, confidence, and interest in the benefits of
to cope with artificial intelligence and robot nursing tech-
AI in medical practice. It was found that as the education
nology that will increase the quality of care, improve the
level of the participants increased, the artificial intelligence
outcomes of the patients and reduce their anxiety levels.
anxiety scores increased and the increase in the anxiety lev-
els before and after the education was not significant. Kang
et al. [14] revealed in their study that the roles and respon- Author contributions EE: conceptualization; ınvestigation; methodol-
sibilities of nurses increased with the development and use ogy writing—review and editing. DK: roles/writing—original draft;
writing—review and editing. SŞ: original draft; writing—review and
of robotic surgery, stress was caused by the increasing role
editing. ÜB: ınvestigation, methodology.
of nurses and more support was needed. In the study, nearly
half of the operating room nurses had experience working Funding No funding was received for conducting this study.
in the operating room between “1–10” years. Nasreldin Oth-
Data availability Data is available from the corresponding author upon
man et al. [40] nurses working in the operating room had
resonable request.
“1–5 years of experience,” and 74.7% had not received any
training on artificial intelligence. In the study in which the Declarations
operating room nurses’ opinions, experience and individual
innovativeness on robotic surgery were examined compara- Conflict of interest The authors declare that there is no conflict of in-
terest.
tively, the operating room nurses had experienced between
“1–5 years” [16].

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