voICe


About voICe

The Department of Intensive Care of the Radboudumc, Nijmegen, the Netherlands, developed a special iPad communication app for awake ICU patients using artificial respiration and for patients with a trachea cannula or an NIV mask.

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About voICe

The Department of Intensive Care of the Radboudumc, Nijmegen, the Netherlands, developed a special iPad communication app for awake ICU patients using artificial respiration and for patients with a trachea cannula or an NIV mask. ICU patients are often unable to speak and have to communicate with their neighbors and the professionals by for example lip reading, writing or using a letter board or a keyboard/laptop. Because of several different causes, these methods are not sufficient enough for good communication. Looking at interviews of patients and their neighbors, we can conclude that these methods of communication are seen as very annoying. This causes feelings of despair and frustration for both the patient and the employees.

This communication-app for the iPad developed for ICU patients, named voICe, improves the communication for and with them. Using the app requires only a small amount of muscle power and locomotion, works intuitive and is simple and understandable for everyone. The app “learns” the choices of the patients and adapts itself to these. The communication app also has the possibility to record a video message for patients by a professional or a patient’s neighbor and contains a clearly visible clock and date indication.

The communication-app voICe’s development started in November 2012 and was introduced in the middle of May 2013 to the ICU of the Radboudumc: many other ICU’s in the Netherlands and the Dutch speaking part of Belgium work with voICe now. The English version of the app was released in March 2016

Target group

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.

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Target group

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.


Using 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.

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Using 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.
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Through the ‘preference screen’ direct contact can be adjusted to the most chosen themes of the patient.
  6. 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.
  7. An easy or a basic version with 4 or 6 pictograms (settings).
  8. 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.

Advantages of the voICe app

  • 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.


Frequently Asked Questions FAQ

Information

Please look at http://www.voice-intensivecare.com for more information. For the Dutch version, see http://www.voice-intensivecare.nl
 


  • The app is downloadable in the Apple store of iTunes. Search at ‘voice intensive care’, ‘voice’ or ‘intensive care’. link to iTunes There’s a free trial with basic words and a paid, complete version. This costs €79,99. If you need a large number of voICe apps, you can purchase the app at the VPP program of Apple. https://volume.itunes.apple.com/nl/store.


Missing hand locomotion

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.

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Missing hand locomotion

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.
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