Evaluation of a Mobile App to Promote Family Caregiver Engagement in Symptom Assessment and Management During Mechanical Ventilation in the Intensive Care Unit
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Family
- Sponsor
- University of Nebraska
- Enrollment
- 18
- Locations
- 1
- Primary Endpoint
- Dosage of ICU-CARE
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The purpose of this randomized controlled pilot trial is to develop and test mobile app, Intensive Care Unit-Caregiver Activation Response, and Engagement (ICU-CARE). ICU-CARE provides a simulated learning environment to encourage family caregivers of mechanically ventilated patients to assess two patient symptoms, thirst and anxiety, and perform specific nonpharmacologic comfort measures to help alleviate patient symptom burden.
Detailed Description
Critical care guidelines call for the liberal inclusion of family caregivers into bedside care, but despite convincing evidence that active family participation improves the patient and family experience as well as safety, quality, and delivery of care, critical care nurses have few evidence-based strategies to engage family caregivers as active participants in the provision of care in the intensive care unit (ICU). The broad objective of this proposal is to develop and test a mobile app, Intensive Care Unit-Caregiver Activation Response and Engagement \[ICU-CARE\]. ICU-CARE provides a simulated learning environment that incorporates established motivational learning theories to encourage family caregivers of mechanically ventilated patients to assess two patient symptoms, thirst and anxiety, and perform specific nonpharmacologic symptom management techniques to help alleviate the patient's symptom burden. This project, guided by the Individual and Family Self-Management Theory, aims to (1) Establish the feasibility and acceptability of the ICU-CARE intervention for family caregivers enrolled in the experimental arm; and (2) Determine the influence of the ICU-CARE intervention on the caregiver process characteristics, proximal caregiving outcomes, and distal caregiving outcomes as compared to family caregivers enrolled in the control arm. To address these study aims, a convenience sample of 60 family caregivers of mechanically ventilated patients will be recruited into this randomized controlled pilot trial. 30 participants will be enrolled to the control group which will receive usual care with routine caregiver support practices. Intervention participants (n=30) will be enrolled to an experimental condition ICU-CARE, that will consist of a theoretically grounded mobile app program to promote caregiver engagement in symptom assessment and management in the ICU. This project will help further define the scope, extent, and nature of patient and family engagement in the ICU, and if proven feasible, our intervention holds the potential to shift the ICU nursing practice paradigm by integrating family caregivers as dynamic partners in ICU care.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Adult Caregivers of mechanically ventilated ICU patients who are:
- •Age 19 or older
- •Able to understand English
- •Able and willing to use the hospital-provided tablet devices
- •Can view images on a screen and hear audio through a standard headset
- •Have basic reading skills and the ability to read aloud
- •Critically ill patients in the ICU who are:
- •Age 19 or older
- •Mechanically ventilated
- •Expected to require\> 72 consecutive hours of mechanical ventilation during their ICU stay
Exclusion Criteria
- •Adult Caregivers of mechanically ventilated ICU patients who are:
- •Caregivers of patients who are not currently undergoing mechanical ventilation
- •Caregivers of patients who are not calm, cooperative (a Richmond Agitation- - Sedation Scale score between +2 and +4),
- •Caregivers of patients who cannot reliably report symptoms of thirst and anxiety
- •Caregivers of patients who have a documented hearing deficit.
- •Caregivers who do not visit the patient frequently (at least once per day for a minimum of 1 hour as described by nursing staff)
- •Critically ill patients in the ICU who are:
- •Recovering from any of the following surgeries: Glossectomy, Maxillectomy, Neck Dissection, Facial/neck flap
- •Receiving aggressive ventilator support such as positive end expiratory pressure\> 15cm of water, prone ventilation
- •Not alert per nursing assessment (Richmond Agitation-Sedation Scale Score +2 or greater)
Outcomes
Primary Outcomes
Dosage of ICU-CARE
Time Frame: Through study completion, estimated 3 years.
Number of doses of the intervention per participant
Enrollment Feasibility of ICU-CARE
Time Frame: Through study completion, estimated 3 years.
Total subjects screened, approached, consented and refused
Sustainability of ICU-CARE enrollment
Time Frame: Through study completion, estimated 3 years.
Differential attrition rates - the number of subjects in each group that complete all study follow-up measures
Acceptability of ICU-CARE
Time Frame: Through study completion, estimated 3 years.
Total score of a modified version of the Educational Material Acceptability Instrument. Minimum Score = 11; Maximum Score = 55. Higher score indicates greater acceptance.
Secondary Outcomes
- Influence of ICU-CARE on Proximal Caregiving Outcomes - Symptom Management(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Proximal Caregiving Outcomes - Caregiver Anxiety(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Proximal Caregiving Outcomes - Patient Thirst(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Caregiver Satisfaction(At study enrollment and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Patient Agitation(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Patient Pain(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Caregiver Process Characteristics - Caregiver Activation(At study enrollment, 24-48 hours after study enrollment, and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Caregiver Process Characteristics - Caregiver Preparedness(At study enrollment, 24-48 hours after study enrollment, and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Caregiver Process Characteristics - Caregiver Self-efficacy(At study enrollment, 24-48 hours after study enrollment, and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Proximal Caregiving Outcomes - Symptom Assessment(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Proximal Caregiving Outcomes - Patient Anxiety(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Caregiver Global Health Status(At study enrollment and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Caregiver Anxiety & Depressive Symptoms(At study enrollment and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Caregiver ICU Experience(At study enrollment and 2-4 weeks after ICU discharge)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Duration of Ventilation(Once every 24 hours from the date the patient is enrolled in the trial to the date the patient is discharged from the ICU, an average of 2 weeks.)
- Influence of ICU-CARE on Distal Caregiving Outcomes - Sedative Exposure(Through study completion, estimated 3 years.)