Fulfilling the psychological and information need of the family members of critically ill patients using interactive mobile technology: A randomised controlled trial
Introduction
There have been numerous studies that identify needs of family members in the intensive care unit (ICU). Literature has revealed that information is one of the top needs as rated by family members (Noor et al., 2012, Jacob et al., 2016, Chien et al., 2006, Kinrade et al., 2009, Lee et al., 2000, Wong, 1995). This information should include, for example, the patient’s condition, medical procedures, as well as understanding why things are being done. A study by Damghi et al. (2008) found that ICU staff do not explain enough about the medical equipment used on patients, or about the medical procedures. It can be difficult for ICU nurses to explain technical and medical procedures to family members who do not have a medical background. Not knowing however, may lead to family members feeling helpless; as well as other psychological effects such as anxiety and pressure, especially when they are required to make critical decisions on behalf of the patient. This is demanded on top of other strong emotions including shock, denial, anger, despair, guilt and the fear of the loss of a family member (Verhaeghe et al., 2005). Rukholm et al. (1991) found that the need for information is strongly related to the levels of state anxiety (anxiety experienced in face of threatening demands or dangers). Their study showed that anxiety decreased when information was provided and this was consistent with the study by Chien et al. (2006) about the relationship of needs-based education and anxiety of the ICU patient’s families. As information is very important for the relatives of patients in ICU, Bijttebier et al. (2000) found that such a need was even independent from demographic influences between different relatives. A literature review of 46 studies concluded that information appeared to be the greatest need of family members of critically ill patients (Verhaeghe et al., 2005). Providing adequate, accurate and comprehendible information is very important to the psychological well-being of family members of ICU patients.
When it comes to receiving information, Damghi et al. (2008) found that families with high levels of education may be more demanding. This was especially valid when they were confronted with unfamiliar medical and technical terms. Ward (2001) observed that inappropriate responses to the needs of family member might lead to heightened levels of anxiety, fear and misunderstanding. Although families with higher education may be more demanding for information, it is also important for families with lower education to receive accurate information, and that it is provided in an understandable manner (Davis-Martin, 1993, Freichels, 1991, Molter, 1978). Otherwise, there may be detrimental consequences; for example, loss of family trust and impairment of the family’s ability to make appropriate decisions for the patient (Damghi et al., 2008). Family members seek control by searching for more information in different ways. It is believed that ICU nurses can have an important role in empowering families by providing psychological support and fulfilling the family's pivotal need for information (Jamerson et al., 1996, Plowfield, 1999).
Utilisation of advanced technology has always been an essential component of care for the patients in the ICU. Lu et al. (2005) found that mobile computing is becoming an important tool in healthcare and its popularity has risen in the past five years. Many, if not all, healthcare workers are likely to be familiar with the latest mobile tablet computers (tabs). They now play an important part in our social lives. Tabs have a potential to aid improvement of health-care delivery; in particular the educational aspect of family members in ICU in order to fulfill their information need. Tabs may act as a form of teaching aid for more effective technical explanations of the medical and nursing procedures and prognosis, etc., to the family members of ICU patients.
Lu et al. (2005) consistently found from a literature review that mobile computing added value to clinical practice. For example, it allowed clinicians to access clinical information promptly when and where it was needed; it also improved the exchange in information and hence reduced medical errors; and it provided feedback to clinicians for clinical decision making at the point of care. Overall, hand held computers like tabs were found to enhance and promote communication. Doctors perceived that handheld computer applications like those performed through a tab improved the productivity and interactions with patients (McAlearney et al., 2004). They also felt that the quality of patient care and services were promoted. Nurses also reported that information technologies as such are a positive contribution to patient care and the nurse-patient relationship (Lupianez-Villanueva et al., 2011). However, there are limited empirical studies available that investigate and evaluate effects of the use of tabs, in particular its potential ability to be used as an aid to psychological support and satisfy information need of the ICU patient’s main family members (MFC).
In summary, technology is a tool that supports knowledge building (Jonassen et al., 2008), it acts as an information vehicle and social medium for exploring knowledge that enhances learning and communication. It is an intellectual partner to promote learning by reflecting. The use of technology, in this case the tabs, is believed to be able to establish the knowledge base about condition and current care of critically ill patients for the MFC; to allow them a means to accessing their needed information; to engage their dialogue with nurses; and to help them articulate what they have known and learnt through the technology. Satisfaction of such information need of the family members is a factor that could contribute to reduction of their anxiety and stress (Shorofi et al., 2016). Based on this understanding, outcomes of the present study were psychological well-being in terms of stress, anxiety, and depressive symptoms; and satisfaction of MFC to the information need and education.
The purpose of this study was to determine whether education of families by tab (EF-T) about the patient’s condition was associated with improved anxiety, stress and depression levels compared to the education of families by routine (EF-R). The null hypothesis of the study was that there would be no improved psychological status of MFC, after communication and education by nurses with the aid of a Tab
The objectives of the study were to,
- 1.
evaluate the stress, anxiety and depression levels of MFC after EF-T or the EF-R (control)
- 2.
evaluate the satisfaction of MFC after EF-T or the EF-R (control).
Section snippets
Study design and setting
The study was a randomised control trial (RCT) conducted in an adult ICU of a public district hospital, in which participants from the intervention and control group were required to complete a set of questionnaires before and after EF-T or EF-R. No existing similar study that compared the use of tabs versus routine family education by psychological responses in the context of critical care nursing could be located from literature. A similar study that investigated a key outcome as family
MFCs recruitment and participants flow
Recruitment of the MFCs was conducted over a period of eleven months from October 2012 to August 2013 when a total of 760 patients were admitted. Two hundred fifty-five of these patients met the inclusion and exclusion criteria (unsuccessful inclusion = 66.4%) and their MFCs were approached for recruitment. Among them, 74 (29%) accepted to participate in the study with 39 and 35 MFCs randomised into the EF-T (treatment) and ET-R (control) group respectively (Fig. 1). There was no attrition of
Discussion
Numerically, the EF-R group had a slightly lower stress score (mean = 11.37/SD 10.68) than the EF-T group (mean = 11.69/SD 9.49) at post-test but the difference was statistically insignificant. The stress levels reduced in both groups over time, which was significant as the main effect. However, no interaction effect was observed (Table 3). There was also no significant improvement in anxiety after EF-T; but the results indicated that the EF-T group had a significantly better reduction of
Conclusions
There has already been evidence in the literature that clearly indicates information need of the family members of ICU patients. But there is a paucity of studies that investigate how nurses can be more effective in satisfying this need and promoting psychological well-being. This study sheds light on how ICU nurses may better psychologically support the family members of critically ill patients through information provision and education with the interactive mobile technology (tabs). Results
Funding source
Critical Care Theme, Adult Care Research Division budget 2011/12, School of Nursing, The HK Polytechnic University.
Acknowledgements
The authors would like to express great gratitude to the following clinical staff who provided valuable advice and contributions for this study. Without them, the study could not have been completed: CHAN Hoi Lung, CHIU Booi Ling, LEE Yee Mei, LO Sui Yee, NGAI Man Ying, SIN Chau Wah, YEUNG Wai Yi Irene, and YUEN Yee Man.
This project was funded by Critical Care Theme, Adult Care Research Division budget 2011/12, School of Nursing, The Hong Kong Polytechnic University.
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