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The purpose of this study is to understand the activities in nurses’ work practices in relation to the design process of a self-monitoring application.

A design ethnographic approach was applied in this study.

To solve the problem of translating highly qualitative phenomena, such as pain, into the particular abstract features of a self-monitoring application, design participants had to balance these two aspects by managing complexity. In turn, the nurses’ work practices have changed because it now involves a new activity based on a different logic than the nurses’ traditional work practices.

This study describes a new activity included in nurses’ work practices when the nurses became part of a design process. This study introduces a novel way on how to gain a deeper understanding of existing professional practice through a detailed study of activities taking place in a design process. This study explores the possible implications for nurses’ professional practices when they participate in a self-monitoring application design process.

Designing digital artifacts is not a linear, straightforward process. This is particularly true when applying a user-centered design approach, or co-design, with users who are unable to participate in the design process. Although the reduced participation of a particular user group may harm the end result, the literature on solving this issue is sparse. In this article, proxy design is outlined as a method for involving a user group as proxy users to speak on behalf of a group that is difficult to reach. The article investigates the following research question: How can roleplaying be embedded in co-design to engage users as proxies on behalf of those who are unable to represent themselves?

The article presents a design ethnography spanning three years at a cancer rehabilitation clinic, where digital artifacts were designed to be used collaboratively by nurses and patients. The empirical data were analyzed using content analysis and consisted of 20 observation days at the clinic, six proxy design workshops, 21 telephone consultations between patients and nurses, and log data from the digital artifact.

The article shows that simulated consultations, with nurses roleplaying as proxies for patients ignited and initiated the design process and enabled an efficient in-depth understanding of patients. Moreover, the article reveals how proxy design as a method further expanded the design. The study findings illustrate: (1) proxy design as a method for initiating design, (2) proxy design as an embedded element in co-design and (3) six design guidelines that should be considered when engaging in proxy design.

The main contribution is the conceptualization of proxy design as a method that can ignite and initiate the co-design process when important users are unreachable, vulnerable or unable to represent themselves in the co-design process. More specifically, based on the empirical findings from a design ethnography that involved nurses as proxy users speaking on behalf of patients, the article shows that roleplaying in proxy design is a fitting way of initiating the design process, outlining proxy design as an embedded element of co-design.