Effectiveness of Digital Multimedia Educational Aids Produced by Intensive Care Unit Providers

A multimedia tool for infection prevention and control practices in the intensive care unit: a participatory interventional before-after study

Background

Infection prevention and control (IPC) practices by critical care nurses are crucial in preventing ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI).

Aim

To implement an integrative approach to developing a set of IPC practices and disseminating information on the IPC practices through an educational multimedia tool to improve compliance with the practices.

Methods

This participatory interventional before-after study was conducted in a single tertiary care centre's cardiac surgical intensive care unit (ICU) from May 2022 to March 2023. Thirty-seven nursing IPC practices related to VAP and eight for CLABSI were finalized through a three-step process: systematized review, focused group discussions (five rounds), and Delphi rounds (three rounds). The IPC practices were disseminated through a multimedia tool, displayed continuously in the ICU. Nurses' compliance with the IPC practices observed directly was compared before and after implementing the multimedia tool.

Results

A total of 6043 observations for practices related to VAP and 1957 observations for those of CLABSI were performed. There was an increase in compliance post implementation for 11 IPC practices related to VAP and two IPC for those of CLABSI. There was an increase in compliance with practices relevant to chlorhexidine baths, oral care, cuff pressure maintenance, hypertonic saline nebulization, endotracheal suctioning, scrubbing the hub for central line access, and assessment of the central line for removal.

Conclusion

Through a participatory approach, we developed a set of IPC nursing practices for VAP and CLABSI. Implementing a multimedia tool, which encompasses the newly implemented IPC practices, improved compliance with many practices.

Designing a tablet-based prematurity education app for parents hospitalized for preterm birth

BACKGROUND

As technology has advanced over the last decade, handheld Mobile Health (mHealth) applications have increased in popularity. Pregnancy is one area of mHealth that has rapidly expanded, however very few pregnancy apps are developed in collaboration with health professionals. This creates an environment where the pregnancy information women are accessing may be inaccurate or even dangerous. Additionally, there are relatively few medical apps devoted to prematurity or targeted to women at risk for premature birth. To address the gap in premature birth education, we assembled a multidisciplinary team, including health care professionals, and developed the Preemie Prep for Parents (P3) app.

METHODS

Our team previously conducted 5 focus group meetings to assess the information needs of our target audience. Based on this information we developed a low fidelity P3 prototype. Our software development team transferred the low fidelity prototype into a high fidelity prototype which was hosted on Test Flight (a beta testing platform). We performed heuristic evaluation as well as user testing to improve the P3 app.

RESULTS

User testing of the high fidelity P3 prototype was performed with 13 diverse participants. 6 participants were parents of currently admitted Neonatal Intensive Care Unit (NICU) babies and 7 participants were women who had been or were currently pregnant. The native language of participants included English, Spanish, and Hmong and their educational level varied between completing high school and graduate degree. Participants provided feedback on the content of the P3 app, as well as its organization and aesthetics. The feedback led to 83 iterations of the P3 app prior to its deployment. Overall, participants noted that the information was "informative" and "reliable". They also noted that the P3 app provided control over the information they could view and when they viewed it, stating "I could see info on my time". Overall, participants felt that the P3 app was a valuable tool for mothers in preterm labor and it would help them ask questions.

CONCLUSIONS

Development of a mHealth app provides unique challenges regarding content, reliability of information, organization, and aesthetics. Creation of the P3 app to address the educational needs of women at risk for premature birth required assembling a multidisciplinary team, which included target users, and implementing an iterative design process. The efficacy of this app in improving user knowledge and decreasing anxiety is currently being tested in a randomized controlled trial.