Experiencing the Unexpected: Human-centred Design in Neonatal Intensive Care

Experiencing the Unexpected: Human-centred Design in Neonatal Intensive Care

Patrizia Marti (University of Siena, Italy)
Copyright: © 2012 |Pages: 24
DOI: 10.4018/978-1-4666-0975-4.ch016


This chapter discusses a fundamental concern deriving from the need to increase the focus on the social, emotional and intimate aspects in the design of healthcare technologies. The development of such technologies is in fact often afflicted by conflicting perspectives. While technical perspectives demand rational methods, social perspectives ask for non-rationalistic, phenomenology inspired approaches (Jacucci, 2007). The issue is addressed from the standpoint of a particular socio-technical setting, the Neonatal Intensive Care Unit. In particular, the chapter describes the human-centred and participatory design process, from problem analysis to concept generation, prototype development and testing of a new incubator system employing different technologies. All these technologies aim to provide unobtrusive monitoring, improving the baby’s comfort as well as parent-child bonding by lowering the emotional barrier created by the current incubator setup. The specificity and the delicateness of the NICU setting offers an opportunity to reflect on how different stakeholders perceive, interpret, and take part in the premature baby’s care, and on the role that design can play in envisaging technologies that respect and harmonise different views and needs making the unlucky event of a premature birth a more sustainable experience.
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The Incubator: The Tension Between Protection And Barrier

The incubator is the main stage in care, as it aims to recreate some of the conditions of the mother’s womb, providing the baby with an optimal growing environment with the right amount of heat, humidity and oxygen.

Most medical treatments are administered directly in the incubator to reduce the risk of complications due to outside elements.

The environmental qualities in the incubator are tightly controlled. For example, air temperature may be set to a specific value or automatically adjusted if the temperature of the baby’s skin drops and needs to get warmer.

The NICU is a socio-technical system composed of other additional machinery and different stakeholders, including the parents, who have different access to the incubator and different requirements depending on their role.

The working practice of the neonatal team is based on the continuous combination and integration of data generated by different sources.

Various monitors are placed around the incubator and display the heartbeat and rate of breathing, blood pressure and oxygen level in the blood. Other parameters may also be displayed, depending on the baby’s condition. For example, diagnostic tools permit data integration across the hospital, showing the baby’s x-rays, laboratory results and other information at the bedside that might help clinicians speed up the decision-making process.

Most monitors are equipped with alarms to keep medical staff aware of any changes in the baby’s condition; unfortunately, jarring warnings often alarm the parents, who need to figure out what is going on, and disturb the baby.

The infusion pump administers intravenous medications and fluids. Since the premature baby is sensitive to small changes and therefore precise dosing is fundamental, the pumps are fitted with safety features and alarms to control the dosages. This contributes to the machine’s frightening appearance.

The ventilator administers oxygen to assist the underdeveloped baby’s lungs until they mature to the point where the baby can breathe alone. Use of this machine is one of the causes of the baby’s separation from its parents, creating an emotional barrier against holding the baby.

Other machines may be present around the incubator, such as a phototherapy system which shines a warm blue light over the baby and helps break down extra bilirubin, an open-care warmer to optimise the infant’s temperature as s/he grows stronger and spends time developing outside the close-care incubator, or an x-ray machine.

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