Preparing hospitalized heart failure patients for the anamnesis interview

Preparing hospitalized heart failure patients for the anamnesis interview

Görtz, R.J.C.

De Ridder, H. (mentor)
Vermeeren, A.P.O.S. (mentor)

Industrial Design Engineering

Industrial Design

Master of Science Design for Interaction

2013-04-25

Heart failure patients suffer from a chronic condition that is caused by decreased efficiency of the heart muscle. This limits the physical abilities of the body, and can lead to emotional problems such as depression and anxiety. Heart failure patients generally experience frequent hospital readmissions, and the medical treatments in the hospital are very expensive. In recent research on 'Patient-Centered Care', a structured approach was proposed to create a better cooperation between patients and healthcare professionals during hospitalization. This way, the medical treatment and setup of the care plan can be better tailored to the specific needs of patients. This increases patient satisfaction, improves treatment adherence and can lead to better health outcomes. Following these results, Philips was interested to explore this care approach for hospitalized heart failure patients. The goal of this project was to: "Design an interactive system that increases patient involvement in the development of their personal care plan during hospitalization." Through literature research and observational studies in two hospitals, information was gained about the hospital environment, structure and treatment process in practice. This was followed-up by performing a series of detailed interviews with cardiologists, nurses and patients. This provided thorough insights into the problems of the current hospitalization process, and opportunities for engaging patients in their care more explicitly. Three concrete design directions have been introduced as a result of the research and analysis phase: 1. Support the patient in describing and discussing their personal narrative 2. Support the care plan formulation process by the cardiologist and nurse 3. Support the presentation of the care plan to the patient After an exploration of these directions, it was found that an improvement in the anamnesis procedure would provide the most interesting design opportunity for this project. The explicit design goal was to: "Design an interactive tool to sensitize patients for reflection on their personal situation, and to stimulate them in exploring and expressing their perspective in a ‘lightweight’ and playful manner to the care team." Through an iterative process and close cooperation with medical staff, a design proposal was developed to demonstrate how hospitalized patients can be better involved in the nursing anamnesis interview. The design principle and content of the tool were based on sensitizing techniques from design research, and the theoretical anamnesis framework of Gordon. The development of the concept was based on the anamnesis subject of 'Self-Perception', which resulted in six exercises for the tool design. These exercises focus on the subjective thoughts, feelings and attitudes about oneself. During the design process, the most important design challenge was to find a balance between simplicity of the exercise and meaningful sensitization of the user. The conceptual design and the effect of using the exercises was evaluated during a user test with six participants in an elderly center. All exercises were performed without problems by users independently, and the participants were quickly engaged with the tool. The design was considered to be friendly and open. It helped users to communicate their point of view on the discussion subjects with valuable nuances. The final design of this project is a playful digital application for patients, to improve the quality of the anamnesis. It can be used by patients independently and directly from their beds, on the interactive terminal at their hospital room. The application has two main goals: 1. Sensitizing the patient for the personal subjects of the anamnesis interview. 2. Supporting the discussion of the patient's narrative with the nurse. The design facilitates these goals by providing specific self-reflection exercises that help the patient to understand and communicate about their personal perspective in an easy accessible manner. During the anamnesis interview, the exercise input created by the patient forms starting points for the discussion with the nurse. Through mutual exploration of the produced content they can better locate and act upon potential care problems and opportunities. At the end of the project a final evaluation was carried out with a nurse and heart failure patient from the polyclinic, based on a paper prototype of the application. The goal was to evaluate the design, the potential implementation and its contribution to the quality of care. The results show that the application succeeds in stimulating for self-reflection on the exercise subjects, and that it helped the patient to explain her point of view effectively. The tool makes personal subjects accessible to talk about because of the friendly approach and emphasis on visualizations. The exercise content is balanced for keeping clear visual overview and was found to provide sufficient input for constructing personal stories. In comparison with the current anamnesis approach of asking explicit questions, patients can now discuss personal information more freely and from their own interpretation of the anamnesis subjects. This leads to a more natural and deeper conversation with the nurse. With this input, the care team is better able to provide care that suits the patient adequately.

interaction design
hospitalization
nursing anamnesis

http://resolver.tudelft.nl/uuid:d157228c-8373-4f7d-8c71-23d788649905

2014-04-25

Campus only

Student theses

master thesis

(c) 2013 Görtz, R.J.C.