UX Research, UX Design, Hardware Design
It goes without question that having a newborn baby admitted to the Neonatal Intensive Care Unit (NICU) is a stressful experience. Life is not put on hold as you learn how to navigate an unfamiliar environment and adjust to a new routine, and all other everyday obligations still exist.
Beyond surface-level stressors, a lesser known complication is the missed opportunity for bonding between mother and newborn. The initial weeks of life are some of the most critical for the social and emotional development of a newborn, and physical contact is one of the most important elements of bonding. Unfortunately, this is the least likely means of connecting with their child.
By working within the SOP of routine care in the NICU, Embrace mitigate negative consequences of missed bonding between mother and newborn via a unique combination of software, hardware, and emerging technologies.
A missed opportunity for bonding, a missed opportunity for connection.
The first few weeks of life are critical to establishing a lasting bond between the mother and newborn. While the newborn's physical health might certainly benefit from continued isolated care, emotional development, social engagement, and overall well-being are at risk of being stunted. Without a good initial bond, children are less likely to grow up to become happy, independent, and resilient adults.¹
Every year, nearly 10%, or around 500,000, newborns will be admitted to the NICU immediately following birth for issues regarding weight, respiration, or other health concerns. Being admitted to the NICU can involve a period of isolation that lasts anywhere from a few hours to several weeks.
Winston R, Chicot R. The importance of early bonding on the long-term mental health and resilience of children. London J Prim Care (Abingdon). 2016;8(1):12‐14. Published 2016 Feb 24. doi:10.1080/17571472.2015.1133012
Asking the right questions.
Initial research consisted of speaking with the stakeholders most involved with the NICU (the parents, the NICU nursing staff, and other associated staff), and visiting Cincinnati Children's Hospital NICU and University of Alabama NICU Sim Center in order to better understand the environment.
Parents and nurses were contacted via phone and email, and were asked to describe their experiences starting from initial admittance to the NICU and ending with the discharge process. This lead to a general understanding of the parents' plight, and, perhaps more importantly, informed high-level research goals for ongoing user research. General goals for initial research were summed up in the 3 questions listed below.
1. How involved are parents during the entire experience?
Understanding the parents' role in the NICU will serve as the basis for ongoing research and identify key areas of opportunity or stress mitigation. It is important to know the limits to which parents are able (or expected) to contribute to the care of their child, as this will begin to define the constraints within the system must be able to operate. Further, gauging a parents' interest or ability to remain connected to their child can shape the design to best support their wanted level of involvment.
2. What variables can be changed in the parents favor? Which are fixed, and why?
Constraints and "red tape" are aplenty in a healthcare setting. Understanding the fixed components (e.g. nursing care routines and protocols) will better inform what can and cannot be changed. Knowing this, we can design a system that works in harmony with the current infrastructure, not against it.
3. How can we create a symbiotic relationship between parents and nursing staff?
No matter how much a design feature or service might benefit a parent, it mustn't inhibit the ability for a nurse do their job, or add unnecessary burden. This system will, ideally, result in mutually beneficial outcomes for all stakeholders. For this reason, it was critical to identify points of convergence and conflict among parents, nursing staff, and how it all related to the newborn.
Hearing their voices.
To understand their experiences.
VOICEs OF THE PARENTS
"I felt helpless."
" I felt empty without him in my arms. It was an emotional experience seeing him hooked up to all that stuff. And I couldn't hold him. "
Walking out of the NICU there was a little bit of blame. What did I do?
VOICEs OF THE NURSES
" Sometimes parents can become too cozy and overstep
" It can be overwhelming. Parents are sometimes apprehensive to do basic care because of the wires. "
" We try to keep it as transparent as possible. "
Noting the insights.
As a basis for further research.
1. Isolated babies are better protected from infection, yet can lack the social stimulation provided to pod babies.
2. Parents can be apprehensive to touch or hold their newborns, due to their condition and the equipment attached to them.
3. Parents experience the most negative emotional state immediately following their baby's admittance to the NICU, likely due to a lack of communication and little knowledge of the procedures.
4. Communication between parents and nurses can be ambiguous or even lacking.
5. Parents exhibit different levels of involvement, from those that are hyper-involved to those who are totally absent.
6. A nurse's most difficult task can be managing the parents and their emotions and expectations.
7. The NICU operates on a routine.
8. Parents can eventually contribute to the care of their child.
Visualizing the parent's plight
The entire experience is a stressful one, and it cannot be summarized pixels, colors, or text. However, creating a journey map based on the ethnographic research revealed points of convergence or conflict between parents and nurses, and served as a central point of conversation. Opportunities and pain points became more apparent.
The end result, however successful it might be at mitigating parent's stress, mustn't inhibit the nurses workflow.
Simulating the experience of being in a NICU resulted in more informed user needs.
In order to better understand the role of a nursing team within the NICU, I attended a NICU Simulation training event hosted by the University of Alabama at Birmingham Hospital. This 3-hour training event was focused on preparation or recertification for NICU nurses in emergency settings that immediately follow delivery. These simulations provided valuable insight to the workings and cooperation of a nursing team in dealing with patients and parents. I opted to return for a second simulation event one week later, which reinforced the problem areas I noticed during initial research, and provided valuable stakeholder feedback that subsequently lead to a more comprehensive user journey map.
This stage offers the greatest opportunity and flexibility for getting parents involved and connected.
Parents are often encouraged to contribute to care responsibilities should the baby's state improve. Even if the parent is unable to be physically present, the care cycle runs on a schedule, which affords the parents work it into their own schedules.
Identifying user needs
User feedback was vital at this point in the project, and it was convenient to ask the experienced nurses from the simulation event to evaluate the user journey map, pain points, and opportunities, while contributing their own thoughts and ideas.
The stakeholders were asked to prioritize the opportunity statements in order of importance, which lead to three statements being recognized as the most appropriate to focus on. The common link between all three chosen statements was communication among parents and nurses.
What do parents and nurses feel is most important?
Filtering need statements.
Parents need to a way to interact with their babies remotely.
Isolated babies need a way to socialize or stimulation.
Nurses need to limit distracting parental involvement in order to successfully do their jobs.
Parents need to feel in control of the situation.
Parents need more immediate communication from nurses in the moments immediately following delivery.
The NICU (building) needs to be more comfortable to look at.
The equipment in the NICU needs to be more comfortable to look at.
Parents need to feel more comfortable interacting with their babies in the NICU.
Parent's need their role supplemented in the event that they cannot be there in person.
Market analysis and inspiration
The idea of a comprehensive system that promotes communication between two involved stakeholders is not a new idea; however, existing market options are typically concerned with client-business relationships. Gingr is but one of many pet grooming platforms that provides a channel of communication between owners and pets, and has served as a primary source of inspiration in developing a system that meets similar (but more extreme) communication requirements.
The only remote platform that exists for the NICU is the NicView camera system. Though it claims to be "the next best thing to being there," it lacks any avenue of direct communication between parents and nurses, and parents to newborn. If anything, the simple one-way portal system has the potential to dehumanize the newborn into a collection of pixels on a screen. The parent misses out on the opportunity for bonding with a newborn in the form of physical contact, auditory communication, and limits any chance for interfacing with the nurse.
Initial concept generation used these two services as a starting point before developing into a more refined solution.
Do pet owners have similar needs to new parents?
Well, it turns out they do. Somewhat.
Brainstorming & Idea Generation
From a given prompt of promoting communication between all stakeholders, participants generated ideas.
After listening to stakeholders of the NICU and drawing on inspiration from services in the market like Gingr, ideas were fresh and ready to be put onto paper. The brainstorm was relatively open-ended, yet participants were given the prompt of promoting communication. Ideas tended to be about remote means of communication and interaction, notification methods, and ways to connect parents to nurses.
A simple framework was presented for the participants to build upon. This framework only included core components and actors of the system (e.g. parents, nurses, and any "concrete" elements that must be designed around) so as to not constrain ideas any more than necessary. The results were digitized after the exercise and specific ideas were highlighted for further exploration.
In short, a newborn's auditory system is fully developed upon birth, yet its eyesight is not. If a mother can speak to the baby when it's feeling distressed, the baby will eventually begin to associate the mother's voice with receiving care.
From the brainstorm session and after revisiting the initial interviews, I determined that nurses most wanted a way to ease the parents stress (thus, easing their own burden) and parents mostly wanted a way to see their baby and all of the information that might be available if they were present in the NICU (essentially, they wanted to "be there when they couldn't.")
A rough draft of the system included a webcam to facilitate two-way communication, an online portal for the parents to visually check-in on the baby and see health vitals, and series of notifications regarding the baby's distress or health. This defines the MVP and serves as the basis for future design ideation and refinement.
Harmony via symbiosis.
Defining system-level interaction.
User feedback (Remote)
Input from those who would use the system was critical before proceeding with the design.
Before pursuing any final concept direction, I found it necessary to receive feedback on several concepts from those affected. Upon reaching out to the March of Dimes, I was put in touch with 2 NICU mothers that agreed to participate in a feedback session centered around refined concepts. Being that the 2 mothers were located in different parts of North Carolina, and myself in Alabama, I opted to host a virtual feedback session. This consisted of screen-sharing a template that helped guide conversation, which was populated with their own experiences, thoughts, and wants throughout the conversation.
This proved to be an experiment in and of itself, but ultimately affirmed the direction of several design concepts.
Hearing from the experts.
Gauging user interest in the system and features.
Participants were sourced from the March of Dimes for a remote feedback session focused on understanding their attitudes towards the current concept (both from a system-level and feature-level perspective). The participants were first asked to describe their experiences in the NICU in order to be in the correct mindset for the rest of the study. As they described their experiences, they were prompted to think of ways that their experiences could have been better or eased the stress at certain moments. At the end of this part of the study, participants were asked to think without constraints or boundaries, and provide any "blue sky" ideas that might or might not be feasible - this was to gauge ideal expectations of the system and capture any thoughts that might have been missed in the preceding conversation.
This part of the study lasted around 30 minutes, and helped prepare the participants for discussion on the system and certain features. Ideas and talking points were categorized into the following 3 areas:
1. "What happened?"
2. "How could things have been better?"
3. "What would be ideal?"
Following the interview, the participants were shown 2 different concepts (shown below). They were informed that all information was consistent across each concept, even if one didn't show it on the home page.
Calendar can help parents stay in the loop of procedures and care routine (2/2)
Chat function can double as a "virtual notebook" for online portal (2/2)
Vitals and monitors are necessary to show on online portal (2/2)
Notifications can help parents respond to baby immediately (2/2)
Goals and progress tracking are wanted (2/2)
Ability to speak to baby is reassuring (2/2)
Camera function desired for sharing with friends and family or documenting progress (1/2)
Security concerns of who has access vs. who does not (2/2)
Hesitant to place screen in front of baby (1/2)
While desired, nurse chat function identified as being unrealistic to expect quick reply (2/2)
Online portal Concept 1
Nurse chat is clearly understood, yet little confidence for quick reply (1/2)
Vitals being on same page as live stream are distracting (2/2)
Little understanding of what "request interface" means (2/2)
Online portal Concept 2
Prioritizing livestream of baby is preferred (2/2)
Knowing vitals monitors, chat with nurse, and schedule of procedures is available but not immediately present (2/2)
Chat pop-up modal not immediately understood when collapsed (1/2)
Concept 2 was the clear favorite among the participants.
While knowing the newborn's vital and health information was important to them, it was described as being too distracting from the most important part of the system - their child. Further, the participants found knowing that the nurse was reachable via chat box, even if not entirely visible was reassuring.
Design Iteration & Refinement
User feedback helped to separate "must have" features and functionality from "nice to have," and eliminated undesirable and superfluous features.
The online portal was to act as the hub of the system infrastructure, so initial effort went into incorporating the myriad features and functionalities recognized as "must haves" into it as a starting point. The necessary components (identified in the initial Information Architecture) were given priority.
Once a suitable IA was developed, initial wireframes followed and were refined based on discussion and feedback.
The newborn's livestream
is presented upon login and takes visual precedence over all other elements on the page. This focuses the user's attention on what is important, and leaves any distractions hidden.
The nurse chat box
remains hidden within a popup window, and is with the user on every page they visit. From this chat box, the user can leave messages or request a video call with the nurse. The nurse has the ability to respond to the parent at their discretion.
The health page displays daily updates
about the newborn's weight, growth, age, and any changes (like improved sleep quality) that might happen.
On the right side of the page are the newborn's vitals
, which are live streamed to the portal. The decision to include this information stems from trying to simulate the in-person experience as closely as possible, as parents are typically taught to read the monitors by the nurse when they are there in person.
Colored gauges represent a range from "normal" (green) to "attention required" (red).
User can adjust preferences and settings
Click to watch concept tutorial.
Embrace the connection.
Embrace attempts to simulate a bonding experience between mother and newborn. Upon birth, a newborn's auditory system is fully developed and research shows a preference for their mother's voice. However, their eyesight is underdeveloped to the point of being unable to recognize faces or distinct shapes. Embrace takes advantage of this and will alert the mother when their newborn is in distress. Eventually, a nurse will come to relive the newborn of its stress, but in the meantime, Embrace prompts the mother to soothe and comfort the newborn with her voice. The newborn does not know who is giving it care, but will recognize its mother's voice and, given enough repetition, will eventually associate the care it receives with its mothers voice - effectively simulating bonding between the two.
Made with love by Benton Humphreys, 2020.