samira darkaoui - 4005805january 21, 2014

EXPLORING INTERACTIONS

know, then, whatever cheerful and serene supports the mind, supports the body too.FAITH. HOPE. COURAGE. LOVEENHANCING WELL- BEING OF

~ John Armstrong

ACKNOWLEDGEMENTS

I would like to thank the mammacare nurse Sandra den Besten, the psychologist Els Driessen and the oncologist nurse Nienke van Meeu-wen for their time and expertise. This report could not have been created without their professional advice and opinion.

My deepest appreciations also go out to those that participated in my research and contributed to my project Thank you for all help and your willingness to invest time and energy into this project.

At last, I would also like to thank my two coaches, Stella Boess and Kristof Vaes, for their honest feedback and help. They encouraged me to think further and look at other

BREAST CANCER PATIENTS

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design & research goal

introduction

interaction vision

resultsconclusions appendices

table of contentstable of contents

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design & research activities

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introduction

This is the design and exploration report of the third and fi-nal cycle for the course ID4250 Exploring Interactions. This report continues on the concept that was developed at the end of the second cycle. This cycle focused on developing this concupt further and evaluating it, preferably in the in-tended context with the users.

My topic is about the psychological well-being of female breastcancer patients, undergoing treatment in the hos-pital. With the all the explorations and findings of the first cycle, I decided to develop a concept for a new chemother-apy room where the patient will feel less uncomfortable and which will enable the patients to choose themselves whether to interact with others (in a non-awkward way). The chairs are designed to be more comfortable, since re-search showed that patients experience the chairs as un-comfortable. Besides that, the chairs can be rotated and slided to fit the wishes of the patients, e.g. their viewpoint, interacting with others. Warm and soothing colours were used to create a relaxing and peaceful environment. At last, natural lighting is applied since research showed that pa-tients perceive this as peaceful.

when life kicks you, let it kick you forward.~ Kay Yow

introduction

This report will provide insights into my explorations and further developed concept. Next to that a summary of the results of the first and second evaluation of the design will be presented. This report closes with answering the re-search questions stated beforehand and further recom-mendations for the concept.

January 2014 Samira Darkaoui

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design goal research goal & questions

My design goal focuses on enhancing the psychological well-being of breast cancer patients during their chemothe- rapy treatment in the hospital. The design should: • distract the patient from the fact that they are ill and

getting chemotherapy at that moment. • make the patient feel less uncomfortable. • distract the patient from the ‘unpleasant’ and negative

feelings - that they normally (would) have - as much as possible.

One research goal of this cycle was to explore the interac-tions between patients and patients with their companion. Another research goal was to see how far and if sensual aspects (vision, sound and scent) could enhance the feeling of being comfortable. • To what extent does the concept of the chair work in

the different scenarios (interacting with other patients, interacting with companions and have privacy?)

• How do the patients interact with their companions during a chemotherapy session?

• What colours are experienced as relaxing and peace-ful? (since this is part of my design goal)

• Do patients experience sound and smell as aspects which can alleviate the negative feelings of chemo-therapy?

The outcomes of these questions will help me in establish-ing to what extent the concept actually works with respect to my design goal and interaction vision. It will also help to see how the concept can be developed further in aspects, which I had not thought about yet.

design & research goal

design & research goal

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interaction vision

Figure 01 shows the main activities during chemotherapy which I found most interesting. For those moments I looked at the current interactions:01. Entering chemo therapy room

When the patient enters the chemotherapy room (for the first time), she is rather curious about what will happen, but also really nervous. Often the environ-ment makes them feel even less at ease.

02. Getting the IV This is also a tricky part for the patient, because after putting the IV in, the chemotherapy session really has begun. So, the patient is still anxious and nervous but is reassured by the nurse, her companion and/or other patients.

03. Interacting with others This was the part which I found most interesting since this can differ each time. There are patients who are willing to interact with other patients, because they know what the patient is going through. There are also some patients, who just want to sleep and be left alone. So the interaction qualities can be social or distant, reassuring or dissuasive, natural or distant.

current interactions1

ENTERING CHEMO THERAPY ROOM

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3

GETTING THE IV

INTERACTING WITH OTHERS

interaction visioninteraction visionFigure 01 — Storyboard of the three main activities during che-motherapy.

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when you treat a disease, first treat the mind.~ Chen Jen

As mentioned before the design should distract the patient from the fact that they are getting treatment as well as feel them less uncomfortable. So the qualities of the interaction should be: • Effortless • Relaxing • Peaceful

As can be seen in the current interactions, the patient is rather anxious and nervous. So that is why the design should convey relaxing and peaceful qualities. Also, when interacting with others or not, this interaction should be ef-fortless and simple. Patients already have a lot to deal with so they should not feel obliged to do a certain action.

interaction vision

Figure 02 — Images showing the interaction qualities relaxed and effortless.

Figure 03 — Images showing the interaction qualities peaceful.

interaction vision

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design & research activities

In this cycle I built on my concept and refined it further. I fo-cused on certain scenarios and did explorations on colours and images, sound and scent. Besides that, I tested the concept with some patients and took their comments into account for my final design concept. The latter was also tested once. The different activities will be summed up and then explained individually: • Research activities;

– scenarios – colour research – image research – sound and scent research

• Design activities; • First evaluation test concept; • Final evaluation test.

research activities

SCENARIOSIn order to have a clear focus on the interactions I want to enhance, I looked at the different scenarios that the patients and their companions can interact in. Three main scenari-os were chosen that focused on the interaction between all the forementiond groups.

COLOUR RESEARCHSince my design goal focuses on a relaxing and peaceful environment, I found it was important to explore more with colours. There has already been done research of the use and effect of colours. So I did some research on the mean-ing of colours (and also looked to colours in the Western culture). A selection of colours were chosen that could be applied to the environment of my concept. For the first eval-uation test I made six colour schemes and applied this to six accompanying renders. That part of the test was to see which colour schemes would be preferred and which would fit with my design goal and interaction vision.

IMAGE RESEARCHIn the first cycle I already found that big images/art function as a distractor while sitting in the waiting area or during a scan. In the new chemotherapy rooms at the Albert Sch-weitzer hospital in Dordrecht, the designers also added

design & research activitiesdesign & research activities

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large pictures of nature and animals. The concept in the second cycle ended with a large image, spread over the width of the room. I did some research on what images could be perceived as peaceful and relaxing and collected them, subsequently using those in the evaluation test to see what images the patients experience as most relaxing and distracting.

SOUND AND SCENT RESEARCHOn YouTube there are a lot of sounds, that claim to help relax people or help them fall asleep. A selection was made between these ‘relaxing’ sounds and was tested in the first evaluation test. The aim was to see whether it will indeed relax the patient and if such sounds would be preferred over for example the radio.The olfactory sense is a powerful emotional and memo-ry trigger. That is why many chemotherapy patients have certain scents which remind them of their time during che-mo. There are also a lot of scents, that are used to relax and calm people down. So the question would be whether these sounds will indeed relax them or just remind them of the negative feelings of chemo. This was asked during the evaluation test.

design activities first evaluation test concept

The ideal situation to test the concept was naturally the chemotherapy room. I contacted the oncologist nurse (who I interviewed in the second cycle) to see whether it was possible to test my concept during a chemotherapy session. Unfortunately, it was not possible at that moment. She then informed me that the mammacare nurse had a file with old patients, that gave them selves up as volunteer. This way I could set up an e-mail, which was sent to all the volunteers. Three cancer patients participated in the first evaluation test of the concept. Two of them had breast cancer and one of them had Hodgkin’s disease. All three had chemo-therapy in the past, which made them good participants as they experienced all the feelings and emotions.

The evaluation took place in week 2.07. An overview of the research manual manual is shown in appendix A. The main focus of the test was to see whether the concept was understood well and works acccording to the intend-ed interaction and design goal. The other parts of the test were there to investigate whether the acquired knowledge (colour, sound, scent) also applied to my concept. The test consisted of five parts and results were gained through questions and observations:

design & research activitiesdesign & research activities

This cycle consisted of a lot of designing. At the end of the second cycle I had a 3D model of the concept as well as a simple scale model. I did a lot of designing in the 3D model since this was easy to adjustable. I made several files of the model, so that eachmajor design step was still clearly visi-ble in each of the files. I also kept referring to my interaction vision to see if it should be adapted.

Cycle 2 ended with a rather simple 3D model of the con-cept. This had to be developed further. After my presenta-tion, I also received feedback of point on which I could still concenctrate, for example distraction of the patients, the place where the companions come together and of course the colour/material use. The place where the companions come together (middle area) is the one aspect that changed dramatically. In my first concept it was just a bar where people could come to-gether and made coffee, but the height of the chair could cause ‘conflict’, because of the fact that the companion would be seated higher than the patient. At the end, I also made a scale model of the concept to give a better representation of the sliding and rotating chairs.

In the next chapter the most common changes in the con-cept will be described further.

design activities

1 Architect by Augusto Zamperlini from The Noun Project2 Project by Jaap Knevel from The Noun Project

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sketching model making interactionvision

Figure 04 — Summary of the design activities.

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2.05 2.06 holiday 2.07 2.08 2.09

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SOUND AND SCENT

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Figure 05 — Diagram overview of the different activities executed in cycle 3.

final evaluation test concept

design & research activitiesdesign & research activities

• The first part included brief questions about the che-motherapy the participant had en how she experiened this. This was done to get more insight into the pa-tient’s chemo history as well as a preliminary piece.

• The second part was about acting out the different scenarios using a scale model and puppets. I tried to get the patient into a certain mindset and explained them different scenarios and told them what they would do and how they would experience it.

• The third part was about the colour ranges and imag-es. Using predefined words on cards, the particpant picks the word with corresponding colour range/render and image. They also had the possibility to mention other words than these that were given. See appendix B for the colour ranges/renders and imag-es. The words were: peaceful, relaxing, comfortable, calming/soothing, lighten anxiety/depression and distracting.

• The fourth part was about music during the chemo-therapy session. Questions were asked about how they experience that and subsequently the selection of sounds were played to the participant.

• The last part was about the scent. Questions were about how the patients experienced smell and wheth-er they preferred relaxing scents.

The final design had to be tested as well. The research manual can be found in appendix C. The test was conduct-ed with one former female breast cancer patient. This test consisted of three parts: • The first part was a short questionnaire about the

experiences with her chemo and how the interaction with her companion and other patients went.

• The second part focused on the scenarios and how this fitted in with the newest changes I made to the concept.

• The third part were general questions about the con-cept, design and goal: whether the interaction vision and design goal was indeed realized through this concept.

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reflection

turn your face to the sun and the shadows fall behind you.~ Maori Proverb

design & research activities

In Figure 05 an overview is shown of the performed activ-ities in the third cycle. Looking back at this cycle, it can be concluded that it went rather well. It was a shame that I could not evaluate the concept with the patients during the chemotherapy session, since this is the actual context of the concept. However, I still got to test it with those patients that underwent chemotherapy treatment. On the one hand this was an advantage, since they already went through it and thus having a clear overview of how it was from start to end. Having the holiday was a beneficial aspect, since it allows to work on the project for two weeks more. Still, compared to the other cycles, this was the one I would have liked to have more time for. That way I could test the concept with more people, improve it more and paying more attention to other details.

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results

scenarios

In this chapter the results of the research and design ex-plorations will be described. Only the striking and important data of the explorations will be mentioned.

My design goal focuses on the patient and their ability to communicatie with others or keep their distance (the main idea behind the chair). Considering the functionalities of thes chairs three main scenarios were chosen and de-scribed in which the patients a well as their companions can interact in. 01. Patients interact with other patients (Figure 06)

This can occur when patients do not bring a compan-ion and seek support in their fellow patients. However, it can also occur when you bring your companion and you seek encouraging words from people that went through the same as you. Either way, it is about inter-acting with the patients around you.

02. Patients interact with their companion (Figure 07) This is the situation when you bring your companion and you interact with them. You need them as your support.

03. Companions interact with each other, while the pa-tient is sleeping or prefers some privacy (Figure 08) The middle area of the concept allows the compan-ions to come together to talk about everything. Even though the companions are not the ones getting treatment, they are still suffering. So seeking support by their fellows, can help them deal with it (better).

resultsresults

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ZZZ

Figure 06 — Scenario 01: patients interacting with their com-panion.

Figure 07 — Scenario 02: patients interacting with each other.

Figure 08 — Scenario 03: companions interact with each other, while patients are sleeping or in need of privacy.

colour and image research

COLOURSThe human body reacts to light or the lack of it, which af-fects the person physically, emotionally and mentally. “Co-lour produces a biochemical reaction within our bodies” which produces hormones that regulate moods, emotions among other. There has been a lot of research on colours and what effect it can have on people. Colour can also be

Figure 09 — Information about colour (Retrieved January 21, 2013, from http://www.fashionarium.com/post/619319761/colour-is-light-without-light-there-is-no-life)

experienced differently in other cultures. That is why it is important to adapt the colouts, dependant on the context. For my design I focused on the Western cultures. I looked for colours that could have a positive effect in my design. The following are general responses to colours that are based on research, historical significance and word asso-ciation studies1: • Green

This colour is more visible to the human eye com-pared with other colours. It is the colour of the natural world. Especially the natural greens, forest to lime, are seen as tranquil and refreshing. This means that there is a natural balance of cool and warm undertones (blue and yellow). However green can also evoke neg-ative feelings, since it is also associated with illness. The colour green affects us in a way that it soothes us and relaxes us physically as well as mentally. It also lightens depression, nervousness and anxiety.

• Blue This is the overwhelming favourite colour.It also appeals equally to both men and women. Since the

1 Smith, K. (n.d.). A Glimpse Into The Meaning, Symbolism & Psycholo-gy of Color. Retrieved January 21, 2014, from http://www.sensationalcolor.com/color-meaning/color-meaning-symbolism-psychology/glimpse-meaning-sym-bolism-psychology-color-080#.Ut2w9Xl5-3U

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colour of the ocean and sky is blue, this colour is ex-perienced as a constant: it invokes rest and can cause the body to produce chemicals that have a calming effect. It also sedates the human physically. However not all blues are experienced as serene and sedate. Some shades can convey coldness or uncaring.

• Yellow This colour is meant to encourage communication. It also envokes optimism, enlightenment and happiness. Shades of golden yellow can evoke the promise of a positive future.

• Orange This colour has controversial characteristics. People either have a positive of negative association with orange. However, the colour can stimulate activity and encourage socialization. “Fun and flamboyant” orange emit warmth and energy.

My design goal and my interaction vision focuses on a re-laxing and peaceful environment. Looking at this research, the colour green would be most appropriate. However, yel-low and orange also seem interesting since these colours encourages communicatin respectively encourages social-ization. Another remark was also that I had to test whether these colours indeed evoked these emotions. That is why I made six colour ranges where are these colours were dis-played. Some colours were combined in one scheme and some scheme had different shades of one colour. Appendix B shows the colour schemes that were produced. In the section ‘results first evaluation test’ the outcome of the re-search will be described and what this meant for my design.

IMAGESMy explorations of the first and second cycle led to findings about the importance of images and art. Art was considered as really powerful and functioned as a distractor. However, during the interview with the oncologist nurse, she showed me the new chemotherapy rooms. These rooms had big images of nature and animals and the nurse mentioned that this were placed to relax and distract the patients.

Researching images meant first thinking of what is per-ceived as relaxing and peaceful. Searching for those imag-

resultsresults

es what many people would consider ‘peaceful’ resulted in four groups: • Beach; • Waterfall; • Lake; • Forest - nature.

Many of these images are perceived by the majority as re-laxing. For instance, a website places 30 photographs of nature, claiming that you should see those during sad times to feel joy and calm.2 If this indeed is the case, should be researched. That is why I added the images of appendix B into the first evaluation test to see whether patients in-deed experience such images as peaceful and relaxing and whether it functions as a distractor.

2 Photography Magazine - StuffMakesMeHappy.com (n.d.). 30 Most Peaceful Nature Photos You Should See in Sad Times. Retrieved January 21, 2014, from http://www.stuffmakesmehappy.com/2013/07/30-most-peaceful-nature-photos-you.html

sound and scent research

SOUNDSBesides the eye, the other senses are also working. One of that, is hearing. During chemotherapy you hear the other patients talk (with other patients or with companions), but what about sounds/music? Some hospitals just let the ra-dio play, but there are also hospitals that play nothing at all. Nowadays on the internet one can find a lot of sounds that claim to help you relax or to meditate. Since I already picked certain images, I looked at relaxing sounds of the forest, waterfalls and zen/yoga like. The question however is whether these sounds indeed relax the patients and if so, would they prefer these sounds. A playlist with a small selection of relaxing sounds was made and used in the first evaluation test.

SCENTSThe other sense is the olfactory sense. Smell is such a powerful sense. As humans we can recognize thousands of different scents and we are able to detect scents even in infinitesimal quantities.13

The perception of smell also goes hand in hand with the ex-periences and emotions assocatied. Smells have the ability to evoke strong emotional reaction. Responses of surveys 3 Fox, K. (n.d.). The smell report. Social Issues Research Centre

Figure 10 — Peaceful images.

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showed that many likes and disliked of certain scents are based on the emotional association3.Research has also been done on the effect of pleasant smells. It has been found that the latter can achieve positive effects on the mood of people. However, the scent-prefer-ence is something really personal. There are odours that are considered as unpleasant, e.g. gasoline, but odours that are experienced as pleasant by some, e.g. flowers, can also be experienced as unpleasant. This has to do with the as-sociations and memories that person has with that partic-ular scent. Despite the high level of personal preference, generaliza-tions can be made. For instance, there are certain fragranc-es that universally are perceived as ‘pleasant’, such as va-nilla.

Thus, a scent stimulates the cognitive recognition in the brain. So many people already know what they experience as pleasant scents. But how can this be incorporated in a hospital environment, especially in a chemotherapy room where different preferences come together? There are cer-tain scents that have relaxing qualities, like lavender, cham-omille and sandalwood.24

4 Gentry, P. (2013). Scents for helping with relaxation & depres-sion. Retrieved January 21, 2014, from http://www.livestrong.com/arti-cle/93762-scents-helping-relaxation-depression/.

This element is added to the first evaluation test to see how the patients experienced the overall scent during chemo and how it affected them afterwards. Unfortunately for the scope of this project, more research could not be done on this area, but it is certainly something which should be re-searched further.

Figure 11 — From left to right: lavender, chamomille and san-dalwood. These scents are considered as relaxing.

results first evaluation test

As mentioned before, the first evaluation test consisted of five parts. From each part only the most salient results will be described. The notes of each test can be found in the progress workbook.

PART A - SHORT QUESTIONS • These participants had long chemotherapy sessions.

Each session of two participants lasted about 8 hours. The third participant had sessions of approximately 3 hours.

• One participant found the chemotherapy session bearable because of the atmosphere that was in the room. There were fellow patients, which created soli-darity.

• Space was mentioned by two participant as an im-portant factor. One participant experienced the areas as very cramped, meaning that there was not a lot of privacy.

• Two participants mentioned that the loss of hair is one of the worst parts of the chemo.

• One participant mentioned that the ideal situation to get chemotherapy would be at home. “This way when you are nauseous, you will not still have to wait on the taxi to get home.”

PART B - SCENARIOSThis part focuses on the three main scenarios that I decid-ed and whether the patients indeed use the chairs and their surroundings as I imagined they woud. • When entering the chemotherapy room without a

companion, two of the participants mentioned that they preferred to have contact with other patients. One mentioned that she would like to have an overview and see what happens in the room. The other patients was someone that would like to be more secluded in the beginning, needing reassuring words from the nurse. She did say that when she felt more at ease she would turn her chair to interact with others.

Figure 12 — Participant 1 and 2 wanted to have overview and be able to communicate with others. So they would turn their chair towards the people.

P2 P3

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• When taking a companion, two of the participants would still interact with other patients. They would keep the option open to communicate with others. They mentioned that if they need privacy they would turn more to each other and away from the other patients. Participant 1 would always slide more to her companion to still keep the privacy intact. She did mention that if a chair is turned towards her, that that stimulates interaction.

• Wanting privacy while the companions gather at the bar, meant for all patients to turn them selves from the others in the room. All participants would slide to the other side to get their privacy to seclude themselves as much as possible. When they would see their visit as functional, participant 2 would still turn away from the patients but face herself more towards the nurses: “So that I can leave as soon as possible.”

Figure 13 — Participant 1 would seclude her self more at the beginning, so she would turn her chair away, but not too much.

P1

P1 + C1

P2 + C2

Figure 14 — Participant 1 and her companion would turn to each other and if her companion takes a seat else where, she would also rotate. Participant 2 would also face herself towards the other patients.

Overall the patients understood what the chairs were meant for and in the scenarios where they would prefer rest, they would use the chair to turn away from the patients. They liked the idea and participant 3 mentioned that it would be great if something like this would be incorporated. She did mention that the chair in the middle had the least privacy options compared to the others, since those can turn to-wards walls. Two participants mentioned that if a chair was turned to the patient, it would stimulate communication. I

PART C - EFFECT COLOURS AND IMAGES • Figure 17 shows the results of the different colour

ranges and with what words they associated it with. In appendix B the colour schemes can be found. Num-ber 04 and 05, which were overall green, are mostly perceived as relaxing and peaceful. Comfortable, calming/soothing and lighten depression/anxiety are also terms that were mentioned. This ties into what earlier was said about the colour green, namely that it is relaxing and soothing.

• Number 02 and 06 were the blue colour ranges. The responses to these to differed from each other. Participant 2 found both too cold and clinical. Number 02 however was perceived als calming/soothing by participant 1 and 3.

P1

P3

P2 P2

Figure 15 — Participant 1 and 3 would turn away as much as possible to get their rest as well as when they see it as a func-tional visit.

Figure 16 — Participant 2 would turn towards the wall when she wants rest. However when she would see it as a functional visit she would turn herself towards the people in the room.

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Number colour scheme PARTICIPANT 1 PARTICIPANT 2 PARTICIPANT 301 Distracting (too crowded) Distracting (restless) Distracting (negative)

Restless02 Calming/soothing Clinical Calming/soothing03 Too light (dislike) Warm

ComfortableToo heavy

04 Relaxing PeacefulComfortable

Lighten anxiety/depression

05 RelaxingPeaceful

Calming/soothingLighten anxiety/depressionRelaxing

ComfortableFeel at ease

06 Sleek Too coldClinical

RelaxingPeacefulRestful

Figure 17 — Results of the colour ranges and the corresponding experiences..

• The combination of colours (number 01), that I used in my concept, were experienced as distracting (in a negative way). They found it too crowded. It seems their preference is based on one colours in different shades.

• Number 03 was the colour range of orange and yel-low. This colour scheme was also not received very positively. Participant 2 found it warm and comfort-able. Participant 1 mentioned though, that in combi-nation with the right image this colour range could be nice.

• Almost all images were experienced as relaxing and calming/soothing. There were a few that were disliked by one or two participants, for example the palmtree beach which was too much.

• They all found that the images would be distracting, if just enough happens in the picture. There should be elements in it, where the patient could think about.

• All participants really liked the colour range of green and in combination with the nature images, they expe-rience it as relaxing.

This test about colours and images mostly fitted with the research I done beforehand. The colour green was indeed perceived as relaxing and peaceful and the colour blue as calming/sedate (by two participants). The colours yellow and orange did not fit with the research, so the decision fell really quickly not to use those colours.

Since all participants experienced green as relaxing and this is party of my design goal and interaction vision, I decided to go with this colour range. I will also combine a bit of blue (blue-green colours).

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PART D - SOUND • In two cases there was no music or overall sound on

the background during the chemotherapy session. Those two participants also preferred silence above an overall sound. One of them mentioned that she experienced music as ‘disturbing.’

• Two of the participants did not bring their own music. One of them brought movies, whereas the other did not bring anything, because there was a TV and radio.

• All three participants mentioned that playing the relax-ing sounds longterm would not be ideal. This would become disturbing. Two participants however would like to have such sounds, but then not too long.

• One participant mentioned that the radio functions as a distractor.

The relaxing sounds could be a solution, but the partici-pants did not like the idea that this would play all day long. At some point it will bother you. However, playing it short term is also kind of tricky. Would you play it when the pa-tient comes in? But then everyone will know when a pa-tients enters the room. Another solution could be playing the music from speak-ers, that could be integrated in the head rest of the chair.

But then the problem arises, that other patients could be hindered.Taking all this into account, I decided to just let the radio play. The oncologist nurse told me that patients often take their tablets or other media equipment, so they will bring their own music in most cases. The radio will be turned on on a not disruptive sound level. This way it can also function as a distractor for the patients and companions.

PART E - SCENT • All participants disliked the scent that was present.

One also found that her IV had an unpleasen scent. Two also mentioned the clinical odour of hospitals, which they experienced as unpleasant.

• The associations with scents is really strong. They avoid certain smells which remind them of their che-motherapy sessions.

• Two of them mentioned that a neutral scent would be best, whereas the other patients thouught that a subtle scent, like eucalyptus, would be pleasant. She thought of nature scents, but it should not be too heavy.

results

Group images PARTICIPANT 1 PARTICIPANT 2 PARTICIPANT 3Beach Peaceful

RelaxingToo much (palm trees)Only the beach - relaxing

RelaxingPeaceful

Waterfall Calming/soothing NiceDistraction (positive)

Calming/soothingBeautiful

Lake RelaxingPeaceful(dead end path metaphor - dislike)

You can dream away(dead end path metaphor - positive)

PeacefulCalming/soothing

Forest - nature DistractingRelaxing

Restful“You can see yourself sitting there. All discomfort is temporary.”

ComfortableRelaxingPeaceful

PARTICIPANT 1 PARTICIPANT 2 PARTICIPANT 3Ideal combinationcolour & image

Nature images, like the lake and waterfall: distractor.“It gives the impression that you are outside.”

Number 05 (green colours)Images with a metaphor and relax-ing: what you see, is a distractor.

Combination green/blue: soothing & comfortable. Mountain and lake image relaxing & soothing.

Figure 18 — Results of the images and the corresponding experiences..

Figure 19 — The ideal combination of colour and corresponding images.

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As can be concluded from thee reactions, the olfactory sense is a very difficult, but important, aspect to consider. Every patient will have their own memories with the scents. Even though, I would decide to let a subtle scent be present, it is still likely that afterwards the patients will develop nega-tive feelings towards this scent since it brings back negative memories.

As mentioned before, further research should be done on this area, because this is a really important element. Espe-cially when the treatment is over, the patient still associates this scent with the chemo session.So in my design, there should be a neutral odour as much as possible. This way the clinical scent of the hospital is already less.

OTHER COMMENTS • A omment was made about the IV and going to the

toilet. In my design I incorporated the IV pole into the chair, because of the sliding properties. However, when going to the toilet, the IV always goes with the patient. Together with the patient, I came up with a solution to just have a stand nearby where someone can put the IV pole in and ride it, just like a normal IV could.

design activities

• There was also a comment about the missing cur-tains. In the beginning I decided to not add curtains, because that would break up the openness of the space. Also, the patients could turn away if they wanted. However, when the doctor want to examine the patient, privacy is preferred. So, together with the participants I came up with room dividers, which are also easily stored and can be put next to the chair.

• Participant 1 would like to have something dynamic in the room. I decided to incorporate dynamic images on the big wall, functioning as a distractor.

• I talked with the participants about the middle area, where the companions come together. It was about whether I should screen this area from the rest. The participants found that a screen would not be ideal. Participant 3 mentioned that just the backrest of a sofa would be sufficient.

• There was also a comment about a table where pa-tients can put things on. I incorporated a folding table on one side of the chair. I also added a coat reck and a small dresser where patients can hang up their coats.

All these changes will be shown in the next paragraph.

Figure 20 — Concept at the end of cycle 2.

Figure 21 — Two translucent panels that could divide the area into three areas.

Figure 20 shows how the concept looked at the end of cycle 2. Research still had to be on colours and the middle bar area. In the previous parts several changes as a result of research had been mentioned. In this secntion the results will be shown in renders.

Since the bar was something that was not going to work, I had to look at other options. I came up with some kind of lounge area, where the companions can talk to each other. They also find this situation difficult, so maybe they can find support with each other. For example when the patient is sleeping, I imagine it would not be pleasant for the com-panion to just sit next to the patient, looking at other pa-tients. That is why such a middle area is something wat could help them feel more at ease.

The next question was whether this area should be screened from the patients. An idea came to mind, to create middle high translucent panels, which would still allow the patients to see each other at the other side of the room. Making the screen higher would create a harsh division. However, such low panels does not add much to the room (Figure 21). It seemed rather silly. The participants of the first evaluation test also agreed with this. So, I decided to just put the fur-niture there, were the back rest of the sofa and chairs will function as a semi divider, see Figure 22

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Figure 22 — New layout of the middle area. There is one long reading table with chairs as well as poufs and sofas.

Figure 23 — Top view of the layout: there is no unity. It looks rather scattered.

Figure 24 — Top view of the layout, where the table is extended, creating more unity in the area.

Figure 25 — Render of the layout with extending table. Figure 26 — Addition of the folding table.

Figure 27 — Addition of the dressoir and coat reck: the patient can store their belongings or hang up their coat.

This layout however did not create a unity. As can be seen in Figure 23 the lounge area does not evoke unity. It seems rather scattered. In the meantime I already changed the overall colour in green, since all participant found this colour relaxing.

The next step was to look how this middle area can be per-ceived more as a whole. The solution was rather simple, extend the table, so that the whole area feels connected, see Figure 24 and Figure 25.

results results

In the section ‘results first evaluation test’ several points were already mentioned which I had not thought about yet. For example, the standard for the IV so that patients can go to the toilet. Another example is the addition of a folding table at the side of the armrest. The patient can use it to put her belongings on it. Another addition is the coat reck and dressoir. I had not thought about hanging up your coat or putting your wig somewhere. The coat reck also fits in the interior, since it is in a tree form, matching with the nature images and green colour (Figure 27).

40 41results results

final designThe concept allows the user to turn away when they are in need of privacy. However, especially in the case of the mid-dle chair, the patient can still be ‘seen’ from the side. She is not fully secluded. I already mentioned the idea of room dividers, but there should also be a simpler and easier way. That is when, with the help of a student and a participant, I came up with a folding ‘headrest.’ In the normal situation they are extended to the back (Figure 28), but when in need of seclusion, the patient can just fold the this extension to the front (Figure 29).

Figure 28 — Folding headrest: in normal situation they extend to the back.

Figure 29 — Folding headrest: when in need of extra seclusion, the headrest can be folden open to the front.

Figure 30 — Render of the final design: chairs

CONCEPTThe concept was established, based on the following di-rectives: • Each personal space should have the ability to be

adjusted The patient should be able to move and rotate their chair to for example have a better view. The patient should also decide for herself whether she wants to be social or secluder her self.

• It should be a comfortable and relaxing chair, where the patient is sitting in. This relates to the design goal.

• The interior of the chemotherapy room should offer a relaxing and peaceful atmosphere, since the patients are already ‘suffering’ from the chemotherapy.

The chairs are designed to be comfortable and to enable social activity or privacy. The chairs can slide over a range of 5 meters (through a smart sliding system) and are also 360 degrees rotatable. These chairs are designed this way to allow people to make their own decisions with regard to communicating with others or to seclude them selves more. The chair also has a folding table, which can be used to put things on. Next to that, the chair has folding head-rests. These can also be used to seclude yourself more. Sometimes turning and sliding towards the window would

not be enough. The addition of the head rest can add this extra dimension. Between each chair there is enough space to maintain pri-vacy, but it is also not too big, that it disrupts the social as-pect of the concept. Behind each chair there is a coat reck and dressoir where the patient can hang her coat respec-tively store her wig.

42 43Figure 31 — Render of the final design: middle area and nature image

Figure 32 — Render of the final design: overview room

Figure 33 — Render of the final design: sofa and chairs

The chairs covered the aspect of the interaction between patients, but there is also the interaction between the pa-tient and companion and between the companions. Sometimes, the patient is in need of some privacy or rest. The companion can feel awkward sitting besides her, while she is sleeping. That is why the middle of the area is de-signed like a ‘lounge’ area, where the companions can grab a cup of coffee or read a magazine. This is the place where the companions can gather and share their experiences. There is relatively enough space between this area and the chairs, keeping the social interaction in tact. This area can also be used, when the patient for example has to wait on her chemo. This way she will not have to wait in the hall, but can already observe the others and feel a bit more at ease. The nurses have their own space and still have a good overview on the whole room.

Research showed that green was perceived as relaxing and peaceful. That is why the whole room consists of natural materials (wood) and shades of green. This enhances the relaxing atmosphere. To distract the patient, natural images (e.g. of lakes, waterfalls, forests) are shown on the big wall. This will change from time to time so that the patient will not get bored of the same picture. There is also natural light in the form of area lighting, which is perceived as peaceful.

results final evaluation test

• The concept stimulates communication, but also privacy.

• The room contributes to the fact that the patient feel less patient.

• Attention should be paid to the patients, that are com-ing alone. They feel alone and are nervous.

• Playing the radio is a nice idea, because it functions as a distractor. A possibility could be to put it in the head rest of the chair.

• The natural images makes it really peaceful. In her opinion, without the image it would still be clinical. However, she likes the colour blue more. Adding plants or a fruit basket would add colour and atmosphere. However, it is forbidden to bring flowers due to hygein-ic reasons.

• She would prefer that the middle area would be semi divided.

• The images work as a distractor and she would feel calm and restful with this interior.

results results

44 45

future recommendations

results

Being a designer means also being critical of your own work. Just as any other concept, my concept can be im-proved by mentioning future recommendations.

LOGISTICS • First off, the concept should be tested on a larger

scale with more patients. But also the input of nurses and the companions would be really valuable. I did receive some feedback from the patients about the nurses or companions. However, the concept could benefit a lot if is evaluated by those two groups of people.

ENVIRONMENT • Although there has been paid a lot of attention to pri-

vacy and social communication between the patients in my concept, there should still be thought of the di-vision of each personal space. The idea of the folding headrest and room dividers are feasible, but from the viewpoint of the nurse a room divider could maybe be not so practical.

• Another point of remark is the scent. As established, the olfactory sense is something really powerful. It is associated with memories and experiences. So there should be done further research to look what kind of

results

scents can be spread in order to diminish the clinical scent of hospitals.

• The design of the middle area could also be improved. I already thought of whether to semi seclude this area from the rest, but all my options came up with dividing the room too much, resulting in a loss of the social interaction qualities of the patients facing each other and of the companions (with patients). The question is whether a division is preferred? Either way, this should be researched further.

THE CHAIR • Maybe one of the most important recommendations

is about the chair and especially the technical part. I already gave a feasible solution for the sliding part, but there are other things that should be thought about. For example, dirt piling up in the slot. The effect of the sliding should also be tested: is it going too fast or rather too slow? As one can see, there are still parts that could be looked at and researched further.

The discussion about healing environments is something that is really ‘popular.’ Many researchers and designers are trying to come up with new ways to make the patient feel more at ease in such difficult times. That is why it is maybe even more important to keep the discussion going, result-ing in innovative ways that can be developed further.

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conclusions

conclusions conclusions

In this chapter the research questions that were stated at the beginning will be answered as good as possible. Only the main important data will be used to answer these ques-tions.

TO WHAT EXTENT DOES THE CONCEPT OF THE CHAIR WORK IN THE DIFFERENT SCENARIOS (INTERACTING WITH OTHER PATIENTS, INTERACTING WITH COMPANIONS AND HAVE PRIVACY?)The concept works well in the different scenarios. In the scenarios where socializing is preferred, the participants turned their chair towards other patients. When in need of privacy, they secluded themselves. The interaction with the companions also worked. Par-ticipants mentioned that if they wanted privacy with their companion, they just move closer together.

HOW DO THE PATIENTS INTERACT WITH THEIR COMPAN-IONS DURING A CHEMOTHERAPY SESSION? All participants had a companion with them during the che-motherapy sessions. This interaction was often very loving. Some participants mentioned that they would still interact with other patients even though they have a companion with them. The companions also interact with each other sometimes.

research questions

WHAT COLOURS ARE EXPERIENCED AS RELAXING AND PEACEFUL? (SINCE THIS IS PART OF MY DESIGN GOAL)Research showed that especially green was experienced as relaxing and soothing. Blue was also considered as calm-ing and sedate. During my first evaluation I tested this and indeed all participants experienced the different shades of green as peaceful and relaxing. There was one participant that experienced the colour range of blue as relaxing, but that is also a case of personal preference.

DO PATIENTS EXPERIENCE SOUND AND SMELL AS AS-PECTS WHICH CAN ALLEVIATE THE NEGATIVE FEELINGS OF CHEMOTHERAPY?Smell t is a really strong sense and research showed that often after the chemo, patients still associatie certain scents or colours with their chemotherapy. The question is then, would this be different when adding a pleasant scent in the room? This is something what should be researched further and which I cannot answer since I did not research this.Sound, especially the radio, is considered as a distractor. The peaceful sounds were nice, according to the patients, but not for a long time.

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appendices

appendices

appendix A

RESEARCH MANUAL FIRST EVALUATION TEST

Onderdeel A: Korte vragenlijst over ervaringen tijdens che-mo01. Hoe vaak heeft u chemo gekregen?02. Hoe heeft u de chemo ervaren?03. Wat vond u eigenlijk het allerergst aan de chemo?04. Wat vond u het minst van de ruimte waar u chemo

kreeg?05. Wat zou voor u de ideale omstandigheden zijn om

chemo toegediend te krijgen?

Onderdeel B: Scenario’s01. Patiënten communiceren met andere patiënten

– U komt alleen binnen, bent nerveus en hebt wel wat aanmoedigende woorden nodig. Wat doet u?

– U komt alleen binnen en wil graag weten hoe an-deren het ervaren.

02. Patiënten communiceren met hun +1 (companions) – U komt binnen, samen met een dierbare, en neemt

plaats. Wat doet u? 03. Patiënten willen privacy/rust – Meegekomen per-

sonen verzamelen zich bij elkaar – U bent een patiënt die een chemobezoek als iets

functioneels ziet. U wilt het gewoon toegediend

krijgen en dan het liefst zoveel mogelijk privacy en rust.

– U bent moe door de chemo en u wilt slapen (rust). Wat doet u?

Onderdeel C: Effect kleuren en afbeeldingenU ziet zowel verschillende kleurenschema’s als verschillen-de soorten afbeeldingen. 01. Zou u kunnen uitkiezen welke combinatie (kleur +

afbeelding) voor u het meest overkomt als ‘relaxing’? Waarom?

02. Welke combinatie zou u kiezen voor de term ‘peace-ful’? Waarom?

03. Welke combinatie zou u kiezen voor de term ‘calming/soothing’? Waarom?

04. Welke combinatie zou u kiezen dat alleviates depres-sie/ongerustheid ‘anxiety’ verlicht? Waarom?

05. Als u nu alles zo hebt gezien, wat voor kleurenschema en afbeeldingen zou u graag in een chemotherapie ruimte willen hebben en waarom?

appendices

50 51

Onderdeel D: Geluid01. Luisterde u naar muziek, die opstond of had u uw

eigen muziek mee?02. Zou uw voorkeur uitgaan naar een overall sound?03. Als bij binnenkomst dergelijke muziek wordt afge-

speeld, zou u dan meer op uw gemak voelen? (laat relaxing sounds horen)

Onderdeel E: Geur01. Hoe heeft u geur tijdens de chemo ervaren? Is het een

aspect geweest waar u last van had?02. Zou u graag willen dat er een bepaalde geur zou

heersen, zoals lavendel of eucalyptus?

appendices

appendix BCOLOUR RANGES AND RENDERS

NUMBER 01

NUMBER 02

NUMBER 03 NUMBER 06

NUMBER 05

NUMBER 04

appendices

52 53

IMAGES

Beach

Waterfall

Lake

Forest - Nature

appendices

appendix C

RESEARCH MANUAL FINAL EVALUATION TEST

Onderdeel A: Korte vragenlijst over chemo en de interactie01. Hoe heeft u de chemo ervaren?02. Hoe is de interactie tussen u en degene wie u mee-

nam, verlopen?03. Hoe is de interactie tussen u en andere patiënten

verlopen?04. Had degene die u meenam wel eens behoefte om

anderen te spreken?05. Hoe zou u de ideale ruimte omschrijven, waarin u

chemo zou ‘willen’ krijgen?

Onderdeel B: Scenario’sDoor middel van het 3D model de verschillende scenario’s bespreken en vragen wat de ervaringen en handelingen van de participant zou zijn.

01. U komt binnen met de verpleegkundige. Uw stoel is nog niet vrij, u kunt plaatsnemen aan de tafel. Wat doet u en wat zijn uw ervaringen?

– Hetzelfde, maar ditmaal heeft u iemand mee. Ve-randert er iets aan uw gedrag?

02. U krijgt uw chemo en u bent aan het communiceren met andere patiënten. Uw partner besluit even wat

appendices

54 appendices

koffie te zetten en raakt aan de praat met andere dier-baren. Vindt u dit een geschikte plek daarvoor? Denkt u dat het stimuleert om mensen met elkaar te laten praten?

03. Hoe zou u het ervaren wanneer iemand er afgezon-derd bij ligt (stoel van u weggedraaid)?

Onderdeeel C: Algemene vragen over eindresultaat concept01. Wat voor emoties roept dit interieur bij u op, betref-

fende kleur, sfeer en licht?02. Hoe ervaart u de afleiding in dit concept?03. Hoe zou u u voelen als u chemotherapie kreeg in deze

ruimte?04. Het middengebied, waar de gezellen samen kunnen

komen of waar u even kan wachten. Is dit iets wat u vindt dat kan werken? Of is het eerders iets aflei-dends?

05. Vindt u dat de mogelijkheden van de positionering van stoelen, u in staat stelt om privacy en communicatie te ‘ervaren’?

06. Heeft u het idee dat er iets mist of iets waar niet aan gedacht is?

appendices

courage is not the absence of fear, but rather the judgment that something else is. more important than fear.

~ Ambrose Redmoon