Improving the daily ICU experience from a critically ill patient's perspective

Abstract

The intensive care unit (ICU) is a dehumanizing technical environment causing complications that are all captured in the term post-intensive-care syndrome (PICS). The patient’s well-being could be improved by moving away from this hostile environment toward more patient-centred care. Therefore this report explores how to improve the daily ICU experience from a critically ill patient’s perspective.

Environmental influences in the ICU, like noise exposure, are important contributors to PICS (Abuatiq, 2015). Hearing is the most prominent sense of ICU patients. Thus, the Erasmus ICU is designed to keep sound out. It has been shown that there is no clear relationship between reduced volume levels and physiological improvement (Drahota et al., 2012), and the absence of sound does not necessarily create a positive environment (Truax, 1984). Therefore, this project aims to consider sound in a positive manner since sound is only perceived as noise when it does not fit the patient’s state of being.

After many former patients were interviewed and an Erasmus MC ICU nurse was observed, it turned out that it is hard for patients not to focus on their feelings of frustration, loneliness, discomfort, shame, panic, confusion etcetera and still keep a positive mindset. Thus, the design aimed to redirect the patient’s focus by connecting the patient to the environment.

The Thirteen Fundamental Needs for Human-Centered Design typology was utilized as a source to design a positive experience for the ICU environment. Six fundamental needs (Stimulation, Recognition, Relatedness, Autonomy, Security, and Comfort) were uncovered. Strengthening these needs could improve the patients’ experience.

Mapping a patient’s daily routine showed that need fulfilment changes according to the eventfulness, the presence, or absence of people or sound inside the ICU. A patient’s journey revealed that the absence of people right after leaving causes the most harm to the patient. Thus, the decision was made to focus on this transition moment.

Eventfulness can be determined by measuring sound pressure levels (SPL) in dB in the ICU. So the transition moment from an eventful (high SPL) to an uneventful (low SPL) environment can be detected and vice versa.

New visual/auditory stimuli were developed. These can be introduced to benefit patients’ recovery (Arbabi et al., 2018). The stimuli consist of sounds of nature in combination with a nature-based projection. The audio and the visual stimuli change according to the SPL in the room. This design intervention helps guide the patient into the new environment. It is a subtle way to notify the patient that something is happening. Furthermore, it can distract the patient (when bored or during treatment) and decrease the difference between higher and lower sound pressure levels.

The design was developed, embodied, and finally tested in a simulated ICU environment. The evaluation of the design intervention showed that all participants appreciated the design intervention, mainly because they were distracted from boredom, stress/anxiety, negative thoughts (loneliness) or discomfort. It made the experience more comfortable or relaxed.

Finally, three use cases were presented, redirecting the focus from anxiety, boredom, and loneliness. Additionally, recommendations were made.