Providing information to patients in intensive care units and their families is challenging. Patients often are admitted unexpectedly and experience stress and uncertainty. One source of stress has been identified as unclear, uncoordinated, or inconsistent communication and information. Despite the need
Providing information to patients in intensive care units and their families is challenging. Patients often are admitted unexpectedly and experience stress and uncertainty. One source of stress has been identified as unclear, uncoordinated, or inconsistent communication and information. Despite the need for information, no centrally located, easily accessible, standardized intensive care unit education content exists.
To identify educational content for patients in the intensive care unit and their families across 4 different hospitals, develop a general content database, and organize the general content into a framework for education of patients and their families.
Educational content for patients in the intensive care units of 4 participating hospitals was collected and a gap analysis was performed.
Key content format and categories were identified. Educational content was organized into an information pathway divided into 3 phases: intensive care unit arrival; understanding the intensive care unit and partnering in care; and intensive care unit transitions. The gap analysis revealed substantial variation in content format and categories.
Structuring a digital learning center using different stages of the patient’s stay in the intensive care unit and placing resources in the context of an information pathway can help coordinate education for these patients and their families, and creates a consistent communication guide for clinicians as well. The optimal digital format should be considered in designing the learning center.
Providing information to families is a crucial task for intensive care unit (ICU) nurses and other clinicians.1,2 As described by the American Association of Critical-Care Nurses (AACN) Synergy Model,3 to maximize patient outcomes, nurses need to be proficient in competencies that match the needs and individual characteristics of critically ill patients. These AACN Synergy competencies include caring practices that engage the patient and family, collaboration with patients and families to support the achievement of patient/family goals, systems thinking that leverages system resources for patients and families, and facilitation of learning for patients and families. In addition, the ACCN Synergy Model explains that certain patient characteristics—such as resiliency, vulnerability, stability, and participation in care and decision-making—directly affect the facilitation of learning. Patients admitted to ICUs are often vulnerable and unstable and families may be unfamiliar with ICU routines. Their resiliency is challenged in the face of the stress and uncertainty that is common during critical illness.
A major source of stress for patients and families is unclear, uncoordinated, or inconsistent communication and information.4,5 Patients in the ICU and their families have varying abilities and willingness to participate in care and decision-making.6 Patient education requires a flexible approach, especially with family members who become the main points of contact for decision-making on behalf of the patients.7,8 Family members of critically ill patients consistently identify the need for information and the need for reassurance as the highest priority needs during an ICU hospitalization, yet the need for information is often unmet.9–11
Furthermore, the ICU is a unique setting where patients and family members are coping with stress,12,13 and they need useful, real-time information adapted to the critically ill patient’s anxiety.2 Delivery of information should be sensitive to the patient and families’ current needs, recognizing that some patients report increased anxiety when information is shared before they are ready to receive it.10 Evidence supports that delivery of patient information is most efficient and meaningful when it is presented in small quantities to decrease cognitive load, well timed in response to a patient’s readiness to learn, and rich with the use of multimedia images.14–16
We organized our education content into a pathway divided into 3 phases: ICU Arrival, Understanding the ICU and Partnering in Care, and ICU Transitions.
Despite the documented need for information among patients and families, ICU educational content is often not centrally located or organized to make it easily accessible to patients and families within an ICU. To facilitate such communication, it is important to identify a core set of information that is generally applicable to all ICU patients and families. This core information is not intended to replace the essential face-to-face communication updates that occur in clinical practice, or to cover all diseases or conditions affecting individual patients. Therefore, the primary goals of our study were to (1) identify ICU patient/family educational content across different hospitals and develop a general content database and (2) organize the general content into a framework for patient/family education in the ICU. Ultimately, the results of this study will aid in the development of a web-based ICU patient/family digital learning center. The digital learning center will improve patient outcomes by supporting the nurse in facilitating learning, caring practices, collaboration, and systems thinking, while maximizing patient participation in care and decision-making by providing resources for patients/families that are meaningful within the context of an ICU stay. The digital learning center will also leverage technology to present accessible content on demand.
Context of the Study and Current State of Patient and Family Education in ICUs
The Libretto Consortium, funded by the Gordon and Betty Moore Foundation, was formed among 4 hospitals (Beth Israel Deaconess Medical Center,