Although the current Intensive Care environment focuses on providing the best care, the current sounds in that environment do not contribute to an optimal patient experience, leading to high stress levels. Literature study showed that soundscape augmentation can reduce patients’ stress in healthcare settings if implemented correctly. This project focuses on designing and validating such a system for critically ill patients in the Adult Intensive Care. Throughout the project, key stakeholders are considered; patients, healthcare professionals and loved ones.

A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. Together, this provided a clear understanding of the existing ICU soundscape. It can be stated that the current ICU soundscape hinders healing because it affects patients’ psychological well-being.

Existing interviews from the Critical Alarms Lab, which aims at shaping the future of soundscapes in these environments, are used to explore patient experiences in ICUs. Four unfulfilled psychological human needs were identified as the barriers to a positive ICU experience: lack of autonomy, comfort, recognition and stimulation. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. Together with the context study outcomes, a comprehensive patient journey map was created to gain insights into when those psychological needs are either fulfilled or unfulfilled. Interventions in ICU soundscapes need a tailored approach because psychological needs are constantly changing over time and do not arise and disappear at the same time for everyone. A personalized approach was needed to improve the ICU experience.

Four key interaction moments were defined: Patients before admission, loved ones at the start of the admission, healthcare professionals during admission and patients during admission. Several prototypes were created to conduct usability tests with fellow students and healthcare professionals. Insights were gained on which prototype provided the highest engagement and which technique was most intuitive and useful for integrating the system into the healthcare workflow.

A new brand identity was created, resulting in the final design: Amadé - A Soundscape Augmentation System that provides personalized soundscapes, tailored to patients’ needs. By aligning soundscapes with patient preferences and clinical needs, Amadé reduces stress and improves patient comfort. User interfaces were created, focusing on the right tone of voice for each interaction moment. An evaluation test was conducted with ex-ICU patients in multiple online sessions. There was a positive response to the usability of the interfaces, but distrust of the system’s effectiveness emerged. The feedback and insights gathered from these tests resulted in recommendations for future research and a project reflection.

Despite the fact that product sounds have been shown to have a significant impact on the experience of products, product sounds are rarely considered in design projects and design education at the Faculty of Industrial Design Engineering. Research through literature review and expert interviews revealed that product sound design requires an interdisciplinary approach. A framework was created from different areas of product sound design. This framework separates that product sounds are influenced on three levels. The first is the product features, i.e. the components that act as a sound source. At this level, it is most important to consider how acoustic and engineering decisions can influence the perception of sound as derived from psychoacoustics. The second level, the object level, is about factors that influence the composition of the product and is mostly based on knowledge from subfields of musicology. The third level, the scene level, considers the sound of the product together with its use and location. This makes it possible to assess whether the external influences still result in the desired sound. Based on this framework, a digital audio design tool was developed. The purpose of this tool was to give practical examples of how sounds can be changed. This is achieved by providing parameters that have an impact on the engineering of a product, such as the choice of components and materials, and by allowing a composition of all the features to create the sound of the whole product. Finally, external factors such as the user’s interaction with the product and the influence of the context in which the product’s sound is heard can also be modelled. User testing has shown that this tool allows creative exploration of possible product sounds, while being concrete enough to gather initial design objectives. As an ideation tool, it provides direction for the further development of the product, taking into account its sound.

takeUthere is a digital product design for nurses in the hospital to reduce working stress during work break time. As the professions that help people solve health problems, the hospital staff pay attention to the patientʼs physical condition all the time, including nurses, they face complex and difficult tasks every day. During the work, they need to follow orders from the head nurse and physicians, regulate mood for patients and their families, monitor the medical equipment, track the data and write reports for information sharing with colleagues, etc. This type of work challenges a nurse's professional skills, psychological enduring capacity, sense organ enduring capacity. Metally overwhelming becomes normal status in nursesʼ daily working time. Therefore, providing a balance between sensory and mental during the work break by regulating their mood has its value to be explored. This graduation project aims to solve this problem by introducing a product/service solution. It cooperates with TU Delft Critical Alarms Lab, which focuses on sound-related research and design, in the area of healthcare, academic hospitals, etc. The main goal is to reduce the daily working pressure of nurses through sound and music, therefore creating a positive mood to face their work. The outcome of the project - takeUthere digital product introduced a sound-driven experience in which nurses can enjoy short-term relaxation. It provides detailed sound from a daily office object. The user needs to find it and scan it on the APP. Then it delivers a fantastic charming scenario with 360-degree panorama visuals cooperating with relaxing scenario music. The final design includes APP user experience design, panorama visual design, and scenario sound editing. Moreover, it successfully convinced 8 participants with its unique fun experience. It shows the values for further development possibilities and improvement ideas. It also concluded new implementation opportunities areas followed by future recommendations. The project leads to the following conclusions: (1)Away from stress - design for nurses to use during work break. (2)Suitable for different types of user habits. (3)Simplified interaction yet targeting the problem. (4)Be engaged in the short story. takeUthere, let the sound bring you to a scenario that you ever dreamt of.

Admission to the intensive care unit often has long lasting effects on patients’ further life. Not only can the reason for their admission leave several problems, but also mechanical ventilation, physical inactivity, sedation and delirium are only some of the factors that contribute to the problems left after ICU stay. Over 80,000 people are annually admitted to the intensive care units of the Dutch hospitals alone and, due to technical advancements, a rising number of patients survives critical illness. Post intensive care syndrome is the overarching name that combines all the physical and mental problems related to intensive care unit stay. It has been well established that rehabilitation and early mobilisation are effective counter measures against post intensive care syndrome. It has also been shown that interactive video gaming can play a useful role in rehabilitation as an addition to conventional therapy. Evidence has shown that the use of visual feedback improves performance and adherence to the therapy in comparison to regular of physical therapy. This design study is meant to create a new interactive video gaming device that allows ICU patients that are at least semi mobile and semi cooperative, to play video games with the aim to help them leave the ICU in the best physical and cognitive state as possible. To come up with the right design, a literature study on the relevant subjects has been done. Also, expert interviews with intensive care unit care-giving staff have been conducted and experience has been gained on the intensive care unit of the Erasmus medical center Rotterdam to make sure the design is done in the right context. Based on the outcomes of this research the decision was made to aim the design to help in activities of daily living. From this aim a specific goal was formulated: The goal is to create an interactive video game controlling system that allows ICU patients, that are at least semi mobile and semi cooperative, to play video games that simultaneously helps in increasing muscle strength, delivers distraction from the daily routine in the ICU and stimulates patients cognitively. Together with physiotherapists and intensivists from the Erasmus medical center Rotterdam a list of requirements for the final designs was created. As during activities of daily living hand grip is one of the most important aspects, the decision was made to use sub-maximal grip force control as the desired training form. Because of this two different versions of grip strength trainers were proposed. The first concept uses the medium wrap grasp as input movement and the second concept uses the power-sphere grasps. These are two of the most frequently used grasp types in daily life. The concepts are designed in a way that the force exerted on the device can be used to control a video game. Internal force sensing resistors, connected to an Arduino, translate the force to a useful signal to control the game. Ten prototypes were created to get to the final designs, which were then tested with patients on the ICU. As result of testing and iterating the concepts, two final designs were delivered, fulfilling the list of requirements. Feasibility tests of these designs were done on the ICU of the Erasmus medical center Rotterdam and were promising. ICU patients participating in the tests understood the game well, were capable of performing the required movements to play the game and delivered feedback on the design and the gaming experience. This paper has lead up to a final prototype that has gone through basic testing to check for feasibility and has proven to work. Further scientific research on a larger scale should be the next step to review the clinical effects of the device.

Sleep is a vital restoration mechanism for our health and well-being. Deficiency in sleep can cause physical and mental health problems and reduced quality of life. How well we sleep is closely related to our behavior, and day to day stress can immensely influence sleep quality. Sound and music, on the other hand, is a powerful way to influence human emotions, reduce anxiety, and improve the quality of sleep. Feel Good is a personalized sound experience, designed to reduce stress and induce sleep. It steers the listener’s thoughts to a positive reflection state to prepare the mind and body to fall asleep in contentment. Feel Good’s ever changing layers of sounds are orchestrated by monitoring physiological and environmental data and curates a listening experience made with the listener’s “feel good” moments. Nevertheless, it suggests to improve the quality of sleep by reducing sleep onset latency, sleep fragmentation, and prolonging deep sleep. This research holds an interdisciplinary approach to investigate sleep influencing behavioral factors, stress coping orientations, and sounds in an attempt to bring a sound driven technology to optimize sleep and improve well being in the consumer electronics market.

The intensive care unit (ICU) is a special department of the hospital that admits critically ill patients who need intensive monitoring, supporting, and/or take-over of one or more of their vital functions. The patients are monitored and supported by medical equipment as well as a team of intensivists, nurses and other medical staff members 24/7. Due to the audible alarms of the devices, but also because of conversing people and other machinery and incidental sounds, the ICU transformed into an acoustically hostile environment. Ironically, the ICU’s excessive amount of sounds threatens both patient safety and clinicians’ wellbeing and work efficiency (Redert, 2018). In light of these sound issues in the ICU, this graduation assignment aimed to capture the ICU nurses’ sound-related values and practices and to develop an understanding of the phenomenon of sound in a sociocultural context – the so-called ‘ICU sound culture’. By understanding the ICU sound culture, the second aim of the assignment was to look for opportunities for silencing down the ICU whilst considering the sound cultures. The first aim, capturing and typifying different ICU sound cultures, was addressed in a field research study with a procedure based on contextmapping. The research findings showed that nurses working in the same Dutch ICU and nurses working in different ICUs share three (sound-related) core values: autonomously working (together), being situationally aware and giving and receiving social support. It seems that the accompanying practices are transmitted through learning and typical for the Dutch ICU (sound) culture. However, nurses from different ICUs but also nurses of one and the same team could differ in their value orientations and practicing these. As a result, the nurses can be divided into three types based on shared customs, beliefs and needs, called ‘personas’. The field research showed that similarities and differences exist due to ICU specific sound cultures and ICU specific group cultures within one and the same team. Though different sound cultures and coping strategies with the sounds exist, there is a commonality regarding the ‘sound problem’ (i.e. the excessive amount of sounds in an ICU): in all ICUs, the sounds, or even issues with them, are sort of accepted to a greater or lesser extent due to nurses not knowing why (by being ignorant or indifferent) or not knowing how to reduce sounds. Additionally, the current sound-reducing efforts that do exist are often taken individually, ad-hoc and they have a short-term impact. When ICUs want to reduce the sounds with a bigger impact in the longer term, ICUs need to create ‘sound-issue awareness’ and motivate every individual nurse to act upon the sound issues. This opportunity for silencing down the ICU whilst considering the sound cultures, which was the second aim of the project, was further translated into a campaign for sound cultural change. The campaign challenges the ICU management team and nurses to establish a ‘collectivistic sound culture’, in which every individual nurse commits to the group effort and goal to create a more peaceful sound environment in the ICU.

Virtual assistants are rapidly growing in popularity, triggering businesses around the world to explore their applicability. From a user perspective,, having a conversational interaction with technology has certain advantages, as it is easy to use, hands-free and eye-free. Despite the fact that Transavia already released its first steps with the assistant, there is still minor knowledge about how it can be used effectively to engage with the customer. A techy, social and young customer group - often referred to as Generation Z - is interacting with technology and brands in a very different way than Millenials. As a starting point, a preliminary design goal is formulated which links the technology and the user to an early touch point in Transavia’s customer journey: ​“Design a virtual assistant for Transavia that offers added value in helping Generation Z with finding and/or booking flights”. The contexts of four aspects are analysed: business, process, user and technology, which together lay the foundation for the subsequent user studies. The studies show the flight finding and -booking behaviour of Generation Z, as well as their current and preferred interactions with virtual assistants. Based on the outcomes the witty assistant ‘Tracy’ is conceptualised and piloted using the Google Assistant and Lenovo Smart Display. Tracy focuses on the moment right before booking called pre-booking, and recommends Generation Z affordable trips based on their availability. Alongside user tests the prototype goes through three iterations to optimise various aspects of the design: tone-of-voice, product personality, content and conversational flow. The final design is intended to be feasible for a short term release, and proved there lies true potential in using a conversational interface to engage with Generation Z in the pre-booking phase. Finally, recommendations are proposed for Transavia to support them when continuing with either Tracy or with virtual assistance in general.

Relevance -
Autonomous cars can offer many benefits and potentially nullify the road accidents caused by human error (94%). One of the threats, however, is the mode transitions between the levels of automation. In a highly automated vehicle (level 4), the vehicle can drive completely autonomous, but only during a defined use case after which the user has to take over. This leads to sudden changes in workload which can be detrimental to driving safety. The current designs do not acknowledge these safety issues yet. Therefore the goal of this project is to design a system where the transitions to and from autonomous driving in a highly automated car are comfortable and safe. The project is executed in collaboration with the design agency VanBerlo.

Literature study -
A literature study led to the identification of seven human-factors issues that affect the transitions between levels of vehicle automation, expected to emerge between 2020 and 2032: Vigilance decrements, complacency, manual skill decay, motion sickness, loss of situational awareness, predictability of the car and mode transitions
For automated driving, being a new development, it seems recommendable that the design should focus on building trust with the system and creating a built-in co-pilot that supports the driver in the new, more complex cockpit.
These different automation modes have been divided in assisted driving and autonomous driving with the difference being that in the latter one the system is responsible. In assisted driving, automated features like adaptive cruise control (ACC) and lane keeping can still be used making the system more complex. During autonomous driving, three measurable user states have been defined. Different studies show it takes 30-5 minutes from a sleeping state, 40 seconds from an inattentive state and 8 seconds from an attentive state to get back to the right driving performance level.

Field research -
A test ride with a partial-automated vehicle (Tesla model S) shows minimal feedback from the automated features which leads to confusion. Also, trust was a reoccurring issue emphasised during this ride. Observing six students of a driving instructor during the lessons show unsolved issues in planning, traffic rules and communication. Calm, clear and structured feedback from the instructor was favoured. The driving instructor emphasises the importance of communication to other road users.

Design goal -
The research concludes in the design goal: ‘Make the transitions between fully automated and assisted driving safer by increasing the situational awareness when needed, re-engaging driver vigilance, avoiding mode confusion and establish trust with the system.’

Design -
During assisted driving the HUD shows in combination with augmented reality what the status is of ACC and lane keeping and visualises their functionality to prevent confusion. Levers behind the steering wheel are used to control these features. Holding both activates autonomous driving. The steering wheel provides haptic feedback to indicate the take over after which it retracts as a strong symbolic message of giving the steering wheel to the system.
A framework is designed based on the literature research to facilitate the transition back to assisted driving where situational awareness and driver vigilance increase stepwise before a take over. Haptic feedback in the seat emphasises and pushes the user in the desired user state. If the desired user state is not met afterwards, auditive feedback is used to warn the user until the user state is met. These modalities are always combined with visual feedback to make the message clear. Holding both levers again initiated assisted driving. The steering wheel comes back as a symbolic message of taking the wheel and provides haptic feedback at the point of take over.

Evaluation -
A qualitative study with an interactive prototype, potential users and experts on automated driving is done to evaluate the design. It shows that the feedback modalities of the design work to facilitate the transitions. It is expected, however, that the steering wheel is presented back to the user in an earlier stage to initiate the take over. It remains unclear how the augmented elements work to facilitate ACC and lane keeping.
Next steps should be to evaluate the design further and design a system that communicates with other road users and add more functionality to the retracting steering wheel.