S10 EP5: Nikou Javadi, Innovation and Technology

Nikou provides insight into the world of how technology can reduce anxiety and provide positive clinical outcomes for surgical patients.

If you would like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go. I'm your host, David Cummins, and today we're speaking to Nikou Javadi, who grew up in Iran and moved to Australia approximately nine years ago.

[00:00:30] With a background in architecture, Niko studied nursing at Flinders University in Adelaide. Never afraid to study, Nikou has gone on to study her PhD on immersive technology and how it reduces anxiety in surgical patients, which we're excited to talk about today. Welcome Nikou, thank you for your time to be here.

[00:00:47] Nikou Javadi: Hi, David. Thank you so much for having me here. 

[00:00:51] David Cummins: I'm very excited to talk about your PhD. I think you're about halfway through, is that right? 

[00:00:57] Nikou Javadi: Almost finishing. So hopefully in the next month, I'm going to submit it. 

[00:01:01] David Cummins: I think we were probably halfway through when we tried to arrange this chat, but because of time you've almost finished your PhD.

[00:01:09] Reducing anxiety in surgical patients through immersive technology. Sounds like such a captivating topic, because as the research does talk about anxiety in surgical patients, certainly going into surgical wards, going into theatres does increase anxiety.

[00:01:25] Reducing anxiety does promote better clinical outcomes. So I imagine a lot of people are interested in this topic. Do you mind just talking a little bit more about your topic and what immersive technology is and what your findings are so far about how to reduce anxiety in patients?

[00:01:43] Nikou Javadi: Yeah, sure. I am always getting excited to talk about my research. Well, mainly, as you've mentioned, the high level of stress and anxiety may impact clinical outcomes on top of psychological and satisfaction and patient experience. And interestingly enough, when I started to... do this PhD, it comes kind of from my nursing background and also my curiosity and design background.

[00:02:09] And the questions around, like when patients getting highly anxious, generally speaking they're immune system might drop, then the risk of infection , the risk of having more pain afterwards wound healing and all sorts of difficulties they might experience. 

[00:02:27] There are lots of interventions, which we can say pharmacological, like using the medications or non pharmacological, which using lots of different other interventions.

[00:02:37] I was very excited to work on a role of immersive technologies like augmented reality, virtual reality and holograms, and how they might help patients go through this process and be satisfied. And also like great clinical outcomes or surgical outcomes. So how does this work? 

[00:03:00] Majorly the stress and anxiety, it happens in the brain. If it's not clinical, which I'm not going to the clinical part of it, but majorly it is kind of around rewiring the brain and these technologies help the patients to have different perceptions of what's happening around the surgical areas from the time they are being told they are going to have surgery till they go home and rehabilitation and recovery process.

[00:03:27] So how does this work? The research shows using immersive technologies reduce about 70 percent of patient's stress and anxiety. 

[00:03:38] And based on my research and all the literature review, we came up with the 'RED' rules (which is Relaxation, Education and Distractions). Because different people perceive differently and different people have different coping mechanisms.

[00:03:55] So these three area, relaxation, education and distraction, are mainly part of my research focus and I'm going to use these technologies to educate patients, relax patients or distract patients. 

[00:04:10] David Cummins: That is a phenomenal statistic. So approximately 70 percent of people will have reduction in anxiety in some level through this immersive technology.

[00:04:23] I can't imagine it does, but does your research go into the next step of that means clinically, does it go into the level of detail of the clinical outcomes as well? 

[00:04:33] Nikou Javadi: Well, in actual fact, as I've mentioned, when patients experience less stress and anxiety, whatever has happened in their physiology.

[00:04:44] It just like impact their immune system and impact the wound healing, impact their perceptions from the pain and impact on the anesthesia related issues. And also generally when the wound healing and also staying longer in the hospital, all sorts of things, they just make it worse and complicated the surgical outcome.

[00:05:05] So generally, the less anxious, the better outcome physically and mentally for the patients. 

[00:05:11] David Cummins: So there is a connection between reduction in length of stay and promotion of immersive technologies?

[00:05:18] Nikou Javadi: Yes, that's right. Because majorly the stress and anxiety, it depends on the person or the patient, I should say.

[00:05:27] So these immersive technologies, the way we are approaching in this research, which based on the content, and I should say the software, because the hardware is already there. All the technology is already out there, but our approach in this research is targeting personalised patient centred care through the perioperative journey.

[00:05:48] These immersive technologies in different shape and forms, which we are working on the protocols, what kind of technology with what kind of a content and where needs to be implemented. 

[00:06:00] And all of this is going to help patients to experience less stress and anxiety and then it's going to impact their surgical outcome as well.

[00:06:11] David Cummins: That is a phenomenal statement that you've just made. 

[00:06:14] My mind is boggling with the way that this level of technology and research could be implemented in the commercial world and the clinical world. 

[00:06:23] Can you just go back a step? When you're talking about this level of detail, I assume that you have to be going through the whole patient journey, pretty much when they've been told, if they're lucky enough to get a warning, you're about to receive a hip or a knee surgery or whatever it may be.

[00:06:38] So I imagine this level of 

[00:06:40] intervention has to come pretty much at day one when they're about to discover, or even before that, when they're about to be warned that they're about to have surgery. Would that be right? 

[00:06:50] Nikou Javadi: Exactly! As I said, the perioperative word is the whole journey from the time you are being told you are going to have a surgery till you go home and you do your recovery and rehabilitation.

[00:07:01] So this whole process, it might cause patient stress and anxiety. But the research says it depends on the patients and it depends on the procedure. 

[00:07:13] We use this technology, even before going to the hospital, so based on the research, what we are doing to find the gaps and also find the peaks that would be more helpful and effective to use and implement these technologies in that journey.

[00:07:31] And as you have mentioned, there are different stages that we've identified to implement the technology for different patients. It would be different because I've used patient journey mapping and co design sessions with patients with lived experience. 

[00:07:49] Some of the patients prefer to be informed and have less stress and anxiety intervention beforehand, but some people are comfortable in a way to go for surgery, but then they get anxious afterwards about the post operative care. 

[00:08:04] The protocol of this research is going to cover the whole process or journey based on the information we got from the patients and also the experts point of view.

[00:08:16] David Cummins: As a physio, we were always taught the stronger someone is going into surgery, the stronger they'll be coming out of surgery. 

[00:08:22] So if you're a little bit fitter, if you lose a bit more weight, if you eat healthier, if you are strengthening the muscles surrounding the area that's going to be impacted, you'll have better clinical outcomes.

[00:08:31] What your research is really doing is going to that next level from a mental state and saying the stronger you are and the more prepared you are mentally, you will have better clinical outcomes. 

[00:08:41] But on a clinical level, which is phenomenal. 

[00:08:45] Nikou Javadi: Yeah, that's right. Exactly. Because based on my experience as in my nursing, that is really interesting.

[00:08:52] And I was trying to be observant throughout this research, more, that the patients are more stressed and anxious when they are going to sleep and anesthetised, the way they are waking up and the way they are responding to pain and surgery, it is totally different. 

[00:09:09] The more they are calm, the outcome and the way they are waking up are more calm and their compliance with all this process is much, much easier than the way when they are terribly anxious, the amount of medication needs to be used or the way they are just coping for the whole process.

[00:09:29] journey, it is completely different. 

[00:09:32] David Cummins: So getting into what immersive technology is, you've mentioned it could be a hologram, it could be meditation, it could be AI. 

[00:09:40] Can you just go through a bit more detail about what immersive technology is? And then really what I want to understand is how we can apply it to clinical needs today.

[00:09:51] Nikou Javadi: Yeah, sure. 

[00:09:52] Well, generally the immersive technology terminology covers augmented reality, virtual reality, and holograms. 

[00:10:01] And this research is approaching to use all of these technologies or hardware. But it depends of the stage, it's going to be different. 

[00:10:13] For example, when we talk about virtual reality, we have to use the special goggles to immerse people in the virtual environment.

[00:10:22] So it might not be like, for example, this is just an example. It might not be doable in the operating room, or just like when we are talking about holograms, sometimes patients are anxious and they have to like say goodbye to their loved ones and walk by themselves to the theatre. 

[00:10:44] If we use the hologram system, they can have their loved ones with themselves coming through the whole process.

[00:10:51] So, I mean, all of these technologies kind of... like virtual reality is completely immersing people in a virtual world but augmented reality is a mix of virtual environment on real world. 

[00:11:08] So these technologies, they have similarities with each other. It depends on where we are using them, we are going to suggest which technology in what stage needs to be 

[00:11:19] used.

[00:11:20] David Cummins: So, my dad, for example, is being told a year ago he's going to need surgery at one point in his knees. In that situation, can you just take me through dad's journey through immersive technology to help ensure he's got the best clinical outcome? 

[00:11:36] So, T minus, two years, really, the time he actually has his surgery, to the surgery or to the theatre and then out of that.

[00:11:44] Do you mind just taking us through that patient journey about what could happen and could provide the best clinical outcomes? 

[00:11:50] Nikou Javadi: Yeah, sure. 

[00:11:51] That is one of the research parts, which we've done co-design and Delphi method with the patients and also with experts, surgeons, nurses and anesthetists to see where would be the best to find the gaps. 

[00:12:05] But majorly, it is about two weeks prior to surgery, coming closer in a day of surgery, if it depends on the anaesthesia in the operating room and then going to recovery, immediate recovery to waken up from the surgery, and going to the ward and then discharging to go home. 

[00:12:28] This is the whole process. 

[00:12:30] So when we are talking about two years, yes, immediately if he's been told, he might be stressed and anxious and we can use this technology for that period of time.

[00:12:42] But then that two years, generally speaking, it's a huge gap and he might forget it, he might cope with it. 

[00:12:49] When we get closer within a two weeks, we are going to start to use the technology because it would be, the research shows it would be more effective in that timeframe. 

[00:13:01] David Cummins: So T minus two years, one would assume that they could potentially start with some form of meditation techniques, some form of calming techniques, obviously from a physical point of view, reducing weight, changing diet and maybe doing some strengthening of the knee around that area, but then as you get closer, T minus four weeks, T minus two weeks, talk a little bit more about what those immersive technologies may be, would it be virtual reality at home, virtual reality that maybe might be the actual patient journey, you know, going down the corridor, checking in, like what immersive technologies are you actually talking about?

[00:13:37] Nikou Javadi: Yeah. Well, As I've mentioned earlier, we are aiming to have personalised immersive technology because for example, your dad might prefer to have more information about his surgery, but someone else prefer to be relaxed and like have meditation information. 

[00:13:54] That is one of the things happening in the research that we are in a process of to completely approach the protocol of how we are going to implement this in reality. But giving the quick overview about what's going to happen based on, for example, your dad's scenario, he prefers to know more about the surgery.

[00:14:15] So, we just, as I said... 

[00:14:17] based on the technology we are using, for example, if we use virtual reality, and we set up all the contents about if he's having a knee surgery, all the contents about related about the knee surgery, and then he's going to have the goggles. 

[00:14:36] We haven't decided yet because we are in the process of implementation now to just see if it's going to be in home or if it's going to be in some specific clinics that we are thinking about how we are going to implement it.

[00:14:52] But what is happening now in the world, he might be provided by goggles and to have it at home, and it is like going through the surgery, the hospital, information about his knee surgery, what's going to happen, how is it going to look like, and then from there, if he has any questions, or if he's being satisfied, then we go through the operating room and in operating room, we might use different technology. 

[00:15:24] For example, we might use hologram or augmented reality. And then afterwards in recovery and home, he might have, for example at home when he finished and he's doing his recovery using virtual doctors or virtual physio, virtual nurses, that he might have augmented reality special goggles.

[00:15:47] And if you have any questions, because it might be a bit like difficult to, every time go and visit his physio or his doctor, or he might have some emergencies, some swelling around his knee, some questions, then this technology is going to bring his doctor, his physio, his team, around and then he might interact with them.

[00:16:08] So it depends on where and when we are using the technology. 

[00:16:12] David Cummins: So pretty much there's two main pathways, a clinical education information pathway or a relaxation river beaches and mountain pathway. 

[00:16:22] Either way, depending on the persona and the persona's goals both have the same ish clinical outcomes of reducing anxiety education and also making sure that people are calmer, which sounds like has stronger clinical outcomes.

[00:16:37] That's, that's phenomenal. 

[00:16:40] Nikou Javadi: Thank you. 

[00:16:40] David Cummins: It is very exciting. I know we're running out of time. 

[00:16:43] It's extremely exciting. 

[00:16:44] May I just ask one more question?

[00:16:45] you talk about hologram a few times in theatres. I imagine most people in theatre uh, unconscious but I assume there'll be some times where patients are not.

[00:16:55] I assume when you're talking about holograms, you're talking about conscious patients? in theatres, is that correct? 

[00:17:01] Nikou Javadi: It depends on the type of the anaesthesia because some of the patients might be awake or during the surgery, might be and then the other part is that sometimes in the waiting room areas or while they are going to the theatre to lie down on the operating table while they need to have some injections and all sorts of things, it might take a few minutes to go to sleep. 

[00:17:24] This is also a potential that we can use the hologram, but yeah, definitely while they are anesthetised and asleep, they don't remember anything.

[00:17:31] David Cummins: And, and that hologram, that technology exists in Australia now? 

[00:17:36] Nikou Javadi: Well, based on my knowledge at the moment we don't have it in a form that we are looking for to implement it, but hopefully very soon. 

[00:17:45] David Cummins: Okay, cool. That's fantastic, because I know a lot of people will be quite excited to be the first.

[00:17:48] I know one person in particular who will be very excited to listen to this. 

[00:17:51] So Nickou, that is mind blowingly amazing research. 

[00:17:55] Thank you so much for your time and dedication to this. I imagine a lot of people will get a lot out of this and I think you'll get a lot of phone calls very soon. So good luck with the rest of your research.

[00:18:04] I cannot wait to read it and I think this research is fantastic and one of a kind. So thank you so much for your help. 

[00:18:13] Nikou Javadi: Thanks a million, David. That was very, very exciting and that was an honour to be here and share my research. I really, really appreciate it. Thank you. 

[00:18:20] David Cummins: You have been listening to the Australian Health Design Council Podcast series, Health Design on the Go.

[00:18:25] To learn more about the AHDC, please connect with us on our LinkedIn or website. 

[00:18:29] Thank you for listening.