Press On | Creative Process Journal

PRESS ON A Design Domain project tackling the issue of moral distress among healthcare providers.

Done by: Nur Zafirah [1702466]

Table of contents 01 Title of Project .............................................................7 02 Research Timeline....................................................9 03 Problem/Opportunity.............................................11 Target Audience................................................13 04 Additional Research ...............................................15

Methods of Research .....................................16

Journal Articles .................................17 Interviews .............................................21 05 Insight Gathering ......................................................31

Key Insight ...........................................................33

06 Ideation ...........................................................................35 07 The BIG Idea..................................................................45 08 Development ...............................................................49 09 Final Outcome ............................................................55 10 Bibliography..................................................................67

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01 Title of Project

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Introduction

Press On focuses on tackling the issue of moral distress among healthcare providers.

According to a research article by Theresa A. Brosche, grief is often experienced by a healthcare provider upon the death of a patient, but it is often ignored. Trying to suppress the feelings associated with the death of a patient can take a heavy toll on the caregiver and can lead to compassion fatigue, moral distress, and stress. This can negatively affect efficiency of care, customer service, turnover, cost to the hospital, nursing morale, and nursing retention.

This project seeks to show the target audience that not being able to cope with these emotions is normal and should not be suppressed.

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02 Project Timeline

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12/03: Launch of Project Finding possible topics of interest 13/03: Research & Insight Gathering Portfolio Lesson by Paul 19/03: Research & Ideation Sourcing for information from research articles Selecting key insight 20/03: Research & Ideation Sourcing for information from research articles Ideation for Idea 1 21/03: Research & Ideation Ideation for Idea 2 23/03: Research & Ideation Consultation with Paul Finalising the BIG idea 25/03: Ideation & Development Development of Idea 26/03: Development Development of Idea Prep for crit 27/03: Presentation & Critique Presentation Deck + Feedback 02/04: Open Studio A2 Poster display Debrief by Paul 07/04: Summative Assessment Submission of project portfolio

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03 Problem / Opportunity

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Problem / Opportunity 12

Unlike most other lines of work, healthcare providers are expected to be able to cope with the emotional demands of their job, and expressing their emotions is usually frowned upon. Thus, most would use surface acting strategies to hide their true emotions. However, the suppression of emotions can result to grief, mental trauma and moral distress, and on top of this, they are required to show professionalism as they still need to cope with the emotional wellbeing of their other patients.

Furthermore, as the aging population is increasing drastically, there is a higher demand for healthcare providers to assist the elderly.

In a research article by De Villers, Mary Jo, and Holli A DeVon, Moral distress in nursing has been reported as a significant factor in nurse resignation.

I have chosen this topic because I realised how important it is to bring awareness to this problem as it is often ignored, and it might cause a rise in turnover rates of nurses.

Target Audience

Primary Target Audience Our primary target audience are young adults from age 18 to 35, who are just stepping into the healthcare industry. We chose this age range because we felt that we could still spark their interest in volunteering in this field especially after getting rid of this potential fear.

Before After After consultation with Paul, he advised me to focus my target audience solely on nurses and support staff because they are the ones that spend the most time with the patients.

Secondary Target Audience As for our secondary target audience, we have decided to focus on professionals who have been in this workforce for a long period of time and have a decent amount of experience. Being mentors for the junior staff, they play a crucial role in giving reassurance and support to them.

Finalised Target Audience Nurses and support staff from age 18 to 35, who are just stepping into the healthcare industry.

I’ve decided to zoom into this group of people because, being very fresh in the workforce, they are the ones who are most at risk of moral distress.

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04 Additional Research

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Methods of Research Paul brought up the lack of research to back up the idea that if we help nurses deal better with their emotions, this would mean that the rate of nurses quitting would also drop. Thus, I’ve been advised to do further research or look through the interviews that my team conducted in the previous semester.

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Journal Articles In order to understand what moral distress and the effects it has towards nurses, I decided to dig up the journal articles my team looked at the previous semester.

Interviews My team interviewed students who have yet to enter Medical school, Medical students who are waiting to enter the working field, as well as experienced doctors who have been working in the field for many years. We also conducted interviews via email to the people who could not do a face-to-face interview. I decided to study these interviews again to see if I can find any information to help me in my insight gathering.

For full collection of research, interviews and surveys, do refer to “Close, but not close...� the project journal.

Journal Articles

In the previous semester, as we were focusing on the emotional state of caregivers and volunteers who take care of the elderly, we researched for articles linking to the chosen topic. Titles such as, ‘The strategies used to deal with emotion work in student paramedic practice’, ‘A study of emotion work in student paramedic practice’, ‘Moral distress and avoidance behavior in nurses working in critical care and noncritical care units’, etc. These articles are still relevant to my current research topic which is why I decided to study these articles.

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First things first, what is emotional labour?

How does it affect their work?

Emotional labour is the process of managing emotions to fulfill the emotional demands a job requires. Research has shown that healthcare providers tend to suppress their feelings and this can lead to serious problems if they cannot cope with it. This constant suppression of emotion can be linked to the phrase “pressure cooker phenomenon”, where if their emotions are suppressed, it will go out of control one day when they can no longer handle their emotions.

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Healthcare providers are expected to be able to cope with the emotional demands of the job, and expressing their emotions is usually frowned upon. They also use surface acting strategies to hide their true emotions. However, while coping with their own emotions, they must also be able to cope with the emotions of the relatives of the elderly. This is why it is important that healthcare providers have an outlet where they can freely express their emotions.

Grief is one example. As a healthcare provider, it may be common to see the deaths of their patients. It is common to grieve for the loss of the patient, but while at work, they have to suppress their emotions and can only truly grieve when they are alone. Some might even use deep acting strategies to suppress their grief.

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Sympathetic lethargicness, moral discomfort and outpouring of stress. (Takes a toll on them.)

The productiveness/performance when it comes to responsibility & quality of patient care.

Why is it important to cope with the emotional demands that comes with being a healthcare provider? Why are they unable to cope in the first place?

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Being a healthcare provider requires a huge amount of attention when it comes to technical aspects.

When there is a greater priority on skills, emotional work on the other hand is often being brushed aside & suppressed.

These reasons could lead to the downfall of the spirit and the work of the healthcare provider.

And the physical health of the healthcare providers in the long term can also be compromised.

What is moral distress?

Moral distress is the stress, anxiety, apathy, and burnout that can often occur from repeated loss and when personal values conflict with the environment. Nurses can develop moral distress when they feel constrained from advocating for patients’ interests due to situational or bureaucratic pressures. When there is a greater emphasis on the technical aspects “Moral distress is of nursing care, this the stress, anxiety, leads to less of an apathy, and burnout emphasis on the that can often occur “ethic of care.”

from repeated loss and when personal values conflict with the environment.”

Elpern et al, however, identified that the greatest source of moral distress was related to the ethical issues surrounding death, dying, and the aggressive delivery of care to patients who would not benefit from treatment. Dr Rushton states that moral distress will become more intense as technology expands and that ignoring this problem can effect the quality of patient care.

What are the effects of moral distress and who are at risk?

The effects of moral distress include loss of selfworth, interference with personal relationships, psychological (depression), behavioural (nightmares, crying), and physical symptoms such as heart palpitations, diarrhoea, and headache.

Feelings of powerlessness, hopelessness, and lack of support have been reported, as well as anger, nausea, frustration, grief, misery, and ineffectiveness. Moral distress is not only a situational phenomenon, but also holds the potential for long-term residual effects when moral distress is sustained. There are grievous consequences to sustained moral distress. Persons may carry with them long-term events in which they compromised themselves when faced with moral distress; these times are painful because they betray prized beliefs and values.

In the past 20 years, moral distress has been recognized as more prevalent in nurses working in critical care settings, and there is greater awareness of the influence of environment on its prevalence. Nurses practicing in critical care units (CCUs) are at higher risk of moral distress due to the nature of patient conditions and related ethical issues arising in these settings, for example, endof-life decision-making, autonomy, allocation of scarce resources, and quality versus quantity of life,

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Moral Distress Moral Suffering Moral Residue

Impact on Organisation

Hight Nurse Turnover

Impact on Nurse

Decreased Quality of Care Low Patient Satisfaction

Reputation Accreditation

De Villers, Mary Jo, and Holli A DeVon’s version of “Corley’s model” showing sequential events associated with moral distress.

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Suffering

Impact on Patient

Lack of Advocacy Avoids Patient

Resignation Burn-out Leave Nursing

Increased Patient Discomfort & Suffering

Interviews

Instead of compiling all the interviews that my team have done in the previous semester, I have decided to focus on two interviews that really helped in shaping my key insight. The key information found in these interviews have been picked out and arranged in pull quotes.

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Interviewee 2: Year 2 Medicine student How long have you studied in the Medical field?

One and a half years What interest you to study medicine?

I knew I wanted to be in a place where I could have a lot of person to person interaction, so Medicine was one of the choices.

Face-to-Face Interviews

Have you ever thought ahead of how you would deal with the death of your patients?

I haven’t thought much about it, but I guess it is something that will eventually come. Just thinking about it, it is important to recognize that things like this are not within your control. If you make mistakes then you have to learn from it and “For me, talking about it, not beat yourself up about it, and you do your best but in the end, verbalizing my thoughts, the life isn’t in your hands. For me, and writing my thoughts talking about it, verbalizing my will help.” thoughts, and writing my thoughts will help.

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Since there is a lack of awareness, do you think this is an issue worth dealing with? Like on a big scale?

I’m not sure how you can deal with it on a big scale, but I think it would be nice if mentors will remind their juniors of all different levels, both in school and when you progress up, that it is normal to feel such emotions and it is normal to be stress. So having this normalizing feeling is better, because I can see how, that even now in school, people don’t want to show how stressed they are, so it carries on to working life. It shows professionalism and that you’re not so weak.

Do you think this fear is stopping people from actually going into this field or even volunteering?

I think it is a legitimate reason to not want to go into this field, like if you feel you can’t face this everyday then this is not for you. So it is important to know that this job has this aspect as well, before getting into it.

“Research have shown that grief is often experienced by a healthcare provider upon the death of a patient, but it is often ignored. Trying to suppress the feelings associated with the death of a patient can take a heavy toll on the caregiver and can lead to compassion fatigue, moral distress, and stress. This can negatively affect efficiency of care, customer service, turnover, cost to the hospital, nursing morale, and nursing retention.”

How do you feel about the lack of awareness on the emotions of the healthcare providers? Do you think this is an issue worth dealing with?

“It is bad, because healthcare providers have feelings and are human too, and emotional stress is something they will have to deal with, and I see how this will affect their efficiency because if they are emotionally stressed and they are trying to suppress it, it will definitely affect their work productivity and how they relate to patients, like how they may not want to hold that emotional level of contact with patients, and that will also affect the way patients open up to healthcare providers. I feel that it has to be addressed, although I don’t have particular solutions for it, but I think that every single healthcare provider must recognize and must acknowledge that when things happen, they do feel stressed about it, and that it is okay to show that you are affected by it, because even though everyone around seems to not be affected by it, they are also hiding it. So i think it is important for everyone to recognize it, and to develop your own way to deal with it, because everyone is different.”

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Interviewee 3: Year 4 Medicine student How long have you studied in the Medical field?

This is my 4th year.

What interest you to study medicine?

I liked the aspect of helping people, and I feel it is quite useful knowledge to have for family and friends.

How do you (intend) to serve your patients?

Because as students we talk to patients to learn about their symptoms and how they are managing, so now when I talk to patients, I go beyond asking them about factual things and ask about their lives, because sometimes “...when I talk to they are more patients, I go beyond comfortable sharing with students then asking them about factual things and ask the actual doctors, and as students we about their lives...” have more time so we can be there for them more to listen more. In future it would be different, you will have the responsibility to actually manage them, like refer them to social workers, or call up the nursing home to expedite the processes. It’s about taking the effort to do it.

Have you worked with elderly/cancer patients/ in the A&E before? Describe your experience working there.

Elderly, yes, because there were a lot of old people around. Specifically in the elderly department not yet. Cancer patients, not so much.

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For A&E, there was one patient I did CPR on, who passed away in the end. I did not really have a relationship, in the sense that I did not really talked to her and all I did was do CPR, but it made me think a lot after that experience, because I am a

student and I know my CPR is not very good, I did it because I have to do it to somebody, I just did it to this patient because the doctors thought that no matter how much you do you wouldn’t save her anyway, so it was better I did on her then somebody else whom I may affect. It is true that we have to start somewhere, if not we’ll never be able to do it, and your future patients would be affected. I felt guilty, but it had to happen.

There was another time in A&E, where a patient came in, and he had an aneurysm in his stomach, so he knew that he had it already and it was a very big aneurysm so it could explode anytime, so if it explodes he would die. So on that day, he had pain in his stomach, so he came to the A&E and it was suspected that it had ruptured. So my friend and I went to talk to him, and he happened to be a very nice uncle, very jovial, and we felt quite happy talking to him, and I would say we developed quite a good relationship with him, in that short time, it was quite nice. I mean, it did rupture in the end, and for me and my friend, we saw the whole process of him, from being a very well patient, talking to us to experiencing “I would say we more and more pain, developed quite a and then screaming in good relationship pain. I told him don’t worry it’ll be fine, and with him...”

I realised it wasn’t a good thing to say. So we saw the whole process of death, from screaming pain to not saying anything, to seeing his heartbeat slowing and being dragged to the resuscitation room and then just being left there because they can’t do anything. For me, that was a busy period of my life so I did not have much time to dwell on it, I know I had some emotions, but I just did not have time to think about it. It is still something I would want to reflect on when I’m free, but I still haven’t completely reflected about it.

The third one was at the hospice. In the hospice there are a lot of patients who are in really bad shape. There was one patient who was very young, in her 30s, and she had cancer of the rectum, and it spread to the rest of the body, and when I heard about it I thought it was still okay, and when I went in with the doctors to see her, I thought that I would see a 30 something year old, but she looked like she was 60, even 80. Her hair was all white and she was really thin, everything was hollow, all bones, like a skeleton. I was thinking, people don’t realise this is what cancer really means, it is really chronic.

“Close but not close” What do you think this statement means in regard to working with the patients and elderly? Do you agree with it?

The first thought that comes to my mind is yes.

You are close in some ways, you are talking about a very intimate aspect of their lives, their illness, and especially for the patients with terminal illnesses, it is a big part of their lives, so it is a very privileged position to be able to talk about these issues. Close in the sense where you know about their lives but they don’t know about your life. Close but not close, there is still a professional distance you must maintain, and you cannot go overly close as it is not professional and not advisable for many many reasons.

Experiences with the death of a patient that you were treating/taking care of/attending to?

(Emotionally) I felt sad because he had no family and I wondered why people had to feel such pain. It was eye opening to me that death can just take you, realising how real death is.

“Research have shown that grief is often experienced by a healthcare provider upon the death of a patient, but it is often ignored. Trying to suppress the feelings associated with the death of a patient can take a heavy toll on the caregiver and can lead to compassion fatigue, moral distress, and stress. This can negatively affect efficiency of care, customer service, turnover, cost to the hospital, nursing morale, and nursing retention.”

How do you think doctors/nurses cope with the death of patients?

For those who are affected by it, sometimes they will have time to themselves to cry, and people will talk to them and ask if they are okay.

Do you think it is important to find solutions in helping the emotional side of things in this field?

Definitely. Apparently the depression and suicide “Apparently the rate is very high in this depression and field. That’s the evidence, but even day to day, these suicide rate is very high in this emotions will affect how you work and how you field. That’s the care for your patients, so I evidence...” definitely think this is very important.

Do you agree that sometimes in the field, people keep silent and don’t speak out about these things because they want to hold up a certain level of professionalism?

Yeah, professionalism means you have to show your patient you can still function, if the doctor is breaking down and the doctor needs to be comforted, then who is going to comfort the patient? To be able to function, other people need care, so you need to give them care.

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How do you feel about the lack of awareness on the emotions of the healthcare providers? Do you think this is an issue worth dealing with?

“I don’t think it is so much that they are not aware, they feel a need to be productive and continue to function because there are so many other patients to take care of and reach out for, so I wouldn’t say it is the lack of awareness, it is the lack of importance or significance placed on it. I definitely think there should be an emphasis on this. After one of the patients passed away, I did tell someone in the medical field who is a bit more senior than me like “oh, I just saw one of my patients pass away” and she was like “oh” and she didn’t really think much about it. I feel it is an issue worth dealing with, but ‘how’ is the problem.”

Solutions?

I think it is very difficult. I feel that people do know about it. Talks would help, but i don’t know how much they would, what would help is when it happens, there needs to be enough importance placed on this. Talks are a bit more removed, you can hear a talk but forget about it when a situation actually occurs. Maybe what would be better is systems? Recognizing on hospital level, there is some policy that if a patient dies it must be told that it is important. It must be done on the ground level.

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From: Jayne Date: Mon, 13 Nov 2017 at 1:48 PM Subject: To: Gracia Lee

Interviews via e-mail

1. How long have you worked/studied in the Medical field?

3 years.

2. What interest you to study medicine?

I couldn’t imagine doing anything else. Medicine places you in a position where you can make a definitive change in people’s lives. Few professions give you the privilege of knowing people on such “To help them, you don’t just treat a personal level. To help their illness or disability; you learn them, you don’t just treat about their beliefs, social set-up, their illness or disability; their environment, their concerns you learn about their and expectations. You get to know beliefs, social set-up, their them as a whole, rather than just an environment, their concerns and expectations. You get organ or body system.” to know them as a whole, rather than just an organ or body system. I also wanted a profession where I could make a tangible impact, and medicine allows me to do just that.

3. How do you serve your patients?

As a medical student, I’m not licensed to manage their medical conditions.

This means I have time to talk to them about why they are in hospital/clinic.

From that, I find out things that they didn’t have time to tell the medical team managing them. I get to understand what matters most to them in terms of health and healthcare. Relaying this information to the medical team enables them to better meet the patient’s expectations and address any questions they may be too afraid to ask.

4. Describe the relationship between you and your patients.

I view patients as friends when talking to them. At the same time, it’s important to respect their privacy and read non-verbal cues if the issue being discussed is more sensitive. If I have to ask them about personal issues, I’ll warn them beforehand and check if they’re okay with sharing the information.

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5. Have you worked with elderly before? Describe your experience working there.

Managing elderly patients is very different from managing the paediatric population. Most elderly patients have multiple co-morbidities which the medical team has to take into account besides their acute complaint. It’s also important to consider their social set-up (e.g. who looks after them at home). Psychologically, they may have issues such as depression/dementia.

Taking care of their psychological state and social needs are just as crucial as relieving them of their acute illness.

6. Have you had a first hand experience with the death of a patient that you were treating/taking care of/attending to? How was that experience? (Emotionally) (From a palliative care nurse) when I witnessed my first patient death, I was more scared than sad. It reminded me that death is a part of life and just because we’re young, it doesn’t mean it can’t reach us. As I witnessed more patient deaths, I gradually became more immune to the feeling. I accepted that it’s a natural process everyone goes through and just fulfilled my duties to the best of my ability. I’m no longer affected as much as I used to be by patient deaths.

7. “Research have shown that grief is often experienced by a healthcare provider upon the death of a patient, but it is often ignored. Trying to suppress the feelings associated with the death of a patient can take a heavy toll on the caregiver and can lead to compassion fatigue, moral distress, and stress. This can negatively affect efficiency of care, customer service, turnover, cost to the hospital, nursing morale, and nursing retention.” How do you feel about the lack of awareness on the emotions of the healthcare providers? Do you think this is an issue worth dealing with?

Although I haven’t dealt with this personally, I believe it is an issue worth addressing. All too often, doctors who lose their patients don’t have time to recover from the experience. They “I believe it is an issue worth have to continue their work of caring for others, with no one and addressing...doctors who no time to care for themselves. lose their patients don’t have Not letting their emotions get time to recover from the the better of them is considered experience...many healthcare “professionalism”, so many professionals push their healthcare professionals push feelings aside and soldier on.” their feelings aside and soldier on.

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12. How do you think doctors/nurses cope with the death of patients?

Losing patients will always be difficult. But it makes doctors aware of the power they have to relieve suffering. Healthcare is a profession where you can connect with people as human beings, and although it can be emotionally punishing, it’s still an incomparably rewarding profession.

Knowing that you’re going home with insight “Healthcare is a profession where that will make you a you can connect with people as better doctor tomorrow human beings, and although it can is the best thing about be emotionally punishing, it’s still an being in this profession incomparably rewarding profession. ” The best way of coping is knowing that you have done your best to comfort the patient. We always think the medical profession has succeeded because of its ability to fix. However there are many issues we have no control over. Hence the saying “to cure sometimes, to relieve often, to comfort always” 13. Do you think it is important to find solutions in helping the doctors/ nurses better cope with the death of an elderly/ patient?

Yes, it’s important in the initial stages of training when the healthcare professional may not have experienced the death of a patient.

14. What do you think will help you, or doctors/nurses/caregivers/ volunteers in general, deal with these experiences?

Buddy/mentor system between healthcare professionals at different stages of training and more conversations on coping with death in the medical profession.

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05 Insight Gathering

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“Moral distress in nursing has been reported as a significant factor in nurse resignation.”

Source: De Villers, Mary Jo, and Holli A DeVon, “Moral Distress And Avoidance Behavior In Nurses Working In Critical Care And Noncritical Care Units”, Nursing Ethics, 20 (2012), 589-603

“Apparently the depression and suicide rate is very high in this field. That’s the evidence…”

Source: Interview with Year 4 Medicine Student

“This can negatively effect efficiency of care, customer service, turnover, cost to the hospital, nursing morale, and nursing retention.”

Source: Theresa A. Brosche. A grief team within a healthcare system. Dimens Crit Care Nurs 2007; 26(1): 21–28

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Key Insight The healthcare providers are aware of the problem and that there are ways to deal with these emotions. However, due to the fast-paced working environment and professional responsibilities, they are expected to be able to suppress their emotions and choose to brush it off and soldier on.

“...doctors who lose their patients don’t have time to recover from the experience...many healthcare professionals push their feelings aside and soldier on.”

Source: Interview with Palliative Care Nurse

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06 Ideation

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THE BIG IDEA Press On is phone application that serves as a platform for healthcare providers to verbalise their thoughts and lighten their emotional burden, giving them the push to avoid suppressing their emotions.

TARGET AUDIENCE The primary target audience are young adults from age 18 to 35, who are just stepping into the healthcare industry. The secondary target audience will be professionals who have been in this line of work for a long period of time.

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CAMPAIGN FLOWCHART

Phase 1: Awareness

Phase 2: Engagement

A set of hand sanitizers will be placed all around hospitals for healthcare providers (and even the public) to interact with. It will feature the key aspect of the phone application for the audience to get an idea of what the phone application is all about.

The interactive hand sanitizers will ultimately lead the targetted audience to the phone application. It is a platform for healthcare providers to either verbalise their thoughts or agree with and comment on the thoughts of other healthcare providers.

Brochures will also be placed nearby if they wish to know more about the issue and phone application.

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HAND SANITIZERS

Thoughts of healthcare workers regarding what they feel about the death of their patients as well as other concerns they have.

My patient who passed on, we were so similar in so many ways. I just can’t stop thinking what if it was me?

I CAN RELATE

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The dispenser will be transparent so that users will be able to view the amount of hand sanitizer left.

Another patient passed on and it feels like another part of me is gone.

I just wished we could’ve saved him “I can relate”, “Me too” and “Same” will be printed on the buttons of the dispenser.

ME TOO

SAME

PHONE APPLICATION

The key aspect of the app will be the “I can relate”, “Me too” or “Same” buttons. Users can choose to press on the button as many times as they like or skip to the next thought.

Another patient passed on and it feels like another part of me is gone.

Another patient passed on and it feels like another part of me is gone.

Navigation to lead users back to the home page or profile page. All thoughts shared will remain anonymous.

+1 +1 +1 SAME

SAME

Users can also choose to comment on it or read what other people have to say about it.

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THE OTHER BIG IDEA Send out survival kits in the form of direct mailers to educate the target audience on how to approach someone facing an unseen battle and prompt the other party to verbalise their thoughts.

TARGET AUDIENCE The primary target audience are young adults from age 18 to 35, who are just stepping into the healthcare industry. The secondary target audience will be their family members who live with them as they can also view the direct mailer.

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DELIVERABLES Survival Kit for Unseen Battles

The survival kit will include a guide book with instructions and infographics on how to properly approach someone who might be suppressing their emotions and how to get them to verbalise their thoughts as well as how to respond to them.

The kit will also include tissue packets as well as tools they can use, such as ‘chill pills’ and ‘let’s-fix-you-a-little band-aids’, to approach the other party.

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07 The BIG Idea

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The BIG Idea Press On is a phone application that serves as a platform for healthcare providers to verbalise their thoughts and lighten their emotional burden, giving them the push to avoid the suppression of emotions.

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Campaign Flowchart PHASE 1: AWARENESS An interactive installation will be set up around staff access only areas in hospitals. Audiences will be introduced to the problem and be prompted to download the phone application, urging them to avoid suppressing their thoughts.

PHASE 2: ENGAGEMENT With the interactive installation bringing our audiences to download the phone application, users are able to either share a thought or agree or comment on the thoughts of other healthcare providers.

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08 Development

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Application Wireframes

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PRESS ON

S S E PR N O

ON

Logo

ON PU SH

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COPY VER 1 Lighten that emotional burden.

Avoid that suppression of emotions, Share your thoughts through Press On. Download on App Store and Google Play today.

COPY VER 2 Lighten that emotional burden.

Avoid suppressing your emotions.

Share your thoughts through Press On.

Copywriting

Download on App Store and Google Play today.

COPY VER 3 Lighten your emotional load.

Avoid suppressing your thoughts.

Share your burdens.

Download Press On, on App Store and Google Play today.

COPY VER 4 Lighten your emotional load.

Avoid suppressing your thoughts.

Share your burdens through Press On. Download on App Store and Google Play today.

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09 Final Outcome

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Hand Sanitizer Dispenser

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Logo & Copy I have cut down the number of words to 14, excluding the call to action. The copywriting is written such that every sentence starts with an action word and speaks to the audience at a very personal level by including the word “your�.

PRESS ON Lighten your emotional load.

Avoid suppressing your thoughts.

Share your burdens through Press On. Download on App Store and Google Play today.

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Hand Sanitizer Takeaway

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Pocket-sized handsanitizers will be hung below the body copy as a takeaway which the audience can bring home. The takeaway serves as a reminder to the interactive installation and the existence of our phone application.

Placement

The interactive installation will be set up around staff access only areas in hospitals. Depending on the width and height of the wall, the layout of the installation will adapt accordingly.

Wide Display

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Narrow Display

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Phone Application

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10 Bibliography

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Beckstrand, Renea L., R. Daniel Wood, Lynn C. Callister, Karlen E. Luthy, and Sondra Heaston, “Emergency Nurses’ Suggestions For Improving End-Of-Life Care Obstacles”, Journal Of Emergency Nursing, 38 (2012), e7-e14 <https://doi.org/10.1016/j.jen.2012.03.008> Brosche, Theresa A., “A Grief Team Within A Healthcare System”, Dimensions Of Critical Care Nursing, 26 (2007), 21-28 <https://doi.org/10.1097/00003465200701000-00007> De Villers, Mary Jo, and Holli A DeVon, “Moral Distress And Avoidance Behavior In Nurses Working In Critical Care And Noncritical Care Units”, Nursing Ethics, 20 (2012), 589-603 <https://doi.org/10.1177/0969733012452882> Granero-Molina, José, María del Mar Díaz-Cortés, José Manuel HernándezPadilla, María Paz García-Caro, and Cayetano Fernández-Sola, “Loss Of Dignity In End-Of-Life Care In The Emergency Department: A Phenomenological Study With Health Professionals”, 2017 Ka-Ming Ho, Jonathan, “Resuscitation Versus End-Of-Life Care: Exploring The Obstacles And Supportive Behaviors To Providing End-Of-Life Care As Perceived By Emergency Nurses After Implementing The End-Of-Life Care Pathway”, 2017 Kennedy, Sean, Amanda Kenny, and Peter O’Meara, “Student Paramedic Experience Of Transition Into The Workforce: A Scoping Review”, 2017 Williams, Angela, “A Study Of Emotion Work In Student Paramedic Practice”, Nurse Education Today, 33 (2013), 512-517 <https://doi.org/10.1016/j.nedt.2012.03.003> Williams, Angela, “Emotion Work In Paramedic Practice: The Implications For Nurse Educators”, Nurse Education Today, 32 (2012), 368-372 <https://doi.org/10.1016/j.nedt.2011.05.008> Williams, Angela, “The Strategies Used To Deal With Emotion Work In Student Paramedic Practice”, 2017 McCall, Junietta Baker, Grief Education For Caregivers Of The Elderly (The Haworth Press, Inc., 2000) 68

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