Effectiveness of a self-regulation program using iPad-assisted communication in intubated patients with respiratory failure: A randomized controlled trial
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Abstract
Background & Aim: Communication limitations in intubated patients with respiratory failure increase anxiety, compromise care quality, and may delay ventilator weaning. This study evaluated the effects of a self-regulation program using iPad-assisted communication on anxiety, perceived fulfillment of care needs, and weaning outcomes.
Methods & Materials: A randomized controlled trial was conducted from April to December 2024 and enrolled 60 mechanically ventilated patients with respiratory failure. Participants were randomly assigned to an experimental group (n= 30) and a control group (n = 30). Data were collected on demographics, health status, anxiety levels, perceived fulfillment of care needs, and ventilator weaning outcomes. Statistical analyses included descriptive statistics, chi-square or Fisher’s exact tests, t-tests, and ANCOVA.
Results: Two hours after the intervention, the experimental group reported significantly lower anxiety levels and higher perceived fulfillment of care needs compared with baseline and the control group (p< 0.001). The experimental group also demonstrated a higher weaning success rate (83.33%) than the control group (66.67%) (χ²= 6.76, p= 0.009). Re-intubation within 48 hours was significantly lower in the experimental group (16.67%) than in the control group (33.33%) (χ² = 4.85, p = 0.028). The tracheostomy rate was lower in the experimental group (6.67% vs. 13.33%), but this difference was not statistically significant (χ² = 1.09, p = 0.296).
Conclusion: The self-regulation program with iPad-assisted communication reduced anxiety, enhanced perceived care needs, and improved weaning outcomes. These results support its applicability as a patient-centered intervention to optimize respiratory care in intensive care settings.
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11. Duyndam A, Houmes RJ, van Rosmalen J, Tibboel D, van Dijk M, Ista E. Implementation of a nurse-driven ventilation weaning protocol in critically ill children: Can it improve patient outcome? Australian Critical Care. 2020 Jan;33(1):80-8. https://doi.org/10.1016/j.aucc.2019.01.005
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13. Prasert Y, Namjuntra R. Effects of Self-Regulation Program via line application on anxiety, cooperative behaviors, and duration of examination in patients undergoing bronchoscopy. Thai Journal of Cardio-Thoracic Nursing. 2023;34(1):57–73. https://he02.tci-thaijo.org/index.php/journalthaicvtnurse/article/view/259855
14. Thuchart S, Asdornwised U, Pinyopasakul W, Trakarnsanga A. The effects of Concrete-Objective Information Program on pre-operative anxiety in abdominal surgery patients. Nursing Science Journal of Thailand. 2019;37(2):78–91. https://he02.tci-thaijo.org/index.php/ns/article/view/192756
15. Orawongphaisal S, Saneha C, Poungkaew A, Musikatavorn K. The effect of Concrete-Objective Informational Support Program via smartphone application on anxiety among relatives of urgent patients in emergency room. Nursing Science Journal of Thailand. 2023;41(3):34–49. https://he02.tci-thaijo.org/index.php/ns/article/view/255394
16. Sandoval Moreno LM, Casas Quiroga IC, Wilches Luna EC, García AF. Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48hours or more: A Randomized Controlled Clinical Trial. Medicina intensiva. 2019 Mar;43(2):79-89. https://doi.org/10.1016/j.medin. 2017.11.010
17. Nuanjan A, Thongthawee B, Matchim Y, Saiphoklang N. The effect of perceived self-efficacy in respiratory muscle training with modified Qigong program on duration of weaning from mechanical ventilator in patients with respiratory failure. Thai Journal of Cardio-Thoracic Nursing. 2021;32(1):152–65. https://he02.tci-thaijo.org/index.php/journalthaicvtnurse/article/view/243665
18. Sepahyar M, Molavynejad S, Adineh M, Savaie M, Maraghi E. The Effect of Nursing Interventions Based on Burns Wean Assessment Program on Successful Weaning from Mechanical Ventilation: A Randomized Controlled Clinical Trial. Iranian Journal of Nursing and Midwifery Research. 2021 Jan 18;26(1):34-41. https://doi.org/10.4103/ijnmr.IJNMR_45_20
19. Anumas N, Rattichot C, Songwathana P, Cheevarungrod A. Outcomes of clinical nursing practice guideline implementation for promoting success weaning in difficult weaning patients in neurocritical intensive care units. Journal of Health Science. 2023;32(1):138–50. https://thaidj.org/index.php/JHS/article/view/14423
20. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS quarterly, 1989, 319-40.
21. Guttormson JL, McAndrew NS. Usability Testing of an iPad Communication Application for Mechanically Ventilated Patients. Dimensions of Critical Care Nursing. 2022 Nov-Dec 01;41(6):340-46. https://doi.org/10.1097/DCC.0000000000000551
22. Santiago C, Roza D, Porretta K, Smith O. The use of tablet and communication app for patients with endotracheal or tracheostomy tubes in the medical surgical intensive care unit: A pilot, feasibility study. Canadian Journal of Critical Care Nursing. 2019;30(1). 17.
23. Burns SM, Fahey SA, Barton DM, Slack D. Weaning from mechanical ventilation: a method for assessment and planning. AACN Clinical Issues in Critical Care Nursing. 1991 Aug;2(3):372-89. https://doi.org/10.4037/15597768-1991-3003
24. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 2013.
25. Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks (CA): SAGE Publications; 2014.
26. Vahedian-Azimi A, Bashar FR, Jafarabadi MA, Stahl J, Miller AC; MORZAK Collaborative. Protocolized ventilator weaning versus usual care: A randomized controlled trial. International journal of critical illness and injury science. 2020 Oct-Dec;10(4):206-12. https://doi.org/10.4103/IJCIIS.IJCIIS_29_20
27. Raju GM. iPad with iPad-based Apps: An Optimal Communications Tool in the Intensive Care Unit?. Indian Journal of Critical Care Medicine. 2021 Nov;25(11):1217-18. https://doi.org/10.5005/jp-journals-10071-24034
28. Çelebi C, Yeşilyurt KÖ. Ensuring Effective Communication with Patients Receiving Mechanical Ventilation Support in Intensive Care Units: Current Communication Materials. Cyprus Journal of Medical Sciences. 2025;10(4):228-35. https://doi.org/10.4274/cjms.2025.2025-28
29. Ertürk Yavuz M, Gürsoy A. Computer-Based Communication Tool Provides Effective Communication for Non-speaking Patients: A Quasi-experimental Study. Clinical Nursing Research. 2022;31(4):656-65. https://doi.org/10.1177/10547738211038638
30. Seyedrasooli A, Malakouti J, Jabraeili M, Heykalabadi S, Ghogazadeh M. The effect of the supportive program on the anxiety of mothers of infants with gastrointestinal anomalies. Nursing Practice Today. 2020;7(2):106-13. https://doi.org/10.18502/npt.v7i2.2732
2. Goligher EC, Jonkman AH, Dianti J, Vaporidi K, Beitler JR, Patel BK, Yoshida T, Jaber S, Dres M, Mauri T, Bellani G, Demoule A, Brochard L, Heunks L. Clinical strategies for implementing lung and diaphragm-protective ventilation: Avoiding insufficient and excessive effort. Intensive Care Medicine. 2020 Dec;46(12):2314-26. https://doi.org/10.1007/s00134-020-06288-9
3. Dale CM, Carbone S, Gonzalez AL, Nguyen K, Moore J, Rose L. Recall of pain and discomfort during oral procedures experienced by intubated critically ill patients in the intensive care unit: A qualitative elicitation study. Canadian Journal of Pain. 2020 Sep 24;4(3):19-28. https://doi.org/10.1080/24740527.2020.1732809
4. Bodet-Contentin L, Szymkowicz E, Delpierre E, Chartier D, Gadrez P, Muller G, Renault A, Ehrmann S. Eye tracking communication with intubated critically ill patients: a proof-of-concept multicenter pilot study. Minerva Anestesiologica. 2022 Sep;88(9):690-7. https://doi.org/10.23736/S0375-9393.22.16275-9
5. Kolcak B, Ayhan H, Tastan S. The effect of using illustrated materials for communication on the anxiety and comfort of cardiac surgery patients receiving mechanical ventilator support: A randomized controlled trial. Heart & Lung: The journal of Critical Care. 2023 May-Jun;59:157-64. https://doi.org/10.1016/j.hrtlng.2023.02.005
6. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto (CA): Mind Garden; 1983.
7. Akella P, Voigt LP, Chawla S. To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning. Journal of Intensive Care Medicine. 2022 Nov;37(11):1417-25. https://doi.org/10.1177/08850666221095436
8. Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, Rubio O, Ventura L, López A, de la Torre MC, Keough E, Arauzo V, Hermosa C, Sánchez C, Tizón A, Tenza E, Laborda C, Cabañes S, Lacueva V, Del Mar Fernández M, Arnau A, Fernández R. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019 Jun 11;321(22):2175-82. https://doi.org/10.1001/jama.2019.7234
9. Li Y, Li H, Zhang D. Comparison of T-piece and pressure support ventilation as spontaneous breathing trials in critically ill patients: a systematic review and meta-analysis. Critical Care (London, England). 2020 Feb 26;24(1):67. https://doi.org/10.1186/s13054-020-2764-3
10. Lee HY, Lee J, Lee SM. Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial. Critical Care (London, England). 2022 Dec 23;26(1):402. https://doi.org/10.1186/s13054-022-04281-w
11. Duyndam A, Houmes RJ, van Rosmalen J, Tibboel D, van Dijk M, Ista E. Implementation of a nurse-driven ventilation weaning protocol in critically ill children: Can it improve patient outcome? Australian Critical Care. 2020 Jan;33(1):80-8. https://doi.org/10.1016/j.aucc.2019.01.005
12. Leventhal H, & Johnson JE. Laboratory and field experimentation: Development of a theory of self-regulation. Behavioral Science and Nursing Theory, 1983, 189-262.
13. Prasert Y, Namjuntra R. Effects of Self-Regulation Program via line application on anxiety, cooperative behaviors, and duration of examination in patients undergoing bronchoscopy. Thai Journal of Cardio-Thoracic Nursing. 2023;34(1):57–73. https://he02.tci-thaijo.org/index.php/journalthaicvtnurse/article/view/259855
14. Thuchart S, Asdornwised U, Pinyopasakul W, Trakarnsanga A. The effects of Concrete-Objective Information Program on pre-operative anxiety in abdominal surgery patients. Nursing Science Journal of Thailand. 2019;37(2):78–91. https://he02.tci-thaijo.org/index.php/ns/article/view/192756
15. Orawongphaisal S, Saneha C, Poungkaew A, Musikatavorn K. The effect of Concrete-Objective Informational Support Program via smartphone application on anxiety among relatives of urgent patients in emergency room. Nursing Science Journal of Thailand. 2023;41(3):34–49. https://he02.tci-thaijo.org/index.php/ns/article/view/255394
16. Sandoval Moreno LM, Casas Quiroga IC, Wilches Luna EC, García AF. Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48hours or more: A Randomized Controlled Clinical Trial. Medicina intensiva. 2019 Mar;43(2):79-89. https://doi.org/10.1016/j.medin. 2017.11.010
17. Nuanjan A, Thongthawee B, Matchim Y, Saiphoklang N. The effect of perceived self-efficacy in respiratory muscle training with modified Qigong program on duration of weaning from mechanical ventilator in patients with respiratory failure. Thai Journal of Cardio-Thoracic Nursing. 2021;32(1):152–65. https://he02.tci-thaijo.org/index.php/journalthaicvtnurse/article/view/243665
18. Sepahyar M, Molavynejad S, Adineh M, Savaie M, Maraghi E. The Effect of Nursing Interventions Based on Burns Wean Assessment Program on Successful Weaning from Mechanical Ventilation: A Randomized Controlled Clinical Trial. Iranian Journal of Nursing and Midwifery Research. 2021 Jan 18;26(1):34-41. https://doi.org/10.4103/ijnmr.IJNMR_45_20
19. Anumas N, Rattichot C, Songwathana P, Cheevarungrod A. Outcomes of clinical nursing practice guideline implementation for promoting success weaning in difficult weaning patients in neurocritical intensive care units. Journal of Health Science. 2023;32(1):138–50. https://thaidj.org/index.php/JHS/article/view/14423
20. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS quarterly, 1989, 319-40.
21. Guttormson JL, McAndrew NS. Usability Testing of an iPad Communication Application for Mechanically Ventilated Patients. Dimensions of Critical Care Nursing. 2022 Nov-Dec 01;41(6):340-46. https://doi.org/10.1097/DCC.0000000000000551
22. Santiago C, Roza D, Porretta K, Smith O. The use of tablet and communication app for patients with endotracheal or tracheostomy tubes in the medical surgical intensive care unit: A pilot, feasibility study. Canadian Journal of Critical Care Nursing. 2019;30(1). 17.
23. Burns SM, Fahey SA, Barton DM, Slack D. Weaning from mechanical ventilation: a method for assessment and planning. AACN Clinical Issues in Critical Care Nursing. 1991 Aug;2(3):372-89. https://doi.org/10.4037/15597768-1991-3003
24. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 2013.
25. Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks (CA): SAGE Publications; 2014.
26. Vahedian-Azimi A, Bashar FR, Jafarabadi MA, Stahl J, Miller AC; MORZAK Collaborative. Protocolized ventilator weaning versus usual care: A randomized controlled trial. International journal of critical illness and injury science. 2020 Oct-Dec;10(4):206-12. https://doi.org/10.4103/IJCIIS.IJCIIS_29_20
27. Raju GM. iPad with iPad-based Apps: An Optimal Communications Tool in the Intensive Care Unit?. Indian Journal of Critical Care Medicine. 2021 Nov;25(11):1217-18. https://doi.org/10.5005/jp-journals-10071-24034
28. Çelebi C, Yeşilyurt KÖ. Ensuring Effective Communication with Patients Receiving Mechanical Ventilation Support in Intensive Care Units: Current Communication Materials. Cyprus Journal of Medical Sciences. 2025;10(4):228-35. https://doi.org/10.4274/cjms.2025.2025-28
29. Ertürk Yavuz M, Gürsoy A. Computer-Based Communication Tool Provides Effective Communication for Non-speaking Patients: A Quasi-experimental Study. Clinical Nursing Research. 2022;31(4):656-65. https://doi.org/10.1177/10547738211038638
30. Seyedrasooli A, Malakouti J, Jabraeili M, Heykalabadi S, Ghogazadeh M. The effect of the supportive program on the anxiety of mothers of infants with gastrointestinal anomalies. Nursing Practice Today. 2020;7(2):106-13. https://doi.org/10.18502/npt.v7i2.2732
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How to Cite
1.
Chaihan N, Pirompanich P, Wimoonchart A, Timklay W. Effectiveness of a self-regulation program using iPad-assisted communication in intubated patients with respiratory failure: A randomized controlled trial. Nurs. pract. today. 2025;:X-X.
