Executive summary

Hospice concentrates more on the caring and not on curing of the patient. It is a
condition where patient is in the phase of terminal illness. Hospice care mainly focusses
on providing comfort and best quality of life, when they are at the last phase of their life.
Hospice care services is provided by the healthcare professionals who tries to provide
maximum comfort to the patient physically, psychologically, socially and explaining
spiritual values. The goal of this project was to design a device for showering this
patients without their much movement. This will be small part of providing comfort to
them.
Introduction

Hospice is an ideology of care that adopt end of life as a natural part of life,
seeking neither to rush nor extending the ending process. Not just the people having
cancer are considered hospice. Today, more than half of hospice patients have other
illness which cannot be cured such as late stage heart, lung, kidney or liver diseases,
advanced Alzheimers disease or dementia [1]. Family members can be the primary
caregiver to the hospice patients. Family members can also make decision of
appointing a healthcare professional to take care.
Currently used method for cleaning the patients is by wiping them with wet
wipes. With the wipes, they may not feel as clean and fresh as they feel by getting a
shower. As they cannot move, it is difficult to clean them. And at this stage of their life
they want to remain clean and fresh. The showering device will let the caregiver to
shower them without much movement. We are proposing a device that will enable
family member or healthcare professional to shower patient with soap and water and
clean them in their bed.

Design Rationale

Original problem statement:

After analyzing what are the needs in a hospital area we reduce it to find that nurses
have a lot of time and effort to generate the quality hygiene.
 Revised problem statement:

For hospice patients, especially those who are bed bound are difficult to clean. This may
lead the patient to get less comfort.

Developing a need statement:

Revising the original problem statement into a clearer version allows for a keen focus on
a particular need for a device. In the case of the hospice patients, the main aim is
providing a quality life. The original need statement was mainly focusing on reducing the
nursing effort, improving hygiene and promoting comfort to the bed bound patient.
Although these are all great areas of interest but it does not focus more on our original
need of providing quality life to hospice patients. Some revising was thus done to yield
the following need statement, which allows for many solutions to provide quality life to
the hospice patients especially those are bed bound.

Need statement:

To provide an opportunity to hospice end of life care a chance of getting a quality

bathing procedure while providing comfort to the patient.

Development of the device:

With a clear need statement, developing the device is the next step of the design
process. Cleaning the hospice patients especially those are bed bound is almost difficult
in any case, therefore a device that enables to let this patient shower easily was instead
conceived. Instead of cleaning just with the wipes, this device enables the patient to get
showered in the bed with water.

Target niche:

The prototype device is specifically targeted towards the patients who are at the last
stage of their life. This device can be used at home and at the centers which provide the
facility of the hospice care. It was emphasized that this particular target niche and
presenting solutions to the application need at hand should be maintained throughout
the course of the project.
There are number of medical conditions which leads a person to the hospice stage.
This prototype has been designed which mainly targets this group of people.
 Device function:

This device is designed for showering the patient efficiently. It is underneath the
patient's back. It must be inflated using the air pump from one side so that the patient is
moved upwards from one side. There are sections in between, where the space allows
the caregiver to insert hands between the gaps and the patient's back can be cleaned
easily. Whole device is water resistant, hence there are minimal chances of water
spilling on the bed. Once the patient is showered, it can be deflated and by slight
movement of the patient, it can be removed.

Prototype Design
Components

Figure 1

Figure 2
To implement its function of showing hospice patients, our final device is composed of
three systems, including a supporting system, an inflating system, and a water
circulation system.
The supporting system consists of the boundarysecluded sheet which acts as the
container for water and support for patients before showing, the pillow which supports
the head of patients specially, and the adjustably inflatable mattresses which are utilized
to adjust the position of hospice patients lying supine on the bed sheet.
The inflating system is to assure that the mattress can be inflated to encircle the
patients (to prevent water come out), and that each column of mattresses can be
inflated simultaneously and successfully, which is essential for the whole device to
function normally since the position adjustment is implemented by inflation of mattress.
The water circulation system includes a water pump to shower the patients, two tanks to
store clean and dirty water, and a net of pipes for drain purpose.

Figure 3
For specific dimensions, please refer to Figure 3.

Design Modification

There are several important improvements since we started this design. The initial
design has adopted same idea of bed sheet and its contents. The differences included
no special design for pillow, the mattresses consisting of two columns of large long
chunks. Later, after interviewing with multiple nurses and doctors, we realized that a
separated pillow would improve the comfortness for patients without causing
malfunction of our device. Furthermore, we were informed that the whole chunk of
mattress prohibit the possibility to clean the dorsal part of patient's trunk. Another
problem from engineering is that, it takes longer to inflate the mattress.
Additionally, there was a long and narrow slot in the middle of the sheet we designed for
the purpose of drainage. However, we found it easy to be solved by tilting the sheet to
its downstream direction and leaving one small hole to exclude water.

Material Requirements

Specification

Material Polyurethane

Weight capacity 250lb300 lb

Material type Waterproof

Class type FDA Class I

Type of air pump Husky 120v Electric Portable Air

Compressor/inflator Car/bike 365 164
Type of water pump Hand Bidet Sprayer Set Stainless Steel
Flexible Hose
Ironton Transfer Pump with Suction

Attachment 298 GPH, 115 Volts, 3/4in.

Ports

Water container Plastic, 10 liters

Hose Medium hose 6

Tubing Vinyl tubing

Marketing Analysis
Hospice

Hospice, as a special kind of service provided to patients in their last days, delivers expert
medical care, pain management, and more importantly, the emotional even spiritual support5
fitted to the patients needs and wishes. Sometimes, support is also provided to the patients
loved ones as well5. Compared to common medical service, the biggest difference in hospice is
that hospice focuses on caring rather than curing.
The caregiver usually includes various people from interdisciplinary fields. The team can include
nurses, volunteers, social workers, personal physician, hospice physician or medical director,
hospice aides, bereavement counselors, and speech, physical, and occupational therapists if
necessary.

Patients

In 2014, 1.6 to 1.7 million people in the United States utilized hospice (Figure 4).
NHPCO estimated that approximately 12,00,000 deaths 5 occurred in the U.S. while
under the care of hospice. With the examination of the number of Medicare decedents
by a cancer diagnosis, NHPCO found that 36.6% accessed three or more days of
hospice care in 2001 and 43.3% in 2007 5, which implies that the portion of patients who
need a good shower (people need to shower regularly, however, this need is replaced
by sponge cleaning or wiping 7) increases as time goes by. Moreover, another growth
increases for patients with advanced cognitive impairment and severe functional
limitations. All those information give a big problem for the caregivers, e.g., a roaring
demand for peopleaided shower from a large population of patients without a ability to
take care of themselves.
 Figure 4 Total Hospice Patients Served by Year 5

As the growth of the population of potential customers for our products, the times for
each patient using our product grows too. As is shown in Figure 5, a larger proportion of
hospice patients (approximately 64.5%) died or were discharged over seven days.
Assuming that for each patient who will shower every three days, the total number of
showering times for hospice patients is incredibly enormous.

Piechart
 Figure 5 Proportion of Patients by Length of Service in 2014 5

Care providers

Figure 6 Total Hospice Agencies by Year 5

The hospice service is provided by more and more agencies(Figure 6) with an average
rate of about 5% per year, which is faster than 3.5% per year from the report 2 of 2007's
Last Rights. Usually, patient care is provided in the place including private residences
(home), nursing homes, hospital systems, Home Health Agency and residential facilities
(Table 1). In 2014, 58.9% of patients received care at home compared with the fact that
the percentage of hospice patients receiving care in a hospice inpatient facility
increased from 26.4% to 31.8%6. The growing population of hospice patients and trend
of preferring to inpatients facility both aggravate the burden of hospice agencies. For
example, 46.2% of agencies have to provide daily routine care to over 100 patients
(Figure 7), which requires large amount of labor force. Thus, our device provide an
efficient and safe way to comfort the hospice patients, relieve agencies burden, and
reduce related expenditure for multiple participants including patients, agencies, and
insurance companies et al.

Table 1 Agency Type 5

 Figure 7 Average Daily Census5

Market size (monetary)

The market size of hospice serve grows rapidly. For instance, in 1995, hospices were
only a industry of $2.8 billion, including $1.9 billion from Medicare providing service to
patients in 1,857 hospice programs with Medicare certification 1. Nevertheless,
Medicare alone in 2008, which covers 80% of hospice treatment expenditure, paid $10
billion to more than 4,000 Medicarecertified providers in the United States3,4.

Concluding Remarks
Considering the rapidly growing of both population of hospice patients and number of
hospice servicing agencies, our device would be a boon for both, target niche and
helping organizations. Our device would help the hospice caretaker to skillfully position
and handle hospice patients which can make a significant contribution to peacefulness
to their last days of life.
Interviews with the nurses
Nursing school Cleveland state university:

Nurse: Dr. Janterria Mattews

The idea of the device and the drawing was presented to one of the teaching nurse on 24th Mar.
She appreciated the idea of such kind of device that could help the patient to maintain their
hygiene who are unable to clean themselves. She shared some idea about how the cleaning
procedure is and what could we do to make our device better. She advised that the device will
be good for the hospice end of life care patients.

University Hospitals
27100 Chardon Rd

The idea of the device and the demonstration of the functions that the device will perform, were
presented to the nurses of the hospital. They said that most of the time the patients have I.V.
channels connected to their body, some of them have bacterial infections, some of them have
wounds. Also they expressed their concern on the drying of the bed and the sterilization after
the bathing procedure.

References
1. Plocher, David W. Patricia L. Metzger (2001). The Case Manager's Training Manual. Jones
& Bartlett Publishers. p. 222. ISBN 0834219301.
2. Kiernan, Stephen P. (2007). Last Rights: Rescuing the End of Life from the Medical System
(revised ed.). MacMillan. p. 40. ISBN 031237464X.
3. Davis, Henry L. (20090228). "Growth in hospice care redefines its role in medicine". Buffalo
News. Archived from the original on March 6, 2009. Retrieved 20090321.
4. "While Hospice care is growing, not all have access". Forbes. 20080410. Retrieved 20090321.
5. Facts, N. H. P. C. O. "Figures: Hospice Care in America. National Hospice and Palliative Care
Organization." (2015).
6. 2014, NHPCO National Data Set and/or NHPCO Member Database.
7. Interview with nurses from Medical School of Cleveland State University on 24th March
and University Hospital nurses on 28th Mar.
8. http://www.northerntool.com/shop/tools/product_200664790_200664790?cm_mmc=Googlepla&ut
m_source=Google_PLA&utm_medium=Water%20Pumps%20%3E%20Utility%20Pumps&utm_cam
paign=Ironton&utm_content=50098&gclid=CMeki8Pax9MCFZGIaQodQF0GDg
9.