Effectiveness of self instructional Module on Perception of Needs among Family Members of ICU patients

Mr. Manoj M.G

Lecturer, Medical Surgical Nursing, Wolllega University, Ethiopia

*Corresponding Author’s Email: manumadhuraj@gmail.com

ABSTRACT:

Background: Critical illness of a member of family who admitted in Intensive Care Unit (ICU) will lead other members to a state of tension, fear and anxiety. This will also leads to insufficient fulfillment of their needs. It may include mainly as follows physical, cognitive, emotional, spiritual, social and financial needs. Therefore, the investigator felt the need to evaluate the effectiveness of self instructional module on perception of needs among the family members of patients admitted in Intensive Care Units of selected hospital at Mangalore. Objectives :The present study aims to assess the perception of needs both before and after administration of self instructional module and also to find the association between mean pre-test scores regarding perception of needs among the family members of patients admitted in Intensive care unit and with their selected demographic variables. Method: A pre experimental, study was conducted among 50 family members of patient admitted in intensive care unit of selected hospital at Mangalore using a perceived needs inventory questionnaire followed by administration of self instructional module on needs among the family members of patients admitted in intensive care units. After a lapse of 7 days, post-test was conducted using the same perceived needs inventory questionnaire. The collected data was analyzed by using descriptive and inferential statistics. Results: Assessment of the pre-test scores of perception of needs revealed that, that majority of the respondents, 30 (60%) had averagely perceived their needs, followed by 3 (6%) had good perception of needs, while none of them had excellent perception of needs. Whereas, after the administration of self instructional module the perception of needs level had improved, i.e., 30 (60.5%) respondents had good perception needs, followed by 20 (40%) respondents who had excellently perceived their needs. The mean percentage of the pre-test perception of needs score was 46.93% with total mean and standard deviation of 14.08 and 3.116 respectively. However, after the administration of self instructional module, the mean percentage had increased to 79.27%, with total mean and standard deviation of 23.78 and 2.013 respectively. The study findings also revealed there was a significant association between perception of needs score with the selected demographic variable, education. The obtained ‘t’ value [25.57, P<0.05] was higher than the table value indicating the effectiveness of self instructional module.

Interpretation and conclusion: The study findings revealed that the family members are not meeting or perceiving their needs adequately. The self instructional module was found to be effective in making awareness on needs among the family members of patients admitted in ICU. The study findings implied that self-instructional module had a vital role in perceiving and meeting the needs among the family members of patients admitted in ICU.

KEYWORDS: Effectiveness; self-instructional module; perception of needs; intensive care units; family member.

INTRODUCTION:

Hospitalization of any age group will lead themselves and their family to a stage of stress, anxiety and tension. When a loved one is critically ill, the family members are often in crisis, dealing with the roller coaster of emotions and psychological disturbance associated with the threat of a serious illness. Also the Intensive Care Unit’s environment, with its unfamiliar noises, it’s strange looking machines, the constant bustle of nurses, physicians, supporting staff is a frightening experience for many family members. When they hear that a family member is admitted in an Intensive Care Unit, people frequently perceive that the patient is on the edge between life and death¹.

Intensive care unit is an area designed to meet the special needs of the critically ill patients. Unlike the general ward, it is a closed unit for intensive care of the patients. In Intensive care unit the critically ill patients are on constant monitoring or on special therapeutic treatment under intensive care. Doctors, nurses, and technicians vigilantly work on the patients and handle the life support equipments, pipelines and monitors.²

Meeting the needs of the patient’s family members is an essential part of the responsibility of Intensive Care Unit physicians, nurses who are committed to easing the pain and suffering of these who have critically ill relatives or close friends. The role of critical care nurses mainly involve assisting both patients and their family members to cope with new and often life threatening situations. The critical care nurse should know the needs of family members during the Intensive Care Unit experience. The family members may not know the needs properly; specific information about the needs of the family members of critically ill patient is useful.³

NEED FOR THE STUDY:

Critical illness is always a traumatic event for both the patients and family members. Getting admission to the intensive care unit after serious condition signals a threat to the life of the patient.

Every year in United States approximately 20% of all deaths occur in an intensive care unit. Studies in American hospitals have shown anxiety symptoms in 10-42% and depression symptoms in 16-35% of relatives of critically ill patients.⁴

Nearly 5million patients are admitted to an Intensive Care Units in India every year. Yet studies exploring psychological impact on their relatives are scant. In one study post traumatic stress symptoms were observed in 79% of 199 relatives of Intensive Care Unit patients in an Indian hospital. Although these psychological effects decreases over time, they may be present for 6months to 2years.⁵

A descriptive study was conducted among the relatives of patients admitted in ICU’s of Pune during 2006, to identify the relatives of the intensive care units patient at risk for developing symptoms of post traumatic stress disorder (PTSD). The study identified that during the admission 48% of relatives had a Hospital Anxiety and Depression Scale score (HAD)>11 and 72% showed Impact of Event Scale Revised (IESR) score>26. A total of 35% relatives showed posttraumatic stress reaction consistent with a high risk after two months. The researcher concluded that adequate counseling and provision of information of the group of relatives may prevent lasting psychological problems of Intensive Care Unit admission in the relatives of critically ill.⁶

The investigators clinical experiences revealed that the relatives of patients admitted in the Intensive Care Unit may have more stress and they should get adequate information regarding their needs such as physical needs, cognitive needs, social needs, emotional needs and financial needs spiritual needs.

STATEMENT OF THE PROBLEM:

“A pre experimental study to assess the effectiveness of self-instructional module on perception of needs among the family members of patients admitted in intensive care units in selected hospital at Mangalore.”

OBJECTIVES:

1. To assess the perception of needs among the family members of patients admitted in the intensive care units.

2. To evaluate the effectiveness of self instructional module on perception of needs among the family members of patients admitted in intensive care units.

3. To find the association between the mean pretest score regarding perception of needs among the family members of patients admitted in icu and with their selected demographic variables.

HYPOTHESES:

All hypothesis are tested at 0.05 level of significance

• H₁: There will be a significant difference between the perception of needs among family members of patients admitted in intensive care units before and after administration of self instructional module.

• H₂:There will be significant association between the mean pretest score regarding the perception of needs among the family members of patients admitted in intensive care units and their selected demographic variables

Assumptions

• The family members of Intensive Care Unit patients may perceive the needs to some extent.

• The family members may at the risk of developing post traumatic stress disorders, depression or anxiety due to their relative’s admission to Intensive Care Unit.

• Self instructional module may improve the perception of need among the family members of patients admitted in Intensive Care Unit.

Independent Variable:

Self Instructional Module

Dependent Variable:

Perception of needs among the family members of patients admitted in Intensive Care Units.

Inclusion Criteria:

• The family members who are willing to participate.

• The family members who are staying along with the patient in hospitals.

• The family members who can read and write Kannada or English

• Relatives of both sexes are considered.

Exclusion Criteria:

• Family members who are not interested to participate in the study.

• Family members other than the primary care givers.

Data Collection Instruments:

• Baseline profoma is used to collect the baseline information from selected family members.

• A perceived needs inventory questionnaire.

Part I: Baseline Proforma:

It contained 7 items for obtaining information regarding age, gender, relationship with the patient, education, diagnosis of the disease, admissions of patient to ICU, and previous experience of family member in ICU.

Part Ii: Perceived Needs Inventory Questionnaire:

This part of the tool consisted of 30 items (questionnaire) in 3 areas of needs of family members. The areas were:

• Physical and cognitive needs

• Emotional and spiritual needs

• Financial and social needs

Validity:

Content validity of the tools was obtained by giving the tool to 11 experts. There was 100% agreement for all the items.

Reliability:

The reliability of the instrument was conducted at Indiana hospital Mangalore. Reliability is established by Split-half method using Spearman Brown Prophecy formula. The reliability is 0.83, thus the tool is found to be highly reliable.

Pilot Study:

Pilot study is conducted in Indiana hospital Mangalore from 5^th September to 12^th September 2012. The study was found to be feasible; hence no modifications were done in the study methodology.

Method of data collection:

The data collection period extended from September 15^th to October 25^th, 2012. The pre-test is conducted on 50 family members using a perceived needs inventory questionnaire, following which a copy of the SIM was given to each subject and The post-test is conducted on the seventh day, with the same tool.

RESULTS:

1. Description of sample characteristics in frequency and percentages..

• Most of the subjects (38%) were in the age group of 36-45 years.

• Majority of the subjects (60%) were males and 40% were females.

• Highest percentages of the subjects (32%) were children’s.

• Most of the subjects (32%) were studied up to high school.

• Majority of the Family member’s (32%) had the patient with chronic illness.

• Majority patients of the family members were unexpectedly admitted to the ICU (70%).

• Majority of the family members do not have previous experience in the ICU (64%).

2. Analysis of pre-test and post test scores of perception of needs among the family members of patients admitted in ICU.

Pre test scores perception of needs

Post test scores perception of needs

Level of perception of needs

Percentage range of score

Frequency (f)

Percentage (%)

Level of perception of needs

Percentage range of score

Frequency (f)

Percentage (%)

Poor

Average

Good

Excellent

≤ 40

41 -60

61 -80

81-100

Poor

Average

Good

Excellent

≤ 40

41 -60

61 -80

81-100

H₂: There will be a significant association between the mean pre test score regarding the perception of needs among the family members of patients admitted in Intensive care units and their selected demographical variables.

Sl no	Demographic variables	X² value	P value	df	significance
1	Age	0.447	0.800	2	Not significant
2	Sex	0.654	0.419	1	Not significant
3	Relationship with the patient	0.102	0.992	3	Not significant
4	Education of family member	6.762	0.009	1	Significant
5	Diagnosis	2.689	0.261	2	Not significant
6	Admission to ICU	0.015	0.902	1	Not significant
7	Previous experience	0.142	0.706	1	Not significant

c²₁=3.84, P<0.05; c²₂=5.99, P<0.05; c²₃=7.81, P<0.05

DISCUSSION:

Study findings			Supportive study
1. The total mean percentage of the perception of needs of the family members in the pre-test was 46.93% with total mean and standard deviation of 14.08 and 3.116, respectively. Area-wise mean percentage of perception of needs score was highest (54.00%) in the area of “Social and financial needs” and least (43.27%) in the area of “Emotional and spiritual needs.” In the area of “Physical and cognitive needs”, the mean percentage was 45.27%.			The findings of the present study are consistent with the findings of a study conducted in Bangalore related to the needs of the family members of patients admitted in ICU. The results showed that cognitive need for precise information (83.15%) as the most important need. While spiritual need was considered to be least (47%). 67.14% expressed a lack of satisfaction about the information provided about the patient. while only 50% were satisfied with the information given about physical needs. The study concluded that adequate information provided to family members will reduce their anxiety and in turn they will be able to involve in the care of the patients.⁷
2. The overall mean post-test perception of needs score (23.28±2.013) was significantly higher than overall mean pre-test perception of needs score (14.08±3.116) and the obtained ‘t’ value was 25.57, which was higher than the table value.		The findings of the study was also consistent with A multicentre prospective randomised controlled trail conducted on Impact of family information leaflet on effectiveness of information provided to the family members of intensive care unit patients in France, they studied among relatives of 34 French ICU’s. In the study family relatives of experimental group (n=87) received the information leaflet and controlled group did not (n=88). The information leaflet reduced the proportion of family members with poor comprehension from 40.9% to 11.5% (p<0.0001). In the representative sample with good comprehension the leaflet was assessed with significantly better satisfaction [21(18 to 24, quarterlies] versus [27(24 to 29 quarterlies, p (0.01)]. These results indicate that leaflet improves the effectiveness of information and it has an impact on families.⁸
3. The study findings revealed that there was significant association between perception of needs score and education (c²₁=6.762; table value c²₁=3.84 P < 0.05) but not with other demographic variables.	A prospective study was conducted on measuring the satisfaction of intensive care units family in Morocco. A representative of (n=194) family members from 12 bed intensive care unit at Morocco are asked to fill the society of critical care medicine family needs assessment questionnaire. The aim of the study was to evaluate the satisfaction of patients’ family members using an Arabic version of the Society of Critical Care Medicine’s Family Needs Assessment Questionnaire and to assess the predictors of family satisfaction using the classification and regression tree methods. In univariate analysis, family satisfaction increased with lower family education (p=0.005), when the information was given by a senior physician (p=0.014) and when the society of critical care medicine’s family needs assessment questionnaire was administered by an investigator (p=0.002). Multivariate analysis showed that the education level was the predominant factor contributing to the society of critical care medicine’s family needs assessment questionnaire score. Society of critical care medicines family needs assessment questionnaire increased (greater satisfaction) with a higher education levels.⁹

CONCLUSION:

• Implications of the present study in the nursing practice:

Admission of loved one to the ICU may cause stress and anxiety among the family members. They may have lack of information about the new environment such as ICU. Nurses have a major role in the reduction of stress and anxiety. Through health education methods, the nurse can make awareness about the ICU as well as the hospital environment to the family members of patients admitted in the ICU.

• Implication of the present study in nursing education:

The holistic healthcare approach should be emphasised during the training period of nursing students. Nursing students should be made aware of the importance of understanding the immediate needs of the family members of patients admitted in ICU. Thus they also trained properly to handle the emergency situation in the ICU.

• Implication of the present study in nursing administration:

Nursing administration should take an initiative in creating plan and policies to meet the needs of the family members of patients admitted in the ICU. Nurse administrators need to make some information booklet, leaflet, pamphlet about the ICU set up, facilities available in the particular hospital, information about the hospital layout ate. Thus it will helps meet the needs of the family members to some extents.

• Implication of the present study in nursing research:

Nursing practice need to be based on scientific knowledge. Very few studies have been conducted on the needs of family members of patients admitted in ICU in India. More innovative methods like audiovisual package, information board, can be incorporated and effectiveness can be evaluated.

LIMITATIONS:

· The sample size was small interfered with the generalization of the findings

· The study was limited to one group pre-test post-test design

RECOMMENDATIONS:

· A similar study can be conducted by using experimental and control group.

· A similar study can be conducted using a large sample.

· A study can be conducted on the awareness of hospital environment among the family members of patients admitted in ICU.

SUMMARY:

The study findings revealed that the administration of self instructional module was beneficial for the family members of the patients admitted in ICU to improve the levels of perception of their needs.

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Sl. No.	Area	Maximum Possible Score	Mean	Standard deviation	Mean percentage
1.	Physical and cognitive needs	11	8.48	1.249	77.09
2.	Emotional and spiritual needs.	11	8.54	1.297	77.64
3.	Financial and social needs	8	6.76	1.001	84.50
	Total	30	23.78	2.013	79.27

Group	Mean perception of need score		Mean difference	Standard deviation of difference	‘t’ value
	Pre test	Post test
Family members	14.8	23.78	9.70	2.68	25.57