The Other Patient in the Room
- Delores Currie
- 6 hours ago
- 9 min read
Access to Web-Based Education Improves Emotional Outcomes for Family Members of Adult Patients in the Intensive Care Unit
Clinical Inquiry Project by Delores Currie, BSN RN
Introduction
In the Intensive Care Unit (ICU), patient and family member communication and education is of utmost importance, yet many family members report feeling lost, confused, and frightened throughout the admission (Cooper, 2024). Evidence demonstrates the objective benefits of nurse-led interventions on family member’s perceived satisfaction, quality of communication, and emotional support needs (Naef et al., 2025).
However, patients and family members often report negative interactions with ICU staff, citing cold behavior and frequent use of medical jargon (Haack et al., 2023). Adding additional workload to the already stressed nurses may worsen this perception and lead to poor interactions between family members and the ICU staff. Therefore, an intervention is required to address the educational needs of family members without adding additional responsibilities to the staff.
Many studies have discussed the implementation of educational websites for patients and their family members, and have identified outcomes such as improved anxiety (Haack et al., 2023) and reports of improved support, comfort, and satisfaction with care (Halain et al., 2022).
The general public considers internet resources as their preferred source of health information (Flowers et al., 2024), demonstrating the need for a dedicated web-based education platform created from evidence-based resources for patients and family members adult ICU patients. Furthermore, this resource could be created by the facility, tailored to their policies and the specific experiences likely to be encountered in the unit, which would prevent the misinformation and confusion that often plagues consumers of online health information. It would also save time for direct patient care, as family members can become more familiar with routine treatment mechanisms through the website provided, such as ventilator-associated pneumonia prevention protocols, the use of continuous cardiac monitoring, and central lines.
Finally, there are already established websites for family members of patients in the intensive care units across the world, such as My ICU Guide, registered in Canada (Heyland, 2019) and ICU Steps, which is registered in England, Wales, and Scotland (ICU Steps:the Intensive Care Patient Support Charity 2026). These websites discuss common treatments, therapies, equipment, medical terminology, and more. This could serve as an example for future applications in the United States.
There is not only a need but a precedent for the implementation of a web-based education initiative aimed at the family members of adult patients. This could be applied to the practicum site, which is based in an intensive care unit at a local hospital consisting of twenty beds.
Background and Significance
Patients and family members are becoming increasingly autonomous and have a strong desire to understand their conditions and treatments, and collaborate with their care providers. Internet access has provided an overabundance of resources related to health and wellness, which is often inaccurate and potentially harmful. With so many options, consumers without medical training have a difficult time identifying accurate and safe resources.
This lack of education can lead to emotional and psychological challenges. Bialek and Sadowski performed a statistical analysis of questionnaires completed by 33 respondents using the Perceived Stress Scale, and the Hospital Anxiety and Depression Scale (HADS). They noted that almost fifty percent of family members struggled with post-traumatic stress disorder (PTSD), seventy five percent had symptoms of anxiety and forty percent had symptoms of depression (2021).
Patient portals, which are traditionally used to access health records, communicate with the healthcare team, and promote patient autonomy, have been utilized successfully for educating patients, showing improved outcomes, and decreased costs (Johnson et al., 2023).
Unfortunately, awareness of the resources located within these portals is limited, and not all patients are interested in creating accounts or downloading applications. A systematic review by Johnson et al., demonstrated that usage of patient portals remains less than fifty percent, and the percentage of those who use the resource regularly is lower still, with some reporting usage as low as twenty percent (2023). Significant barriers identified include unintuitive navigation of the user interface, decreased health literacy of patients, and medical jargon used throughout these portals (Johnson et al., 2023).
Research continually indicates that technology-based platforms are beneficial to patients and their family members. This could be successfully applied to the use of web-based education interventions for the emotional support of family members of adult ICU patients. Halain et al., provides application for use, describing the development of a web page designed to provide education for relatives of patients in the intensive care unit (2022). Flowers et al., highlights the lack of support available to family members and provides a repository of resources that can be accessed online (2024). These could be included in the development of a patient and family education website.
The Society of Critical Care Medicine published a clinical practice guideline, which recommends providing education programs for the family members of patients in the intensive care unit, and while they do not make suggestions for or against any specific tools, the recommended educational program could be developed and distributed through this website (Hwang and Hopkins, 2024).
In a qualitative cohort study performed by Haack et al., with 532 family members of patients in the ICU, utilizing the Hospital Anxiety and Depression Scale (HADS). They demonstrated that the use of an education website improved clinical anxiety and led to greater satisfaction among family members (2023).
PICO(T) Question Development Process
The PICO(T) question has been altered many times throughout the research process, with the initial focus being a vague “personalized education sessions”. Later developing into “In the family members of ICU patients (P), does the use of personalized education sessions (I) compared to standard care (C) reduce family member anxiety throughout hospitalization (T)?” Throughout the research process in both 60607 and 67092, I consistently struggled with making my intervention too broad. Professor Reed provided feedback that it may be difficult to locate supporting information with such an intervention.
While I worked on my discussion board posts in 60607, I altered my question many times, and eventually requested a meeting with Professor Saunders. During this meeting, we identified sources related to patient education during rounds, including family members in rounds, and family centered care.
Utilizing a combined CINAHL and Medline database search that I had learned from Professor Saunders, I began with phrases such as “need based education programs”, “nurse led education”, “family centered care”, and “reduced anxiety and other outcomes” and “patients in the intensive care” and similar wording.
I quickly learned that I had to exclude anything related to pediatrics, as a high volume of this evidence is focused on pediatrics, most of my classmates commented on this fact in my discussion posts as well, stating that they initially assumed my focus was on pediatrics, demonstrating a clear gap in research for adult patients in the ICU. I also set my exclusion criteria to articles that were older than five years.
This led me to a different PICO(T) question: "In family members of ICU patients (P), how does just family-centered care (I) compared to no use of family-centered care (C) affect anxiety and other outcomes (O)?” However, an interesting finding was that many studies included the term family centered care, but there is not a general consensus as to what that term means. Joo, Yang, and Kwon (2024) performed a systematic review beginning with 3507 records, with a total of 14 studies in the end. Throughout each article, the lack of a clear definition was a significant barrier to identifying patient outcomes.
This further proved the feedback I had received from Dr. Reed that a broad PICOT would lead to difficulty identifying a solution. I met with Dr. Reed, who helped guide my interventions to something more measurable and specific. We discussed exploring technological interventions, such as ai-based education platforms. We also discussed Elicit.com, which I did not utilize for this paper, simply due to the fear of failing from AI use.
At this point, I decided to once again scrap my previous PICOT and start over. This attempt at a PICOT was “impact of education technology on family members of adult ICU patients” as a general starting point, which I refined and included below. I began a combined CINAHL and Medline database search again, this time using terms such as “structured education sessions”, “technology platforms” “ai-based education” and “patient and family outcomes” and several word variations.
Although there was a lot of literature about AI programs. I decided against using AI interventions as a focus of this project simply because of the many different policies that exist within each facility. I kept seeing web-based interventions in my results. I can imagine it would be difficult to advertise to hospital administrators. Furthermore, I am really hoping that I will be able to create a small example website, just to illustrate the potential benefits in action. Ultimately, I believe my research indicates a need for future use of web-based interventions to address the emotional needs of families of patients in the intensive care unit.
I also reviewed the references of each journal article I read to find secondary articles that would provide more specific information. For this reason, there are a couple sources that are older than five years. Professor Saunders gave me advice that after my initial search, it would be appropriate to find supplemental information in sources older than five years.
My research also included formulation of the evaluation and synthesis table, which I have used in previous semesters and loved. It was extremely beneficial not only in appraising my research, but in organizing it for future use.
The last part of my research process involved identifying a timeline. I re-read my paper and then wondered whether there was a certain time that anxiety peaked in family members during a relative’s ICU admission. I googled that exact sentence and located a preliminary report from 2021 by Bialek and Sadowski, that happened to strengthen other parts of my paper, but also noted that the emotions experienced by family members were more intense closest to the day of admission. With this in mind, and to keep the scope realistic, I determined that my intervention should be aimed at the first three days of admission.
PICO(T) Question
For family members of adult patients in the intensive care unit, does access to a facility approved website tailored to ICU hospitalization as opposed to ad hoc education practices improve emotional outcomes and family satisfaction in the first three days of admission.
This PICOT question type is considered an Intervention, as it compares the effect of an intervention on a patient outcome, using the comparison of standard care.
Element | Description |
P (Population) | Adult family members of patients admitted to an intensive care unit (ICU) |
I (Intervention) | Access to facility approved website tailored to ICU hospitalization (equipment, common treatments and procedures, what to expect) |
C (Comparison) | Common education practices (verbal education and standard printed materials) |
O (Outcomes) | Reduced family anxiety and improved family satisfaction with care and communication |
T (Time) | Within 3 days of ICU admission |
References:
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