Study type and setting: This is a cross-sectional study. The research setting was the intensive care units of Shafa, Bahonar, and Afzalipour hospitals in Kerman, southeastern Iran. These centers provide specialty and subspecialty services for various patients in southeastern Iran.
Sample size and sampling: The sample size with a confidence interval of 95%, was estimated to be 123 individuals in each group using a pilot study on 15 nurses and patients’ families ( = 3.9, = 3.54, S1= 0.6, S2 = 0.94). Regarding the probability of dropout, 140 samples were considered in each group. The convenience sampling method was used for sampling.
Instrument: The instrument was a researcher-made questionnaire based on background information and educational needs. The patient's family background information includes age, sex, marital status, educational level, occupation, monthly income of the family, relationship with the patient. The patient's background information includes age, sex, marital status, educational level, insurance coverage, patient diagnosis, hospitalization time, the time elapsed from discharging, the status of the patient when discharging from the ICU and the patient's current condition. Nurses' background information includes age, gender, marital status, educational level, work experience, work experience in the ICU, position, working hours per month in the ICU, type of shift, and type of employment.
The questionnaire of educational needs of patients discharged from intensive care units was designed by interviewing family members of discharged patients, experienced nurses, physicians working in the intensive care unit, personnel working in rehab centers as well as using literature review. The questionnaire consisted of 67 items and eight dimensions. The dimensions of the questionnaire include: 1) public health (9 items about hand hygiene, patient’s oral care, eye care, skin care, bed sore prevention, care for bed sore, bath in bed, limb physiotherapy, and care of patients in winter ), 2) airway care (15 items about the tracheostomy care and suctioning, use of home ventilator and oxygen container/oxygen maker, use and disinfection of oxygen mask, nasal cannula, t-piece, Ambo Bag, chest physiotherapy, and knowledge of lung infection symptoms), 3) urinary care (8 items about care of internal and external urinary catheter, urine volume measurement, and urinary tract infection symptoms), 4) defecation care (6 items about the frequency of bowel movements and stool color, prevention and control of constipation, prevention and control of diarrhea, use of bedpan for the patient, and removal of the ostomy pouching system and its reinstallation), 5) nutrition and medicine (9 items about preparation and frequency of the patient feeding, feeding through the nasogastric tube or gastrostomy, NGT care, drugs administration to the patient through the nasogastric tube, subcutaneous/intramuscular drugs administration, knowledge of drug side effects), 6) Mental health of the patient (3 items about control of the patient's mental tensions and stresses, depression, and psychological issues ), 7) essential information (11 items about control of the patient’s level of consciousness, vital signs, fever, pain relief , blood clots prevention, care for the patient during seizure, basic cardiopulmonary resuscitation, removal of tracheostomy tube and its reinsertion, and information about the rehabilitation centers for ICUs) and 8) self-care (6 items about control of stress and mental tensions caused by caring for the patient, taking care of his/her physical health, , psychological adaptation to the patient’s condition while caring for him/her, control of anger in dealing with the patient's condition, and managing and planing for patient care). The response to the questionnaire was based on the level of family needs from no needs = 0 to very high needs = 5. The mean scores allocated to each item were used to calculate the educational needs of each dimension, so the minimum score for each dimension was 0, and the maximum score was 5. The sum scores of all dimensions were calculated to assess the total score of the questionnaire. Therefore, the total score ranged from 0 to 40 and the higher the score the higher the educational needs Also, scores from 0 to 13.34 were considered as low, from 13.35 to 26.67, as moderate and 26.68 to 40 as high educational needs. Sixteen faculty members of Razi faculty of Nursing and Midwifery and specialists of the intensive care unit assessed the questionnaire for content validity. The content validity index was 0.99. The questionnaire was given to 30 target people (15 nurses and 15 family members of the patient) to determine the reliability, and the Cronbach's alpha coefficient was 0.91.
Data collection and analysis: The researcher started the sampling after obtaining the code of ethics and permission from the research setting. The researchers extracted patients’ families contact information from the medical records of patients who have been discharged from the intensive care units since 2016. After contacting eligible families, an appointment was arranged at their living place, at the rehab center and, in some cases, in nursing care clinics to fill out the questionnaires. Initially, a description of the research process, its goals, and the confidentiality of the information were provided for the research units. In case the primary caregiver had not had sufficient literacy, the questionnaire would have been completed through the interview. Also, the researcher co-worker was available for literate families in the case of having any question. Because the educational needs of the family may differ depending on the patient's condition after discharge, and as a result, this will affect the nurses' viewpoint, nurse samples were matched with the family samples according to patients’ conditions. The researcher referred to teaching hospitals during different shift works (morning, evening, and night) and provided the nurses with questionnaires. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to describe the characteristics of the samples. Independent t-test was used to compare the family educational needs of caring for the patients discharged from the intensive care units from nurses and families’ viewpoints. Data analysis was done using SPSS version 21.