Time Sphere: Harmonizing Schedules for Nurses and Elderly Patients in Home Care
by Aleksandra Szendzielorz, Carolin Drössler and Lezhi Liang
Does a home visit can feel like an ominous cloud invading your personal space? The warm, reassuring feeling of sunshine? Or a storm rushing through in a hurry? Especially in the initial stages of home care, patients can experience contrasting emotions when receiving care. Each patient is unique and has distinct needs, not only in terms of medical treatment but also regarding how personal interactions during a visit unfold.
To enhance transparency and demonstrate respect for each other’s time, our goal is to facilitate the development of mutual trust and understanding between patients and nurses. Through several interviews conducted with homecare nurses, it has become evident that a significant point of contention is the management and communication of time.
Finding time with care
During our field observations, we noticed that various stakeholders employ different methods to measure and schedule time.
Nurses receive a physical paper list containing the names of patients and their addresses for each day. They mark off their visits on another paper list kept in a folder at the patient’s home. Time planning primarily occurs in a tangible manner on paper. For nurses, real-time information, updates, and time changes are communicated over the phone.
Patients are tasked with finding their own system to remember their appointments and tasks, which can be challenging, particularly for those suffering from dementia.
It’s about time
When it comes to representing and organizing time, we often rely on standardized patterns. Clocks show us the repetition of a circle, following the same pattern over and over every day, whereas timelines or calenders show the progress of time, giving us a past, a present and a future.
But how can we express time in a different way that suits individual needs? Maybe we can imagine it as ripples spreading, paper folding, lines coming together and moving apart, or spheres shifting. There are still many metaphors to be explored in this area.
How might we…
Based on the research and analysis of the gathered materials as well as our own empirical observations, we have formulated the following problem statement:
How might we create a digital system that helps home care patients and nurses to communicate time and appointments in a way, that makes both parties feel valued?
Presently, communication between patients and nurses in home care settings primarily relies on intermediaries such as the clinic’s reception. This arrangement is in place to prevent patients from having direct access to nurse contact numbers, as excessive calls could potentially disrupt the nurses’ workflow. Nevertheless, this mode of communication gives rise to several issues that need to be addressed:
- A notable delay in the transmission of information between the involved parties. This delay hampers timely and efficient communication.
- A lack of consistent communication regarding any potential delays in scheduled visits. This omission often leads to patient anxiety and unease, as they remain unaware of any disruptions or changes to their expected care.
To overcome these challenges, we aim to develop a digital solution that not only bridges the communication gap but also instills a sense of value and importance in both patients and nurses. By doing so, we can enhance the overall patient experience and optimize the delivery of home care services.
Different users, different needs
Our project encompasses the intricacies of communication among nurses, patients, and the organization, acknowledging each party’s distinct needs and roles. To facilitate seamless interaction, we have designed individualized interfaces tailored to prioritize relevant functionalities.
For patients, especially those grappling with cognitive impairments, we recommend employing tablet devices. These devices offer enhanced visibility and interactivity compared to smaller phone screens. The patient interface will incorporate information concerning scheduled visits for the day with possible delays/ changes, along with reminders regarding medication regimens.
To cater to the dynamic nature of a nurse’s work, we decided on mobile phones, ensuring mobility while maintaining vital access to pertinent tools. The nurse’s mobile interface will encompass features such as a patient list for the day, patient profiles, maps, and the ability to dispatch notifications regarding potential complications or delays.
For the organization, defined as the entity responsible for managing nurse schedules and facilitating communication, we propose the utilization of desktop computers. This choice facilitates an expansive overview of most important information. Presently, during emergency situations, the front desk must individually contact field nurses to identify availability for rapid response. Hence, the desktop interface will prioritize functions enabling real-time monitoring of nurse locations and availability. Given the urgency inherent in crisis scenarios, every passing moment holds immense significance.
Time sensitivity
Patients may exhibit varying attitudes towards appointment times. To illustrate this, we have created three representative personas, each representing different levels of sensitivity to punctuality.
Elsa embodies patients who place significant importance on timeliness. Within the nurse interface, Elsa is depicted as a distinct, well-defined circle, symbolizing her adherence to clear boundaries and precise scheduling.
On the other hand, Goran is a patient who allows for some flexibility in punctuality, considering a 15–20 minute delay acceptable. Goran’s circle is intentionally rendered with a slight blur, indicating the possibility of minor deviations from the scheduled time.
Anna’s persona represents patients with a more relaxed approach to appointments. Regardless of the actual arrival time, Anna is always pleased to see her nurse. Anna’s circle lacks clear borders, appearing blurred, which symbolizes her higher tolerance for time variations and a more fluid concept of punctuality.
Day in the life with home healthcare
To give you an idea of how our project works, we present an account of a typical day in the life of Lina - a nurse providing home care services.
Lina commences her daily routine by reviewing the roster of patients assigned for the day and cross-referencing it with the corresponding maps of their residences conveniently accessible on her mobile device.
Anna gets up in the morning and goes through her list of appointments and medications for the day.
Linda can switch the interface view to show real-time visits
After finishing her first visit Linda receives a call from the clinic with information about some priorities and emergency situations. The institution is able to see which nurse is currently visiting and which is on the way.
Linda has to change her schedule and the order of patients. When he reaches a priority situation, she can check the patient’s profile in the application with the most important information.
Due to the situation, Linda needs to notify the other patients of the delay. It can send a message directly to their devices. The patient on his device in real-time sees the upcoming appointment with the nurse in the form of approaching circles.
After visiting all appointments, Linda returns to the clinic.
Future Opportunity
Looking ahead, we envision this product to have scalability and the ability to connect with a wider range of stakeholders, including social workers, physical therapists, and family members. Its form should not be limited to a standalone product, but rather serve as a visual medium within existing systems (e.g. TakeCare), sharing databases with other healthcare systems. By extracting elements of time management from it, we aim to incorporate an emotional design that bridges the perceptual differences among different roles.
Feedback & Reflection
During our final presentation in Stockholm, we received valuable feedback from participants. They pointed out that our interface, while aesthetically pleasing, lacked intuitiveness, which could hinder patient understanding during the initial stages due to varying levels and stages of cognitive functioning. It was suggested that differentiating various display modes to accommodate different levels of comprehension would be beneficial.
In the subsequent reflection session, we took a step back and approached the generation of this concept from a more holistic perspective, critically evaluating the assumptions on which we were based. We assumed that the access to information was real-time and unlimited. However, in reality, due to concerns about the confidentiality of patient privacy and the independence of different systems, data is often not interoperable. This is why nurses still primarily rely on exported paper printouts to organize work and record information. Looking back on our final outcome, we tried to create digital interfaces for different parties that allow for interactive information and multi-device synchronization. Then we realized that our product lacked a clear arrangement for the information flow: how the scheduling of home visits and medication-related information would be initiated? then processed by whom? and ultimately reach the intended recipients in what form? and how it would be stored? Many details such as these need to be thoughtfully considered.
Thanks for reading, and please do not hesitate to contact us with any questions or feedback :)
