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Nutzer- und Aufgabenanalyse für ein sozio-technisches System zur Unterstützung der Kommunikation und Reorientierung beatmeter Patientinnen und Patienten in Intensivstationen: Ergebnisse und methodische Herausforderungen
... While mechanical ventilation support is vital, it also has limitations. Mechanically ventilated ICU patients are nonvocal and unable to speak due to the need for an artificial airway (intubation or tracheostomy tubes), which creates a significant communication barrier [10]. This barrier does not only affect the patients themselves, who may experience stress, frustration, and anxiety due to their inability to express themselves, but also complicates the efforts of healthcare providers and family members involved in the recovery process [1,9,28]. ...
... In this article, a new assistive system for this context is introduced. The system is based on our previous work in this field [10,15,17,18,19]. Here, we present the main components of the assistive system, including a novel, ball-shaped interaction device to control the graphical user interface (GUI). ...
... Following the human-centred design methodology, we refer to user and system requirements previously specified based on a comprehensive context analysis [10,15,17,18,19]. In previous work, the specialized interaction device BIRDY meeting the aforementioned requirements has been described [19]. ...
Critical care patients in intensive care units often require mechanical ventilation. This intervention usually involves a loss of the patient’s verbal communication for the duration of the ventilation. The weaning process from ventilation, in particular, causes increased stress. This significantly challenges patients and all others involved in the recovery process. Augmentative and Alternative Communication concepts may offer various options to mitigate this limitation. A novel assistive system for communication, information, and control, based on a ball-shaped interaction device, was designed to meet the needs of these weaning patients. To examine the maturity of the prototype before clinical trials, it was evaluated in a laboratory usability study with healthy elderly adults (N=22) regarding the learnability of the interaction, suitability for communication purposes, and the overall user experience. The results indicated that participants quickly learned the interaction and could successfully use the system as intended. This provides a solid foundation for a comprehensive field study with the weaning patient population.
... The procedure resulted in an elaborated user analysis including descriptions of user groups along with their characteristics and personas of different types (primary, negative, served and customer). Furthermore, a detailed context analysis was done [17]. An organization and a task analysis gave additional information on the context. ...
Intensive care patients that are weaned from mechanical ventilation are facing substantial physical and psychical stress. Due to the breathing tube, they often cannot voice their basic needs adequately. Possible consequences, amongst other complications, are a prolonged healing process and a delirium. To address this issue and support patient communication in intensive care, we provide a solution tailored to patients that are dealing with limited cognitive and physiological abilities, hindering them to use traditional devices efficiently. For this purpose, we develop a novel interaction device tailored to the special situation of in-bed interaction.
In this paper, we present key requirements for the device, which are relevant to the interaction itself as well as possible interaction gestures that may be performed with the device. The basis for this is a human-centered design process consisting of a comprehensive user and context analysis, as well as a requirements analysis. As a result, we identified three categories relevant for the interaction, namely look and feel, sensors, and actuators. The results of the requirement analysis were precise enough to start the actual development process of the device.
Rufsystem 4.0 in der Intensivpflege – Brücke zwischen Patienten und Pflegenden
Klassische Patientenrufsysteme sind elektronische Meldesysteme, die – beispielsweise in Krankenhäusern – genutzt werden, um Pflegenden über optische Signale Anliegen von Patientinnen und Patienten aufzuzeigen. Dies erfordert, dass Pflegende nach Wahrnehmung des Rufes aktiv in das Patientenzimmer gehen und im Gespräch die konkreten Anliegen abfragen müssen. Problematisch ist dies bei beatmeten Intensivpatienten im Weaning, die in ihrer Kommunikationsfähigkeit stark eingeschränkt sind und so ihre Anliegen nur mit unterstützter Kommunikation mitteilen können. In dieser Interaktion zwischen Pflegenden und Weaning-Patienten fehlen effektive Methoden zur unterstützten Kommunikation, und daher wird diese Kommunikation oftmals als belastend empfunden [1].
Im Rahmen des multidisziplinären Verbundprojekts ACTIVATE wird ein soziotechnisches interaktives System zur Förderung der Re-Orientierung von und Kommunikation mit beatmeten Patienten – insbesondere in der Weaning-Phase – entwickelt. Dazu wird unter anderem ein Modul zur Optimierung der Fernkommunikation in Form eines innovativen Rufsystems erforscht und entwickelt. In unserem Konzept können Patienten ihr Anliegen basierend auf einem Themenkatalog spezifizieren und drahtlos eine entsprechende Nachricht senden. Das System organisiert dabei entsprechend automatisch die jeweilige Zuordnung an das korrekte mobile Endgerät der zuständigen Pflegekraft unter Berücksichtigung von Kontext, Status und Aufgabenverteilung. Hierzu steht den Patienten ein spezialisiertes Eingabegerät zur Verfügung. Pflegende können den Eingang der Nachricht bestätigen und über das System Feedback – beispielsweise eine Lesebestätigung – senden.
Für das Personal bietet das Konzept die Vorteile, dass unnötige Wege eingespart werden können und eine umständliche Erfragung der Anliegen entfällt oder vereinfacht wird. Patienten profitieren ebenfalls von der Möglichkeit, Anliegen einfacher mitzuteilen. Das Feedback kann Ungewissheit reduzieren, ob der Ruf wahrgenommen wurde. Dabei wird auf Basis von Priorisierung, der Möglichkeit der Rufdelegation und weiterer Mechanismen bspw. durch Einbindung von Servicekräften ein effizienter Nachrichtenfluss gewährleistet. Potenziell hinderliche Faktoren für die Akzeptanz sind zum einen, dass zu detailliertes Feedback an den Patienten Erwartungen wecken und so Druck auf die Pflegenden ausüben könnte, dem diese aufgrund der hohen Arbeitsbelastung nicht gerecht werden können. Zum anderen besteht ein Risiko, dass der Einsatz weiterer Technik zunächst als Mehraufwand wahrgenommen und abgelehnt wird. Diese Aspekte wurden bei der Entwicklung berücksichtigt.
Literatur
[1] Abuatiq, A. (2015). Patients’ and health care providers’ perception of stressors in the intensive care units. Dimensions of Critical Care Nursing, 34(4), 205–214.
Quality improvement in medicine depends on the measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators, but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed. Most topics remained except for early mobilisation which was introduced instead of hypothermia following resuscitation. Infection prevention was added as an outcome indicator. These quality indicators are used in the intensive care peer review, a method endorsed by the DIVI. A validity period of three years has been planned for the quality indicators.
A major predicament for Intensive Care Unit (ICU) patients is inconsistent and ineffective communication means. Patients rated most communication sessions as difficult and unsuccessful. This, in turn, can cause distress, unrecognized pain, anxiety, and fear. As such, we designed a portable BCI system for ICU communications (BCI4ICU) optimized to operate effectively in an ICU environment. The system utilizes a wearable EEG cap coupled with an Android app designed on a mobile device that serves as visual stimuli and data processing module. Furthermore, to overcome the challenges that BCI systems face today in real-world scenarios, we propose a novel subject-specific Gaussian Mixture Model- (GMM-) based training and adaptation algorithm. First, we incorporate subject-specific information in the training phase of the SSVEP identification model using GMM-based training and adaptation. We evaluate subject-specific models against other subjects. Subsequently, from the GMM discriminative scores, we generate the transformed vectors, which are passed to our predictive model. Finally, the adapted mixture mean scores of the subject-specific GMMs are utilized to generate the high-dimensional supervectors. Our experimental results demonstrate that the proposed system achieved 98.7% average identification accuracy, which is promising in order to provide effective and consistent communication for patients in the intensive care.
Background:
Despite the rapid proliferation of health interventions that employ digital tools, the evidence on the effectiveness of such approaches remains insufficient and of variable quality. To address gaps in the comprehensiveness and quality of reporting on the effectiveness of digital programs, the mHealth Technical Evidence Review Group (mTERG), convened by the World Health Organization, proposed the mHealth Evidence Reporting and Assessment (mERA) checklist to address existing gaps in the comprehensiveness and quality of reporting on the effectiveness of digital health programs.
Objective:
We present an overview of the mERA checklist and encourage researchers working in the digital health space to use the mERA checklist for reporting their research.
Methods:
The development of the mERA checklist consisted of convening an expert group to recommend an appropriate approach, convening a global expert review panel for checklist development, and pilot-testing the checklist.
Results:
The mERA checklist consists of 16 core mHealth items that define what the mHealth intervention is (content), where it is being implemented (context), and how it was implemented (technical features). Additionally, a 29-item methodology checklist guides authors on reporting critical aspects of the research methodology employed in the study. We recommend that the core mERA checklist is used in conjunction with an appropriate study-design specific checklist.
Conclusions:
The mERA checklist aims to assist authors in reporting on digital health research, guide reviewers and policymakers in synthesizing evidence, and guide journal editors in assessing the completeness in reporting on digital health studies. An increase in transparent and rigorous reporting can help identify gaps in the conduct of research and understand the effects of digital health interventions as a field of inquiry.
The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured.
To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit.
Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication.
Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards).
Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.
Introduction: Available communication methods for intubated patients in the ICU are insufficient to meet patient needs. Both ICU patients and their care providers report broadly unsuccessful communication attempts, resulting in less effective medical care and undue stress1,2. Use of existing methods - including letter boards, writing, and mouthing words - for mechanically ventilated (MV) patients has led to a consensus that new methods are required3. We report on the testing of a new system designed to address the communication needs of MV patients that is currently being tested in a low- to medium- acuity surgical ICU4. Methods: We have developed several generations of prototypes designed to address patient communication needs. Design of this device has focused on ICU-specific communication needs, including ICU-specific content, infection control, simple design, and capitalizing on motor movements that can be easily performed by most ICU patients. Initial testing, starting with non-MV patients able to give more detailed feedback, has begun in a low- to medium- acuity surgical ICU. Recently developed prototypes combine custom-built tablet software, focusing on the needs that nurses believe patients wish to express in the ICU setting, with a newly designed manually operated access device. The system produces visual and auditory output to allow patients to answer basic questions and effectively convey information. Results: Initial patient impressions are encouraging, particularly among patients who have recently experienced mechanical ventilation. Many patients are unfamiliar with tablet software or struggle with manual dexterity required to access the tablet screen directly, further indicating the need for an external access method as part of the system. The content suggested by nurses via a previously conducted survey has been confirmed by patients as relevant to their experience. Conclusions: A novel manually operated communication system has elicited both positive reviews and helpful feedback from patients.
Intensive care unit (ICU) patient care bases - among others - upon the staff's assumptions about each patient's subjective preferences and experiences. However, these assumptions may be skewed and thus result in client-professional gaps (cp-gaps), which occur in two subtypes, hyperattention and blind spots to certain burdens. cp-gaps typically reduce quality of care. We investigated whether cp-gaps of either subtype exist in a 36-bed ICU of a university hospital.
Observational study on 82 consecutive patients of a 36-bed university ICU, who voluntarily answered a psychometric questionnaire focusing on patients' experiences during an ICU stay. The questionnaire was reliable and valid (Cronbach's alpha, factor analysis). It consisted of 31 Likert-scaled items, which represented three scales of perception (communicative, intrapersonal, somatic) supplemented by 55 binary items for more specific information. Details of the questionnaire are given in the text. Demographic, educational, and medical data were registered too. Patients reported their subjective ICU experience 2-7 days after ICU discharge. Analogously, 60 staff members (physicians and nurses) reported their assumptions about patients' experiences. After correction for a general bias, group differences indicated cp-gaps.
Twelve cp-gaps were found. Hyperattention was found in four communicative and three intrapersonal items. Blind spots appeared in two communicative, two intrapersonal, and one somatic item. The pattern of cp-gap subtypes (hyperattention/blind spots) goes well with self-attributional bias - a model of social interaction.
cp-gaps in ICUs can be identified using analogue questionnaires for patients and staff. Both subtypes of cp-gap occur. cp-gaps are substantially influenced by self-attributional bias.
Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.
To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed.
Effective nurse-patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN.
Systematic review.
This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided.
Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option.
Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak.
Cases and duration of mechanical ventilation in German hospitals : An analysis of DRG incentives and developments in respiratory medicine
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- A Geissler
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in German hospitals : An analysis of DRG incentives and developments
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Using the framework method for the analysis of qualitative data in multidisciplinary health research
- N K Gale
- G Heath
- Cameron E Rashid
- S Redwood
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the
framework method for the analysis of qualitative data in multidisciplinary health research. BMC Medical Research Methodology
2013; 13:117.
A cost-effective and simple electronic solution to communication with patients with tracheostomy in a burns and intensive care setting
A cost-effective and simple electronic solution to communication with
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