Stille
Stille is a physical-digital service that aims to help caregivers maintain their empathy and their energy to care, by supporting caregivers’ emotional well-being.
Context
Helping an older adult find a caregiver, delineating the caregiver’s tasks, monitoring the caregiver’s work with the older adult, and ensuring the caregiver’s own well-being*…can be…among* the most important interventions to ensure the well- being and safety of frail older adults.
– Dr. Louise Aronson, “Elderhood”, 2019
Aging is a demographic trend affecting many countries in Asia, Europe and America.
In rapidly aging societies like Denmark, the demands on institutional caregivers of elders will increase, worsening the stress of an already-demanding job in a talent-crunched profession. This is reflected in the high annual turnover rates for professional caregivers (~25% per year at a nursing home in Denmark).
“Slowly their empathy kinda drains: (the carers get) hardened…(This is) a huge problem…(elderly) people can get very angry when they’re not met with empathy & understanding…the lack of understanding can actually accelerate ‘bad behaviour’ (in elderly people).”
– Rachel, Activity Center Manager
Caregiver burnout also causes a loss of empathy, which in turn creates downstream problems of “bad elderly behaviour”.
Conversely, a Singaporean medical professional shared with me that
- Caregiver empathy can alleviate “bad elderly behaviour”, which is sometimes managed by sedation. An anecdote shared with me was about an elderly man with dementia, who initially needed to be sedated due to his bad behaviour; after his son hired a new caregiver who was much more empathic, the bad behaviour disappeared, as the new caregiver took the time to listen to him, asked him to repeat his stories, etc.
- There are caregivers of the elderly who work in the field for 5, 10, 20 years with a continued spark and no burnout.
This caused me to think about the possibility of the opportunity area, which became my brief.
Brief
What if we can help institutional carers of the elderly in Copenhagen to maintain their empathy & energy to care for 5, 10, 20 years?
This was my starting point for the project, which was selected with the help of a nursing home manager through a sorting-cards prioritization (pictured).Concept
Stille – Concept video from CIID IDP on Vimeo.
It does this through three modules, which
– Allow caregivers to emotionally support each other through sending audio messages of appreciation
– Provide timely prompts for caregivers to reflect on their day and visualizing the caregiver’s mood patterns
– Provide micro-breaks at a physical break station
The solution strategy was to recharge the energy and empathy of the caregiver by appreciation and gratitude (which are positive expressions of empathy), either through individual mechanisms (via the Self-Care and Micro-break modules) or through their co-workers (Co-Worker Care module). The positive empathy could then cascade through the eldercare institution, via the Co-Worker Care module.
Stille – Co-worker Care Module from CIID IDP on Vimeo.
1- Co-worker Care Module
This module allows the sending of audio messages of appreciation and thanks, between co-workers.
Research pointed to a lack of emotional support as a critical gap; at the same time, most caregivers I interviewed relied heavily on their co-workers for ad hoc emotional support. This can be difficult during the shift, as the pace can be very frantic. After the shift, the co-workers tend to split their own way, and sometimes do not see each other for days.
This service module is delivered digitally via a mobile app, allowing co-workers to record and send audio messages after the shifts. It was influenced by Design Principles 2, 3 and 5.
The sharing of audio messages of appreciation was tested via a Whatsapp chat group amongst some of the caregivers: the result was good enough that they continued with the practice even after my project was over (see pictures).2 – Self Care Module
This module supports caregivers’ self-care, by allowing them to reflect individually. The module allows caregivers to
- view their recent moods and microbreaks history with a dashboard
- track their moods
- reflect on prompt questions, curated to help them process their emotions (based on their moods)
- record an audio journal
Research indicated that not all caregivers dealt with stress by going to their co-workers: some needed their own time away. Some talked aloud, even to themselves, and a number of them reflected on their own emotions (see Design Principle 2) and work at the end of the day. The audio journal and prompt questions were influenced by Design Principle 5.
This module is delivered digitally via a mobile app, allowing caregivers to conveniently access this module during the shift and after work.
Stille – Individual Reflection Module from CIID IDP on Vimeo.
Stille – Microbreak Module from CIID IDP on Vimeo.
3- Microbreak Station Module
This module augments the caregivers’ existing rest areas in the nursing home, with a physical vibrating “chestnut”* that helps take their mind away from their stress. It is activated by the caregiver surrendering their phone to the station, and by picking up the “chestnut”.
Research indicated that caregivers would “escape” to certain areas out of sight from the residents to get some rest and respite. Sometimes the caregivers would just look out the windows; sometimes they would end up engrossed with their phones. The soothing nature of tactile interactions (see Design Principle 4) was tapped on to augment the rest areas, to help create a break (see Design Principle 1).
(*Note: chestnuts have a special significance in Danish culture. It signifies the arrival of autumn, and many Danes carry a “lucky chestnut” in their pockets in the autumn.)
Design Principles
Address the Stress: create a break. The picture showed the emotional seismograph of a nursing home part-timer (sketched on a tablet): the thin line was her “happiness” chart, while the thick grey line was her “stress”. As she said to me, “happiness is not the same as stress.” Thus, it was not sufficient to create meaning, but there was a need to design for a break, even a small one.
Focus on the emotional, not the physical. Existing preventive measures at the nursing home were focused on physical well-being, and not emotional well-being.
Emotional support was ad-hoc and between co-workers. There was an opportunity to design for the emotional well-being of caregivers.
Reinforce social bonds & support amongst co-workers. Co-workers were an existing source of emotional support and well-being, but the support was currently ad-hoc and unstructured. This was an opportunity to deliberately systematize the social support amongst co-workers.
Tactile interactions to calm & soothe. A caregiver brought chestnuts during a shift, and throughout the evening, chestnuts were handed out to staff and residents alike; this had an observable calming effect on both staff and residents.
Non-written reflection mechanism. Almost all caregivers though about their work, and found it useful. However, five caregivers were given five notebooks to journal over two-weeks: this yielded only THREE pages of reflections. As one caregiver said to me, “If we had to write, it is just another task.” There was an opportunity to create non-written mechanisms that help caregivers reflect on their shifts and emotions.
Process
Research
This generated a few areas in aging and eldercare, including:
- How might we help elders to maintain their daily routines?
- How could we help elders be calmer, and less agitated or sad?
- How could we preserve the “life space” of elders with mobility issues?
Eventually, I zoomed in on the brief by putting all these areas onto sorting cards, and asking a nursing home manager to prioritize. (See Brief section above).
After the brief was prioritised, the research process proceeded in two phases.
Phase 1 involved shadowing the caregivers of a single floor in the nursing home. I shadowed the caregivers for three shifts (total 21 hours): two day- and one evening-shifts. There were some co-creation sessions, involving sacrificial prototypes. The shifts were documented in the research video below, which shows a typical day in the life of a caregiver:
A Day in the Life of a Nursing Home Floor (Stille Research video, public) from CIID IDP on Vimeo.
Phase 2 involved a series of co-creation sessions with the caregivers (10 in total). The first co-creation sessions were initially used to refine concept ideas from Phase 1, with increased fidelity. This was a mistake, as the fidelity of the prototypes ramped up too quickly, and the feedback was polite but not candid. An advisor pointed out that I was still unclear what I should prioritize, and what should be physical vs. digital. It was also unclear how and where my solution would fit within the existing service ecosystem of the nursing home.
Thus I deliberately went back to the caregivers with sorting cards and a few blank Post Its, to get the data of what the caregivers would prioritize (this was “emotional support from co-workers” and “individual reflection time” respectively, which became the first two modules of my solution). Subsequent sessions involved deliberate testing of specific hypotheses using prototypes (see below), together with open-ended co-creation of possible solutions.
Prototyping & Iteration
Sacrificial Prototypes
Sacrificial prototypes were used to catalyze conversations with the caregivers during Phase 1, and to generate ideas on possible solutions with them. The concepts for these prototypes came from a group brainstorming with the whole IDP 2019 class, and are pictured below:
The Story Sharer was a concept of an app that allowed the sharing of stories between caregivers, about their memorable interactions or experiences with certain residents. This was designed to strengthen the bonds between co-workers (Design Principle 3). This ran into the privacy constraints (there were guidelines against naming or identifying caregivers); it was a trainee nurse who suggested sharing stories and appreciation for co-workers instead. This became the nucleus of the Co-Worker Module.
The Mood Bracelet was a concept to allow co-workers to more clearly signal their moods to each other, allowing for reinforced social bonds and also focusing on the emotional (Design Principles 2 & 3). A trainee nurse pointed out that this could be achieved by simply asking each other “how are you feeling” during their staff meetings: hard to beat that!
Hypotheses testing to find the balance between physical vs. digital The initial research and sacrificial prototypes yielded initial validation: as mentioned above, my initial instinct was to ramp up the fidelity, but the feedback was polite and not candid.
Consequently, I went back to using sorting cards. I also created a storyboard to test the different modules (co-worker care, self-care) using both digital and physical devices, and also used lo-fi screens (i.e. Post Its) and hi-fi screens to test and find out what needed to be physical vs. digital.
- Arunima Singh (Thesis advisor)
- John Lynch
- Adrian Westaway
- Clara Subirats
- Elena Gianni
- Tobias Toft
- Finn Müller
- Josh Walton
- Blair Johnsrude
- CIID staff, especially Simona, Alie, Mette, Moises, Martin
- IDP 2019 (love y’all)