Patients' and Care Providers' Perceptions of Television-Based Education in the Intensive Care Unit

Melissa L. Thompson Bastin, BS, PharmD, BCPS; Grant Tyler Short, PharmD, MBA; Aaron M. Cook, PharmD, BCPS, BCCCP; Katie Rust, BSN, RN; Alexander H. Flannery, PharmD, BCCCP, BCPS


Am J Crit Care. 2019;28(4):307-315. 

In This Article

Abstract and Introduction


Background: Delivery of patient education materials to promote health literacy is a vital component of patient-centered care, which improves patients' decision-making, reduces patients' anxiety, and improves clinical outcomes.

Objectives: To evaluate perceptions of television-based patient education among patients, caregivers, nurses, and other care providers (attending physicians, advanced practice nurses, physician assistants, and resident fellows) in the intensive care unit.

Methods: A Likert-scale survey of the perceptions of patients, caregivers, nurses, and other care providers in the medical and cardiovascular intensive care units of a large academic medical center. Perceptions of the effects of television-based education on anxiety, knowledge, and health-related decision-making were assessed.

Results: A total of 188 participants completed the survey. Among them, 75% of nurses and 76% of other providers agreed or strongly agreed that television-based education improved patients' and caregivers' knowledge (P = .95). More nurses (47%) than other providers (29%) agreed that television-based education would lead to more informed health decisions by patients (P = .04). Patients and caregivers are 23 times more likely than providers to strongly agree that television-based education reduces anxiety, and they are more optimistic regarding the benefits of television-based education (relative risk ratio 23.47; 95% CI 9.75–56.45; P < .001).

Conclusion: Patients and caregivers strongly suggested that television is a useful tool for providing health literacy education in an intensive care unit.


Health systems are increasingly faced with financial and regulatory pressures to increase efficiency and decrease costs while maintaining high-quality, outcome-driven patient care. One approach to improving overall health outcomes is providing patient-centered care, which enables patients and caregivers to assume an active role in managing their own health care.[1] However, mounting data suggest that poor health literacy is a barrier to making informed and appropriate health-related decisions.

In 2003, 12% of the US population had a proficient level of health literacy, whereas an alarming 36% of the population had basic or below basic health literacy.[2] Patients insured by Medicaid or Medicare and those who are uninsured represented the lowest health literacy rates, and this group included a disproportionate 65% of Hispanic patients.[3] Low health literacy is a significant, independent, yet modifiable risk factor for hospital readmission within 30 days of a discharge.[2,4,5] A qualitative British study of the impact of socioeconomic status on patients' participation in health care revealed that patients with low socioeconomic status are less likely to ask their providers questions and have less overall understanding of their medical problems.[6] Thus, medical centers providing care to patients of low socioeconomic status and patients with poor health literacy must find innovative and effective ways to improve health literacy, thereby reducing adverse health outcomes. Doing so is especially important in intensive care units (ICUs), where improved health literacy could reduce anxiety, improve decision-making, and possibly reduce 30-day readmission rates.

"Improving health literacy may reduce hospital readmissions."

Admission to the ICU is a life-changing event for patients and family/caregivers. Anxiety and depression are prevalent among family members visiting a relative in the ICU;[7,8] these emotions can be related to a lack of knowledge and understanding of what is to come. A cross-sectional Canadian study of adults with terminal diseases (cancer, chronic obstructive lung disease, heart failure) revealed that most patients (88.7%) did not understand the basics of cardiopulmonary resuscitation (CPR), that the majority (97.3%) had inaccurate knowledge regarding outcomes of CPR, and that only 37% of patients desired to have a conversation about end-of-life care with their provider.[9] This anxiety and depression, coupled with the increased complexity of care in the ICU, create extra pressure on surrogate decision makers when making critical, time-sensitive decisions. The decisions are life altering and require providers to share clear, unbiased health literacy information.

Education modalities are typically classified into 3 categories: verbal, written, and multimedia-based (including television, computer, and other audiovisual methods). All of these modalities improve patients' understanding to various degrees. Theis and Johnson[10] studied the impact of different education platforms and found that multimodal (including audiovisual) education was superior to written forms, and both of those are superior to verbal-only education. They concluded that verbal education should not be used alone, given its low impact on increasing knowledge.[10] In fact, a systematic review of 23 studies confirmed their findings.[11] That review and others confirm that audiovisual teaching modalities are superior to standard verbal or written modalities, and that print information tailored to the specific patient improved recall more than general printed education materials did.[11–13] These data suggest that a combination of teaching modalities tailored to each patient or caregiver can improve situational understanding of health care.

Numerous education modalities have been studied with regard to providing disease-related education to patients admitted to general care areas of hospitals and patients in outpatient clinics. The impact of these educational modalities in the ICU, however, remains to be fully understood. The purpose of this study was to determine the perceptions nursing staff, other health care providers (including attending physicians, physician assistants, advanced practice registered nurses, and resident fellows), patients, and caregivers may have regarding television-based education in the ICU.

Our institution recently contracted with a vendor of television-based education to provide tailored, multimodal education for patients admitted to our hospital and their caregivers. This education system provides high-quality video-based patient education using a combination of direct instruction and model patient reenactments of situations in order to display situations that could be encountered during the hospital stay. The videos are followed up with written education materials and verbal teach-back by the nursing staff and other providers. We had no contact with the education vendor before, during, or after the study period, nor did the vendor provide financial or other support for this study.