Scalable Training for ICU Nurses: No-Code Scenario Builder & Interactive Game
This project was an exciting one; not only that it marked my first foray into game development, but also the unique challenge of ensuring scalability. Given that the end users are medical professionals, it was clear that the solution should require no coding skills for the instructors.
This case study delves into the creation of a training platform comprising a mobile game application and a content management system (CMS), designed to equip junior healthcare workers with the skills needed to manage high-acuity patients efficiently and effectively.
Role
Role
UI/UX Designer
Client
Client
A Hospital In Singapore
Duration
Duration
October ‘23 - January ‘24
Main Contribution
Main Contribution
User Interview
Sketch Prototype
UI & Interaction Design
Usability Testing
Client Management
Challenge
Junior healthcare workers face a steep learning curve in high-acuity care units due to resource constraints, theoretical training gaps, and limited clinical practice opportunities. Reliance on senior staff also pose resource constraints. Traditional training methods are time-intensive and do not scale well with increasing demand. As a result, ineffective learning can have a direct and serious impact on patient care.
How might we train our junior healthcare workers more efficiently and interactively to help them identify and manage patients in acute medical conditions?
Junior healthcare workers face a steep learning curve in high-acuity care units due to resource constraints, theoretical training gaps, and limited clinical practice opportunities. Reliance on senior staff also pose resource constraints. Traditional training methods are time-intensive and do not scale well with increasing demand. As a result, ineffective learning can have a direct and serious impact on patient care.
How might we train our junior healthcare workers more efficiently and interactively to help them identify and manage patients in acute medical conditions?
Results
A training platform comprising a mobile game application and a content management system (CMS), designed to equip junior healthcare workers with the skills needed to manage high-acuity patients efficiently and effectively.
A training platform comprising a mobile game application and a content management system (CMS), designed to equip junior healthcare workers with the skills needed to manage high-acuity patients efficiently and effectively.
200
Average Game Sessions
Average Game Sessions
73.5%
Gameplay Improvement
Gameplay Improvement
25+
Pilot Players
Pilot Players
Preparing for the Upcoming High Demand of Training and Ensuring Quality Patient's Care
The attrition rate among nurses have been increasing in the past 5 years, which resulted in the increasing ratio of nurse to patient from 1: 3.75 to 1:10.
The attrition rate among nurses have been increasing in the past 5 years, which resulted in the increasing ratio of nurse to patient from 1: 3.75 to 1:10.
This has pushed for the decision of the government to hire 4000 nurses in 2023. However, hiring is just part of the solution to solving the problem. Once hired, there is a demand for them to be trained, to ensure quality patient care.
This has pushed for the decision of the government to hire 4000 nurses in 2023. However, hiring is just part of the solution to solving the problem. Once hired, there is a demand for them to be trained, to ensure quality patient care.
“All health professionals, including nurses, don’t hit the ground running, and need an appropriate period of supervision and mentoring, the specifics of which would depend on training and prior experience,”
Dr Jeremy Lim, a public health specialist
Teo, J. (2024, January 15). 4,000 nurses hired in 2023 for Singapore’s public hospitals as attrition rate rises. The Straits Times. https://www.straitstimes.com/singapore/health/4000-nurses-hired-in-2023-for-singapore-s-public-hospitals-as-attrition-rate-rises
User Needs Discovery Phase
Getting First-Hand Experience of the Induction Program
Getting First-Hand Experience of the Induction Program
To truly understand the end-user's perspective, we immersed ourselves by visiting the ICU department to experience its atmosphere firsthand.
To truly understand the end-user's perspective, we immersed ourselves by visiting the ICU department to experience its atmosphere firsthand.
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Cognitive overload when:
- undergoing training
- handling a patient case
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Cognitive overload when:
- undergoing training
- handling a patient case
Before visiting the ICU, we explored the learning center, where I faced the scale of the information junior nurses must process.
Observing the ICU rooms revealed even greater cognitive demands. Beyond operating machinery, nurses had to monitor patients' conditions, and make critical decisions.
With such significant cognitive load, junior nurses have to learn how to prioritize and act decisively.
Before visiting the ICU, we explored the learning center, where I faced the scale of the information junior nurses must process.
Observing the ICU rooms revealed even greater cognitive demands. Beyond operating machinery, nurses had to monitor patients' conditions, and make critical decisions.
With such significant cognitive load, junior nurses have to learn how to prioritize and act decisively.
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Lack of Practice:
- limited access
- limited availability
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Lack of Practice:
- limited access
- limited availability
During our visit to the ICU ward, we learnt that permissions are required to access essential machines. This highlighted a critical challenge: junior nurses’ opportunities to learn are often opportunistic and limited by systemic constraints.
An accessible solution that offers opportunity to practice on myriad conditions can be useful.
During our visit to the ICU ward, we learnt that permissions are required to access essential machines. This highlighted a critical challenge: junior nurses’ opportunities to learn are often opportunistic and limited by systemic constraints.
An accessible solution that offers opportunity to practice on myriad conditions can be useful.
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Disorganised Information
Informal Teaching
Feel basis
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Disorganised Information
Informal Teaching
Feel basis
Information is scattered across the preceptors, making it difficult to ensure standardise information delivery .
There is little standardization in how critical information is presented, such as treatment protocols and expected physiological responses.
Thus, a standard will serve as common understanding and reduce confusion among nurses.
Information is scattered across the preceptors, making it difficult to ensure standardise information delivery .
There is little standardization in how critical information is presented, such as treatment protocols and expected physiological responses.
Thus, a standard will serve as common understanding and reduce confusion among nurses.
Building on the three key insights, we recognized the importance of creating a solution that is both engaging and accessible. However, without a clear and well-organized structure, information can become overwhelming and hinder the learning process for junior nurses, creating unnecessary barriers.
Building on the three key insights, we recognized the importance of creating a solution that is both engaging and accessible. However, without a clear and well-organized structure, information can become overwhelming and hinder the learning process for junior nurses, creating unnecessary barriers.
Analysing Junior Nurses' Experience
Analysing Junior Nurses' Experience
There is a need to understand the best format of the solution and where we could integrate it. For this reason, I look into the typical user journey of a junior nurse:
There is a need to understand the best format of the solution and where we could integrate it. For this reason, I look into the typical user journey of a junior nurse:
Further interviews with nurses revealed three critical requirements for the solution:
Bite-sized information: Allowing nurses to quickly grasp essential knowledge without feeling overloaded.
Scalability: Enabling the addition, updating, and easy dissemination of new scenarios to meet evolving training demands.
Visual reinforcement: Providing a realistic visual experience where nurses can see the impact of their decisions on patients, mirroring real-life scenarios
Further interviews with nurses revealed three critical requirements for the solution:
Bite-sized information: Allowing nurses to quickly grasp essential knowledge without feeling overloaded.
Scalability: Enabling the addition, updating, and easy dissemination of new scenarios to meet evolving training demands.
Visual reinforcement: Providing a realistic visual experience where nurses can see the impact of their decisions on patients, mirroring real-life scenarios
From these insights, we set the direction of the solution:
From these insights, we set the direction of the solution:
An accessible, bite-sized format that enables nurses to practice their decision-making skills and visualize the impact of their actions on patients, bridging the gap between theory and practice.
The solution should also allow administrators to seamlessly incorporate new scenarios to meet evolving training needs.
Information Gathering and Making Sense
From a Linear Template to One that Branches and Loops
From a Linear Template to One that Branches and Loops
Once the general direction of the solution and its format were established, my team delved deeper into the content.
Gathering the content was challenging as there is no existing resources or structure for them.
To address this, we first identified the necessary actions for a single scenario. Drawing from our knowledge of a similar project, we provided the nurses with a structured template and a sample scenario to guide them.
Once the general direction of the solution and its format were established, my team delved deeper into the content.
Gathering the content was challenging as there is no existing resources or structure for them.
To address this, we first identified the necessary actions for a single scenario. Drawing from our knowledge of a similar project, we provided the nurses with a structured template and a sample scenario to guide them.
However, we quickly realized that the scenarios were far more complex than we initially anticipated. To illustrate this complexity, below is a sample from the four scenarios we received.
However, we quickly realized that the scenarios were far more complex than we initially anticipated. To illustrate this complexity, below is a sample from the four scenarios we received.
Translating Complex Scenarios into Programmable Cases
Translating Complex Scenarios into Programmable, Repeatable Cases
Clarifying complex scenarios required extensive back-and-forth discussions. We faced several challenges, particularly in understanding the information as accurately as possible, as the nature of the product’s use case demanded it. Additionally, every feature we proposed needed to be scalable to fulfill the established need.
Clarifying complex scenarios required extensive back-and-forth discussions. We faced several challenges, particularly in understanding the information as accurately as possible, as the nature of the product’s use case demanded it. Additionally, every feature we proposed needed to be scalable to fulfill the established need.
The On-going Discovery Process till Delivery
As we worked on the product requirement document, we realised that additional had to be incorporated to support the system. Given its sheer complexity, gathering all requirements upfront was nearly impossible. Instead, we proceeded with the design and development process while remaining fully aware that new needs would emerge as we tested the system with clients.
As we worked on the product requirement document, we realised that additional had to be incorporated to support the system. Given its sheer complexity, gathering all requirements upfront was nearly impossible. Instead, we proceeded with the design and development process while remaining fully aware that new needs would emerge as we tested the system with clients.
Emerging Need One: Extensive Patient’s Reactions
Emerging Need One: Extensive Patient’s Reactions
The biggest challenge in this project was deconstructing the various patient scenarios and identifying patterns that could be programmed into the system. Leveraging my engineering background, I collaborated closely with developers to map out the system’s logic, ensuring every scenario was both realistic and scalable.
The biggest challenge in this project was deconstructing the various patient scenarios and identifying patterns that could be programmed into the system. Leveraging my engineering background, I collaborated closely with developers to map out the system’s logic, ensuring every scenario was both realistic and scalable.
From the above exercise, we identified several key patterns for the patient's reaction to the medical decision made in the system. We also need to ensure that the system could dynamically adjust based on specific patient presentations—a constant reminder of the phrase often repeated by practitioners
From the above exercise, we identified several key patterns for the patient's reaction to the medical decision made in the system. We also need to ensure that the system could dynamically adjust based on specific patient presentations—a constant reminder of the phrase often repeated by practitioners
“The next intervention to take depends on the patient’s presentation”
A Senior Nurse
This led to the creation of the Modular Patient Presentation System, enabling administrators to simulate various equipment configurations and reaction seamlessly. This modular approach ensured that administrators could create realistic scenarios.
This led to the creation of the Modular Patient Presentation System, enabling administrators to simulate various equipment configurations and reaction seamlessly. This modular approach ensured that administrators could create realistic scenarios.
Emerging Need Two: Achieving the Impossible —An Exhaustive List of Required Medications in the Game
Emerging Need Two: Achieving the Impossible —An Exhaustive List of Required Medications in the Game
When treating medical conditions, various treatment options must be considered. One of the most common treatments is medication. However, managing medications involves multiple factors—when and where to administer them, dosage, delivery methods, limits, and increments.
As we gathered details for this project, both our internal team and the nursing team encountered several workflow challenges:
When treating medical conditions, various treatment options must be considered. One of the most common treatments is medication. However, managing medications involves multiple factors—when and where to administer them, dosage, delivery methods, limits, and increments.
As we gathered details for this project, both our internal team and the nursing team encountered several workflow challenges:
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Internal Team's Challenges:
How can we ensure we have all the necessary medication information?
Can the client provide a comprehensive list of all medications?
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Internal Team's Challenges:
How can we ensure we have all the necessary medication information?
Can the client provide a comprehensive list of all medications?
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Nursing Team's Challenges:
Gathering all relevant medication information is time-consuming.
Why were some medications and the relevant information missed?
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Nursing Team's Challenges:
Gathering all relevant medication information is time-consuming.
Why were some medications and the relevant information missed?
To address these challenges, we developed the Button Manager. As new scenarios arise, there is a high likelihood that required medications may not yet be included in the system. With the Button Manager, senior nurses can independently add new medication options without relying on developers. This ensures the system remains adaptable and reduces the need for continuous development efforts to accommodate new treatments.
To address these challenges, we developed the Button Manager. As new scenarios arise, there is a high likelihood that required medications may not yet be included in the system. With the Button Manager, senior nurses can independently add new medication options without relying on developers. This ensures the system remains adaptable and reduces the need for continuous development efforts to accommodate new treatments.
Reflection: Observation Fosters Empathy and Mental Gymnastics of Scalable Solution
Working on this project has given me a newfound appreciation for nurses. Most people recognize that nursing requires immense passion and emotional resilience, but after our first visit to the ICU ward, I quickly realized how much more is involved. Beyond emotional strength, nurses must also possess deep medical knowledge—something often associated more with doctors.
Additionally, this project has been an intellectual challenge that pushed my engineering mindset. It required me to extract patterns from complex information, understand intricate linkages, and develop logical flows to ensure a seamless and scalable solution.
Overall, this was a truly rewarding experience—one that strengthened my ability to empathize with users while refining my problem-solving and analytical thinking skills.
Working on this project has given me a newfound appreciation for nurses. Most people recognize that nursing requires immense passion and emotional resilience, but after our first visit to the ICU ward, I quickly realized how much more is involved. Beyond emotional strength, nurses must also possess deep medical knowledge—something often associated more with doctors.
Additionally, this project has been an intellectual challenge that pushed my engineering mindset. It required me to extract patterns from complex information, understand intricate linkages, and develop logical flows to ensure a seamless and scalable solution.
Overall, this was a truly rewarding experience—one that strengthened my ability to empathize with users while refining my problem-solving and analytical thinking skills.
