An important aspect of the interactive screen is the staff-control system and it’s User Interface (UI). The staff-control system was integrated into a new workflow where technology has until now been absent. The system needs to be used by staff in a high stress environment and therefore should be self-explanatory. To create acceptance, the staff was actively involved in the development of the staff-control system which was developed via contextual research. In an iterative process the needs of the staff were evaluated, focusing on functionality and interaction design. Three sessions were performed. The first focused on the needs of a staff-control system. From these needs, features were created and implemented in a first specification. In the second and the third iteration the functionalities were tested making use of user scenarios, co-participation and usability tests.
Results
The results of the contextual research were integrated into a functional research prototype of the staff-control system. The functionalities were distributed over three tab menu’ (i.e. a guidance plan menu, an application control menu to turn on/off applications, and a settings menu to control volume, brightness, level, day/night modus, clock module and language). The homepage gives an overview of occupancy of the rooms and provides the possibility to start a video conference with the client. The staff UI can be controlled from any PC (e.g. in the control room) or tablet in the psychiatric ward.
Sense of control
The staff-control system allows the staff to adapt the settings and availability of the functionality in the high care rooms. Depending on the level of psychosis, the staff can enable various applications on the interactive screen which are specifically developed to support the recovery process.
While the sense of control is a primary need for the clients, it is also an important aspect for the work environment of the staff. It is stressful for the staff to be unable to treat clients with extreme emotions in a humane manner. Providing alternative ways to help them could therefore also reduce staff anxiety. To comply with the high safety levels in high secure wards it is important for the staff to select the available functionality and in some extreme cases restrict the available applications for a client. If the amount of stimuli is not appropriate for the level of psychosis, the staff can disable this functionality. The staff allows the client to set his own environmental settings, but when the level of stimuli exceeds, the staff is able to overrule the settings with the staff-control system, see Figure 3.
Figure 3 Room specific menu of staff-control system; on top the client info, and three tabs: the guidance plan (left), the application control (middle) and settings (right)
From the contextual research we have learned the importance of the staff-client interaction. Decisions of the staff should be clearly communicated, e.g. if the staff disables a function, this icon is than ‘crossed out’ rather than that this function disappears. The latter would make the client more suspicious which can harm the already vulnerable relation between them. The staff-control system allows the staff to tailor the settings (e.g. brightness and volume) of the room to the psychosis level and needs of client. In addition, the clock mode, language of the rights and guidelines and timeslot of the night mode can be adjusted. During the night, the interactive screen in the high care room switches to the night mode, lowering the brightness of the screen during the night.
Figure 4 Volume enabled (left), disabled by staff (right)
Communications
To meet the staff’s need of having an overview of occupancy of the high care rooms, the homepage of the staff-control system provides this overview. This displays relevant information; name, username and date of clients’ birth. The information is coupled to the interactive screen in the high care rooms and can be easily adjusted. The overview aims to improve staff-staff communication.
To provide a basic structure for the client, the staff can enter a guidance plan. The guidance plan includes the time and detailed description of activity, number of staff members, and additional notes. A default guidance plan can be used to ease the insertion of a plan. The plan appears in the high care room directly after it is shared. This digital guidance plan replaces the paper based version and can be safely used even in the most extreme levels of psychosis. To make the guidance plan easy to understand, it makes use of standard icons, see Figure 5.
Figure 5 Icons used in guidance plan
To enhance the staff-client interaction and communication between both, video-conference functionality is available. Visual contact with the caregiver can enhance trust for the client. Video-conference allows more flexibility and can even be used in extreme situation in which it is considered not to be safe for the staff to meet the client in person. It is anticipated that both the enhanced communication and empowering of the client with the control of the room may help lower the number of incidents and enhance de-escalation in such support rooms.
Conclusion
The learning’s from the user experience tests were used to develop a system to support the de-escalation of clients. The staff UI which is a crucial element of the overall prototype running at the GGzE institute in Eindhoven, as it enables the staff to adjust several aspects of the high care rooms to optimally adjust the rooms to the needs of each individual. The client has a high need for control, but at the same time the staff should also be able to intervene; the staff-control system allows the staff to control functionalities displayed on the screen on the high care room. The concept allows having an open discussion about which of the applications (photo wall, drawing module, communicator, etc.) is accessible to the client at the current psychosis level. This gives clarity about the restrictions and opens the communication between staff and client. It is speculated that the presented concept gives the client the feeling of being in control which may lower the number of incidents and enhancing the de-escalation process. Therefore, the staff-control system does not only add technology it is also designed to improve the workflow of the staff.
In this iterative process we have seen that the co-creation with a high involvement of the staff is very effective. To develop a successful concept, the collaboration from experts from the field in an early phase is crucial. In April 2013 an evaluation study was started that includes the investigation to the experience of both clients and staff with the new prototype. Results are expected at the end this year. If the staff-control system meets expectations, it will strongly benefit by an improved staff-client interaction and experience for both parties.
Acknowledgments
We would like to thank the full staff at the High Care Unit at the GGzE, Grote Beek at Eindhoven for their time, support and suggestions. We would like to thank Juergen Vogt and Laurens Boekhorst for the software development.
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