The Trust-Breaker in Clinical Automation: A Socio-Technical Review of Human-Robot Interaction and System Abandonment in Nursing and Telemetry Ecosystems

Abstract

The Fourth Industrial Revolution has integrated autonomous systems into high-stakes medical ecosystems, yet a critical adoption gap persists, driven by socio-technical failure rather than mechanical insufficiency. This paper introduces the “trust-breaker” framework to analyze why clinicians strategically abandon advanced robotics, such as Robot on Wheels (RoW) medication units and biomimetic telemetry drones. A trust-breaker is defined as a discrete moment of robotic unpredictability, ranging from operational path-planning errors to sensor-fusion desynchronization, that violates the supervisor’s mental model. This study posits that the Registered Nurse’s role has transitioned from a physical provider to a system supervisor, creating a supervisory paradox in which monitoring inconsistent, autonomous agents increases cognitive load beyond the demands of manual labor. When this load exceeds operator capacity, it triggers cognitive collapse, leading to the strategic abandonment of the system. From an engineering management perspective, this abandonment transforms significant capital investments into stranded assets with zero return on investment. The paper concludes by proposing a shift toward Industry 5.0 human-centricity, advocating for reflexive feedback loops, global compliance with data sovereignty, and a collaborative standard of care to foster trust-resilient clinical ecosystems.