Development and validation of an educational information web page for family members with relatives in the Intensive Care Unit (ICU)
Introduction
The Intensive Care Unit (ICU) is regarded as a crisis by patients and their family members. Primary caregivers are mainly concerned with patient care in the ICU as they are worried about the life-threatening event, which might result in the loss of their loved ones (Jensen, Ammentorp and Ording, 2011). Therefore, family members may experience anxiety, depression and post-traumatic stress in response to the patient's critical illness (Abdul Halain et al., 2021, Chang et al., 2018). Apart from providing information to nurses, an effective education intervention offers social support and acts as the primary source of psychological comfort for family members. These events will assist them to minimise fear and anxiety and coping with the stressful ICU environment (Schnock et al., 2017).
Education information (EI) intervention is vital to family members during patients' hospitalisation in an ICU to meet their psychosocial needs in such a stressful situation. Therefore, the ICU staff performs an important task to provide the family members with appropriate and precise information. The development of an EI based on a needs assessment, implement and evaluate the psychosocial needs of families of these patients can promote quality of care, thus increasing family satisfaction (Kynoch et al., 2016; Schnock et al., 2017). Mohamed (2016) reported that healthcare providers in the ICU need EI or guidelines to educate family members to fulfil their information needs.
The existing literature on the needs of ICU families have been studied extensively using the Critical Care Family Needs Inventory (CCFNI), an instrument developed by Molter and Leske to measure the needs of ICU families (Leske, 1991, Leske, 1984, Molter, 1979). Five needs were identified by patients' families in the ICU, namely, assurance, proximity, information, support, and comfort (Leske, 1992). A previous study conducted in Malaysia found that most family needs included assurance, information and proximity (Mohamed, 2016, Dharmalingam et al., 2016, Hashim and Hussin, 2012; Liew et al., 2018; Siah et al., 2012). Providing psychological support and guidance to all family members during such a distressing period necessitates the availability of easily understandable information (Garrouste-Orgeas et al., 2012). Chien et al. (2006) discovered that delivering a needs-based EI to families of newly admitted critically-ill patients reduced anxiety and met immediate psychological needs. Providing necessary orienting information on hospital systems, ward environment, equipment, treatment and processes or rules could be very helpful to families who are new to the ICU. Such information is useful in reducing family members’ stress and increasing their satisfaction with the communication and information provided by ICU staff (Chien et al., 2006, Chiang et al., 2017).
A systematic review by Kynoch et al. (2016) of studies published between 2010 and 2014 established the best practice in addressing the needs of family members with a relative admitted to the ICU. The researchers found the prominent family's need for information about their relative in the ICU; this review predominantly investigated interventions to inform and educate families regarding their relative's care, diagnosis, and prognosis. Chiu et al. (2004) used the Critical Care Family Needs Inventory (CCFNI) to examine the effectiveness of individualised education supplied to family members of ICU patients within two days of admission. Specifically, the use of CCFNI was compared with a control group who received standardised education protocol by the nurses in the ICU. The experimental group who received individualised education experienced significant anxiety reduction and increased satisfaction compared with the families in the control group. In a Malaysian study, Othman et al. (2016) discovered an intervention using information booklets resulted in a significant increase in family satisfaction regarding patient decision-making, with pre-and post-test mean values of 54.05 (Standard deviation; SD = 10.23) and 71.1 (SD = 19.10), respectively.
According to Schnock et al. (2017), educational content for ICU patients and their families should be developed across hospitals. A comprehensive content database should be created, and general content should be organised into a framework for patient and family education. Siegenthaler et al. (2012) found that mobile computing is becoming an essential tool in healthcare, and currently plays a vital part in human social lives. The utilisation of modern technologies in the ICU has long been recognised as an essential aspect of patient care. Mobile technology can improve healthcare delivery, particularly educating ICU families and meeting their information needs. The present research will provide important information and social support on a smartphone via a web page, which will help in reducing nurses’ workload. It is the responsibility of nurses as holistic care providers to attend to the needs of family members to assist them in coping with pressures, providing patient support, and maintaining their feeling of well-being. In the ICU, a family EI intervention has been shown to reduce anxiety, depression, post-traumatic stress, and generalised stress while increasing family satisfaction with care (Davidson et al., 2017). This application will also benefit family members since they could access appropriate content on-demand based on their readiness and requirements.
A recent systematic review and meta-analysis review by Shafipour et al. (2017) of studies published from 1990 to 2016 on effective nursing interventions for meeting family members' needs in the ICU. The findings showed that education reduced the anxiety level in families with patients in ICUs but the reduction was not statistically significant. Likewise, Khalaila (2014) reviewed articles published between 2000 and 2013, revealing that most experimental studies lacked sufficient evidence to support that appropriate intervention reduces anxiety among family members. The gap revealed the need for intervention about the needed and essential information to be provided to ICU families to meet their needs and reduce psychological distress.Although various studies have addressed the patient's family needs for information about their relative in the ICU, but to date, there has been no educational information web page or modern technologies application in the ICU for patients' family members is developed to help them learn the required knowledge related to the ICU that can easily accessible on-demand based on their needs and reduce workload for ICU staff. Therefore, this study aims to develop and validate an educational information web page for patients' family members in the ICU to help them learn the required knowledge related to the ICU.
Section snippets
Aims
- 1.
To describe the development of the Educational Information (EI) material.
- 2.
To validate and test the reliability of the EI material.
- 3.
To assess the system usability of EI material for the webpage.
Development of the educational information material
This EI material was developed using a methodological approach in three steps: 1. Bibliographic survey; 2. Design and development of the educational material; and 3. Validation of the materials by experts in the subject and representatives of the target audience and evaluation (Echer, 2005) (Fig. 1). During this phase, the researcher defines the problem, identifies the source of the problem and determines possible solutions. The main objective of this phase is to employ the needs of information
Results
The findings are presented in three stages: development of EI material, EI validation, and webpage usability.
Educational Information (EI) intervention material
The EI was developed according to Echer (2005) with each phase is explained in detail. The EI content was validated using the Educational CVI in Health by Leite et al. (2018). The EI material was found to be well suited for the family members to get information when their relative is admitted to the ICU. All information and content of the EI can be modified easily to meet the family members' information needs. The objective of sharing in educating families with all the information is to help
Conclusion
Education information (EI) to the patient's family members will assist them in learning the necessary knowledge related to the ICU, which includes providing information about the environment and facilities of the ICU, support services, the staff roles, the patient’s common medication and procedures, nursing care for the patient and transferring from an ICU. The EI web page had an acceptable CVI value of 0.83 while the content had an excellent usability score of 0.81. Furthermore, the use of
CRediT authorship contribution statement
Azura Abdul Halain (AAH): Conceptualization, Methodology, Writing – original draft. Tang Li Yoong(TLY): Visualization, Investigation, Supervision, Writing – review & editing. Chong Mei Chan (CMC): Data curation, Methodology, Writing – review & editing. Noor Airini Ibrahim (NAI): Investigation, Resources, Writing – review & editing. Khatijah Lim Abdullah (KLA): Writing – review & editing.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
We thank all the research participants who participated in the study.
Funding Source
Self-Funding.
References (50)
User’s guide to correlation coefficients
Turk. J. Emerg. Med.
(2018)- et al.
Stress-related symptoms and social support among Taiwanese primary family caregivers in intensive care units
Intensive Crit. Care Nurs.
(2018) - et al.
Fulfilling the psychological and information need of the family members of critically ill patients using interactive mobile technology: a randomized controlled trial
Intensive Crit. Care Nurs.
(2017) - et al.
Effects of a needs-based education programme for family carers with a relative in an intensive care unit: a quasi-experimental study
Int. J. Nurs. Stud.
(2006) - et al.
Family needs of patient admitted to Intensive Care Unit in a Public Hospital
Procedia Soc. Behav. Sci.
(2012) - et al.
Healthcare in the pocket: mapping the space of mobile-phone health interventions
J. Biomed. Inform.
(2012) Needs of adult family members after critical illness: prescriptions for interventions
Crit. Care Clin.
(1992)- et al.
A review and a framework of handheld computer adoption in healthcare
Int. J. Med. Inform.
(2005) - et al.
Psychological distress among the family members of Intensive Care Unit (ICU) patients: a scoping review
J. Clin. Nurs.
(2021) - et al.
Analysis of the concept of nursing educational technology applied to the patient
Rev. Rede Enferm. Nord.
(2014)
Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas
Cienc. Saude Coletiva
Smartphones and health promotion: a review of the evidence
J. Med. Syst.
Principles and methods of validity and reliability testing of questionnaires used in social and health science researches
Niger. Postgrad. Med. J.
SUS: a quick and dirty usability scale
Effectiveness of a needs-based education program for families with a critically ill relative in an intensive care unit
J. Clin. Nurs.
Mobile phone use in education and learning by faculty members of technical-engineering groups: concurrent mixed methods design
Front. Educ.
Family response to critical illness: post-intensive care syndrome-family
Crit. Care Med.
Guidelines for family-centered care in the neonatal, pediatric, and adult ICU
Crit. Care Med.
The needs of Malaysian family members of critically ill patients treated in Intensive Care Unit, Hospital Universiti Sains Malaysia
Malays. J. Med. Health Sci.
The development of handbooks of health care guidelines
Rev. Lat. Am. Enferm.
Impact of an intensive care unit diary on psychological distress in patients and relatives*
Crit. Care Med.
Pembinaan, Kesahan dan Kebolehpercayaan Modul Kemahiran
J. Teknol.
Developing and validation usability evaluation tools for distance education websites: Persian version
Turk. Online J. Distance Educ.
Ording H. Withholding or withdrawing therapy in Danish regional ICUs: frequency, patient characteristics and decision process
Acta Anaesthesiol. Scand.
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- 1
Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Department of Nursing, Faculty of Medicine and Health Sciences, UPM, Serdang, Malaysia, RN, MSc (Critical care), Doctoral Researcher. https://orcid.org/0000-0001-9801-9022
- 2
Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, RN, PhD, Senior Lecturer. https://orcid.org/0000-0001-9460-4208
- 3
Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, RN, PhD, Senior Lecturer, Professor. https://orcid.org/0000-0002-8599-3018
- 4
Department of Anaesthesiology, Faculty of Medicine and Health Sciences, UPM, Serdang, Malaysia, MBBS (Malaya), MMed Anaes (UKM), Senior Lecturer. https://orcid.org/0000-0001-8089-5665
- 5
Department of Nursing School of Healthcare and Medical Science, Sunway University, Selangor, Malaysia, RN, PhD, Senior Lecturer, Professor. https://orcid.org/0000-0002-7185-6004