● subsequently, nursing frameworks were

proposed to illustrate dynamic interactions

occurring between nurses, computers, and
enabling elements that optimize a user’s
● is broadly defined as an intellectually rich ability to process information via
and highly impactful phenomenon computers.
influenced by four disciplines: ● These became the early foundations for
- (1) Human Factors/Ergonomics, incorporating human factors approaches
- (2) Information System, into the design of information technologies
- (3) Computer Science , and used by nurses. However, there were still
- (4) Library Information. limitations identified in these early models
because they did not explicitly make the
patient part of the model and they didn’t
define the context or include all elements
of nursing’s metaparadigm proposed the
● Human factors is a discipline that optimizes Informatics Research Organizing Model,
relationships between technology and which emphasized all elements of nursing’s
humans. Human factors has been defined in metaparadigm including the system, nurse,
a number of ways by a number of experts. patient, and health.
In healthcare, human factors experts ● Later, Alexander’s Nurse—Patient Trajectory
attempt to understand relationships Framework was proposed. Alexander’s
between humans, tools they use (i.e., framework utilizes nursing process theory,
computers), living and work environments, human factors, and nursing and patient
and tasks they perform trajectories as components of a framework
● Human factors experts apply information that can be used to evaluate patient care
about human characteristics and behavior systems. The midrange framework
to determine optimal design specifications specifically emphasizes the use of human
for tools people use in their daily life. The factors approaches to link patient care
goal of a human factors approach in processes, nurse and patient trajectories,
nurse-led systems is to optimize the and nursing and patient outcomes. In this
interactions between nurses and the tools discussion, the framework has been
they use to perform their jobs, minimize modified to explore HCI in the context of
error, and maximize efficiency, optimize nurse and patient trajectories as technology
well-being, and improve quality of life. is integrated into nurse-led systems.
● HCI, concerned with interactions between Examples of HCI design and research using
people and computers, is an area of study this model will be used to achieve the
concentrated on by human factors experts. objectives.
HCI is defined as the study of how people
design, implement, and evaluate interactive
computer systems in the context of users’
tasks and work. HCI emerged in the 1980s as
an interdisciplinary field incorporating ● The discipline of HCI incorporates
ideals of computer science, cognitive proponents of interaction design.
science, and human factors engineering Interaction designers are concerned with
professionals, but since has grown into a shaping digital things for people’s use.
science incorporating concepts and Concepts proposed by interaction designers
approaches from many other disciplines in healthcare have significant implications
for design of pervasive technologies that
are being developed and adopted by
healthcare providers and patients.
Interaction designers are characterized as
● Early pioneers in nursing informatics set the shaping and transforming processes through
stage for development of nursing the use of digital devices; they consider all
information systems and their use in storing possible futures for a digital design space;
information, knowledge development, and designers frame a problem at the same time
development of technology in caregiving they are creating a solution; and finally,
activity. These early models had several designers address instrumental and
limitations including a lack of technical aspects of digital media, but also
environmental and task oriented elements, recognize aesthetical and ethical aspects of
conceptual differences across frameworks, designs.
and a lack of time dimensions;
 Aesthetics influences cognitive and
emotional processes of people who interact
with technology and is a strong determinate
● One problem for the millions of older adults of user satisfaction and pleasure, which are
who have multiple chronic illnesses is that important HCI outcome metrics.
they want to remain at home as long as Traditionally, HCI researchers have
possible. However, at the end of life, these emphasized objective performance criteria,
chronic illnesses result in greater frailty, such as time to learn, error rates, and task
decline in independent daily activities, and completion times; other aspects such as
greater safety concerns such as falls. aesthetics have been. In the current
Furthermore, as these conditions progress context, aesthetics refers to the beauty and
often older adults experience reduced pleasing appearance of technological
mobility with greater isolation from their artifacts designed to solve complex
peers. Solutions to problems faced by these health-related problems.
frail individuals are needed to help them
age in place and to have better experiences
at the end of their life.
● Solutions for these problems are being
developed by an interdisciplinary team of
software designers at the University of
Missouri in an independent living facility
called TigerPlace To maximize efforts, the
formation of an interdisciplinary interaction
design team was critical in initial and
ongoing stages of developing solutions for
these age-old problems. The
multidisciplinary team included nurses,
● physicians, sociologists, computer
engineers, architectural designers, and
informatics specialists. Rich dialog was
produced from multiple perspectives that ● For a long while, perceptions have been
enhanced our ability to produce a wide that information technology can help
variety of solutions, including embedded improve diagnostic accuracy, make
sensor systems that assisted in early information more accessible, and can
detection of declining health experienced improve the representation of facts in
by older adults living in TigerPlace. While medical records. However, with the
developing these solutions the design team everywhereness of technology embedded
concurrently considered crucial aspects of throughout our world and the robust forms
HCI design such as aesthetics, ethics, of technology being used, ethical
usability, and user experience. Examples are considerations for HCI are becoming
drawn from these experiences to paramount. For instance, consider the
demonstrate principles of HCI design example of designing for mobile platforms,
three main problem areas of design have
been proposed for these types of devices
including use of screen space, interaction
mechanisms, and design of mobile user
interfaces.

● The sensor technologies being used at

TigerPlace have been incorporated into the
living environments of resi- dents choosing
to age in place at this facility. Future use of
these sensors includes possible interactions
with other types of users, such as families,
physicians, nurses. So, their input into the
development of this technol- ogy is critical
● Aesthetics has been defined as, “of or during all stages of development and
relating to beauty”, and “pleasing in implementation. In order to meet ethical
appearance: ATTRACTIVE easy to use obligations to the public who will eventually
keyboards, clear graphics, and other use these sensor systems, the design team
ergonomic and aesthetic features”. incorporated multiple HCI methodologies to
 examine user’s perceptions of the interface
and to examine the functionality of the
interface. For instance, our team con-
ducted many key informant interviews with ● Traditional outcomes associated with HCI
residents liv- ing with sensors to explore methods are efficiency, effectiveness, and
their lived experiences with the sensor satisfaction, which, as stated, are highly
systems (Demiris et al., 2004). Finally, we related to how usable a piece of technology
conducted task-oriented usability is. These outcomes have been a long
assessments that were electronically standing, central feature of HCI for many
documented with usability software, called years. With current emphasis by national
Morae, with each type of end user institutes, such as National Institute of
(residents, families, nurses, physicians) Standards and Technology, on incorporating
(Alexander et al., 2011b). Through these HCI methodologies into the life cycle of
usability assessments the design team developing technologies, HCI principles and
identified potential problem areas methods will continue to grow in
encountered during interac- tions for each importance. Theoretical frameworks or
user type. Again, these findings were used models of clinical care using any form of
by software designers to improve the technology should incorporate HCI outcomes
functionality, aesthetics, and appearance of related to both the clinician and the
the sensor interface. Usability patient. For example, satisfaction with
methodologies are important to meet particular technologies will differ depending
ethical obligations of software design on whether the interaction being evaluated
is between a patient and a computer or a
● nurse and a computer.
● Usability evaluation determines the extent
that a technol- ogy is easy and pleasurable
to use by determining if it is well adapted
to users, their tasks, and that negative
outcomes are minimized as a result of use
(Bastien, 2010). Usability evaluation has
been a staple of HCI research- ers for the
past 30 years and continues to grow in
prominence as technology advances have
been made around the world. HCI designers
have proposed that usability is inherently
measureable in all electronic technologies,
that usability evaluation determines if an
interactive system is usable, and if a system
is usable, then usability evalu- ation can
determine the extent of usability using
hardy usability metrics, and finally, that
usability evaluation is an accessible form of
analysis and easy enough to learn about in
HCI literature (Cockton, 2013). There are a
large number of methods available for
designers to use to assess the usefulness of
a piece of medical technology.

● Contextual Inquiry
● Delphi Technique
● Heuristics
● Cognitive Walkthrough
● Focus Group
● Cognitive Task
● Analysis Usability Test