Nicola Liston Empathic Design by nikki liston

empathic design

empathic design a comment on the re-design of hospital furniture

Nicola Liston s3377561

Mentor: Scott Mayson

RMIT Industrial Design Honours

All design, photography and graphics by

Nicola Liston

Thanks to...

Scott Mayson- for directly telling me when I was just plain wrong

Simon Cunningham -for putting up with e-mails, texts and calls regarding timber questions at all hours of

“It look’s like a cat spewed on it” -Dr Mayson 2015

Messages Simon Cunningham

the day and night.

Details

Cross grain is what I’ll need yeh? Tue 13 Oct 1:45pm

yeah it only comes in long grain im pretty sure Fuck

It’ll work this way Oh k niccccee What thickness would you think?

Bryan Cush -for being a fantastic sounding board and wealth of knowledge

Messages

Bryan Cush

Details

Hahah that’s it! I may require your expert opinion on what fastener you think would be best if you have a minnie tomorrow? http://pages.ebay.com/link/?n av=item.view&alt=web&id=37 18360699&globallD=EBAY-AU 6g x 3/4” Stainless Pin Torx Self Tapping Screws (3.5mm x 20mm)x100 I would say for hospital use you would want something tamper proof (similar to the torx pin screws I used in the struts table). Self tapping with quite a tight thread for hardwood is what I generally use.

Thanks to...

Andrew Hustwaite -for informing me on the ins-outs of steel and making steel happen!

Catherine Mahony for letting me pester her with

question of “how would a nurse do this..” nearly daily

Messages

Details

Cad Fri 27 Mar 5:12pm

Adjectives decribing the hospital environmentl/daily life Fri 27 Mar 7:28pm

Today’s not a good day to ask: exploitation, frustrating, peopleareidiots, stupidsystem Sat 28 Mar 1:20am

Bar bae Naw*

Sally Bourke letting me pick her brain on subjects of aged care facility

Wendy Sansom exposing me to the hospital

environment and the treatment of pressure injuries Mum and Dad for being polite, feeding me when I

forget to eat and letting me leech for one more year despite their best interest.

Messages

Mama

Details

Sun 13 Sep 4:34pm

Going to get drumstick or magnum -want one?? Magnum please! Thanks Almond?0 Yes please Magnum here Fri 2 Oct 6:56pm

Do you want something from the fish &chip shop in Port Melb? Grilled fish or souvlaki? No thanks mum. Thanks I’m actually at caths Read 2/10/2015 Saturday 8:35 pm

Tea is ready

You’ll never really understand someone until you’ve considered things from his point of view… Until you climb inside his skin and walk around in it” -Harper Lee, To Kill a Mockingbird, 1960 7

Table of Contents Sebastiaan Pijnappel: Mimosa

Introduction How I came up with this What it means

what is the state of things?

What is a Pressure Injury (PI)

The Market

A background

Assessment Scales

Physical Inverventions

Quantitative costs

Lifestyle Variables Reflection

Methods Aged care Site visit Langford Grange

Hospital site visit Eastern Health Box

Reflection

The Field

Hill

Royal Childrens Hospital Site Visit: The positive impacts of natural shapes

Interview with Jack Fisher

on the healing process

Research: What is an Ideal

DESIGN DEVELOPMENT

Australian Policy

Political and Social trends

Reflection

Combining all the elements

Interdisciplinary approach

PRECEDENTS Factory 15 Cocoon

Immersion Experience Symposium

2015:

Neri Oxman: Gemini Longue Benjamin Hubert: ‘Pod’

Muka Design Lab: Reves Chair

Positive distractions within the care

Medical Research In The Future

Recuperative Environment?

CONTEXT AND APPLICATION environment

APPENDICES CitatioNS

42 43 44

100

130

141

160

Introduction Rethinking Furniture in the Care Environment

I first considered this project after having a

C: “Sometimes I find myself having to convince

of Victoria’s most renowned private hospitals.

is a good idea. It’s like I’m educating them of

coffee with my friend C, who is a nurse at one

patients that moving from where they are lying

We talked about the plans for the weekend and

their health, when really I need to be doing

once we had each decide on which onesie

other things. Sometimes if I’m on nightshift, or

we would wear, I asked her a very mundane

I’m ‘rostered’ to a ward where there are heaps

question, mostly out of politeness…

of patients, I just don’t have the time.”

Me: “So How’s work”

I watched my friend’s expression change. Her

C explained to me that sometimes in her ward,

and a hint of anger washed over her features.

incredibly painful for patients. PI’s have a

brows furrowed and a sense of hopelessness

patients get Pressure Injuries (PI) which are

I knew this look well as I’d seen it a few times

number of contributing factors. However, as I

when we were discussing men, or lack-there-of.

was to discover later, the most common- and

C: “Well….” (deluge of information) eyebrows

arguably the most preventable, is mobility.

raised emoji

As I continued to listen to my friend express

C proceeded to disclose her frustration at her

her disappointment I heard the sense of

inability to help her patients, I knew she was

resignation in her voice, which I really consider

perfectly capable as she has always had this

dangerous in her profession. There is of course

really deep maternal intuition about her. You

no malice in her actions and I wouldn’t consider

see aside from having to have an expansive

it negligence or incompetence more or less it

medical knowledge base, nurses are also

is an issue of the affordance of her time. In the

required to have an excellent beside manner

international currency time is money.

which requires that ‘maternal aspect’ to

manifest itself into a kind of empathy that allows her to do her job effectively.

Abstract

Pressure Injury, Hospital furniture, Empathic Design, Vulnerability, Rethinking

design assist in providing an experience that

will reduce the necessary time a patient spends within a care environment?

When entering a hospital environment it is not uncommon for patients or visitors to perceive the space as a cold, sterile or unwelcoming

experience. In many instances, a visit to the hospital may be because of undesirable

circumstances. Patients have expressed

feelings of exposure and vulnerability during

The market aesthetic for hospital furniture has

become stagnant. It appears as though design has been purely fixated on function — failing to recognise the detrimental impact of their

design choices — with off-white, tubular, non-

porous, antibacterial-surfacing decision-making processes.

treatment and rehabilitation. These feelings

Through developing an empathic holistic

effected sleep patterns, hypertension and more.

psychological needs during their stay, this

become physically evident within patients via

These factors are likely to hinder the patient’s rehabilitation and extend their stay within a hospital setting.

Through reviewing local and international

understanding of patients’ physiological and project explores means by which design,

through the medium of furniture, can create an environment that effectively assists in patient rehabilitation.

hospital data, this research has revealed that a large proportion of patients, during both short

and extended stays, have a very high chance of developing a pressure injury. This development is then likely to further extend a patient’s

stay, which therefore decreases the number

of available beds and increases government expenditure on health.

These factors all raise the question: How can

Introduction

â&#x20AC;&#x153;Patients felt disempowered, longer worth living...â&#x20AC;? Vic Government Health Information 22.03.2008 (A report on the impact of Pressure Injury on quality of life)

many felt like life was no

How does it get to this point? What can we do? 13

Introduction What is Empathic Design?

Notions of empathy are difficult to express

Empathy and Sympathy:

something one can bottle and place on their

sympathy suggests. Rather, empathy is an

day.

state with an understanding of how it must feel.

the built environment that designers can

feel we need experience what they experience

in a tangible form.Empathic feelings are not

We do not feel sorry for the user, as

desk and retain as a keep-safe for a miserable

acknowledgement of a feeling or an individuals

There are however, means and ways through

In order to understand how an individual must

provide an experience that evokes empathic feelings from the user.

Introduction

In this project I researched with the

Site visits to:

ambition to understand:

-Box Hill Eastern Health Hospital

-Langford and Grange Aged Care facility

- The emotions and journey of a patient within a

-Royal Childrens Hospital

hospital environment (both long term and term)

-The Victorian Comprehensive Cancer Centre

following trauma

(VCCC)

-The experience of being a nurse within a public and private setting

Reviewing copious amounts of research

-The problems faced by Aged care nurses

papers

-The management and treatment of Pressure

With a focus on:

Injuries within aged care facilities and Hospital

-Government Healthcare Expenditure

environment.

-Future prospects for healthcare with an

Through interviews with:

ageing population

-Jack Fisher (Long-term trauma patient)

Wendy Sansom (Stomal Therapy / Wound

-The impacts of aesthetics to pysiological and

-Sally Bourke (Clinical Services Manager)

-The impacts of colour on health

-Nature references in design

Clinical Nurse Consultant at Eastern Health)

psychological health

Langford Grange Aged Care Facility

-Catherine Mahony (Orthopaedic Nurse

-The impacts of form on health

-Noise related stress and anxiety

The Field

What is the state of things? A BACKGROUND

WHAT IS A PRESSURE INJURY?

The occurrence of pressure injury (PI) during

to highlight these risk factors yet we find that

stays in hospital remains an international

problem for global healthcare. Since 2008

conclusions have not been clearly drawn.

hospitals in The United States no longer receive

According to the European Pressure Ulcer

Stage IV pressure injury that develop during a

Pressure Ulcer Advisory Panel (NPUAP)

reimbursement “for care related to Stage III and hospital admission”(NBCH, 2009)

Currently there is no clear way to determine appropriate action of either preventing the

occurrence of a PI or treating a PI. This may

be due to the fact that insufficient research has been done to explore comparisons in current

products or treatments. Perhaps it is due to the fact that each patient may present with varied combination of risk comorbidities, thereby

meaning that a ‘blanket approach’ may not be applicable in treatment or prevention.

In any case, there remains a consensus that

pressure ulcers are a considerable burden to our healthcare system; utilizing commodities of time, expense and causing an impact on

quality of life. Research has been undertaken

Advisory Panel (EPUAP) and the National

“A pressure ulcer is localised injury to the

skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A

number of contributing or confounding factors are also associated with pressure ulcers;

the significance of these factors is yet to be elucidated”(NPUAP, 2013)

What the NPUAP and EPUAP definition

explores is the concept that medicine has not yet fully identified all the “factors” involved

in pressure injury development or treatment. This conclusion means that further research

is needed. This research may be in the form of a design perspective or it may reach its

conclusion from another discipline. Through

The Field

my research I will attempt to develop designs

Braden Scale:

Injury

level of risk for development of pressure

role in the treatment and prevention of Pressure

“Use the Braden Scale to assess the patient’s ulcers.”

ASSESSMENT SCALES

The evaluation is based on six indicators:

sensory perception, moisture, activity, mobility,

In an effort to examine the likelihood of an

nutrition, and friction or shear.”

individual acquiring a pressure injury during

their stay, most hospitals or aged care facilities

Scoring:

several assessments; the most widely used

made up of six subscales scored from 1-3 or 4,

will carry out a form of assessment. There are

The Braden Scale is a summated rating scale

are the Braden Scale, The Norton Scale and

for total scores that range from 6-23.

the Waterlow Scale. These assessments need

A low Score indicates a “lower level of

to be completed within twenty-four hours of

functioning and, therefore, a higher level of risk

admission, to ensure that any patient admitted

for pressure ulcer development”.

with an existing pressure injury can be properly

“A score of 19 or higher, for instance, would

covered by their insurance. If the assessment

indicate that the patient is at low risk, with no

does not take place the within twenty-four

need for treatment at this time.” The score

hours it is concluded thereafter that the injury is

significance of the score consequently plays

acquired within the hospital and therefore costs

a role in the medical treatment of the patient.

will be covered by the hospital.

(Braden, 1998)

With the above scale we would naturally

make the assumption that given nurses have

The Field

knowledge of a patients predisposition to

acquiring a PU they would do everything in their power to decrease the occurrence. However,

treatment of pressure injury.

Thomas (ibid) contends that there is “ no

THE MARKET

be attributed to the use of an assessment scale,

Currently the market of pressure injury treatment

decrease in pressure ulcer incidence that could despite an increase in intensity of interventions” Rotation and Movement Immobility is considered to be the biggest cause of PI development.(See table) In an

effort to reduce the likelihood of development

nurses are advised to move that patient every

two hours (Thomas, 2014) or four hours (kruger, 2013). By providing movement for “5 minutes ” the movement through limbs and subsequently

and prevention is broad and varies depending on the location of the pressure injury. Pressure injuries occur at numerous different sites all

over the body (see figure). This creates a wide array of products tailored to specific areas.

Pressure Injuries are mainly “predominate in the sacrum and the heel” (kruger, 2013). These two areas have an extensive amount of products

that have been developed with a specific focus on the treatment and healing process.

reduces pressure of tissue and bones and will

The Boot:

breakdown.” (kruger, 2013). Not all individuals

foam boot, the air boot and the fibre boot.

“allow adequate perfusion and prevent tissue

The boot comes in different forms such as the

are able to be mobile during their stay in Aged

Care or the Hospital environment. This has

caused a proliferation in products available to the patient aimed at both prevention and

-Foam boot limitations is that it gets hot

-Air boot, lightweight but must maintain the air pressure

-Fibre boot the fiber wicks to take away

The Field

heat and moisture. Some brands are covered

of pressure ulcers compared to standard

assit patient bed mobility

are three different styles of support surfaces,

with a slick surface that is easy to clean and

hospital mattresses”. (Thomas, 2014). There which include mattress overlays, mattress replacements and specialty beds.

Sheepskin: Sheepskin has been attributed to a reduction of

shear(Damien J Jolley, 2004). However, through

Mattress overlays: Mattress overlays are

is not seen as a feasible treatment. The nature

-can use water, gel, foam, air, and combinations

discussion with Wendy Sansom sheepskin use

designed to be applied directly over a mattress.

of the product requires great care in washing

as mediums

and maintaining the material texture. Sansom

-can be static redistributing pressure over a

concludes that “inevitably the material ends up

wider tissue area) or dynamic systems (using

being boiled in the hospital laundry and loses

a power source to alternate air currents and

it luster” ironically causing issues of friction for

pressure against the body)

the patient.

Mattress replacement systems: are for the use on a hospital bed frame without an underlying

Surface Pressure Reducing Devices: The Air mattress is commonly used in the

mattress,

hospital environment, their availability and brand is dependent on each institution.

can use water, gel, foam, air, and

can be static or dynamic

combinations as mediums

Whilst “one type of device has not been

shown to be superior to another… (it has

Specialty beds: are freestanding entire units in

been recognised that there is a) clear benefit

place of hospital beds Specialty beds include

of pressure-reducing devices in prevention

low-air loss beds (utilizing separate air-filled

The Field

cushions individually monitored) and air-

pressure ulcers varies between(Foster, 2012)

silicone beads to simulate a fluid environment)

$70,000 respectively.

fluidised beds (utilising warm air forced through (Kruger, 2013)

PHYSICAL INTERVENTIONS BY

and Thomas to be between $40,000 and

-it is estimated the overall cost of PU’s to US each year is $11 billion. (Thomas, 2014)

HOSPITAL STAFF

LIFESTYLE VARIABLES

-Reduction of shear forces by limiting the head

Age:

-Placing soft pillow under the heel (Damien J

to damage due to thinning and increased

of the bed to an angle below 30°(NPUAP, 2013)

We know that “aging skin is more susceptible

Jolley, 2004)

friability”(Romanelli, 2006). In conjunction

-rotation of patient every two to four hours QUANTITATIVE COST In an effort to derive meaning from what

with age being a risk factor we also need to

account for the fact that “One of the outcomes

of advancing medical technology is that people are living longer.”(Prentice, 2009).

exactly pressure injury quantifiably costs the

This prevalence of PU’s in the elderly is seen

monetary costs and death rates.

population accounts for about 70 % of all

community, some statistics place emphasis the -The rate of death through pressure ulcer

complications in the US alone is estimated to be at 60,000 (Thomas, 2014) and (kruger, 2013) -The estimated cost of treatment of single

in a finding that concluded that the “geriatric pressure ulcers”(Thomas, 2014)

Nutrition: In an annual report given by the Alfred Hosptal a study found that of their

The Field

different methods of treatment to patients. There

underweight patients in 2008 “Over 50 per cent

remains no set cure to pressure injuries, rather

were found to have pressure ulcers” this was

suggestions are offered to primary caregivers

then compared to “20 per cent in the healthy

by researchers to prevent and treat.

weight range and 15 per cent in the overweight

With the help of design an effective solution

range.”(Williams, 2008)

could be found to reduce the incidence

pressure injury. Through utilizing different

Complications:

design methods we can collaborate with other

-External factors such as the resource of time

professionals and explore varied ways in design

management of nurses.

can assist

-Difficulty in diagnosing, due to nature of the pressure injury

INSIGHT

REFLECTION

An interesting concept was that several papers

Overall Hospitals and Aged Care facilities are

including Thomas and Romanelli contended

presented with the difficulty in preventing,

was that “Pressure ulcers cannot always be

identifying, and treating pressure injuries. Each

prevented”.(Romanelli, 2006) Which has led me

of these areas listed above requires further

to further examine the risk factors and their role

exploration so as to correctly diagnose and

into the eventual outcome of a pressure injury.

treat the patient. The aptitude in a nurses ability to classify patients and the time consuming method of rotation every two hours causes

considerable strain on the finite resource of

a nurses time. Comorbidities and risk factors vary between patients thereby determining

Soooo...

WHERE

It DOES

S I T ? In which context

Why is it relevant?

Who cares?

collaborative

furniture

design

empathic Medicine

Research

design

Context and Application Positive distractions within the care environment

Positive distractions within the care environment

NATURE

reduce stress.

“Mounting research is providing convincing

LIGHTING

improves outcomes such as stress and pain.”

have been found by research to effectively

Beauchemin found that lighting can play a very

influential role in helping to combat depression.

evidence that visual exposure to nature (Robert Ulrich, 2003)

A study in a Swedish hospital found that

In a study conducted in 1996 Beauchemin

patients who had recently undergone heart-

severe depression could “reduced their stays

natural scene, reported “less anxiety/stress and

exposed that patients admitted to hospital for by an average of 3.67 days if assigned to a

sunny rather than a dull room”.(Beauchemin KM1, 1996)

“Using light as an intervention to reduce

depression in clinically depressed as well as non- depressed patients is a relatively

surgery that had a landscape picture with a

needed fewer strong doses of pain drugs than a control group assigned no pictures” (Ulrich, 1991).

Another group of patients assigned an abstract picture, however, had worsened outcomes compared to the control group.

inexpensive intervention that has been shown to yield consistently positive results” (Ulrich, 2004).

Context and Application

A randomised study found that adult patients

undergoing a bronchosopy procedure reported less pain if they were to look at a nature scene mounted on the ceiling rather than a blank

ceiling (control condition) (Gregory B. Diette, 2003)

A study of cancer patients has shown that

virtual reality can dramatically affect a patientâ&#x20AC;&#x2122;s health. The study suggests that when patients were shown a nature walk while in bed or a

hospital room they showed signs of reduced

anxiety and symptomatic distress. (Susan M. Schneider and Linda E. Hood, 2007)

Context and Application â&#x20AC;&#x153;Even fairly brief encounters with real or

simulated nature settings can elicit significant

recovery from stress within three minutes to five

minutes at most (Parsons & Hartig, 2000; Ulrich, 1999). Investigators have consistently reported that stress-reducing or restorative benefits

of simply viewing nature are manifested as a constellation of positive emotional and

physiological changes. Stressful or negative

emotions such as fear or anger diminish while levels of pleasant feelings increase.â&#x20AC;? (Ulrich, 2004)

By comparison, considerable research has demonstrated that looking at built scenes lacking nature (rooms, buildings, parking

As designers it is our objective to improve

the human condition. Ulrich and others, have continuously contended the many benefits of nature and its impact on physiological

as well as psychological states. Within our

endeavours to create, it is imperative that we create with meaning and reason behind our design decisions. It is not enough to merely

place something in an environment with little

consideration to the aesthetic impact on the user. We can take our cues from nature by

incorporating curves and radiating warmer

hues. Each of these homages to nature will aim

to act as triggers for the user to be reminded of a place beyond hospital walls or an aged care facility.

lots) is significantly less effective in fostering restoration and may worsen stress. (Ulrich, 2004)

Context and Application

Currently the Australian population average

MEDICAL RESEARCH IN THE FUTURE

years in 2012. This is up from 13.3% in 2009.

The medical and scientific field of research

is not sustainable for Australian Government.

to continuous expenditure on research by

age is increasing, with 17% of people over 65 (ABS, 2012) Some research suggests that trend As life expectancy increases, experts detail

how health expenditure is disproportionate to Gross Domestic Product (GDP) (ABS, 2012)

However, others have been more cautionary in drawing a direct link, suggesting “it is…

unclear if increases in life expectancy will be accompanied by more years in good or poor health” (Chomik, 2014)

AUSTRALIAN POLICY Policies in Australia are based on statistical

analysis that is forecast by experts who look

at current trends to determine potential future

outcomes. The future growth, distribution and

is not static, and their dynamism is attributed government to improve the human condition.

This objective of constant improvement of the human condition is something that designers should also continuously strive for.

When looking at the potential outcomes of

my research it is integral that I incorporate

any progression in medical research into my

project. In an effort to design for the future, it is paramount to interpret what that may look

like. In this instance this can be done through examining current societal, political and

cultural trends surrounding the medical realm and determining likely patterns.

age structure of the population are key factors

The Australian Government explores future

issues in Australia. This extrapolated data is

from the best data currently available. Every

underpinning many analyses of long-term policy used to structure policies on “service provision, such as health and aged care.” (ABS, 2009)

opportunity and designs policies established Five years the Australian Government collates the ‘Intergenerational Report’. This year

Context and Application

(2015) the ‘Intergenerational Report’ has been

less people are expected to produce more, and

in 2055. The report describes the three P’s

those unable to work.(Hockey, 2015)

released with forecasts of Australian trends

are expected to take on more responsibility for

responsible for driving the economic growth of our country-Population, Participation and Productivity.

Dr. Karl Kruszelnicki asserts “currently our population is larger in size and older in

1975

years”(Kruszelnicki, 2015). The report suggests that the population size could double to as

many as 40 million in 40 years. It goes on to

predict that of this 40 million, there may be 7

million Australians over the age of 65. With this growth we would expect a growth in GDP. However, we are finding the inverse to be

2015

true. In 1975 the report found that there were

7.3 people in the age bracket between 16-64

working, for every one person over 65. Today we find 4.5 for every 1 person over 65 and

the report forecasts that there will be only 2.7

people participating in the workforce for every one person over 65 by 2055. This means that

2055 Participants in the workforce proportionate to every one person over 29

65 years old

Context and Application INTERNATIONAL PROJECTION PROPORTIONS OF POPULATION OVER 65 YEARS

Australia

China

40% 35% 30% 25% 20% 15% 10% 5%

1995

1990

1985

1980

1975

1970

1965

1960

1955

1950

Context and Application

2050

2045

2040

2035

2030

Japan

2025

2020

2015

2010

Indonesia

2005

2000

ndia

Graph 1)

Context and Application

1.4% of Australians total Healthcare expenditure is spent treating Pressure Graph 2)

Injuries.

However, it is a global problem

Context and Application

Total Health expenditure to GDP ratio, 1986-87 to 2010-2011

10%

HEALTH EXPENDITURE TO GDp RATIO (percent)

9% 8% 7%

Source: AIHW Health Expenditure Database

Year

2008-09

2006-07

2004-05

2002-03

2000-01

1998-99

1996-97

1994-95

1992-93

1990-91

1988-89

1986-87

2010-11

Context and Application

THE PROBLEM

OPPORTUNITY

Political and Social trends

Interdisciplinary approach

As mentioned above the statistical analysis

Through the lens of design I hope to identify

growing population. In conjunction with an

contribution in reducing the strain on our

suggests a continuation of an ageing and expansion in overall population we would

expect to see an increase in our nations GDP.

However, with an increase in the elderly population we are not experiencing the

correlating increase in GDP that should be

proportionate to population growth. Instead we

find that if much of the population is the elderly, and is unable to work than the contribution to

GDP decreases and the budget for healthcare needs to increase. Such inverse growth is not

sustainable. In an effort to reduce the impact of

factors that may be altered to have an effective healthcare system. We can hope to reduce the incidence of hospital acquired pressure injury through the medium of furniture. The furniture

encourages its use and therefore encourages independent ambulation of patients. The

benefits of independent ambulation are many

as listed on page 25. In all of this we can hope

to reduce hospital spending on treatment of PI. If a reduction in incidence could be achieved,

it is likely that we may see more beds available, as days spent in hospital are â&#x20AC;&#x153;almost doubledâ&#x20AC;? by the acquisition of PI. (kruger, 2013)

this burden there are areas where design may be able to help.

Context and Application

PROBLEM

concludes that the hospital acquired pressure

Immobility

problem for a resource- constrained public

injuries are “a serious clinical and economic

hospital system (Graves, 2005). The experience

Over the course of 2002 to 2006 the Victorian

of a time poor and ‘constrained’ hospital system

Quality Council (VQC) conducted a state-wide

is not unique to public hospitals.

survey biennially on “The prevalence of PI

within Victoria’s health services.” Their findings

As ‘C’ contends that, constraints and “budgets

acquisition is immobility (Strachan, 2006). In

-(C,2015)

suggested that the biggest risk factor to PI

are also an issue in private healthcare”

conjunction with immobility the report contends that pressure injury prevalence should not be

‘C’ is a nurse currently working within one of

considered inevitable but rather preventable

Victorias largest Private Hospitals. Through her

(Strachan, 2006)

experience ‘C’ often finds herself “unable to

dedicate enough time” with one patient. Within

INTENT:

her ward ‘C’ often needs to rotate patients

to alleviate pressure injury and encourage

The chair needs to be designed so as to

individuals to get out of bed for a range of

relieve the burden that is currently placed on

health reasons. (mind map on my to get out of

nursing staff. To reduce this burden we need to

bed?)

determine the factors that discourage (or make difficult) independent movement.

‘C’ adds “encouragement can be difficult

as I try not to be too harsh. The problem is

One report conducted by the National

that I need to educate the patients on the

Centre for BioTechnology Information (NCBI)

consequences of their immobility” which

Context and Application

can often be “really time consuming and

-If the patient is obese a hover mat would be

patients, of which 3 had pressure injuries. This

All of these steps require skill and can consume

for examination and coordinate multiple moves

Overall the process needs to be reviewed

frustrating”. In one shift ’C’ was assigned with 7

required

required ‘C’ to fill out numerous patient charts

a lot of a nurse’s time.

and rotations for her patients.

An outline of the process involved in

inflating an air mattress for a patient

with a pressure injury within a private hospital:

-Acquire a spare bed frame

-Wait for half an hour whilst the air mattress inflates

and this is the area where potentially design can play a role and explore time saving and

intuitive systems or products that would assist the nurse. If this were to eventuate the likely outcome would be that more time could be

spent on treating patients diseases rather than this hospital acquired pressure injury.

-Place appropriate friction-reducing linen on the

PROBLEM:

-Check to ensure that the mattress isn’t

Detriment to quality of life

through the air mattress) and adjust the airflow

For design to continue to be relevant in the

-Ensure that the bed settings are supportive to

improving the human condition. In a report

bed

‘bottoming out’ (where the bed frame can be felt accordingly the patient

-Arrange for four medical staff to move the

patient from one standard high-density foam mattress to bed to the air mattress.

future, we need to articulate our intent on

by undertaken by Victorian Government in

2009 the researchers uncovered that patients undergoing treatment for pressure injury felt that:

Context and Application

“quality of life is deteriorated considerably, with patients feeling a sense of disempowerment and that life was no longer worth living” (DOH, 2009) This “sense of

OPPORTUNITY:

be addressed. Illness and injury is something

these are the linchpins for establishing an

Developing empathy The psychological effects are invaluable to the

disempowerment” is something that needs to

eventual outcome of the project. Essentially

that interferes with our quality of life. Within the

empathetic relationship which will help to

sporting world it has been well documented

drive my decision making process. These

that athletes dealing with injury feel a sense

psychological effects are key in the area of

of “simultaneous mood disturbance and

improving quality of life. To help gain an

lowered self esteem”(Smith, 1990). The link

understanding of these psychological effects I

between these medical diagnoses is that

have recorded some accounts of impairment to

the psychological state of a patient can be

quality of life as expressed by the nursing staff.

affected from a form of physical impairment.

Design has a major role in changing this sense

“I once looked after a resident who had MS. She

physical outcomes of pressure injury we are

wheelchair and She weighed 130kg. She spent

of disempowerment. Whilst we can see the

spent 16 hours a day in a poorly fitting electric

often unable to determine the psychological

lots of time outside of the facility visiting friends,

disadvantages of such a physical injury

going to bingo, shopping and baby sitting her grand daughter. Unfortunately the pressure

caused a 9cm deep 2cm round pressure ulcer on her sacrum. She became bed bound with 2 hourly turns 24 hours a day. She could no

longer do the things she enjoyed doing. She

Context and Application

became reclusive and was diagnosed with

depression, which was treated with medication.

Of particular interest is Standard 8, which

pressure ulcer by which point she had given up.

patients from developing pressure injuries

It took 8 months for us to properly heal the

She no longer wanted to leave facility, gained more weight and became extremely hostile to staff.

-Anna Teper

As designers it is imperative that through

prototypes and iteration we can discover novel and exciting ways to challenge the status quo. REFLECTION

Within current settings we find that Pressure

Injury has been identified as a major problem

was developed with an objective to “Prevent and effectively manage pressure injuries when they do occur.”(Picone, 2015) This inclusion into the government-supported standards, demonstrates that there is recognition at a

national level of the impact of pressure injury on the hospital system. Also ‘Standard 8’s’ inclusion in NSQSA helps to establish PI

treatment and care as a priority within the broader community’s consciousness.

Having a detailed understanding of current

for Government. It is estimated to be costing

policies surrounding pressure injury will allow

(MTAA, 2014)

to implement my project. Through exploring

the Public Health sector $2.6 billion annually.

The National Safety and Quality Standards

and Accreditation (NSQSA) are a Government funded Commission. In 2006 the commission developed standards designed “to lead and

coordinate national improvements in the safety and quality of health care.”(ACSQHC, 2014)

me to determine the proper means by which

accounts described by those nurses working within the environment I hope to establish an

empathetic base from which I can make more considered decisions. Through ideation and prototyping I hope to continually grow and

develop my project. Most importantly I think that this project will need to be approached from both a preventative and treatment

perspective, as both are incredibly important to address.

Context and Application

Reduced risk of chronic diseases, such as cancer, cardiovascular disease and type II diabetes

Improved weight management Reduced risk of developing musculoskeletal disorders.

well being from a psychological perspective as well as physical one

its about providing an escape from our surrounds self ambulation freedom options

creating something aesthetically powerful enough to invite its use

Through colour Through taking references from nature which

studies have shown have a calming effect on patients

Through collaborative and empathetic design methods

Through prototyping different iterations/ ideations 39

Precedents

Factory 15 Cocoon Immersion Experience Symposium 2015:

“Cocoon is a 360 degree by 220 degree

spaces, which slowly peel away.

directed and produced by Factory Fifteen.

is transitory, evolving, animated. Our city is

spherical, immersive video installation

Cocoon places the participants inside several shells of abstract and figurative architectural

Cocoon believes architecture is not static, it our cocoon”.

-Factory Fifteen(2015)

Precedents

Cocoon was exhibited at the SAT Immersion

consider future environments. These designers

2015.

reside in their heads through mediums of

Experience Symposium in Montreal in May

are communicating these visualisations that

sight and sound. We are taken on a journey

Cocoon is an immersive visual piece that

that physically envelops us. Where ‘Cocoon

takes the user on a journey. It affords people

dramatically varies is that is does not attack

the ability to imaginea different reality with the

the sense of touch, We cannot feel the future

assistance of visual aids.

through this medium none the less the notions of escapism are relevant.

Factory 15 is “radical animation-architecture studio. Factory 15 present a series of films

depicting very different future worlds. They

mould their wildly imaginative future scenarios into ultra-detailed shorts that are at once

cautionary tales and fantastical celebrations

of modern technology’s infinite possibilities”. DAZED.

http://www.factoryfifteen.com/7931/studio RELEVANCE The relevance of this animation architecture lies in its radical concepts of escapism.

Cocoon presents people with an opportunity to

Precedents

Neri Oxman: Gemini Longue

RELEVANCE The relevance of Gemini is its ambition

to provide a secluded environment. The

piece is very conceptual. Gemini’s reclined design means that individuals would be

Through this low reclined chair Oxman creates

“a semi-enclosed space surrounding the human with a stimulation-free environment” http://www. materialecology.com/projects/details/gemini the nodes created through 3d printing that

unable to easily get in and out of it. The

feature on the interior surface of the lounge

use the furniture is really important to my

noise reduction is particularly pertinent in the

simple functionality of being able to easily piece. It is expected that many patients

may have different physical disabilities. The piece of furniture is one element to a whole experience of relaxation, recuperation and

act as sound dampeners. This concept of

busy high paced environment which has many

unwelcome and invasive noises that run through it every day.

healing. If I were to present patients with another difficulty of using furniture (Such as Oxman does), the whole concept of relaxation and is disrupted.

Precedents

Benjamin Hubert: ‘Pod’

“http://www.dezeen.com/2011/05/03/pod-

by-benjamin-hubert-for-devorm/ the concept behind ‘Pod’ is to create a

“relaxed and separated” space “from the hustle and bustle of daily life. It creates a room-in-

room experience with the perimeter of the chair around the user’s head.”

notion is something that I wish to incorporate

the person privacy but also provides sound

opportunity for potential to relax with

. The felt encloses the individual affording

into my design as I strive to provide ample

dampening properties. After sitting in one

distractions being at a minimum. Relaxation

of these chairs i can say that the felt can be

in a hospital environment could potentially be

descirbed as almost behavinglike blinkers

best achieved through this sense of peripheral

on a horse, it blocks out external distraction,

removale and engagement in only what is

removing the iyou from their immediate

immediately in front of you, whether that be a

peripheral surrounds. This type of ‘blinker’

good book or another form of media

Precedents

Muka Design Lab: Reves Chair

vulnerbility felt by the patient. Through this

creation of an enclosed space the individual â&#x20AC;&#x153;We wanted to design a chair that protects you like a child in a tent,â&#x20AC;?

(Abajo, 2015)

Notions of protection and cocooning is what is relevant in this design.With the hospital

environment or when recovering from injury

feels enveloped leading to connotations

of security. The dynamism to provide the individual with the option to open up their

surrounds at their own volition also important

as the design should be inclusive to a range of emotions.

there are distinct feelings of exposure and

Precedents

Mimosa: a space divider by Sebastiaan Pijnappel Personal space is not limited to the physical

Exercising control over variables of space.

others but also refers to the intimacies in our

little opportunity to offer outlets where space

space that we create between ourselves and social interactions. Personal space allows us to non-verbally articulate relationships between

ourselves and others. These articulations occur through but are not limited to; body language, eye contact and facial expressions.

When we consciously place barriers between

ourselves and others we are communicating a desire for privacy. This could be for a number

of different reasons. In this instance the barrier is placed as a means for the patient to escape their immediate surrounds.

Hospital space is dynamic. Thereby there is

and territorial behaviour can occur. Through

the medium of furniture I hope to bring together notions of territory, personal space and

escapism. Over the course of several days post operation patients may be very familiar with their surrounds but this does not necessarily mean that they are comfortable. Research

suggests that the ability to mark ones space as your own, has the capacity to provide comfort. Within the hospital environment we find that patients express feelings of exposure and

vulnerability as expressed by Jack Fisher in his interview. Much psychological research

has been conducted that concludes that such

feelings can be alleviated by giving the patient a sense of control over their environment or through affording the patient territoriality.

Precedents

Soooo...

How

Do You

KNOW This

Will

Work?...

METHODS

Methods in Design Aged care Site visit Langford Grange Aged care Facility with Sally Bourke

Why a ‘site visit? It is important for the designer to demonstrate a level of empathy towards

people. Exploration of the ways in which staff and patients interact and with each other

but also their environment was imperative to understand.

The Roho air cushions are used to reduce friction and sheer for many patients.

“If you try to build an emotional connection with

a group, you’ll find that you can create products that do more than ‘solve problems.’ These

products become intimately tied to identity. This provokes an internal dialogue – a relationship –

INITIAL OBSERVATIONS OF LANGFORD GRANGE AGED CARE FACILITY

between a person and the product, system, or

-The facility is all one story

(Kolko, 2015)

transportation of patients in high care in wheel

service.”

REVIEW OF SITE VISIT METHOD The site visit involved a guided tour taken

by Sally Bourke who is the clinical services manager at Langford Grange

Within this environment there were several things that were really unique.

-“This allows for easy maneuverability and chairs”(Bourke, 2015)

-Hallway are lined with railing the hallways are

approximately 2metres in width. This large width of hallways means again that transportation of patients is easier and

“having the railings encourages independent movement for the patients”(Bourke, 2015) -Every patient has his or her own room. -There are 120 patients

-50 patients are high care -62 are ageing in place

Methods in Design

quadro cushion that retails at $725 SUMMARY The guided tour showed me an environment

EquaGel cushion on a placed on a patients chair as they are seated for long hours

that was filled with routine. Whilst there for

the two hours I did not see any independent

-Out of those 40 are wearing booties to prevent

ambulation the mood of the patients was tired.

or treat pressure injury

In complete contrast, the nurses moved with a

-Of the high care patients there are around

sense of urgency and had a kind of buoyancy

4-6 patients who need to be moved into a

about them. Although this cheerfulness may

wheelchair and then sat in the cafeteria for

have been bias, as the nurses were aware of

mealtime

my tour and observations of their behavior.

-This means that patients are moved from

Overall I feel that it must be very difficult to

chair to wheel chair and back again this is

treat patients with an array of products. I am

something that nurses want as “any movement

by no means suggesting that we should have

from one position to another is considered

a blanket approach but I do believe that there

beneficial.”(Bourke, 2015)

appears to be little consideration at treating

- Instead of having chairs that have inbuilt

the problem of self ambulation; which through

cushioning systems nurses at ‘Langford

this observation, seemed to be a relevant and

Grange’ are required to move patients cushions

pervasive issue.

from one chair to another

-Within the facility the nurses tended to favour the use of Roho cushions I saw a high profile

Methods in Design

Reflection: Understanding the Aged Care Environment

INSIGHT

what if instead of this continuous depletion in patientâ&#x20AC;&#x2122;s independence that forces nurses to dedicate more time treatments, there was an opportunity to create tools and devices that increased efficiency.

Sally Bourke demonstrating the assisstive lift mechanisms.

Depletion in independence: Nurses already spending time showering patinets

The chairs used to maneuver patients

Methods in Design

The overall aesthetic of the environment was

What are other therapeutic methods escape?

furniture. Being an aged care facility each room

Are the memories captured and hung to remind

a combination of pastel colours and tubular

was decorated with the individuals own finishes.

them of who they are beyond the walls?

Most rooms were covered in photographs of loved ones and each had their own recliner

Maybe they are merely conversation starters?

home.

We each have our own life storyâ&#x20AC;Ś Exposing it

To me what is interesting about this is the desire

reminds us of whom we are.

chair in their room, which they bought from

on walls maybe allows us to recall it daily and

to be surrounded by images of life outside of the confines in which they find themselves.

Maybe it creates a sense of familiarity in an

Each of these individuals during a time of

unfamiliar environment?

illness look to another time, another place or

live vicariously through their relatives images of travel. Each of these individuals during a time

of illness look to another time, another place or

live vicariously through their relatives images of graduation and travel. REFLECTION What is it about this method of escape through the medium of photographs?

Methods in Design Hospital site visit Eastern Health Box Hill with Stomal Nurse and Pressure Injury Specialist Wendy Sansom Hospitals are sites that have certain

environmental factors contributing to their overall experience that are unique unto themselves.

Hospitals are dynamic and adaptable with

movement and the affordance of movement being a key aspect.

Hill Rom Beds using linear actuators to ensure the patients posture is correct and customised to their shape

Heel Cup made from foam. Used to prevent friction and shear

Howard Wright Mattress uses Dartex material

Methods in Design

Visiting Eastern Health Hospital in Box Hill

provided the experience of a current hospital environment.

Similar to my visit at Langford Grange Aged

Care Facility there was this sense of dynamism I feel that generally it comes from the concept that the spaces are open, covered in vinyl or another surface that could easily be

wiped clean. I feel as though I should blame

Biatain Silicone patches are used on patients wounds to absorb some of wound excrement. They also prevent friction from occuring at the site of the wound

Hollywood for my thoughts I had whilst there, as in the movies I felt that anything could happen in that space, ‘maybe someone died right

there’. The hospital temperature was completely ambient so it became interesting to me that we associate these places with being cold and

Hospitals overall have “this sense of rhythm…

sterile, maybe closer to Frankenstein’s lab, than

But, there is also a kind of sense of inertia as

a relaxing place to recuperate.

monitoring is constant. You can’t just stop.” -C

The people who visit hospitals can often find

Visiting Eastern Health Hospital in Box Hill

the environment overwhelming, (C) there are a

provided the experience of a current hospital

number of reasons for this but the most likely

environment. (Include mind map)

reason is potentially the negative association of seeing the ones they love, ill. There’s a

Methods in Design

strong linking between their illness and their

Furniture specifically designed for the

Often hospitals are considered to fit a kind of

language that is tubular and pastel. Overall it

surrounds, which is the hospital environment. mould.

“we think of over-lit and sterile environments, with visual stimulation limited to small, wallmounted televisions.”(Cappon, 2014)

hospital environment has a particular design

fundamentally fails to incorporate the aesthetics of design into the product. In an effort to rectify this I will prototype various different potential solutions that would be representative of the future hospital environment

More recently it appears architecture is leading

Through examining the design language

can be seen for example with the recent Royal

to explore where the benchmark is in furniture

the way into the future of Hospital design. This Children’s Hospital. The architects objective was to create a hospital environment had

“Considered detailing (that) invites the human

touch and de-institutionalizes the hospital genre.” (Stanisich, 2012)

throughout the Royal Childrens Hospital I hope for the hospital environment

“The project sets a new benchmark in this

restrictive building typology and that it will

be seen as a game-changer for healthcare in Australia.” (Stanisich, 2012)

REFLECTION Current hospital furniture is stale, sterile and poorly designed with little consideration

to the overall environment of the hospital.

Methods in Design Royal Childrens Hospital Site Visit: An Exploration of Architecture’s Role in Future Hospital Design. I walked through The Royal Childrens Hospital

There was this incredibly strange vibe of we

the colours used, and the design language

sick and we’re sorry hopefully these things will

unguided, making notes of the architecture,

know you don’t want to be here, your child is

used to communicate a feeling of openness

distract you and provide a sense of normality

and nature.

you so urgently need.

There was immediately colour and distinction

The colours were beautifully tied through

through themes of floors

illustrations of animals of australia With themes on each floor The grampians The ottways

The great ocean road

The alpine national park Melbourne city skyline

Relayed by these totems on each floor

which carried prose on each subject giving

vivid descriptions on potential scenes in the environment

Methods in Design EXAMINING THEMES

Entrance

Beach level-The Great Ocean Rd

Earth level-Central Victoria

Forrest level- The Grampians

Tree Tops level -The Ottways

Melbourne City Skyline level

Methods in Design

It locates the places where melbournians are likely to travel, and took the holiday that they

could not, have back into the environment that they most likely unwillingly find themselves in.

This visual encapsulation is a form of escape for that parent/relative/sick child

I imagine people striking up conversations

reminicing of past times spent in these places or promises to visit in the near future.

This is a really powerful mechanism of escape through architecture and design. It affords the

patient a middle ground to where they are (in the hospital) and where they want to be.

The images are really powerful, hand drawn lines with overflowing watercolours. The

cues were not subtle Cute australian animals

exagerated and overt reminders of the power of nature to the healing process There was a distinct connection to Victorias

Cues of green and pores and circles and leaves

of life outside of the hospital walls. existence.

sharp nothing jaggered

Natural environment that reminded you that you

Curvature and radiuses everywhere nothing

Methods in Design

Trampoline and many other restaurants create almost a shopping centre feeling, where inidviduals are able to find themselves distracted from their illness

The Royal Childrens hospital provides a means

of escape through the inclusion of: -Services such as a

-Hair Salon

-Nail Salon.

-Through retail with

-a market

-several other gift shops

Methods in Design

-Chain restaurants:

REFLECTION

The visit to the Royal Childrenâ&#x20AC;&#x2122;s Hospital helped

- McDonalds, Trampoline, Sushi Sushi - countless cafes scattered between and behind many corridors.

to really confirm my concepts of the importance of escape or distraction from the surrounds of

-Within the main opening there is also an

the hospital/care environment during recovery

interactive touch screen where people can play

or illness.

games.

The varied restaurants and shops afford

people options, thereby implying a sense of freedom and choice that is potentially not

afforded to them in the decision of being in this environment in the first place.

There is a feeling of being very similar to a

shopping centre in the larger courtyard area. On the other hand within the wards there

is more of a sense of distraction through illustration and coloured themes that

consistently run throughout each floor.

Each are different mechanisms of distraction employed in the same environment

Methods in Design

noisey Noises 62-64 decibels Lanyards, keys

acoustics

non porous

Nurses desks conversations

cotton starched sheets

Buzzers

easily cleaned vinyl

vinyl surfaces pastels blue white Bustling sterile

visuals

confronting

space fluorescent

do we feel cold due to association with sterile?

association with illness movement dynamism

clean cold (its actually ambient) 23

gowns

Continuous “you can’t just stop” cyclical

Methods in Design Reasearch: What constitutes a healing environment? What role does design have? THE IMPACT OF A ‘NATURE INSPIRED’ ENVIRONMENT ON THE HEALING

A desire to sit in a chair rather then having

PROCESS

to be told what to do, may be a welcome change to patients.

“A growing scientific literature is confirming

that the conventional ways that hospitals are

designed contributes to stress and danger, or

more positively, that this level of risk and stress is unnecessary: improved physical settings

can be an important tool in making hospitals safer, more healing, and better places to work.”(Ulrich, 2004) REFLECTION The current furniture is not suitable for all

patients. In particular, pressure injuries are of concern. Treatment could potentially be

lessened through employing suitable prevention methods.

Reduction of incidence of pressure injuries

could mostly be found in increasing mobility.

Through providing furniture that encourages its use there is potential to encourage mobility.

Biophilia: â&#x20AC;&#x153;The bond between human beings and other living systemsâ&#x20AC;? (Edward Wilson, 1984) 65

Methods in Design Nine Day Journal: Sally Bourke Clinical Services Manager at Langford Grange Aged Care Facility BACKGROUND/BRIEF

THE JOURNAL; As recorded by Sally Bourke

Through a site visit I am able to gain information

DATE: 6th OF MAY

Sally Bourke to maintain a journal for a period

with reddened area to L) mid outer foot.

from my own perspective. However, I asked

over a week that would record the frequency of pressure injuries and their treatment.

The journal tracks the treatment of 4 separate patients suffering from a pressure injury over the course of a week. Three of the pressure

injuries are located on the sacrum and one is on the heel.

The journal details the decision making

Staff member (EEN) informed me of resident

On investigation- area reddened, painful overnight and early morning.

Resident only sleeps on her L) side- discussed sleeping on R) side- she is unable to.

Resident gets up overnight x1 for toilet. Unable to use spenko booties.

process and the need for nurses to make

Noted R) foot outer ankle bone slightly red

knowledge of the patients.

good moisturiser

executive decisions based around their intimate

This journal really does highlight that despite the fact that nurses in this care facility are

highly involved in the patients movements and activities, there is still potential for pressure injuries to occur.

Trialling sheepskin to end of bed- along with

Footwear reviewed- resident usually wears slippers- which are suitable.

CASE TWO

Methods in Design

Review of 2 sacral breaks high care residents.

and fortified diet and drinks. Secura Z10

applied to sacral break to provide barrier.

Chronic pressure area to wounds.

Resident again very poor intake and palliative.

Resident 1: Wounds been present for past 4

PAC attended, RN review of wound weekly-

months- started post fractured hip (unrepaired), resident became palliative at time. Sacral

Care staff to apply Z10 bd and PRN to sacrum.

wound almost healed 1 mth ago- was very superficial, reviewed today- worsening,

Dressing applied to wound 2/7 which had come

DATE: 8th OF MAY

Dressing- Allevyn gentle and hyperfix to

Weekly review.

off.

Review of 2 sacral areas

sacrum 3-4 daily often dressed earlier.

Resident 3: stage 2 pressure injury- some areas

Redressed wound today. Residentâ&#x20AC;&#x2122;s health

of broken down- other areas dry.

deteriorating again- becoming more frail, diet

intake poor, on fortified diet and drinks already.

Over last 6 weeks air mattress put to bed,

Palliative diagnosis again

equagel cushion to chair. Resident a large

gentleman over 100kg, initial wound to sacrum

Resident has 2nd daily rest in bed days to

healed with PAC and devices.

assist with pressure area care, air mattress to bed.

Review of area likely IAD (incontinence

Resident 2: Sacral break to R) cheek, no

incontinent, had reviews from continence

associated dermatitis) Resident highly

dressing to wound, no improvement to break-

reps, multiple toileting and pad changes daily.

resident on air mattress, has rest in bed days

Trialling night pad to go on later at night.

Methods in Design

Resident 2: Resident with history of sacral

Resident reviewed by dietician- on fortified

2 wound, resident on air mattress and equagel

months.

break, reviewed by RN earlier in week. Stage cushion.

On review changed cream to secura Z30 bd. Air mattress not working correctly. Mattress taken off bed for repair.

Hand over for strict PAC while mattress off

bed. Resident recently declined in health and is thereby less mobile. Hand over to staff to

ensure gel cushion used in arm chair and wheel chair. Resident continent and good dietary intake

Review of residents L0 mid outer foot- pressure area, area no longer reddened now using sheep skin

DATE: 11th OF MAY

Review of weekly wound low care Resident 4: stable palliative.

No dressing to wound- to continue secura Z30 to break bd- secura cleaner before applying cream.

drinks and diet, recent weight loss- 14kg in 3

Continues to eat soups and desserts, drinks well.

Seen by speech pathologist re meals-

discussed with NUM diet- now trail having

soups and vitamised diet for meal as tolerated. Gel cushion to recliner chair and wheel chair. DATE: 15th OF MAY

Received trial of new booties for pressure area care for heels-

Given to Resident 1: who complains of pain to

feet and heels overnight.

Staff concerned about residents bunion area to L) foot. Area reddened- most foot wear

inappropriate tight, heels, slippers worn- tight ove bunion area- speak with resident and

family member- slit cut in slipper for pressure

relief- also discussed purchasing appropriate footwear.

Methods in Design

Reviewed 2x sacral wounds 1 improvedcontinue using secura range

Resident 2 wound deteriorated despite PAC,

cushion, air mattress, toileting, pad changing

and review of continence. Diet good- resident obese

Review of palliative residents wound no dressing required- improving- likely as resident resting

in bed daily. Secura cleanser and Z10 to wound tds & PRN

REFLECTION Through looking at this journal it is clear that

the life of a nurse is based on problem solving through trial and error.

There isnâ&#x20AC;&#x2122;t a blanket approach to treating

pressure injury or to dealing with patients. Each

patient will present with a range of comorbidities and it is the nurseâ&#x20AC;&#x2122;s job to explore potential

options that will provide the best outcomes.

The journals relevance is that it helps to create a picture and lends insights into the daily

occurrences within the care environment and is particularly focused around patients with

pressure injury which often leads to immobility. 69

Methods in Design Sketching

When I first commenced undertaking drawings

for this product the initial output was incredibly abstract and included sharp edges.

Methods in Design

Through my research I have discovered

that there are certain forms or perceived

environments that have been documented to

reduce the incidence of stress during recovery as well as decreased length of stay in the hospital.

Methods in Design

The Images above explore feelings of

evelopment and the environment of an enclosure

Methods in Design

Methods in Design Sketching: The positive impacts of natural shapes on the healing process

REFLECTION

For example, a study in a Swedish hospital

Ultimately furniture has the possibility to be

were assigned a picture with a landscape

off or work at. Why is it that in an environment

found that heart-surgery patients in ICUs who scene with trees and water reported less

anxiety/stress and needed fewer strong doses of pain drugs than a control group assigned no pictures (Ulrich, 1991). Another group of

more to us than a place to sit or a table to eat where there is such a potential to feel so

exposed and trapped is there nothing beautiful to look at?

patients assigned an abstract picture, however, had worsened outcomes compared to the control group.

Methods in Design Interview with Jack Fisher “Vulnerable and Just Exposed...” BACKGROUND Jack Fisher was a patient at one of Melbournes

Fisher comments that his back injury left him

following a critical car accident where he was

two weeks and sitting up independently was

renowned hospitals for three consecutive weeks

unable to get out of bed without assistance for

thrown from the vehicle. Fisher shattered his

difficult.

left arm and sustained serious posterior trauma and nerve damage in his arm. Fisher was the

When prompted about feelings of anxiety

only one in the vehicle. Fisher now has follow

and depression Fisher contends that he felt

to regain full use of his arm and movement of

Fisher mentions that he felt “vulnerable and just

up appointments with a fine motor specialist

“alone in many ways and just generally unwell”.

his back. Aside from the physical effects of

exposed” as nurses came through his rooms

the accident Fisher found himself in a different

he describes himself as “kind of feeling like a

mental state whilst in the hospital.

number”.

“Mostly I was just angry that I knew I wouldn’t

Jack Fisher concludes that “ there wasn’t much

thinking how stupid am I, why did this happen.”

was, I was just there… I couldn’t leave and I

be able to play (AFL) anymore, I just remember

I could do, I didn’t have control over where I

didn’t really know what life was going to be like

Fisher was an aspiring Footballer at age 19

after footy. Living day to day, almost waiting for

when he sustained the injury earlier this year.

a kind of change is really annoying. I remember

However, the accident has rendered his AFL

thinking ‘this is bullshit’ what am I going to

career highly unlikely. Fisher explains that

do…”

he felt “trapped” as his doctors and nurses explained it was “all about recovery”.

Methods in Design

NL:What do you remember?

5 days later after they’d worked out how to

JF:“I was driving down a dirt road and I hit a

continuously lying down for 11 days straight.

root which was coming from the side of the

road. I was thrown from the car and the car

rolled. I woke up and I was in a fair bit of pain but I just thought, ‘no-one is going to find me

tackle it, I had an operation on my wrist. I was

NL:“Your mum is a nurse did she come in at all and look after you? Roll you over?”

down hear’. The first thing I did was I wriggled

JF:Yes, mum came in and repositioned me but

down for my mobile but couldn’t feel it. I then

think its time you start to move around.

my fingers and toes. So I padded myself

stood up had a look around and thankfully

there was my mobile on the ground. I called the ambulance and spoke to a girl who was

really nice she stayed on the phone to me for

after the 11 days the physio came in and said “I

NL:“At any point during the 11 days, did you feel as though you could move?”

40minutes kept me awake I supppose. The

JF:No, no chance the physio got me up and as

taken into Horsham Mum, Rube (Ruby, sister)

out so that was the end of that try

police came first then the ambulance. I was

and Tobe (Toby) were there. I was pretty out

of it by then I’d had some morphine. I woke up at 2am and found I was in a neck brace and

bandages and was really uncomfortable which

soon as that happened my shoulder popped

Then the next day I sat up and sort of felt light

headed and passed out. Over that whole time I hadn’t been to the toilet by myself either.

made me pretty difficult to deal with I was pretty

NL:“Did they give you any type of assistive

I was meant to go to the Royal Melbourne

anything?”

agitated.

instead of Horsham but there had been an

equipment to help you move a long or

accident in Mildura or something so they had

JF:Yes, I had this thing on wheels which could

the following day at 8am which I don’t really

using that

no beds. I was flown to the Royal Melbourne remember.

I had my first operation on my arm and then

support me so I sat on the end of the bed tried

NL:“Could you move around the ward?” 80

Methods in Design

there for 5 days.

NL:“So over this whole time you

obviously had a lot of

time to think, what were you mainly thinking about? Had you

considered its

implications on your footy?”

JF:Yeh definetly that was was I though about JF:No I never moved around really I was

sharing a room with two other guys. One older guy who moaned a lot and had broken his

pelvis and was in a lot of pain as you would be. NL:“So you were in there for how long” JF:13 days all up in Royal Melbourne there turn around is pretty fast and mum and dad told

me that whenever they came to see me it was

always so busy. Because I was at the end of the ward I didn’t really see the traffic though.

From there I left to Brunswick rehab which is

part of Epworth. Here I was in a wheelchair. I

never really left my room though I was there for 3 days. Like I would sit up to eat and stuff but I never left the room and didn’t stand.

firstly in the Royal Melbourne I knew that there

was no way I would play the upcoming season. I had given it 4 years already in he Ballarat

Rebels and I knew that wouldn’t happen this year. I spoke to uni and they were really go

about it, I’d already completed my first year at

Victoria University studying Physical Education

and Health. I was living in Hawthorn at the time but I moved back to Ballarat to obviously get

the support I needed. I moved myself across to Fed Uni in Ballarat which I prefer I feel like its a better course there.

NL:“Were you also considering the manual labour at the farm?”

JF:Yeh I knew I would be able to do it again,

it would just take a while and it would be a bit

Then I was moved to St Johns Ballarat and was 81 different

Methods in Design

NL:“You had mentioned that the Royal

JF:Each day there was a board like a program

trauma room with you can you describe the

set goals but it didn’t matter if you didn’t

Melbourne had two other patients in surroundings?”

JF:here was no natural light which was really

annoying, I never knew what time of day it was and it really irritated me, the other guy snored really loudly and I made sure that I had an

of the day and it changed everyday and it

complete them. (Setting objectives but positive reinforcement, no negative punishment, just encouraging) They also would come in an

measure the range of movement in my elbow and wrist and note any improvements

extra sleeping tablet so that I wouldn’t wake up.

NL:“With St Johns, what was that like?”

really cold and dark and sterile.

greens was nice to be in, more like ‘homely’

I was worried that I wouldn’t get to sleep. It was NL:“When you were in Brunswick, what were

JF:Very similar to Brunswick, big windows,

your surround like there?”

NL:“I terms of the future what happens now?”

JF:Much better much nicer, I had my own

my elbow and 1 on my wrist. I need two more

room (private healthcare), own T.V, leather

couch so I could use that if I wanted (provision of options)

NL:“Do you remember what the colour scheme of the room was at all?

Mostly green and white and greys but it was

really nice and I had a window.. The beds were well made very patient friendly, accessible NL:“Was there a way in which the nurses

measured your progress? Did they encourage you at all?”

JF:Well I’ve already had two operations on on my wrist but another for the cyst that I

developed whilst lying in bed for 11 days. My

spleen has fully healed which the doctors were also really happy about.

NL:“You developed a pressure injury?” JF:Yeh it just sort of wore away at the area

between my bone and muscle and skin as I was lying down for so long (Jack is 20 the fact that a young healthy male sustain this injury and was

left lying completely still for this amount of time is ridic) 82

Methods in Design

NL:“So physically theres still three more

I can’t fault them I just don’t see why there

operations”

isn’t natural light and nicer things in the Royal Melbourne, everything was so sterile, which I

JF:Yeh hopefully no more!

understand but the Rehab places were just some much more homely.

NL:“Mentally what was the process?” JF:I mean it was really hard because I couldn’t go down to the beach and do the things I

wanted. I had booked tickets to falls and stuff. I know I should be thankful that it wasn’t any

worse and when I put it into that perspective I am. It could have been worse.

NL:“Socially things were changed to ?” JF:Yes, well I couldn’t do some of the things

that I wanted to . I wanted to play a game of

footy as all of my friends were playing for the

Southern Mallee Giants, so I snuck in a game. I told Dad, he said “I don’t want to know about it and don’t tell your mother”. She found out, she wasn’t very happy, I got a text the next day. I

just wanted to be in amongst it again, out there. I didn’t do anything anyway I sat in the forward pocket and kicked a few.

NL:“Are there any sort of recommendations you’d make for the overall environment?”

JF:Well yes, I mean the nurses were fantastic

Methods in Design

REFLECTION This Interview really encapsulated the overall

and out of control of their situation, as Fisher

consume people when they are sick or injured.

order to have a sense of freedom individuals

sense of frustration and anxiety that can

This research suggests that perhaps more

needs to be done in the way of providing a kind of escape, a safe environment where

the individual is able to feel secure. Hospitals

need to place more emphasis on the physical environment and its role in providing the

environments that afford the patient with the

privacy they need to recover and recuperate. This interview also encouraged me to look

contended, “there wasn’t much I could do”. In need options. Independent ambulation is not an option- the option to sit up, the option to

stand, the option to move, to go to the toilet

unassisted- suddenly all if these options are

taken away from you. Things that you consider easy or mundane prior to a pressure injury, a surgery or any other trauma that requires

extended stays on hospital become exhausting feats.

more closely at inclusive design and really

If an individual has some level of control over

incorporate individuals from all different age

they have some basic freedoms afforded to

understand ways in which design can groups and backgrounds.

where they sit, what they hear and see then them.

WHAT IS AN IDEAL RECUPERATIVE ENVIRONMENT?

Having Options:

Patients often feel a sense of hopelessness

Methods in Design Research: What is an Ideal Recuperative Environment?

REDUCTION IN NOISE

contended, “there wasn’t much I could do”. In

Biotechnology Information (NCBI) some

need options. Independent ambulation is not

According to the National Centre for

order to have a sense of freedom individuals

hospitals produce between 62.2 and 64.6

an option- the option to sit up, the option to

decibels during the day.

stand, the option to move, to go to the toilet

unassisted- suddenly all if these options are

It has been documented that noise has potential

taken away from you. Things that you consider

to cause stress. Researchers have noted that

easy or mundane prior to a pressure injury,

“noise signals are subcortically connected via

a surgery or any other trauma that requires

the amygdala to the hypothalamic-pituitary-

extended stays on hospital become exhausting

adrenal-axis (HPA-axis).

feats.

Through experiments scientists uncovered that

If an individual has some level of control over

release of these hormones such as cortisol

they have some basic freedoms afforded to

noise releases stress hormones and continuous

where they sit, what they hear and see then

can have long lasting detrimental effects,

them

cardiovascular disease, insulin resistance,

catabolism, intestinal problems and hormonal

imbalances. Overall the effects of noise on

an individual should be prevented wherever possible.

Having Options:

Patients often feel a sense of hopelessness

and out of control of their situation, as Fisher

Methods in Design

REFLECTION So what is designs role? This sense of freedom could be introduced

through the medium of assistive furniture that is collaboratively designed with other healthcare professionals and experts. The furniture is designed with a sense of empathy toward

the patient and thus aims to provide a kind

of pod not dissimilar to a plant or the cocoon of a butterfly where the patient can heal and recuperate.

There are also the conceptual notions of the

pod as potentially being almost embryonic in

its feel. The feeling of a protective space that

protects you from the outside world and allows you to heal. This womb-like experience is what I am hoping to embody and realise through

aspects of my design. I think that this type of

‘protection’ and ‘shielding’ is important to the healing process as individuals it is an innate part of the human experience whe we feel vulnerable or exposed.

Methods in Design

Paper Prototypes: Exploration of form and scale

This folded

pattern is something that I experimented with. The folding mechanism is

something that interested me as it had the ability to divide spaces and create barriers thereby creating privacy

When moving into the stage of paper

-which materials would be best suited for the

I needed answered and that could only be

requirements/standards?

prototyping there were several questions that

hospital care environment and what are the

effectively investigated through creating these

-what colours are most suited to relaxation?

forms it essentially is a form of troubleshooting.

-different sound dampening mechanisms? -how can I make this inclusive design?

-What shapes and forms provide the basis for which I can create a kind of pod

Methods in Design

This circular form is something that really

spoke to me in terms of the way it casts these This folded arch style form would allow the

user to have a sense of privacy. There would

long shadow lines almost like a negative space of a rainbow.

need to be a kind of pulling forward and back

mechanism and the legs that extend out in the front at completely impractical.

This pattern featured opposite, began to take on a different kind of role in being a way in which I could manipulate light

Methods in Design

Within all of this I realised that it these iterations were not really accurate reflections of nature so I moved back towards the pod style and shape

Explorations on the impact of color revealed

that blues and yellows are the more relaxing

and therapeutic colours as they are reminiscent of the sea

Methods in Design Explorations of shape and form

A view from the users perspective

Methods in Design

Intentionally replicating

notions of nature through the medium of furniture

Methods in Design Sketching: Revisited, exploring the form nd overall aesthetic

Methods in Design

Methods in Design Drawings explore the ergonomics

of the environment and anticipate the overall feel the piece will provide

Drawings examine particular

angles of recline suited to the

environment and overall aesthetic desired

Methods in Design Drawings depict the intended curvature of the piece

mimicking natural curvature of a leaf found in a ntural landscape

Drawings explore arm rest heights and placement as well as seat

cushioning and desired seat pressure

Methods in Design Timber Prototypes: Exploration of material behaviour and scale

Methods in Design

Tasmanian Oak was ultimately the most desired timber for my product. I found that this timber was well represented through-out many of Melbournes major hospitals. (Royal Childrens Hospital, Box Hill Eastern Health Hospital, Victorian Comprehensive Cancer Centre). The objective within the

project is to have a relevant reference to a world outside of the walls of hospital that provides a mechanism or a platform for escape from discomfort.

The colour and shape of the timber play a role in triggering the patient to psychologically escape

from their immediate surrounds. Through referencing nature, designers are able to evoke memories 97 or feelings of other landscapes, which is done heavily throughout the many levels of the Royal Childrens Hospital.

what

soooo...

is it... 98

Design Development

Design Inc

â&#x20AC;&#x153;A growing collection of scientific

knowledge supports the beneficial contact provided between people and nature in modern buildings and both interior and exterior landscapes.

Focusing particularly on biophillic

design qualities and understanding their impacts on occupants

has the potential to improve

health and recovery, cognitive

functioning, worker productivity,

healthy childhood maturation and development, greater community sense of place and enhanced

coping and adaptive behaviour.â&#x20AC;? 100

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rmadillo

Escapism

Privacy

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Empathy

Noise Reduction 103

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In understanding the escapism it is paramount

to understand the circumstances that afford that possibility which is referred to as ‘Environmental psychology’

Environmental Psychology– refers to

Escapism

“transactions between individuals and their physical settings.” In these transactions,

individuals “change their environments, and

their behaviour and experiences are changed by their environments.” (Gifford, 2007)

Gifford suggests “territory holders then benefit from a greater sense of self-determination, identity, and even safety.” (Gifford, 2011) Escapism: Through the employment of a material

enclosure – escapism will be provided.

The ‘armoured plates’ will ensure minimal

peripheral vision, allowing the user to feel

enveloped and enclosed. The environment

utilises native Australian timber in an effort to more closely align the individual with nature

experienced in the outside world that they are familiar with. Thereby affording the patient easier recall of the outside world, through familiar natural visual cues.

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Design Development

Even fairly brief encounters with real or simulated nature settings can elicit significant recovery from stress within three minutes to FIve minutes at most (Parsons & Hartig, 2000; Ulrich, 1999) 105

Design Development

Exercising control over variables of space

Hospital space is dynamic. Thereby there is

little opportunity to offer outlets where space and territorial behaviour can occur. Through

the medium of furniture I hope to bring together notions of territory, personal space and

escapism. Over the course of several days post

Privacy

operation patients may be very familiar with their surrounds but this does not necessarily mean

that they are comfortable. Research suggests

that the ability to mark ones space as your own, has the capacity to provide comfort.

Privacy and a sense of control: The proposed environment aims to reduce the potential for un-invited intrusions into

an individuals space. A sense of space, demarcation and territoriality are all key

factors to afford an individual with a feeling of ownership which in the hospital environment

translates to reduced stress and anxiety levels

and thereby ensures a more effective recovery.

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Design Development Design Development

There was no natural light which was really annoying, I never knew what time of day it was and it really irritated me, the other guy snored really loudly and I made sure that I had an extra sleeping tablet so that I wouldn’t wake up. I was worried that I wouldn’t get to sleep. It was really cold and dark and sterile” -Jack Fisher (2014/2015 Trauma Patient) (Liston, 2015)

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Design Development pRIVACY through NOISE REDUCTION

“MLV is commonly used as a carpet

underlayment, The foam backing mat is

recommended under carpets as it provides a

vibration cushion. This helps reduce footfall and impact noise. MLV without the foam cushion would be under the subfloor or in walls and

ceilings or as second layer to increase sound reduction even more.”

The environment utilises neoprene so as to increase the sound absorption as well and

provide a material exterior that is suitable to the overall aesthetic.

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Design Development

Privacy

“Medical equipment and staff voices often produce 70 dB to

75 dB levels measured at the patient’s head, which approach

the noise level in a busy restaurant” (Blomkvist et al., in press, 2004).

“Noises from alarms and certain equipment exceed 90 dB

(for example, portable X-ray machine), which is comparable

to walking next to a busy highway when a motorcycle or large truck passes.” (Ulrich, 2004)

“A study in a NICU measured peak levels once per minute and 109 found that 31 percent of peaks exceed 90 dB” (Robertson et al., 1998).

Design Development

reminded of a place outside if the hospital

confides which is especially important in long term stays.

Empathy

ENGAGING DESIGNED EMPATHY THROUGH MATERIAL SELECTION

Tasmanian Oak.

The timber is sourced locally and aims to

provide users with easily recognisable visual

cues of the natural environment. This concept

borrows heavily from the same emphasis placed on nature referenced through out Melbournesâ&#x20AC;&#x2122; Royal Childrensâ&#x20AC;&#x2122; Hospital and The Victorian Comprehensive Cancer Centre. The overall

intention is to afford patients the ability to be

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Design Development

Warwick Fabrics: - Global Soft Jet

This material was chosen as it effectively

serves to apply a “homeliness” aesthetic. This Warwick fabric represents this through the

warmth found in the weave and the tactile feel of the cloth, which is often found within many residential environments. The importance of

this ‘feel at home’ aesthetic is that it allows the patient to experience a familiarity with their

immediate surrounds- It removes the piece from being procedural- which is typically

demonstrated through antibacterial, plastic and moisture wicking materials.

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Design Development

Honey-Comb Cushion

Exploration and research into the use of

Equagel Cushions and Roho Cushions (used within aged-care facilities and hospitals

throughout Australia) has led me to develop a

concept for a cushion that would aim to reduce

the incidence of pressure injury and encourage further use of Armadillo.

The cushion has a cross-bracing system in a

honey-comb like pattern. The pattern provides cushioning 110mm thick.

Through testing and evaluating I found

this thickness to be more than adequate to accommodate for an individuals comfort.

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The mould MAKING PROCESS

Materials:

-Structural Pine 35mm x 90mm -MDF

-Flexi Ply

-8G 75mm Chipboard Screws -Titebond III

X 1 layer of MDF board

X 1 layer of Structural Pine arranged securely X 11 reps!

Wrap flexi ply,

SANDING. SANDING. SANDING

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Design Development PROTOTYPING -Timber thickness

-Material thickness

-Upholstery solutions

It was important to understand how the MLV and neoprene will line up on the hoop pine,

Through contacting a melbourne supplier I was able to have three moulds made up to play

with and apply different fabrics. In conjunction fabric allocation it was also important to note the desired thickness. Initially my thoughts

lent themselves to the idea that the thicker the hoop pine, the sturdier the piece would be.

However, through examining an MDF mockup at the 20mm I was able to confidently

recognise that this was simply too thick; and the outcome would require further research to gain a better aesthetic and still meet my strength requirements.

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“It’s the fuzzy stuff that counts” -Liam Fennessey Lecture 30.03.2015

The steel curves are an integral part

to the overall experience. They help to really bring in the overall fluid natural aesthetic with a usually rigid and straight material.

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Design Development

MATERIAL COMMUNICATION - “cos’ we are living in a material world...” -(Madonna 1984)

controlled QUIET

acoustics

porous

CONVERSATIONS

leather couches

television

cosy soft

PERSONAL meaningful images photos ‘lived in’

visuals

relaxed

COSY WARM

how to communicate ‘warmth’ through visuals?

feelings of safety static predictable

clean

warm gowns

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Design Development

There is an implied strength to steel, which can often give the material a

harsh/coarse look. Within this instance the material usage is the skeleton of Armadillo that works to support and enclose the user.

The steel frame is strong, and behaves as a more permanent and secure

structure within an ever changing and dynamic hospital environment.

We understand that current hospital

furniture has connotations of ‘dynamism’ which lends itself to being mostly

on castors, lightweight and easily

manoeuvrable. The sense of static,

slowness and ‘predictability’ make for a less stressful environment. The steel is

intended to communicate stability and

permanence to the patients. This bridges the nexus between hospital and home environment.

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In this instance all of the elements combine. The steel

The upholstery

The carbon fibre plates

The Tasmanian oak plates The Brass fittings

All contributing to the overall function and

aesthetic of Armadillo in an effort to provide

the most effective recuperative environment for patients.

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project reflection 130

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Armadillo

This project commenced with a single idea from a nurse who just felt frustrated with the way

things were. Her genuine expression of anger and disappointment at the hospital system;

and the sense of helplessness she conveyed to me, really helped shape my project direction. I could see that her frustration could be the

embryonic stages of resignation. I listened—

and tried to really understand what the root of her problems were.Essentially, it was discontent with the

seemingly preventable pressure injuries that consumed

her time and ate

through the resources.

Her poignant contention of “there’s got to be a better way” had me going down

rabbit holes with numerous

failures. But, in the end with a

thorough understanding and empathic

approach Armadillo was conceived.

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Armadillo

Design is about innovation and improvement. As designers we need to try to find the best

solution to the problems that we are faced with. I had no idea how I was going to solve this

problem of pressure injuries I just needed to trust that through my research I would find a

“You are lost the instant you

solution. It is absolutely terrifying considering

know what the result will be”

that there is a considerable amount of money

-Juan Gris

already being pumped into the medical

industry. I doubted that with my resources I

would find anything worth consideration. Still I knew that there must be another way so

I maintained focus on all of the ‘ empathic questions’ to the problem.

-Why aren’t patients moving as frequently as they should be?

-What helps them to move?

-What exactly is a medical environment?

-How do patients feel when they are in hospital? (Both long and short term)

- Why is a medical environment the way it is?

133

Armadillo

-Where do we see current change?

of pressure injuries will only get much worse.

I sought to answer all of the above questions

see an increase in government expenditure on

-Who is leading the charge in this change? utilising all the resources I had. I explored each rather thoroughly, and each in turn

had deeper more complex answers which inevitably lead to more questions.

My research uncovered that the facets

of medicine are many and varied … and all are deeply related to and dependent

Economists suggest that we can expect to

health as people live often unwell for longer. However, as the elderly remove themselves

from the workforce and no longer contribute to GDP who will fund all of this required capital for health expenditure? There is no blanket

approach and it is easy to get caught in a web of helplessness.

on government policies. The problem of

However, one cannot discount the now proven

multi-pronged approach. Ranging from

that psychology and physiology are intrinsically

pressure injuries requires a holistic and

nutrition to two hourly turning of patients by

staff. The friction and sheer of skin against a

mattress on one side and bone on the other

is in many cases unavoidable. Efforts can be made (two hourly turnings and fortified diets) and many times the nurses are successful if they are excessively vigilant. During

these efforts many resources are utilised,

for example; nurses labour, special sheets,

special air mattresses, wedges, creams, and dieticians. Each of these products and all

of this labour requires endless amounts of

funds. We know that the problem is mainly

found in (although not exclusive to) patients over 65. With an ageing population it is a

reasonable expectation that the problem

research championed mainly byRoger Ulrich

linked and can be deeply affected by the built environment. Ulrichs’ results were landmark finds in 1991 in his report ‘View Through a Window’. Since then Ulrichs’ experiments

have been independently reproduced and

repeatedly have yielded the same results. If designers can prove their usefulness within

a hospital anywhere, it will not be wielding a scalpel or changing a bedpan but rather it

should be within the aesthetic arena. We really need to demonstrate our care for the patient

and understand the impact of our designs on patients. This can occur through designers

studying the psychology of colour and shape; choosing warm hues and borrowing heavily

from natures’ voluptuous curves (ocean scenes 134

Armadillo

and forests). As we move toward the future

it is imperative that we include this research

into our hospital designs and recognise the

factors that contribute to an ideal recuperative

environment that will most effectively benefit the patient. As designers, we need to intervene in

an empathic manner and say no to tube chairs, off-white plastics and antibacterial surfacing finishes; each diminishes the experience for

the patient, who is most likely going through more than enough suffering. Why canâ&#x20AC;&#x2122;t we

improve their experience and thereby reduce

their time in a hospital bed which is ultimately the overarching objective of all hospitals and government health?

Armadillo acts as a note to this experience.

Armadillo intends to provide the patient with an environment that is exclusively their own

within a highly invasive and exposed space

that can often be emotionally tumultuous. The

enclosed Armadillo plates act as a shield to the outside and block unwanted peripheral views. Armadillo intends to provide an empathic

environment to the user when so often they will only experience sympathy.

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OUTCOME...

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Appendix APPENDIX 1

1)Within an average shift can you give a rough estimate on the number of patients you would treat that would have a pressure ulcer at any stage. 2)Do you feel competent in your ability to identify a pressure ulcer? 3) do you feel competent in your ability to treat a pressure ulcer 4)Have you ever â&#x20AC;&#x2DC;packedâ&#x20AC;&#x2122; a pressure ulcer? 5) Could you describe an experience where you felt that the patient had a reduced quality of life due to a pressure ulcer? 6) Have you ever had to transfer a patient on to an air mattress to prevent/treat a pressure injury? 7) Often pressure ulcers are difficult to treat and can be time consuming, do you feel that there may be a way to reduce the time spent treating a pressure ulcer? 8)What tools do you use to diagnose a pressure ulcer (braden, waterlow, Norton scales)? 9)Any other information you feel is relevant or may be useful to treat pressure ulcers

142

Appendix

1)Within average around 1-2 patients per shift.

nutrition is as important as an pressure cushion

2)I definately feel competent identifying a

the wound.

pressure ulcer.

3)I also feel confident in treating an ulcer. 4)I have never packed a pressure ulcer. 5) Working with a patient who was unable to sit out of bed for more than an hr due to the pressure placed on the sacrum ultimately

irritating the ulcer. This left the patient lying in

bed more throughout the day leading to a build up in the chest and the patient developing

nasty cough. This reduced their quality of life significantly.

6)I have identified the need for an air mattress

and the nurses have ordered and implemented this.

7)I think a team approach and educating

everyone involved in the care of the patient

would reduce the time spent by one person. 8)We used the braden score. 9)When a patient is identified as at risk or has

actually developed a pressure area, a referral to 143

or mattress as this crucial in aiding recovery of

-Reannah Marino (Nurse, aged care facility)

Appendix

1) We currently have 1 resident with a pressure

6) Yes. We use air mattressâ&#x20AC;&#x2122; for prevention

She entered the facility with the pressure ulcer

ulcer.

ulcer on the medial line of her greater right toe. and we are working hard to heal it. 2) Yes 3) Yes and if I was unsure I could always refer to our wound nurse for advice. 4) Yes 5) I once looked after a resident who had MS. She spent 16 hours a day in a poorly fitting

electric wheelchair and She weighed 130kg.

on all residents we deem at risk of a pressure

7) The biggest problem I have found with treating pressure ulcers is the lack of

consistency between nursing staff. If a patient is recommended to be bed fast, there will always be a member of staff who will decide to get

the patient out of bed. If dressings are to be

changed daily, there will always be a member of staff who decides it would be better every second day etc. consistency would equal a faster healing time.

She spent lots of time outside of the facility

8) We currently use the waterlow scale.

baby sitting her grand daughter. Unfortunately

9). In an aged care facility pressure ulcers

pressure ulcer on her sacrum. She became

to hygiene we check skin integrity of the the

visiting friends, going to bingo, shopping and the pressure caused a 9cm deep 2cm round bed bound with 2 hourly turns 24 hours a

day. She could no longer do the things she

enjoyed doing. She became reclusive and was diagnosed with depression which was treated with medication. It took 8 months for us to

properly heal the pressure ulcer by which point she had given up. She no longer wanted to

leave facility, gained more weight and became extremely hostile to staff. I would say that is a

should be fully preventable. When we attend patient. We also change positions of residents 2 hourly who are unable to reposition themselves. We use pillows and wedges to alleviate

pressure on boney areas of the body and

ensure weight it distributed evenly. Prevention is the key.

-Anna Tepper (Nurse, Aged care facility)

massive loss of the quality of her life.

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Appendix

Sarah Beckhams response 1)1-2 patients per shift 2)Yes 3)Yes 4)Yes 5)Iâ&#x20AC;&#x2122;ve had a patient that came into hospital from an facility with a deep multiple staged pressure injury. It required IV antibiotics multiple

times a day, dressings twice a day, surgical

intervention. It will never heal completely and will always require medical intervention.

6)Yes on my ward we use air mattresses frequently.

7)If you turn your patients at least every two

hours if not more frequently to reposition them

there will be less of a chance that they will get a pressure injury. Turning a patient takes roughly 5-10 minutes which is better than spending

30minutes doing a pressure injury dressing. 8)Braden

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Appendix

1. Sometimes one or two in one shift and some

to mobilise and sit out of bed to improve post

on the age and acuity on the ward.

and bowel movements.

times none for a couple of weeks, depending

operative lung function, muscle strengthening

2. Yes

6. Yes, any of my patients I identify as having

3. Yes

injury are transferred to an air mattress. I may

4. Yes, a stage 4 necrotic ulcers packed to the bone.

a pressure injury or being at risk of pressure do this a couple of times in one day or week and sometimes I wonâ&#x20AC;&#x2122;t need to do this for a couple of weeks.

5. I had a patient transferred to my ward from

7. More access to equipment such as air

home could no longer cope with managing

planning, eg sometimes patients are assessed

a nursing home for pressure area care as the

the pressure area. The patient presented with a stage 4 ulcer, pain, fever and was refusing

pressure area care and dressing changes from

the nurses because of the pain this caused her. She was palliated by her doctors and family

the next day and passes away 3-4 days later,

however her last days of her life were spent in

extreme pain and in my opinion- suffering. This

mattresses and seat cushions. Also better

as being high risk of a PA post operatively and they are transferred to an air mattress from the operating table instead of a normal mattress.

This saves the time consuming task of dragging the patient across and also the pain and

discomfort this can cause to do so while they are awake.

is more extreme example, more commonly I

8. I am required to fill out a Braden Scale risk

post hip and knee joint replacements following

I do this because it is my job and I need to

see people affected by stage 1 pressure areas an epidural in surgery. While some of these

patients are unaware of the injury others find it more noticeable and then feel uncomfortable

when the time comes to sit out of bed in a chair. This slows down their recovery as they need

assement tool daily for each patient. While

legally document the fact that I have assessed risk and strategies I have put in place, I tend to rely more on my clinical judgement when determining if a patient is at risk and what

interventions will be most appropriate for them. 146

Appendix

9. Diligent nursing care and good patient

education and compliance is the most effective way to prevent and treat pressure ulcers. Due to the time consuming nature of nursing it is

crucial to have reasonable staff to patient ratios and work loads for nurses so they can provide consistent and quality pressure area care.

For me keeping these ratios low and continuing education to nurses and patients is the most useful tool in treating pressure ulcers

Catherine Mahony (Nurse, private health sector)

147

148

APPENDIX 2

FIVE PEOPLE ARE EVERY BORN SECOND

149

Appendix

Five people are born every second(Worldometers,

process. Co-design is essential to many designers

2014) and each person born is an amalgamation

as Baum contends “to make a perfect bike, its

of varying features of those that ‘made’ them.

rider must be present in the design”.(Baum, 2014).

Each person is comprised different intellects

The exclusion of the user is what causes excess

depending on what they are subjected to.

in items, as there is no level of sentimentality built into the design. Dieter Rams contends that if

Each person will have different life experiences,

we continue such design behaviour “our current

different crushes different first kisses. If each

situation will cause future generations to shudder”

person has these, than they hopefully have what

(Brassier, 2014)

is referred to as a personality. If each person has a personality, how is it that as designers we can

The Industrial Revolution marked a move from

enforce our design on them without consideration

hand production processes and craftsmanship

to their personality? Why don’t we provide enough

into machine-aided manufacturing. It was indeed

opportunity through versatility in our design that

“a revolution which…changed the whole of civil

tailors our design to the users wants and desires?

society” (Engels, 1845). As we evolved and moved

Why do we reserve the right to make assumptions

through the industrial revolution we picked up

about what we think looks nice and then expect

new skills and discarded others developing our

people to buy it?

understanding of new technologies. However, in the midst of all this growing and shedding it can be

Instead of this purging of concepts and creating

said that our eventual mutation in the design world

more things, why don’t we allow room for

has left us incomplete. It is here that we can find

manufacturing at a local level with the intention

opportunity to revisit, the dedicated craftsmanship,

of customisation in the design specifics? Often

and the ‘tailor-made’ aspect on a contemporary

designers fail to include the user in the design

level. We are finding ourselves in a ‘one size fits 150

Appendix

most’ style of thinking and forcing our products

that are following us and design so that those

onto people instead of creating for them. Our

born in the next five seconds can build on what

pieces of work are often personal, as they are

we do now. This is an opportunity to consider

essentially an extension of the designer; right from

sustainability in everything we undertake and

the initial embryonic conceptual stage in our head,

create with the end user in mind throughout our

through to the end tangible outcomes. However, as

whole design process.

we navigate our way to the future “it has become more accepted that customers are willing to pay more for products that cater to their individual size, taste, style, need, or expression.”(Du, 1998) Broadly speaking it seems that we have failed to utilise our skill set, to personalise products to the individual. This is hindering our ability to offer an heirloom quality to our product. We can work many hours in an effort to make changes or we can work very little and aimlessly. At the end of the day toward the receding of our lives (and others hairlines) when we ask ourselves “how did we do?” I feel that the results will be in CAPS LOCKS, situated slightly upward in our line of sight. In an effort to apply meaning to what we do as designers, it would be wise to consider those

151

152

APPENDIX 3

TECH DRAWINGS

chris fixed a0 middle plate

top component chris fixed A0

153

1842mm length

154

542mm excess

1918.9mm length

1934.6mm length

448.9mm excess

155

442.94 excess

470

SCALE 1:1

R30

FRONT

R8 0

221

TOP

287.37

BACK CUSHION OF CHAIR

143

SIDE

R40

R47

415

575

2.50

234

282

R412.50

470

R30

TOP

590 SCALE IS 1:1

R100

FRONT

SIDE

320

0 0.8

R45

110

590

R70

490

SEAT CUSHION

490

156

157

Citations FIELD

Braden, B. (1998). The Braden Scale for

Injury. The Journal of Spinal Cord Medicine.

(Ed.), http://www.healthcare.uiowa.edu/igec/

Payment Policy [Press release]. Retrieved from

Predicting Pressure Sore Risk. In T. B. Scale tools/pressureulcers/bradenscale.pdf. Iowa: University of Iowa.

Damien J Jolley, R. W. (2004). Preventing

NBCH. (2009). Hospital-Acquired Condition

http://www.nbch.org/nbch/files/ccLibraryFiles/ Filename/000000001630/HAC Payment Policy Toolkit (final version) 081109.pdf

pressure Ulcers withthe Australian Medical

NPUAP. (2013). Prevention and Treatment of

controlled trial. http://cmapspublic3.ihmc.us/

NPUAP (Ed.), National Pressure Ulcer Advisory

Sheepskin: an open-label randomised

rid=1GYQY2M17-1T1HX28-DFN/17-Preventing pressure ulcers with the Australian Medical

Pressure Ulcers a Clinical Practice Guideline. In Panel. United States: NPUAP.

Sheepskin.pdf.

Prentice, J. (2009). science and practice of

Foster, J. G. W. (2012). Advanced Practice

Australian Wound Management Association.

Nursing of Adults in Acute Care. Philadelphia: F. A. Davis Company.

kruger, E. A. (2013). Comprehensive

Management of Pressure Ulcers in Spinal Cord

Pressure Ulcer Management. Journal of the

Romanelli, M. (2006). Wound Healing. Dermatalogic Therapy, 19(6).

Thomas, D. R. (2014). Pressure Ulcers in the Ageing Population

Williams, J. (2008). Quality of Care Report. In A. Health (Ed.), Quality of Care Report. Australia: Alfred Hospital.

158

Citations CONTEXT AND APPLICATION

ABS. (2009). Future Population Growth and

Graves, N. (2005). Modelling the economic

Statistics.

patients in Australia National Center for

Ageing. Canberra: Australian Bureau of

losses from pressure ulcers among hospitalised Biotechnology Information: National Institute of

ABS. (2012). Disability, Ageing and Carers,

health.

Australia: Summary of Findings. Australia: Australian Bureau of Statistics.

Gregory B. Diette, M., MHS; Noah Lechtzin,

ACSQHC. (2014). Australian Commission on

Aline Devrotes, RN; Haya R. Rubin, MD, PhD.

MD, MHS; Edward Haponik, MD, FCCP;

Safety and Quality in Health Care Annual Report

(2003). Distraction Therapy With Nature Sights

2013/14, Sydney. ACSQHC,

and Sounds Reduces Pain During Flexible Bronchoscopy. Baltimore: John Hopkins

Beauchemin KM1, H. P. (1996). Sunny hospital

University School of Medicine.

rooms expedite recovery from severe and refractory depressions. Alberta Canada.

-Juan Gris, from â&#x20AC;&#x153;The Collected Writings of Robert Motherwell,â&#x20AC;? edited by Stephanie

Chomik, R. (2014). Aged care in Australia: Part

Terenzio (Berkeley and Los Angeles: University

1- Policy, demand and funding. Canberra:

Of California Press, 1992), 256.

Hockey, J. (2015). Intergenerational Report

Comcare. (2015). Benefits of Movement-Be

2015. ACT: Australian Commonwealth.

Upstanding. In A. G. Comcare (Ed.). Canberra: Australian Governement.

kruger, E. A. (2013). Comprehensive

Management of Pressure Ulcers in Spinal Cord

DOH. (2009). Pressure Ulcers Victorian

Injury. The Journal of Spinal Cord Medicine.

Government Health Information. Victoria: State Government of Victoria.

Kruszelnicki, K. (Writer) & A. G. Canberra

159

Citations

(Director). (2015). Challenge of Change. Canberra.

MTAA. (2014). Cost of Wound Care

management in Australia. http://www.mtaa.

org.au/about-the-industry/value-of-technology/

wound-care/costs. Retrieved 11/03/2015, 2015 Picone, D. (2015). Australian Commission on

Safety and Quality in Health Crae. 2015, from http://www.safetyandquality.gov.au/about-us/ governance/

Pijnappel. Sebastian Mimosa-divider https://

Susan M. Schneider and Linda E. Hood.

(2007). Virtual Reality: A Distraction

Intervention for Chemotherapy. Durham, NC. Ulrich, R. (2003). Healing arts: Nutrition for the soul. (pp. 117-146). San Francisco.

Ulrich, R. (2004). The Rold of the Physical Environment in the Hospital of the 21st

Century: A One-in-a-Lifetime Opportunity

(pp. 1-27). Texas: College of Architecture, Texas A&M University.

vimeo.com/35457945

Graph 1) referenced from

Smith, A. (1990). Emotional Response of

Brown%20-%20Aged%20care%20-%20

Athletes to Injury Mayo Clinic. Minneapolis, Minnesota: University of Minnesota.

Strachan, V. (2006). Pressure Ulcer Point Prevalence Survey 3 (PUPPS) statewide

report. In V. S. Government (Ed.). Melbourne: Department of Human Services.

http://www.natsem.canberra.edu.au/storage/ past%20present%20future.pdf

Graph 2) referenced from:http://

australias-hospitals-at-a-glance-2012-

13/%EF%BF%BChttp://www.aihw.gov.au/ australias-hospitals-at-a-glance-2012-13/

160

Citations METHODS

Abajo, L. (2015). Muka Design Lab’s Reves

architectureau.com/articles/2012-australian-

Blomkvist, V., Eriksen, C. A., Theorell, T., Ulrich,

Ulrich, R. (2004). The Rold of the Physical

and psychosocial environment in coronary

A One-in-a-Lifetime Opportunity (pp. 1-27).

Chair has a backrest “like a shirt collar”.

interior-design-awards-public-design/

R. S., & Rasmanis, G. (in press). Acoustics

Environment in the Hospital of the 21st Century:

intensive care. Occupational and

Texas: College of Architecture, Texas A&M

Environmental Medicine.

University.

Bourke, S. (2015). Langford Grange Site Visit. In

Robertson, A., Cooper-Peel, C., & Vos, P.

N. Liston (Ed.). Melbourne.

(1998). Peak noise distribution in the neonatal

intensive care nursery. Journal of Perinatology,

Cappon, J. (2014). Medical Staff Quality and

18(5), 361-364.

Patient Safety. 8, 4-5.

Walder, B. M. F., David Phys; Meyer, Jean-

Gifford, R, L. S., and Joseph P. Reser (2011).

Jacques MD; Lançon, Michel Eng; Romand,

“Environmental Psychology.

Jacques-A. MD (2000). “Effects of guidelines implementation in a surgical intensive care

Kolko, J. (2015). Lean Doesn’t Always Create

unit to control nighttime light and noise levels.”

the Best Products. Harvard Business Review.

Society of Critical Care Medicine 28(7).

https://hbr.org/2015/05/lean-doesnt-always-

create-the-best-products

Soundproofing, S. (2015). “Soundproofing floors and walls.” Retrieved 20/6/2015, 2015, from http://www.soundproofing.org/

Stanisich, K. (2012). The Royal Childrens

Hospital. Architecture AU, (April 2012). http://

161

“When you have interesting questions, you will get to interesting ideas” -Tim Brown IDEO 2014

162