See teh YouTube movie 2013 about voICe; thanks to Thijs Tollenaar UMC St. Radboud Nijmegen.
Possibilities of voICe.
The communication-app voICe has several possibilities/features: The patient (adult or child) can – by touching pictograms (+ text) – indicate if something is needed, if there’s a physical problem or e.g. in the patient’s current mood. The first version contains 46 pictograms, sorted in 6 different themes and based on an inventory of the most common asked questions and shown problems for patients and professionals in the ICU. If the patient touches a pictogram, a voice (man/woman/boy/girl), tells what the patient wants or what is wrong.
The voICe-themes are:
- My feelings
- My body
- My treatment
- My basic words
- My relaxation (2 x; for children a special ‘relaxation’ screen has been developed).
- My caretaking
The ‘generation-proof and neutral’ pictograms are drawn in such a way that they’re understandable for every user of the app.
- The subject ‘pain’ gains extra attention. The patient can indicate through the app where he has pain and through the use of an NRS-score he can indicate the level of pain.
- To expand the possibilities of the communication-app and to make it more complete, the app has a sign- and keyboard. The patient is able to communicate by typing texts or draw/write something. The keyboard is simple, has huge letters and there’s a choice between a QWERTY or a ABC keyboard system.
- The app contains the possibility for the patient’s family/friends to record a personal video message which the patient can play when he has a need for this. One might also consider the possibilities of using the video messages for a day program/schedule or therapy.
- The app contains a clearly visible clock-, day- and date screen which can say the time, day or date when touching the screen. Also, the location can be set and spoken by the app.
- Through the ‘preference screen’ direct contact can be adjusted to the most chosen themes of the patient.
- The app can – for patients with a minimal or no hand locomotion – be used in a ‘yes-no-model’ , where the patient can choose to confirm or to reject pictogram that has been proposed by the patient’s neighbors or a professional. This way of working is comparable with using a keyboard, but it is easier and faster.
- An easy or a basic version with 4 or 6 pictograms (settings).
- The iPad can also install other different (medical) apps. When needed, they can give useful extra information to the patient. If someone chooses to install different apps for the iPad (e.g. about anatomy), communication through voICe can be easy and supportive in explaining/illustrating/locating the disease or discomfort.
Impression of the voICe-screens. To give you, the reader, an impression of the subjects that the voICe takes, see a representation of the majority of the subjects that are saved in themes/pictograms below.
Example of the screen ‘Main menu’.
Example of the screen ‘Date, time & location’
Example of the screen ‘Themes’‘.
Example of the screen ‘My feelings’.
Example of one of the screens about pain.
Example of the screen ‘My treatment’
Example of the screen ‘My basic words’
Example of the screen ‘My Leisure time’.
Example of the screen ‘My Leisure time’ for kids.
Example of the screen ‘My personal care”; details are worked out in several pictograms.
Advantages of the app voICe
- Patients get ‘back’ their ‘voice’; they can make clear which problems there are, what they need or what they do not want.
- The patient will become active instead of passive and is able to get back some of the control; he can make choices again.
- Patients, their closest and the workers will be less frustrated by easier communication . People will understand each other faster and better.
- Through constant reminders for date, time and place, the patient can improve his orientation.
- Hearing and seeing a (video) message of one of the closest of the patient can be a support; we can also imagine a message about the daily program for the patient.
- Depending on the patient, caregivers can adjust the care in a better way. The app makes it possible for them to communicate easier and more focused with the patient. In this way they’re able to gain specific information about the patient in a short and systematic way and they can directly ask the patient for feedback about the healthcare provision and other interventions.
Target group and range. The app voICe is primarily developed for patients at the IC/MC with their communicative limitations. The app can be used as a communication tool as well for others with similar communicative problems during (or partly during) the time sick and the healing process . With that in mind people can help patients after a stroke with a motoric aphasia, patients with a trachea cannula caused by a head/neck problem, patients with a muscle or muscle-nerve illness, patients in geriatrics and many others. A careful estimation, based on the data of the National Intensive Care Evaluation (NICE) 2012, learns us that at the ICU’s in the Netherlands every year at least 12.000 – 15.000 ICU patients during (or partly during) their time sick or their healing process, can use voICe to improve the quality of the communication. No good estimation is possible now about the range for other mentioned groups.
Scan control and one-button-control. The app voICe is also controllable with a one-button-system through the use of a small adapter (brands for example Pererro) for the iPad. Because of this, people with a missing hand locomotion, e.g. illnesses with paralysis as result, can scan, choose and activate the pictograms with a single light pressure button, a lip button, blow button or other special controlling buttons. Furthermore, Apple provides an IOS built in scan system for scanning and appointing subjects & pictograms shown on the iPad. This is a very important development, because till now there are only a few other simple mobile communication devices.
Covers, screenprotector & iPad support
For the protection of the iPad and hygiene, we chose to apply an Apple Smart Case (material polyurethane) around the iPad, in combination with a non shiny screen protector. This way the iPad is well protected against damages caused by bumping and it can be cleaned with alcohol wipes. An advantage of the non shiny screen protector is that it minimalizes the amount of reflection; 2 people can communicate with voICe together. Alternative for the Apple Smart Case is the (more expensive) Griffin Airstrap Med iPad case, which is developed in cooperation between doctors and nurses in the USA, to use it in, for example, hospitals. A (custom made) supporting pillow for the iPad can support the wrist/forearm, because some patients can’t lift their arm properly anymore and can therefore risk leaving the hand on the screen of the iPad. Pressing the home button, without knowing, can be the result of this. A holder can be purchased which sticks the iPad to the bed.
Theft prevention and ‘what to do if……’ Of course storage of the iPad(s) at an available and safe place, where the iPad can be charged as well, is very important. Also, at the IC/MC of the Radboudumc, the following facilities have been made:
- Engraving the iPad(s) with the department and organization name (backside)
- Striking covers around the iPad(s)
- Screen background with big letters that contain the department information + text about track & trace system.
- Registration of the iPad in the Apple-track & trace system: the iPad can be localized when stolen and the memory can be deleted; this way, information about our patients can not be seen by unauthorized individuals.