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Sound-driven design is an emerging, human-centered design practice informed by technology and listening in the multisensory dimension of interaction. In this paper we present a discourse analysis approach aimed at qualitatively understanding the constituent concepts of such a practice, by means of semi-structured interviews with sound designers, design researchers, engineers and expert users in the context of critical care. Preliminary results show that sound-driven design is inherently embodied, situated, and participatory, that the four categories of interviewees equally contribute to the definition of the design problem, and yet that a clear, shared arena is still missing.

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Conceptual design and communication of sonic ideas are critical, and still unresolved aspects of current sound design practices, especially when teamwork is involved. Design cognition studies in the visual domain represent a valuable resource to look at, to better comprehend the reasoning of designers when they approach a sound-based project. A design exercise involving a team of professional sound designers is analyzed, and discussed in the framework of the Function-Behavior-Structure ontology of design. The use of embodied sound representations of concepts fosters team-building and a more effective communication, in terms of shared mental models.

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Neonatal Intensive Care Units (NICU) are environments with a high level of sensory stress. Medical advances and technology have contributed to increase the ratio of survival of premature infants but some devices and practices expose these babies to excessive noise and toxic sensory stimuli for which they are not prepared. This is related to an increase of neonatal morbidities, that are considered as minor sequelae, but that can greatly alter the life of the child and the family. Those responsible for hospital management and caregivers who want to take a step forward, need standards to guarantee the benefit of neonatal health and a proper physical and cognitive development of these babies. Design activity, from a Human-Centered Design approach (HCD), together with Developmental Centered Care (DC) contribute to identify and reduce adverse environmental conditions for newborns and premature infants. The purpose of this paper is to establish a method to provide design recommendations and good practice guidelines from evidence and especially from in-situ observations carried out in neonatal units by a multidisciplinary team (i.e., nurses, NICU supervisors and designers). Thus, we identify proposals to reduce stress situations and obtain potential benefits in the development of the hospitalized infant through adaptation of the NICU macroenvironment (i.e. the reduction of light and noise).

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Intensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called 'alarm fatigue' and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.

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In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed.

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As designers and cognitive scientists begin to explore human experience as a relation between people and products, there is a need for constructs that index relational properties (i.e., properties of a product that are dependent on properties of an actor). One such construct that has recently become popular with designers is affordance. Affordances, such as pass-through-able, depend on properties of both an object (e.g., width of an opening) and properties of an actor (e.g., girth or shoulder width). In this article, three relational constructs are suggested to reflect important properties of the coupling between humans and products: affording, specifying, and satisfying. Affording refers to constraints on the action coupling between actor and product. Specifying refers to constraints on the perceptual or informational coupling. Finally, satisfying refers to constraints on value (e.g., attractiveness or desirability). The case is made that each of these three constructs are critical to determining the quality of the experience of an agent with a product (e.g., the capacity for satisfying interactions).

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This article addresses the need of including acoustical perspectives in the debate on alarm fatigue within the healthcare domain. We show how conceptualisations and proposed solutions to alarm fatigue are unequally distributed across what could be called the ‘alarm chain’: a generic model of the core structural elements and dynamic relations that constitute any alarm scenario. A focal point in the alarm chain – the ‘alarm mediation cleft’ – seems to divide the alarm fatigue literature from the segment of the alarm literature that deals with auditory alarm design. The current healthcare discourse on alarm fatigue is centred around the ‘premediated alarm phase’, which has the consequence of an unfortunate dichotomous approach to the functionality of sound. We address some shortcomings of this approach and outline some methodological implications and potentials of searching for signs of alarm fatigue in the ‘post-mediated alarm phase’.

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In health care, the design, development and commercialization of innovative products is often found frustrating due to the slow inefficient and difficult nature of its systems. One part of this problem is the fact that health systems are highly regulated complex systems that include various stakeholders and unique challenges. Nevertheless, designers and other innovators are
often unaware of these unique features of health systems. It is important that designers and managers are able to understand the system, anticipate challenges and account for them in their work.

We therefore aim to establish and evaluate an overarching conceptual model, which can delineate both the systems of health care innovation process and the relevant stakeholders in these systems. This paper reviews the application and potential benefits of one of the promising models called Multilevel Design Model (MDM) by employing an expert-participatory testing on multiple cases in documented clinical reports (n=8). The evaluation of the MDM model followed by further adaptations and changes to the model itself, as well as to the accompanying user guidelines. With some adjustments, the MDM was able to visualize and explain the systems of the health care innovation process in a systematic and shared manner usable for health product designers, innovators and health organizations. We propose the adjusted MDM model for further use in the design and development of health care innovations in order to avoid the typical stagnation of product dissemination after implementation.

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Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses' perceptions and common clinical practices toward clinical alarms, where little information is available.

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Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.

The excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter alarms should be configurable. Because computer devices are more reliable than humans, an opportunity exists to improve physiologic monitoring and reduce alarm fatigue.

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