The Patient Factor

Applications of Patient Ergonomics

Rupa S. Valdez, Richard J. Holden

• Publisher: CRC Press
• Year: 2021
• Print ISBN: 9780367720896
• eBook ISBN: 9781000358728
• Edition: 1
• Topic: Technology & Engineering
• Subtopic: Service Industry
• Index: Technology & Engineering

Patients are increasingly encouraged to take an active role in managing their health and health care. New technologies, cultural shifts, trends in healthcare delivery, and policies have brought to the forefront the "work" patients, families, and other non-professionals perform in the pursuit of health. This volume closely examines notable application areas for the emerging discipline of Patient Ergonomics – the science of patient work.

The Patient Factor: Applications of Patient Ergonomics, Volume II reviews the definition of Patient Ergonomics and discusses the application of Patient Ergonomics across contexts. It analyzes patient work performed in emergency departments, transitions of care, home and community settings, retail pharmacies, and online communities. It also examines applications to groups including veterans, pediatric patients, older adults, the underserved, and people engaged in health promotion.

The Patient Factor is ideal for academics working in health care and patient-centered research, their students, human factors practitioners working in healthcare organizations or at technology companies, frontline healthcare professionals, and leaders of healthcare delivery organizations.

Section III

Patient Ergonomics Populations

7 Designing for Veterans

Arjun H. Rao

Flight Deck Research & Concept Development Texas A&M University

Farzan Sasangohar

Wm Michael Barnes ‘64 Department of Industrial and Systems Engineering Texas A&M University

Contents

7.1 Unique Challenges Faced by Returning Veterans

7.1.1 Physical and Cognitive Challenges

7.1.2 Sociocultural Challenges

7.1.3 Organizational Challenges

7.2 Patient Ergonomics and Veteran Care

7.3 Case Study: Patient Ergonomic Design of Interventions for Veteran Mental Health

7.3.1 Phase I: Understanding the State-of-the-Art in PTSD Care

7.3.2 Phase II: Data Collection and Analysis

7.3.2.1 Veteran Experiences That Shaped Design Functionalities

7.3.2.2 Developing a Novel Stress Detection Algorithm

7.3.3 Phase III: Design and Evaluation

7.4 Design Guidelines for Veterans

7.4.1 Design for Persuasiveness

7.4.2 Design for Discreetness and Privacy

7.4.3 Design for Support and Trust

7.4.4 Design of Surroundings

7.4.5 Design for Accessibility

7.5 Conclusion

References

Since 2001, the United States has deployed over two million service members to conflicts in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]), with over half of them being deployed more than once (Hautzinger et al., 2015; Seal et al., 2007). Recent estimates from Brown University’s Watson Institute of International & Public Affairs put the combined death toll of U.S. service members at 6,900. In addition, 970,000 veterans report either a physical or cognitive disability upon return (Hautzinger et al., 2015). Common physical injuries include burns, orthopedic injuries (including loss of limbs), and traumatic brain injury. Moreover, many veterans also experience operational stress and mental health disorders including post-traumatic stress disorder (PTSD; Church, 2009). In addition to addressing the health-related aspects of disability, veterans also face several micro- and macroergonomic challenges in reintegrating into society.

7.1 Unique Challenges Faced by Returning Veterans

7.1.1 Physical and Cognitive Challenges

Much attention has been paid to physical ergonomics issues faced by returning veterans (e.g. Robbins et al., 2009; Sherman & Sherman, 1983; Smurr et al., 2008). Studies have suggested that military personnel who have served in Afghanistan and Iraq are more likely to have physical impairments relative to those who have served in other conflicts owing to the increased exposure to improvised explosive devices (Wade, 2013). Commonly reported impairments include wounds to the extremities resulting in amputations, sensory impairments, and head injuries (Owens et al., 2007). Amputations and injuries to the spinal cord can result in reduced physical dexterity, difficulty with prolonged sitting or standing, and challenges with mobility. Sensory impairments can lead to difficulty in hearing, seeing, or reading content, and issues in accessing electronic resources.

Studies have shown deployment stressors and exposure to combat result in severe mental health issues including anxiety, depression, and PTSD. PTSD is considered one of the “signature wounds” of returning U.S. military veterans (Tanielian & Jaycox, 2008, p. iii) and is among the most prevalent and functionally disabling conditions (Lew et al., 2009). Research has shown veterans are 5%–25% more likely to be affected by PTSD based on when they served (e.g. Vietnam War, Gulf War, Operation Iraqi Freedom [OIF], Enduring Freedom [OEF], and New Dawn; Kessler, 1995; Rodriguez-Paras et al., 2017). A recent meta-analysis by Fulton et al. (2015) estimated PTSD prevalence at 23% among veterans who returned from OIF/OEF. Failure to treat PTSD can have severe monetary and societal consequences, highlighting the need to improve access and treatment-seeking opportunities (Institute of Medicine and National Research Council, 2007; Sledjeski et al., 2008). Despite the prevalence of treatment options, the absence of veteran-centered, evidence-based interventions grounded in human factors and ergonomics (HFE) design principles limits the effectiveness and outcomes of current treatment techniques.

7.1.2 Sociocultural Challenges

Social isolation is a major barrier for returning veterans to reintegrate into their communities, impacting loved ones and the society. A study on the occupational performance needs of young veterans showed that engaging in relationships, re-enrolling in school, driving, maintaining physical health, and establishing healthy sleep habits were among the top challenges (Plach & Sells, 2013). Similarly, an interview-based study by Thomas et al. (2014) showed that social isolation, loneliness, depression, and hopelessness were mentioned as frequent precursors to suicide events among veterans. Loneliness and social isolation combined with physical disability and mental disorders have resulted in 41%–61% higher risk of suicide among OEF and OIF veterans (respectively), compared to the general U.S. population (U.S. Department of Veterans Affairs, 2019).

Research has shown the prevalence of societal stigma against seeking access to mental health care. Stigma can be self-directed or public, leading to self-discriminatory behavior and lack of opportunities, which can in turn result in negative professional and personal consequences (Corrigan & Kleinlein, 2005). Unfortunately, over two-thirds of those suffering from mental illness do not seek treatment and suffer in private (Henderson et al., 2013). This is especially prevalent among military veterans (Hoge et al., 2004; National Council on Disability, 2009; Pietrzak et al., 2009). Consequently, approximately 50% of returning veterans who are screened positive for PTSD or other psychiatric conditions are not willing to seek help (Brown et al., 2011; Hoge et al., 2004; Tanielian & Jaycox, 2008).

7.1.3 Organizational Challenges

Research has shown that veterans have trouble navigating the complex care systems. Specifically, previous studies have highlighted barriers relating to veterans’ interactions with the U.S. Veterans Affairs (VA). A study involving women veterans highlighted increased wait times, scheduling issues, as well as difficulties with administrative paperwork and navigating the complex care system (Vogt et al., 2006). Moon and colleagues have argued that the care system in itself may be a barrier as it has evolved into a highly complex system involving multiple stakeholders (Moon et al., 2017, 2018). A recent study by Bovin et al. (2018) investigated veterans’ experiences navigating the VA-mental health system and highlighted the lack of information or correct guidance about accessing services. Therefore, there is a need to augment the existing veteran care system to one that: (1) enables patients to seek care more easily to manage their condition; (2) supports healthcare professionals and informal caregivers; and (3) leverages the advances in technology to provide tools for health-related education, engagement, and treatment.

7.2 Patient Ergonomics and Veteran Care

“Patient work” consists of activities carried out by patients and informal caregivers in clinical, home, and community settings (Holden et al., 2013; Valdez et al. 2015). In recent years, “patient ergonomics” (or patient-centered human factors)—the application of HFE to study and improve patient work—has emerged as a new subdiscipline of HFE (Holden & Mickelson, 2013). Employing the systems approach, patient ergonomics applies HFE and related design techniques (e.g. usability engineering) to improve patients’ and nonprofessionals’ activities (in some cases with a healthcare professional) toward achieving health goals (Holden & Valdez, 2018). Given the complex and multifaceted nature of the challenges faced by returning veterans, a patient ergonomics approach shows promise.

Literature on veteran patient work has investigated the role of informal care providers for the veteran population. One study found that veterans with spinal cord injuries relied heavily on informal caregivers for their daily health activities (Robinson-Whelen & Rintala, 2003). Another study of 89 veterans showed higher intensity of informal care (~47 hours per week) relative to primary VA care (~5.6 hours; Van Houtven et al., 2010). Social and technological factors also play an important role in the patient and informal caregiver performance (Holden et al., 2013). An analysis of 198 frail male veterans’ informal caregiver networks indicated these veterans had on average three people they relied on for emotional support, instrumental aid, health appraisal, and health monitoring. These supports were primarily family members including adult sons and daughters (Abbott et al., 2007). In some cases, informal caregiving can have adverse effects on the care provider. A survey study involving 135 family care givers revealed that more than a third of the respondents reported high strain while providing care, while only reporting moderate levels of satisfaction (Wakefield et al., 2012). Further, this study showed that the number of veterans seeking counseling for mental health disorders was a predictor for caregiver burnout. Therefore, there is a need for further research into patient ergonomics that could be utilized to support such effortful work.

A recent macroergonomic model of patient work emphasized not only the patient and tasks but also associated tools or technologies as part of the “inner triad” of important interacting microergonomic components (Holden et al., 2017). The availability, accessibility, and usability of these tools are important factors to facilitate effective patient work (Holden et al., 2015). Studies have highlighted the need to use appropriate tools to support care givers and veterans when working toward health goals (Wakefield et al., 2012). Geographic and accessibility barriers could be mitigated through the use of technology-enhanced interventions such as the VA’s care coordination and telehealth program (Darkins et al., 2008). Features such as alerts and alarms, in addition to other technology-enabled functionality, may further support veteran’s self-care efforts. However, human-factors-based approaches should be used to create technologies that are well integrated with characteristics of these intended users, tasks and broader macroergonomic factors to avoid undesirable consequences stemming from use of technology-based support systems (Brewin et al., 2010).

A patient ergonomics approach could be used to address many of the challenges of the veteran population detailed earlier. Here, in the following case study, we illustrate the u...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Preface
• Editors
• Contributors
• SECTION I Introduction to Applications of Patient Ergonomics
• SECTION II Patient Ergonomics Settings
• SECTION III Patient Ergonomics Populations
• SECTION IV Conclusion
• Index