Content uploaded by Adrienne Henkel
Author content
All content in this area was uploaded by Adrienne Henkel on Aug 16, 2018
Content may be subject to copyright.
A preview of the PDF is not available
Nutzer- und Aufgabenanalyse für ein sozio-technisches System zur Unterstützung der Kommunikation und Reorientierung beatmeter Patientinnen und Patienten in Intensivstationen: Ergebnisse und methodische Herausforderungen
Abstract and Figures
Motivation/Problemstellung: Das Projekt ACTIVATE hat zum Ziel, ein soziotechnisches Unterstützungssystem zu entwickeln, das die Kommunikation, Reorientierung und Umweltkontrolle von schwerstkranken Menschen in Intensivstationen in der Phase der Entwöhnung vom Beatmungsgerät (Weaning) fördert. Im Rahmen der initialen Nutzungs- und Aufgabenanalyse wurden verschiedene methodische Herausforderungen deutlich, die in diesem Beitrag analysiert und diskutiert werden sollen.
Methodik: Die initiale Nutzungs- und Aufgabenanalyse erfolgte mittels einer Kombination folgender Untersuchungen: systematische Literaturrecherchen („scoping reviews“), nicht-teilnehmende Beobachtungen im Feld der Intensivpflege (n=10), semi-strukturierte Einzelinterviews mit Intensivpatienten (n=16) und deren Angehörigen (n=16), Ärztinnen/Ärzten (n=6) sowie Gruppeninterviews mit Pflegekräften (n=26) und Therapeutinnen/Therapeuten (n=2). Die empirischen Ergebnisse wurden dem Ansatz des Human-centered Design (HCD) folgend in Personas und personabasierte Szenarien sowie Prozessmodellierungen zusammengeführt.
Ergebnisse: Die Datentriangulation ergab folgende Schwerpunkte für die zu unterstützenden pflegerisch-therapeutischen Prozesse: frühzeitige und genaue Erfassung der Patientenbedürfnisse im Weaningprozess (z. B. Durst, Schmerzen, Atemnot, Liegeposition und Bewegung im Bett), Ermöglichung einer subjektiv effektiven Kommunikation zwischen den Patientinnen/Patienten und dem personellen Umfeld (pflegerisch-ärztliches Team, Angehörige) sowie Förderung der Reorientierung und Partizipation (z. B. durch frühzeitige und regelmäßige Information über Zeit, Ort und klinische Situation). Darüber hinaus konnten verschiedene für die Funktionen und das Design des Unterstützungssystems relevante Kontextfaktoren auf der Patienten-, Personal-, Prozess- und Infrastrukturebene identifiziert werden. Allerdings zeigten sich auch Grenzen in der Exploration der Nutzungsbedürfnisse und Kontextfaktoren. Diese ergaben sich aus dem begrenzten Erinnerungsvermögen der Patientinnen/Patienten hinsichtlich des Weaningprozesses, Divergenzen zwischen der Patienten- und der Personalsicht und der noch unscharfen Gestaltungs- und Funktionsmerkmale des intendierten Unterstützungssystems in dem sehr frühen Entwicklungsstadium. Letzteres forderte das Vorstellungsvermögen aller in die qualitativen Erhebungen eingeschlossenen Personengruppen stark heraus.
Schlussfolgerung: Die initiale Nutzer- und Aufgabenanalyse erbrachte wichtige Hinweise für die weitere Entwicklung des ACTIVATE-Unterstützungssystems. Zugleich wurden methodische Herausforderungen deutlich, die im weiteren Projektverlauf sowie in künftigen ähnlichen Projekten zu berücksichtigen sind. Das Projekt ACTIVATE bietet hierfür wertvolle Erkenntnisse und unterstreicht die Notwendigkeit eines engen disziplinenübergreifenden Austauschs über die setting- und populationsspezifisch geeigneten Entwicklungsmethoden.
Figures - uploaded by Adrienne Henkel
Author content
All figure content in this area was uploaded by Adrienne Henkel
Content may be subject to copyright.
... The ACTIVATE research project [62] focuses on the development of a communication system used between weaning patients and professional caregivers as well as other medical staff members or relatives of the patient. The intended system is supposed to provide orientation, participation, and a sense of control among patients while supporting caregivers in their daily routine [33]. Thus, an ability-based requirements analysis executed for this project should emphasize the abilities of both patient and caregiver, 12 insights about which technology and forms of interaction are best suited for supporting communication between these users. ...
The notion of Ability-Based Design , put forth by Wobbrock et al. [80, 82] as a solution to the challenge of creating accessible technology, has been discussed in human-computer interaction research now for over a decade. However, despite being cited as influential on various projects, the concept still lacks a general characterization of how to implement its required focus on abilities. In particular, it lacks a formulation of how to perceive and model users within an articulated design process. To address this shortcoming, we rely on conceptual user modeling to examine Ability-Based Design and propose a characterization of it that is not dependent upon a specific project or research effort, but that enables the ability-based design of new technologies in a systematic manner. Our findings show that Ability-Based Design’s focus on abilities requires important changes in typical user modeling approaches that cannot be met with current techniques. Based on the challenges identified through our analysis, we propose a first modification not only of current user modeling, but of current requirements analysis approaches to address abilities and their intertwined dependencies with tasks and contexts as core elements of conceptual models in Ability-Based Design. We thereby demonstrate not only the complexity of modeling users’ abilities, but also draw out promising ideas and perspectives for future research, emphasizing the need for future evaluative work on our approach.
... In ACTIVATE, we reviewed the literature and conducted qualitative user research (particularly, interviews and focus groups with the target user groups) to generate data-driven user personas and corresponding problem scenarios specifying the context of use [12]. We discussed and refined these results and examined their implications in further workshops. ...
Ventilated intensive care patients represent a sizable group in the intensive care unit that requires special attention. Although intensive care units are staffed with more nurses per patient than regular wards, the situation is often precarious. A situation that has become more acute during the COVID-19 pandemic. Weaning from mechanical ventilation as well as the limited communication abilities pose substantial stress to the patients. The incapability to impart even basic needs may negatively impact the healing process and can lead to delirium and other complications. To support the communication and information of weaning patients as well as to foster patient autonomy, we are developing a smart environment that is tailored to the intensive care context. While the provision and connection of smart objects and applications for this purpose can be time-consuming, self-organization and self-explainability may present helpful tools to reduce the effort.
In this paper, we present a framework for self-explaining and semi-automatically interconnected ensembles of smart objects and ambient applications (that are integrated into smart spaces) used to realize the assistive environment. Based on a description language for these components, ensembles can be dynamically connected and tailored to the needs and abilities of the patients. Our framework has been developed and evaluated iteratively and has been tested successfully in our laboratory.
... Each scoping review consisted of systematic literature searches in several electronic databases and complementary searches via Google Scholar and reference lists of eligible articles, followed by systematic two-step selection of relevant articles and standardized data extraction (Tricco et al. 2018). The primary data collection comprised (i) 10 semi-structured, non-participating observations by members of all project team partners in two ICU wards, (ii) semi-structured topic-guided face-to-face interviews with 16 ICU patients directly after being successfully weaned off from a respirator and 16 relatives of such patients, (iii) three focus groups with 26 nurses, one physiotherapist, and one chaplain, and (iv) semi-structured topic-guided face-to-face interviews with 6 ICU physicians (Henkel et al. 2018). The main purpose of the observations was to ensure that key members of all project partners share a basic understanding of the ICU care environment, the goals and procedures of nursing and medical care for ventilated patients and the symptoms and needs of patients undergoing weaning from mechanical ventilation. ...
In intensive care units (ICU), mechanically ventilated patients undergoing weaning from the respirator represent a highly vulnerable population. To support their early re-orientation and participation, the ACTIVATE project aims to develop and pilot a socio-technical system that facilitates the communication between these patients and
the ICU health care team. Such digital health technologies (DHT) need to be assessed in terms of ethical, legal and social implications (ELSI) before they can be introduced in health care practice. In the ACTIVATE project we chose the Model for Ethical Evaluation
of Socio-Technical Arrangements (MEESTAR) as guiding theoretical framework to assess relevant ELSI. Based on our intermediate findings and experiences, the objective of this article is to reflect on the applicability of MEESTAR to the assessment of ELSI of support systems targeting the acute care for critically ill patients. Following
the Socratic approach, various data sources and research methods are iteratively applied for the ELSI assessment of the ACTIVATE system under development. Numerous positive implications and potential challenges, varying with the perspectives of patients and health professionals, especially nurses, were identified. Based on the
preliminary findings and experiences, we expect that the implementation of the Socratic approach in combination with MEESTAR will ensure that relevant ELSI of the ACTIVATE system will be early detected and taken into account in the development and adaptation of this support system.
... 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.
... 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 (Henkel et al., 2018). An organization and a task analysis gave additional information on the context. ...
Due to the obstruction of verbal communication, mechanically ventilated patients in intensive care units often cannot impart their basic needs. Possible consequences are a prolonged healing process, delirium, and other complications. To overcome the communication barrier, we provide a specialized solution to support communication in intensive care. Since patients bound to the bed are not able to use traditional devices efficiently, we develop a novel interaction device tailored to the intensive care context. In this paper, we present key requirements for the device, which are relevant to the interaction itself. These requirements resulted from a human-centered design process consisting of two studies, several workshops, and a comprehensive user and context analysis. We identified three categories relevant for the interaction, namely look and feel, sensors and actuators.
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.
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.