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Nurses face significant physical demands during patient care, leading to high rates of musculoskeletal disorders (MSDs) among nurses in long-term care. Exoskeletons demonstrate promise in supporting nurses and nurse managers with MSDs; however, social contextual factors are crucial to their design and implementation. Through thematic analysis of 17 semi-structured interviews, this paper reveals social contextual factors important to exoskeleton use among nurses and nurse managers in long-term care. Participants expressed concerns about workplace discrimination, co-worker perceptions of their capabilities, and patient confidence. Our findings highlight the need for supportive organizational cultures and open communication channels. Recommendations include in-depth systems analysis to assess exoskeleton feasibility and efficacy, involving input from frontline nurses/managers, management, and patients. These findings can aid human factors and ergonomics (HF/E) experts in balancing social contextual factors and other work system elements to design work system contexts and exoskeletons that promote optimal outcomes in long-term care settings. 

The mental demands associated with operating complex whole-body powered exoskeletons are poorly understood. This study aimed to explore the overall workload associated with using a powered wholebody exoskeleton among expert and novice users, as well as the changes in workload resulting from novices adapting to exoskeleton-use over time. We used eye-tracking measures to quantify the differences in workload of six novices and five experts while they performed a levelwalking task, with and without wearing a whole-body powered exoskeleton. We found that only novices’ pupil dilation (PD) increased, while experts showed a greater proportion of downward-directed pathfixations (PF) compared to novices while wearing the exoskeleton. These results indicate that novices’ mental demands were higher, and that experts and novices exhibited distinct visuomotor strategies. Eyetracking measures may potentially be used to detect differences in workload and skill-level associated with using exoskeletons, and also considered as inputs for future adaptive exoskeleton control algorithms. 

Exoskeletons are an emerging form of technology that combines the skills of both machines and humans to give wearers the ability to complete physically demanding tasks that would be too strenuous for most humans. Exoskeleton adoption has the potential to both enhance and disrupt many aspects of work, including power dynamics in the workplace and the human-machine interactions that take place. Dyadic Power Theory (DPT) is a useful theory for exploring the impacts of exoskeleton adoption. In this conceptual paper, we extend DPT to relationships between humans and machines in organizations, as well as human-human communication where use of an exoskeleton has resulted in shifts of power.