Lina Goldstein
The vein preservation experiences of people with chronic kidney disease and criteria for medical alerts to prevent harm
Patients with chronic kidney disease (CKD) face the challenge of avoiding medical treatment that could damage their veins needed for an arteriovenous fistula for hemodialysis. Patient safety in healthcare is a complex issue, requiring a deep understanding of patients' journeys, interactions with healthcare providers, and the systems surrounding them. To address this, my PhD research was conducted to understand and describe the experiences of patients with CKD, their whānau, and healthcare providers, as well as the existing systems and strategies in place. The aim was to establish design criteria for a medical alert system to protect patients' veins, specifically tailored to the context of Aotearoa/New Zealand.
The research followed a pragmatist research paradigm, incorporated kaupapa Māori frameworks, and employed qualitative methods such as semi-structured interviews, observations, and participatory design workshops. The participatory approach emphasized collaboration and inclusivity, with a significant involvement of Tangata Whenua to ensure that design innovations would address health inequalities in New Zealand. The findings revealed a lack of awareness and acknowledgement among healthcare providers regarding the importance of protecting veins for dialysis fistulas, while patients were often aware of the need to preserve their veins. Power imbalances between patients and healthcare providers negatively impacted patients' ability to prevent harm.
My research also highlighted the inadequacy of existing medical warning systems and phlebotomy systems in addressing the visibility and usefulness of medical alerts for vein preservation, leading to alert fatigue and potential long-term damage to patients' veins. Furthermore, the research involved the creation of service blueprints, patient storyboards, and systems diagrams to illustrate the patient's journey with CKD, their interactions with healthcare providers and systems, and areas where medical harm commonly occurs.
As a result, a set of design criteria was developed to form the basis for creating and evaluating a medical alert system aimed at improving patient safety and changing healthcare providers' behaviours to protect patients' veins for dialysis fistulas. These design criteria have the potential to increase healthcare providers' awareness and acknowledgment of the long-term harm to patients' veins, promote shared knowledge of vein preservation, and reduce the need for patients to advocate for themselves, ultimately contributing to a more positive experience for renal patients, their families, and healthcare providers. The research underscores the importance of understanding real-world problems in Aotearoa/New Zealand to inform the design of medical alert systems.
Supervisors
Awards and Achievements
EARLY-CAREER RESEARCH AWARDS FINALIST
Te Titoki Mataora MedTech Healthtech Week, Best Project Competition.
2023
VICTORIA UNIVERSITY DOCTORAL SCHOLARSHIP
Te Herenga Waka Victoria University of Wellington
2021-2023
DOCTORAL SUBMISSION SCHOLARSHIP
Te Herenga Waka Victoria University of Wellington
2024
Qualifications
Master of User Experience Design
Bachelor of Design Innovation