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Research and Design Explorations

Project Exploring Interactions Aratrika Roy 4237811

Design Goal
The project aims to create a friendly, comfortable and stress free solution to help patients prepare themselves physically, mentally and emotionally for a joint replacement surgery.

Interaction Vision
Letting the patients have access to adequate information regarding the ailment, surgery and recovery in an interesting and user-friendly manner in order to induce a stress free and relaxed mental state to help them gain the confidence and trust needed for the procedure.

Research Questions
This research asks the following questions:

How are the patients prepared physically, mentally and emotionally for joint replacement surgery? Who are involved in the process and what methods do they follow? How are they given the information that they need to know for the whole procedure? How are their questions answered? How is their stress and anxiety in the pre surgical period dealt with and reduced? How can they be helped to feel confident and trusted to go for the surgery?

Design and Research Activities


For this project I did my activity-focused research at Reinier de Graaf Hospital, Delft. I conducted qualitative interviews and observation to execute and analyse my research findings. I interviewed the patients, doctors, consultants and physiotherapists about the entire procedure starting from the patients diagnosis to the recovery period post surgery i.e. the patients journey and the various interactions between the patients and the hospital staff involved in the process. I tried to capture the emotional factors - stress, anxiety, lack of confidence, etc. that the patients go through before the surgery and the methods that the orthopaedic surgeons and consultants use to deal with them.

Methods
In this research the following methods were used to gather the corresponding data: Subjects - Qualitative interviews - Sensitizing Booklets - 3 elderly patients ( 2 Female, 1 Male) - Knee and hip replacement surgery

1 day after surgery

Stages of the patients journey - Consultation with orthopaedic surgeon - Diagnosis - Preparation for surgery - Consultation with orthopaedic consultant - Physical and mental preparation - Surgery - Recovery Tools - Tools used to explain the procedure to the patients - Information booklet with the information regarding the surgery - Models of the artificial joints - Tools used to measure pain Expert Suggestions - Qualitative Interviews with Orthopaedic surgeon, Orthopaedic consultant, Physiotherapist - Sequence of meetings and sessions with the patients - Information shared with patients - Discussion with patients regarding their current state, surgery, pros and cons of the procedure - Gauging the emotional state of the patients, supporting them - Response from the patients end - Suggestions from the surgeons, consultants, nurses

Research Analysis & Results


From my interviews with the patients, doctors and hospital staff, I found out that the process of helping the patients prepare themselves physically, mentally and emotionally for the surgery requires a lot of attention. Patients who are well-informed are usually more satisfied. It influences the way the patients look at their situations, the need and requirement of going for the surgery, risks, complications and healing time, what expectations to keep from the surgery, the recovery period and measures needed and above all acquiring the mental strength, confidence and trust to go for the joint replacement. Following are the data collected from the observation and interviews regarding the pre surgical phase.

Interview Findings
Interview with patients

People Patient 1

Objects Information Booklet, Information from the internet

Environment Orthopaedic Surgeons Clinic, Orthopaedic Consultants Chamber

Patient 2

Model of prostheses, Information Booklet

Orthopaedic Surgeons Clinic, Orthopaedic Consultants Chamber

Patient 3

Previous Information from his wifes surgery, Information Booklet, Model of prostheses

Orthopaedic Surgeons Clinic, Orthopaedic Consultants Chamber

Messages Information from the booklet, internet, verbal discussion with the doctor and consultant, possibilities, risks, complications and healing time Information from previous experience of hip replacement , risks, complications and healing time, Anticipated expectations , Unknown reaction to injection Information from the booklet, lot of information from experience of his wifes surgery, friends and neighbours experiences, risks, complications and healing time, discussion with the doctor and consultant

Services Information provided by the doctor, questions answered by consultant

Information provided by the consultant, doctor

Information provided by the consultant, questions answered, Very stressed out, cramps before surgery helped to calm down

Interview with Orthopaedic Surgeon Most important points - Sees the patient only once in the polyclinic before the surgery - During diagnosis he tell the patients that it will take 1 year to recover - And that they will be released the next day after the surgery - Explain the complications, what can go wrong - If the patients decide to go for the surgery, put them on waiting list(Specific surgeon) or go for quick surgery - Gives them an information booklet about the new knee/hip to read - Sends the patients to the orthopaedic consultant for more information a few weeks after they decide to go for the surgery - The surgeon feels that The patients are always very insecure, so its important that they get all the information. - Its important to give the patients adequate information and answering their questions before the surgery

Its important to give information about the risks of the wear and tear of the prosthesis itself If the doctor thinks the risks are too high for the surgery, he scares the patient off even if he wants to go for the surgery He calls the patients one day before the surgery to reassure them Patients waiting for the surgery is a very vital area The patients also ask him questions inside the Operation Room In the ward he sees them twice after the surgery for 2-3 minutes each time He sees them again 6 weeks after the surgery Recovery meeting checks orthopaedic parameters, X-ray Room for improvement information prior to the surgery, so that the patients can be prepared better on what to expect, specific for their expectations

Interview with Orthopaedic Consultant Most important points - Test their physical state (heart monitoring), informing (booklet), informing (consult), informing (group meeting), check up one week before surgery - Sees the patient twice before surgery - Tries to ensure them that it is an intensive surgery, but have to be careful in order to not scare the patient too much - Shows the artificial joints and explains - Sometimes patients are so scared that they dont want to know much - Discuss products that will help them in the recovery, e.g. toilet lifter, shower chair, etc. - One week before surgery, they try to estimate whether the patient needs extra care - check if they arranged the physiotherapy after the surgery - inform them about what they cannot do after the surgery, no cycling, no swimming, no driving, no bending - Talk about what will happen after the surgery, how they have to deal with their temporary limitations - Personal situation of patients, need for caregiver - Sometimes patients are afraid, in tears, the consultant listens carefully - The fear is not always the surgery. It can also be the fear of going home. Then she tries to explain the options. It can also be the partner who cannot take care of the patient. - Sometimes patients do not take their medicines regularly, and it is hard to check - I sometimes notice that they did not read the booklet and I doubt that they understood everything correctly. - If patients keep saying they cannot do it, I try to confirm that they can do more than they think. - Sometimes a patient acts angry or unfriendly. Then I try to discover why they act this way. Mostly I ask if they are afraid. And then they brake and tell they are indeed afraid. And then I try to help them explain the things they are afraid of. - Recovery meeting check the wound, rate the pain, check regularity of exercises, medicines

Interview with Physiotherapist Most important points - Takes charge of the patients within 2 hours of the surgery - Physiotherapy two times a day after surgery - Takes care of how the wound is, whether it is leaking - Helps the patients walk - Listens to their health concerns - Gauges the patients mood - Asks them to rate their pain before and after surgery on a scale of 1 to 10 - Physiotherapists goal after surgery is to check the discharge criteria - Mobilise the patients in a good and safe way - Coach the patients with the help of walking aid, chair etc., - Keep a check on how they are doing the daily activities - Patients are discharged within 2 days after surgery - Physiotherapist writes a report on their physical condition - For reference for the next therapist - They dont have much influence on the patients after they are discharged - But they would like to know, keep track of how they are doing Outcome of the Interviews From the observations and interviews, I found out that the way the patients were provided information prior to the surgery is quite uninteresting and rather drab. The information booklet on a new knee/hip given to them for reading has a lot of scope for improvement. There is the need of an interactive system which would help them with adequate information before surgery, answer their questions and prepare them better on what to expect. My design would therefore focus on a solution which will help the patients prepare themselves physically, mentally and emotionally for a joint replacement surgery in a stress-free, friendly, comfortable manner.

Patient Journey

Research Flow
Goal Definition

Literature Review

Research Design

Sampling

Interview, Observations

Data Collection

Data Analysis

Preliminary Design

Pilot Test

Final Design

The research and design process shown above is an iterative process that does not actually end until the final design. Every refinement is made until satisfactory.

Concept Direction
Designing a solution to let patients have access to adequate information regarding joint replacement surgery in an interesting, interactive and user-friendly way

Initial Ideas
Idea 1 Design of an Interactive Interface, video where the doctor takes the patient through the entire journey, explains everything, answers F.A.Q and interacts with the patient timeline. Improved patient- doctor communication, for making the patient feel confident, trusted, well taken care of & satisfied.
Interactive Interface for patients to explore all the information, get questions answered

Doctor interacting with patient timeline

Patient timeline

Idea 2 Design of an Information Booklet in the form of a storyboard Simple, interesting, friendly, relaxing

Explaining the surgical procedure, risks, complications and healing in a simple, friendly, humorous manner

Explanation of all procedures with illustrations , not a lot of text

Illustrations from real life, daily activities

Friendly and Humorous Illustrations

Conclusions
The research findings show that before the joint replacement surgery the patients are given some information by the doctor, but mostly by the orthopaedic consultant. Their stress, tension, anxiety, fears and trauma is also taken care of by the consultant with the help of verbal discussions. They are given information booklets about the artificial joints, sometimes group meetings and their questions are answered. But there is the need of a system where the patients can explore and understand the entire procedure themselves and work out what exactly they should focus on and thus prepare themselves better on what to expect, specific to their expectations. Furthermore, the information should be provided to them in a more interesting and friendlier manner in order to help them release the stress and feel confident.

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