Developing and Evaluating a Novel Educational Intensive Care Unit Wall Map

Abstract

The COVID-19 pandemic significantly affected the ability of intensive care unit (ICU) clinical staff members to communicate with family members of critically ill patients. Before the pandemic, ICUs in the United States had embraced patient- and family-centered care, a strategy that enhanced communication. The ongoing pandemic and resulting limitations on family visitation practices have dramatically changed the way ICU clinicians are able to interact with, communicate with, and provide education to family members.1-7As a result of family visitation restrictions during the pandemic, the clinical staff in the medical ICU (MICU) at Vanderbilt University Medical Center (VUMC) identified the need to provide supplemental education to family members on bedside equipment. We found on Twitter an example of an educational wall map that was created by Southmead Hospital in Bristol, the United Kingdom. We followed up with that ICU team, which shared the template they had used to create the wall map in collaboration with a professional design team and a related survey to assess family perceptions of the tool.8The objective of the ICU wall map created by the team at Southmead Hospital was to help educate patients, families, visitors, and staff members about equipment used in the MICU. The map is a visual aid that uses simple iconic illustrations and describes the function of the equipment in language that is clear and understandable to people not familiar with medical terminology.Working with the same graphic designer team used by the Southmead Hospital staff (Marles + Barclay Ltd, Bristol, United Kingdom), we adapted the educational wall map for VUMC. The aim of the customized wall map was to provide family members with information on the specific medical terminology pertaining to equipment commonly used to treat ICU patients and the basic purpose of each instrument. The wall map shows various types of medical equipment surrounding a figure representing a patient (see Figure). Each instrument is labeled with its medical term and has a color-coded line that leads to the anatomical area of its function; beneath the medical term for each tool is a simple description of its function in easy-to-understand language, which was developed in conjunction with the director of patient education and the design team. Examples of the label and description are as follows: “Pulse ox—Measures the oxygen in the blood,” “EKG monitor—Monitors heart rhythm, blood pressure, and oxygen,” and “Dobhoff tube—Feeding and medicine tube that goes from nose to the stomach.” A QR code was included to link to a short survey that used Research Electronic Data Capture (REDCap)9 to obtain anonymous voluntary feedback from family members on the perceived usefulness of the ICU wall map and any other comments on the ICU experience.The wall map was hung outside the ICU near the family waiting area. A separate online anonymous voluntary REDCap survey was used to assess staff members’ perception of the ICU wall map and its effectiveness in providing supplemental education to family members. This project was approved by the Vanderbilt University institutional review board.A total of 16 family members, friends, and other visitors have provided feedback on the ICU wall map: 2 spouses (12%), 1 significant other (6%), 2 children (12%), 2 cousins (12%), 1 sibling (6%), 3 friends (19%), and 5 other visitors (31%). Aspects that have been cited as most helpful include the use of graphics to help identify the equipment, plain-language explanations of the ICU equipment, and the overall layout. In terms of specific comments, one parent noted, “It’s been great being in a teaching hospital. Everyone has been open to answering questions and helping us understand.” An ICU patient’s child commented, “It is good to see a team that works together. The nursing staff are excellent.” A sibling remarked, “Nice to have this assistance.” Suggestions have included making the map interactive with a touch screen and an audio component and having the QR code link to more extensive explanations—for example, “What is end tidal Co2?” and “What is a normal range?”A total of 38 clinicians provided responses to the clinician survey: 32 registered nurses (84%), 2 physicians (5%), and 4 advanced practice providers (11%). Thirty-four staff members (89%) responded affirmatively to having seen the wall map. Of these, 15 respondents (44%) reported that they were unsure of the effect that the wall map had in terms of educating family members. Some clinicians reported that the feedback from family members was positive and that during discussions of plans of care, family members recalled learning the names and functions of pieces of ICU equipment. Some noted that the wall map’s use of pictures and simple explanations of complex medical devices was useful and “a clever way to provide visitors with information.” The descriptions of the equipment were noted to be simple enough for someone outside of health care to understand. Several staff members suggested either placing the wall map in patients’ rooms or offering a handheld version to visitors to allow real-time application of information. A labor and delivery staff member commented, “I love the colors and overall layout. I think we should put one outside every ICU.”For visitors unfamiliar with the critical care environment, the machines, equipment, and technology can be threatening and overwhelming, exacerbating an already stressful situation. The use of an ICU wall map to provide family members with information on commonly used ICU equipment has been beneficial as a means of delivering supplemental educational content. A valuable feature is family members’ ability to provide staff members with feedback on the ICU wall map as well as general comments related to receiving care in the ICU. While acknowledging that they were unsure of the degree to which the wall map was effective in educating family members, clinicians believed that the tool was helpful in facilitating a better understanding of various types of ICU equipment and their function. The ICU wall map serves as a visual aid, helping family members and other visitors learn about the care provided to their loved one in the ICU.The authors acknowledge the following individuals who assisted with various aspects of this project: MICU clinical staff of VUMC; Lori Anne Parker-Danley, PhD, Director of VUMC’s Department of Patient Education; Sarah Folliard, DNP, APRN, AGACNP-BC, Vanderbilt University School of Nursing; Stephen M. Robinson, MD, ICU consultant, Southmead Hospital, Bristol, United Kingdom; and Gill Marles and Adrian Barclay of Marles + Barklay, Bristol, United Kingdom. The staff survey portion of this project was conducted in partial fulfillment of the doctor of nursing practice (DNP) degree program requirements for Chuck Venable.