Digital Repository Masters Theses Spring 2026 Family Communication Education for the Critical Care Emergency Nurse Course Khaleesha Williams Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Williams, K. 2026. Family Communication Education for the Critical Care Emergency Nurse Course. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Family Communication Education for the Critical Care Emergency Nurse Course Project Title by Khaleesha Williams Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 4/24/2026 Date Khaleesha Williams, RN, CCRN, TCRN, MSN Student 4/19/2026 Student Name, Credentials (electronic signature) Date Jamie Wankier Randles, EdD, MSN, RN 04/24/2026 MSN Project Faculty Date (electronic signature) 04/25/2026 Anne Kendrick (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Family Communication Education for the Critical Care Emergency Nurse Course Khaleesha Williams Annie Taylor Dee School of Nursing Weber State University Jamie Wankier, EdD, MSN, RN MSN Project 2 Abstract Purpose/Aims: The purpose of this MSN project is to design and propose the implementation of an evidence-based family communication educational intervention within the United States Army Critical Care Emergency Nurse (CCEN) course to improve nurses’ confidence and preparedness when communicating with families in the intensive care unit (ICU). Rationale/Background: Effective communication in the ICU is essential to patient safety, family satisfaction, and shared decision-making. Current CCEN course instruction emphasizes pathophysiology and clinical management but lacks structured education on communication. The literature demonstrates that ineffective communication contributes to family distress, misunderstandings about prognosis, and potential adverse events. Methods: Educational interventions, structured simulation scenarios, and facilitated debriefing materials were developed. Other materials included a V.A.L.U.E mnemonic and pre- and postsurveys to evaluate the learner experience. Results: The literature highlights that ICU nurse–family communication is complex yet emotionally charged, that ineffective communication worsens family distress and patient outcomes, and that structured, simulation-based communication education improves nurses’ confidence, family satisfaction, and patient outcomes. Conclusions: Integrating structured family communication education into specialty critical care curricula has the potential to enhance patient- and family-centered care, promote quality and safety standards, and support workforce stability. Keywords: critical care nursing, family communication, simulation education, patientcentered care, evidence-based practice 3 Family Communication Education for the Critical Care Emergency Nurse Course In the inpatient critical care setting, patients are frequently unable to verbally communicate and advocate for themselves, requiring surrogate decision-makers and family members to provide emotional support and advocacy on their behalf (Beuret & Veislinger, 2022). Families involved in decision-making are predisposed to psychological, physical, and socioeconomic burdens beginning with the emotional impact experienced upon admission to the intensive care unit (ICU) to end-of-life decisions (Shirasaki et al, 2024). Effective communication education ensures that patients and their families are well-informed and supported by all healthcare team members during significant changes in patient status, ultimately enhancing the timeliness of decision-making and optimizing patient outcomes and family satisfaction (Abdallah et al., 2025). To maintain a comprehensive plan of care centered on safety and quality, nurses should be educated regarding communication with families in their introduction to critical care. Poor communication is a persistent cause of sentinel events, including communication between clinicians and families (Communication between Clinicians | PSNet, 2019). A significant example includes conversations with identified family and surrogates regarding end-of-life, goals of care, and plans for the future, which are introduced as soon as possible, not only when the patient reaches hemodynamic decline (Tuesen et al., 2022). Lack of timely and effective communication with families to clarify incapacitated patients’ wishes places patients who wish not to receive life-sustaining treatment at risk for experiencing adverse events related to intensive care unit hospitalization (Gorman et al., 2024). These adverse events include nosocomial infections from treatment modalities such as ventilators, emergent procedural complications, or ischemic skin lesions from long-term vasopressor infusion (Gorman et al., 2024). As patient 4 advocates, nurses should be educated on effective communication with family members, from identification and initial assessment through the entire continuum of care. During this time, families attribute additional distress and dissatisfaction to poor communication or a perceived lack of emotional support (Linton, 2020). Nurses new to critical care face the challenge of learning and implementing concepts unique to the specialty, while navigating the unique psychosocial aspects of critical care that surround patients and their family support. Therefore, collaboration with families and discussing these critical plans of care is essential for the promotion of safety and quality. While the clinical and psychosocial complexities of intensive care units persist, the number of new graduate nurses entering the specialty has increased due to critical staffing shortages following the COVID-19 pandemic (Stewart, 2021). The United States’ bedside nursing shortage has led to an increase in hiring newly licensed nurses, or nurses without ICU training, with a turnover rate of 18-60% in the first year (Blackmon et al., 2023). This shortage has created opportunities for recent graduates to quickly enter the workforce and gain valuable experience. However, nurses’ preparation for the clinical and psychosocial challenges from their learning institutions varies and requires a comprehensive orientation process to meet the demands of critical care, often in a short amount of time (Stewart, 2021). Onboarding activities and training should not exclude education on communication with families. According to Elias and Day (2020), newly qualified nurses find positive family interactions important in their transition to critical care. Likewise, newly qualified nurses who lacked confidence in speaking with families struggled for fear of misspeaking. Healthcare facilities and organizations can bridge the gap and ease the transition of newly licensed nurses into critical care. Formal critical care nurse residency courses incorporating communication 5 strategies into the didactics or clinical experiences can ensure nurses feel prepared to provide family support and promote shared decision-making (Zare et al., 2023). Effective communication with patients' families in high-stress environments is a critical skill for critical care nurses. To address the gap between the need for formal residency education and the content of military nursing specialty courses, educational initiatives must explicitly teach and reinforce these communication skills. Statement of Problem The United States Army Critical Care Emergency Nurse (CCEN) course is an 18-week, didactic and clinical program that prepares nurses for intensive care unit or emergency department nursing care (Abbott, 2025). Eligible nurses must have at least two years of medicalsurgical nursing experience before starting the course. During the course, nurses learn systemsbased critical care and trauma-based content, followed by clinical experiences, simulation training, and projects to assess learning (Abbott, 2025). Students learn anatomy and physiology, pathophysiology, as well as the medical and nursing management for standard disease processes requiring intensive care unit admission, such as respiratory failure, diabetic ketoacidosis, stroke, uncompensated shock syndromes, sepsis, acute coronary syndromes, burns, and trauma. Students also learn therapies and management for various treatment modalities, including ventilator settings, continuous renal replacement therapy (CRRT), vasoactive drugs, extracorporeal membrane oxygenation (ECMO), hemodynamic monitoring, and targeted temperature management. The current practice of the CCEN course instruction delivery focuses primarily on disease pathology and nursing considerations. Graduates are well-prepared to handle complex medical situations and adapt to changes in patient hemodynamic status (Abbott, 2025). The 6 course emphasizes the physiological and pathological aspects of critical illness to the cellular level, from disease pathogenesis to cellular apoptosis, and the necessary nursing interventions to manage these conditions. However, the course focuses on pathophysiology and nursing considerations, rather than emphasizing communication. Notably, it does not equip students to discuss goals of care, admission to the ICU, changes in patient condition or prognosis, transition to comfort care, and debriefing after critical events. Upon graduation, CCEN course graduates may feel unprepared to engage in conversations with families regarding their understanding of their loved one’s declining hemodynamic status or how to therapeutically communicate with families transitioning patients to end-of-life care. CCEN graduates are at risk for lapses in family communication, which can lead to potential safety and quality-related adverse events (Elias & Day, 2020). Graduates must learn through trial and error and seek guidance from experienced nurses on their units to foster conversations regarding the goals of care. This enables them to provide families with updates or changes in patient status that require quick decisions from patient surrogates. The identified problem is that nurses enrolled in the CCEN course do not receive education and skills about navigating difficult conversations with families and patients in the ICU setting. This problem can impact patient care delivery and create gaps in communication, leading to decreased family satisfaction, increased length of stay, or miscommunication regarding goals of care. This MSN project aims to explore adding an Essentials of Critical Care Nurse-Family Communication Day to the CCEN course. To understand how it may benefit nurses' confidence in communicating with families regarding goals of care discussions, admission to the ICU, changes in patient condition or prognosis, transition to comfort care, and debriefing after critical events in the ICU setting. Through incorporating family communication 7 education, nurses can better manage patient status changes, overcome communication barriers, and improve patient outcomes (Jones, 2023). Significance of the Project Incorporating a critical care nurse-family communication education class into the CCEN nurse course has several benefits for CCEN nurses and patients. First, it can enhance nurses' confidence in discussing patient status and goals of care with families, an invaluable skill for nurses during critical moments (Joo et al., 2025). Reifarth et al. (2024) suggested that training addressing empathetic communication increased overall confidence in care delivery in critical care settings. If new ICU nurses are equipped with a basic understanding of when and how to communicate changes in patient status to families, they can then focus on mastering the clinical skills needed to perform their duties as ICU nurses, such as setting up bedside procedures. Secondly, Cary et al. (2024) suggested that improved communication with families in the ICU increased family satisfaction. Lastly, communication education can improve the overall patient experience, as families who feel included and understood are more likely to be satisfied with the care provided (Sangi et al, 2023). A comprehensive approach to critical care nursing education, including communication education, can lead to improved patient outcomes, as strong communication is linked to increased adherence to treatment plans and enhanced patient satisfaction (Jones, 2023). This project aims to improve patient and family-centered care by equipping nurses with the communication strategies necessary to clarify discussion points after family meetings, explain the necessity of procedures common in the ICU, accurately and confidently convey changes in patient status, and foster healthy relationships with families, leading to clear goals of care (Wesleyan University, 2022). 8 Additionally, this MSN project can potentially reduce emotional distress for families by helping nurses understand their role as a liaison for families, informing and supporting them to make timely decisions, which will improve patient outcomes and nurse satisfaction. Communication education can foster a collaborative environment in which nurses, patients, and families work together toward common goals (Berger et al., 2023). Integrating communication education into the CCEN course can significantly enhance the quality of care provided, benefiting nurses, patients, and their families. To further understand the impact and necessity of this project, it is essential to review the existing literature highlighting the challenges and best practices in this critical area. Review of the Literature A literature review explored current evidence on the need for, use, and effectiveness of nurse-family communication education in the ICU. The PICOT question guiding this project's literature review was: In nurses completing the Critical Care Emergency Nurse (CCEN) course, how does family communication education, compared to no family communication education, affect their confidence in communication with patients and families throughout the duration of the course? Multiple systematic reviews and quantitative and qualitative studies were used to identify current evidence to support this project. The identified framework for this project is the Iowa Model of Evidence-Based Practice to Promote Quality Care (Melnyk & Fineout-Overhold, 2022). Framework This MSN project will apply the Iowa Model of Evidence-Based Practice to Promote Quality Care to facilitate the integration of research evidence into clinical practice. Originating from the University of Iowa hospitals and clinics in the 1990s, this model aims to systematically 9 guide clinicians through the process of implementing evidence-based practice (EBP) (North Carolina The process begins with identifying a “trigger,” which can be a clinical problem, new research findings, or organizational priorities, and may be problem-focused or knowledgefocused (Melnyk & Fineout-Overhold, 2022). Once a trigger is recognized, the next step is to clearly define the clinical question or purpose of the topic, ensuring it aligns with organizational priorities. Several feedback loops exist within the framework, the first being the evaluation of whether the topic is a priority. The next step is to engage a multidisciplinary team, bringing together stakeholders from various backgrounds to guide the systematic search for relevant research, critically appraise the quality and consistency of the evidence, and synthesize the findings. Another feedback loop involves evaluating if the evidence is sufficient. If the body of evidence is not strong enough to support the topic, the team may conduct further appraisals of evidence, including local practice or QI data, theory, case studies, or scientific principles, or conduct their own research (Melnyk & Fineout-Overhold, 2022). The next step is the development of a pilot for practice change, a critical step in the EBP process (Melnyk & FineoutOverhold, 2022). Baseline and post-implementation data are collected to evaluate the outcomes during this step. The final feedback loop of the framework involves evaluating if the change is appropriate for adoption in practice (Melnyk & Fineout-Overhold, 2022). If the practice change is not suitable for adoption and implementation, options include redesigning the intervention, gathering additional evidence, or conducting further research to inform practice decisions (Melnyk & Fineout-Overhold, 2022). If the pilot demonstrates success, the change is finally disseminated and implemented on a broader scale. The Iowa Model framework is applied to this project as it heavily emphasizes the pilot 10 phase. The problem-focused trigger of lack of communication education within the Critical Care Emergency Nurse (CCEN) course has been identified. The identified purpose of the project is to provide education for nurses in the course, aiming to improve nurses’ confidence in nurse-family communication and ultimately enhance care coordination in the ICU. By identifying a course instructor as a content expert for the project, the project's topic has been assessed and validated as a priority. Team identification includes key stakeholders such as students, course instructors, and the CCEN course director. The body of evidence will be compiled using prominent online databases accessed through Weber State University, the Agency for Healthcare Research and Quality (AHRQ), and professional organizations such as the American Association of CriticalCare Nurses (AACN). Upon completing the synthesis of evidence, it is essential to assess whether there is sufficient evidence to support the need for family communication education in critical care nursing and simulation as a means of learning. Because the CCEN course follows consistent start and end dates each year, designing and implementing a pilot program for nurse-family communication education within a particular class is straightforward. Pre- and postimplementation surveys will help determine whether the education instruction and simulation portion is appropriate for adoption into the curriculum. Strengths and Limitations The Iowa Model of Evidence-Based Practice to Promote Quality Care is a widely used nursing framework that offers notable strengths and limitations. One of its primary strengths is its structured step-by-step approach, allowing usability across all experience levels (Melnyk & Fineout-Overhold, 2022). Another strength of the project is the critical decision points, acting as feedback loops to ensure the necessity and consistency of the project (Melnyk & Fineout- 11 Overhold, 2022). For example, if the appraised evidence supporting nurse-family communication education is insufficient for the pilot design, the framework guides clinicians in conducting further research to ensure the pilot is developed on the best available evidence. There will be multiple sources of evidence to aid in the design of the pilot for this project, including evidence supporting nurse-family communication education for critical care nurses and evidence supporting the use of simulation for communication education. However, the Iowa Model has some limitations. One limitation is that it can potentially be resource-intensive, requiring significant collaboration, evidence appraisal, and pilot testing. As a result, smaller healthcare settings may find it challenging to implement all steps of the model effectively (Melnyk & Fineout-Overhold, 2022). To overcome this challenge, resources should be extracted in-house, to include simulation staff, teaching venues, and materials, and leveraging online technologies when appropriate. Another limitation is that the model requires stakeholder buy-in to sustain practice change (Melnyk & Fineout-Overhold, 2022). Using the Iowa Model for an interpretive descriptive design, Duff et al. (2020) found four key determinants of an EBP culture: process, support, facilitation, and context. Upon the project's implementation, all four determinants must be considered annually, posing a challenge to consistently improve the delivery and format of communication education. Search Strategies A literature search utilizing CINAHL, Google Scholar, and PubMed databases, as well as the Agency for Healthcare Research and Quality (AHRQ) and the American Association of Critical-Care Nurses (AACN), was performed to identify current evidence. Filters were used to search articles published from 2019 to 2025 to ensure the most up-to-date articles were reviewed and appraised. Boolean combinations for critical care nurses, family communication, and 12 existing communication tools were utilized to find relevant research. Search terms included “critical care nurses” OR “intensive care unit nurses” OR “ICU nurses” AND “communication” OR “communication tools” AND “family” OR “family education”. Alternate search terms included “family meetings,” “FICUS,” and “family-centered care”. Along with articles intended for the adult intensive care unit population, results also included pediatric, neonatal, and palliative care environments. Pediatric and neonatal articles were not excluded from the search; however, no articles that included these populations were appraised and included in this review. Synthesis of Literature The literature review identified three significant themes: communication dynamics in the ICU environment, the effects of ineffective communication on patient and family outcomes, and the need for nurse education on communication with families. The first theme outlined common communication dynamics in the ICU, which are complex and require clear, empathetic, and culturally sensitive interactions to overcome barriers such as emotional distress, altered health literacy, and systemic challenges (Abdullah et al., 2025; Berger et al., 2023; Beuret & Veislinger, 2021; Jones, 2023; Reifarth et al., 2024; Stewart, 2021; Teusen et al., 2022). The second theme examined how effective communication in the ICU significantly enhances psychological wellbeing and patient outcomes for both families and nurses, while poor communication exacerbates emotional distress, leads to misunderstandings, and prolongs ICU stays (Abdallah et al., 2025; Beuret & Veislinger, 2021; Cary et al., 2024; Linton, 2020; Shirasaki et al., 2023). The third theme examined how communication education for ICU nurses enhanced their ability to facilitate clear and empathetic interactions with families and clinicians, leading to improved patient and family satisfaction, stronger therapeutic relationships, and greater workforce stability (Abbasi Siyah Sangi et al., 2023; Blackmon et al., 2025; Chia et al., 2020; Jones, 2023; Joo et al., 13 2024; Shirasaki et al., 2023). Family-Nurse Communication Dynamics in the Intensive Care Unit The ICU is a highly stressful environment, and family members, who may otherwise comprehend healthcare information in lay terms, often experience altered health literacy due to emotional distress and anxiety, which can make it challenging for them to understand complex medical information and participate meaningfully in care decisions (Jones, 2023). From the moment a patient is admitted to the ICU, critical decisions for survival are made. These decisions require input from patients and family members or surrogates, should the patient not have the physical capability to make decisions for life-sustaining treatment when needed (Tuesen et al., 2022). Research from Tuesen et al. (2022) highlighted the importance of family involvement in completing and understanding the Physician Orders for Life-Sustaining Treatment (POLST) form during admission. Patients identified family members as key participants in these discussions, emphasizing the need for their active role in decision-making. Throughout the length of stay in the ICU, next-of-kin identification, explanations of what to expect in the ICU, patient status updates, critical decision points, and delivery of bad news all require different levels of communication. Beuret & Veislinger (2021) further examined common communication methods and the issues they may cause, noting that numeric statements, such as percentages or ratios, do not necessarily improve family understanding of prognosis compared to qualitative statements. In fact, numeric expressions like “1 in 5 patients” may be misinterpreted or perceived as pessimistic, underscoring the importance of using supportive and clear language (Beuret & Veislinger, 2021). This review suggested that while visual aids and brochures about ICU equipment and procedures can be helpful, the way prognosis is communicated should prioritize 14 emotional support alongside clarity. However, as patient acuity becomes more critical, these decisions and updates require careful attention, and several unique barriers to effective communication exist in the ICU. Barriers to effective communication between healthcare teams and families in the ICU are well-documented in the literature, as several studies identified an array of contributing factors (Abdullah et al., 2025; Beuret & Veislinger, 2021; Jones, 2023; Stewart, 2021). Jones (2023) conducted a comprehensive review and identified three primary barriers: health literacy, diversity, and the impact of the COVID-19 pandemic, as well as cultural sensitivity. Jones (2023) noted that when communication lacks cultural awareness, families may feel unheard or misunderstood, which can erode trust and hinder collaboration. The COVID-19 pandemic further complicated communication, as family liaison teams were introduced to bridge gaps created by visitor restrictions (Jones, 2023). However, many of these team members lacked specialized training in critical care, resulting in inconsistent messaging and additional confusion for families (Jones, 2023). Abdallah et al. (2025) highlighted systemic barriers in low-resourced and understaffed healthcare organizations, where inadequate communication training for staff further impeded effective interactions with families. Stewart (2021) identified four significant barriers through qualitative interviews with newly licensed nurses: challenging learning environments that demand rapid adaptation, frequently changing nursing shift patterns, cultural clashes, and the high-risk culture inherent to the ICU. These factors contributed to communication breakdowns, making it difficult for nurses to establish rapport and trust with families. Perceptions of therapeutic communication itself can further challenge the delivery of empathetic and supportive communication. Reifarth et al. (2024) revealed, through a mixed-methods study, that families 15 and clinicians often hold differing beliefs about what constitutes empathetic language and behavior. Notably, families identified reassurance of non-abandonment as the most empathetic gesture, highlighting the importance of emotional support and continuity in care. Moreover, Berger et al. (2023) found that in-person family meetings were significantly more effective than clinical decision tools in providing families with a clearer understanding of patient prognoses and facilitating decision-making. These meetings fostered direct communication, allowing families to ask questions, express concerns, and participate actively in care decisions. In the ICU, effective communication that is clear, supportive, and culturally sensitive is essential for helping emotionally distressed families understand complex medical information and participate in critical care decisions, yet numerous barriers can hinder this process. Communication Impacts on Patient Outcomes and Nurses Research conducted by Abdallah et al. (2024) further underscored the significance of effective communication. This cross-sectional descriptive study of 244 family members of adult ICU patients utilized the Family Intensive Care Unit Syndrome (FICUS) inventory surveys, Ryff’s Psychological Well-being Scale, and the Healthcare Communication Questionnaire. The study found that healthcare communication serves as a direct conduit in the relationship between family dynamics in the intensive care unit and psychological well-being (Abdallah et al., 2024). Shirasaki et al. (2023) added to this perspective by demonstrating that information handouts and diaries are valuable tools for both understanding patient prognoses and providing emotional support to families. In the palliative care context, Cary et al. (2024) evaluated a bedside toolkit designed to improve communication between clinicians and caregivers in a surgical ICU. Families reported that the toolkit empowered them to formulate more informed questions for 16 interactions with their care team, thereby enhancing their engagement and understanding. However, lack of communication can exacerbate the unique psychological impacts of critical care on both nurses and families. Linton (2020) drew upon Erich Lindemann’s Crisis Theory to describe the profound psychological toll experienced by family members of ICU patients. Common behaviors, such as hovering, seeking information, tracking patient progress, and garnering resources, reflected the intense need for knowledge and support from nursing staff (Linton, 2020). These emotional and psychological challenges are collectively referred to as Family Intensive Care Unit Syndrome (FICUS), which encompasses symptoms like anxiety, depression, and post-traumatic stress (Abdallah et al., 2025). Effective communication with and support for families can substantially improve such heavy psychological burdens on family members. Beuret & Veislinger (2021) add that families’ inaccurate expectations, often stemming from misunderstandings of prognosis by clinicians, can lead to overly optimistic beliefs and prolonged ICU stays, even in cases of poor or grave prognoses. Ultimately, effective communication in the ICU is crucial for enhancing the psychological well-being and engagement of both families and nurses. In contrast, poor communication can intensify emotional distress and lead to misunderstandings about patient prognosis and care. Benefits of Communication Education for Nurses Nurses play a pivotal role as facilitators of communication between clinicians and families in the ICU (Jones, 2023; Shirasaki et al., 2023). Nurses’ position at the bedside enabled them to bridge gaps in understanding and foster meaningful interactions that supported both patient care and family well-being. Chia et al. (2020) conducted research that identified four key aspects of ICU communication training: the fundamentals of communication, factors influencing communication, strategies for evaluating communication effectiveness, and the outcomes 17 associated with training. Findings recommended a multimodal approach to communication education, incorporating topics such as delivering bad news, building therapeutic relationships, shared decision-making, ethics, and leadership roles (Chia et al., 2020). Research also supported the use of safe learning environments, including both didactic and simulation-based methods, clear objectives, dedicated timelines, and the application of Kirkpatrick’s Hierarchy, a four-level model for evaluating training effectiveness (Chia et al., 2020). Joo et al (2024) reviewed nurse knowledge of patient- and family-centered care across more than 2,000 records, concluding that educational programs focused on these principles would benefit ICU nurses. However, the authors noted that further research is needed to address specific knowledge gaps, particularly in areas such as self-awareness, clarity of beliefs and values, and collaboration. The research shared here highlights the evolving nature of communication training and the need for ongoing curriculum development. Blackmon et al. (2025) demonstrated the practical benefits of communication education through a fellowship program for newly graduated nurses, which included training in family communication. Remarkably, the program achieved a 96% retention rate of participants after one year in their respective ICUs, suggesting that such training not only improved communication skills but also supported workforce stability. Abbasi Siyah Sangi et al. (2023) further reinforced the value of family-centered education, finding that family satisfaction scores improved following the implementation of communication training for ICU nurses. Collectively, these studies underscore the need for structured, multimodal communication training for ICU clinicians. By addressing the occupational and interpersonal aspects of communication, these programs fostered improved relationships with patients and families, enhanced satisfaction and contributed to a safer and more supportive ICU environment. 18 Structured, multimodal communication training for ICU nurses enhances their ability to bridge the understanding between clinicians and families, improves patient and family satisfaction, supports workforce stability, and fosters a safer, more supportive ICU environment. Summary of Literature and Application to the Project This MSN project literature review examined the vital role of communication between nurses, clinicians, and families in the ICU. It highlights the communication dynamics that exist within the ICU (Abdallah et al., 2025; Jones, 2023; Stewart, 2021; Tuesen et al., 2022). The literature also examined the psychological effects of ineffective communication in the ICU on families and nurses (Abdallah et al., 2025; Beuret & Veislinger, 2021; Cary et al., 2024; Linton, 2020; Shirasaki et al., 2023). Finally, the review highlighted the importance of structured communication training for ICU nurses, demonstrating that multimodal educational programs improved both family satisfaction and nurse retention (Abbasi Siyah Sangi et al., 2023; Blackmon et al., 2025; Chia et al., 2020; Jones, 2023; Joo et al., 2024; Shirasaki et al., 2023). Overall, the research emphasized that compassionate, clear, and consistent communication is crucial for supporting families, improving patient care, and promoting a safer ICU environment. The information explored in this section supports the proposed MSN Project, which will incorporate family communication education into the didactic and simulation components of the CCEN course. Project Plan and Implementation The aim of this MSN project is to implement an evidence-based educational activity within the CCEN course that improves ICU nurses’ ability to communicate effectively with patients’ families, addressing challenges such as inconsistent reporting and family dissatisfaction through stakeholder collaboration and data-driven instructional design. The overall goal is to 19 ensure the activity is relevant, impactful, and sustainable by integrating structured evaluation, ongoing revision, and multidisciplinary teamwork, ultimately supporting quality, family-centered nursing practice. Plan and Implementation Process The primary objective of this initiative is to implement an evidence-based educational activity within the CCEN course that enhances ICU nurses’ ability to communicate effectively with patients’ families. This plan integrates stakeholder collaboration, a thorough assessment of learner needs, and a structured evaluation to ensure that the intervention is both relevant and impactful. Utilizing the Iowa model for evidence-based practice, this project’s process begins with the identification of problem-focused triggers (Melnyk & Fineout-Overhold, 2022); namely, newly trained ICU nurses frequently report challenges in communicating with distressed families, which can lead to inconsistent reporting, family dissatisfaction, moral distress, or conflict. The variability in nurses’ prior communication training and confidence levels further compounds these issues (Elias & Day, 2020). It is the aim that the CCEN course faculty and program director consider addressing this issue a strategic priority, warranting the development of an evidence-based intervention, as evidence reveals that recognizing that family communication directly influences patient- and family-centered care outcomes. The next step involves forming a multidisciplinary team of stakeholders, each with distinct roles. These stakeholders include the MSN project coordinator, the CCEN program director, course instructors, and CCEN students. There will be three meetings with the CCEN program director; the first meeting will highlight the key themes outlined in the research, including the communication dynamics that exist within the ICU (Abdallah et al., 2025; Jones, 2023; Stewart, 2021; Tuesen et al., 2022), communication impacts on patient outcomes and 20 nurses (Abdallah et al., 2025; Beuret & Veislinger, 2021; Cary et al., 2024; Linton, 2020; Shirasaki et al., 2023), and the benefits of communication education for nurses (Abbasi Siyah Sangi et al., 2023; Blackmon et al., 2025; Chia et al., 2020; Jones, 2023; Joo et al., 2024; Shirasaki et al., 2023). Requests for endorsement via Memorandum for Record (MRF) for statistical analysis by the Army’s Medical Center of Excellence will also be discussed. Subsequent meetings with the program director will occur throughout the implementation process, concurrent with meetings with the remaining stakeholders. To guide the design of the intervention, the MSN project coordinator will assemble, appraise, and synthesize evidence from peer-reviewed literature on ICU family communication, ICU nurse confidence in family interactions, and professional standards supporting familycentered care. The evidence demonstrates that structured nurse-family communication education activities improve family satisfaction, while simulation and role-play enhance skill transfer (Chia et al., 2020). Additionally, needs-based education, facilitated through these formative assessments, increases learner engagement and outcomes (Sirianansopa, 2024). With sufficient evidence to guide practice, the MSN project coordinator will proceed to design the intervention. A pre-course needs assessment is conducted using an electronic survey distributed to enrolled CCEN nurses. At the second touchpoint with the program director, pre-course survey feedback will be collected regarding best practices for delivering surveys to CCEN students, as well as the clarity of content in both surveys. This survey collects data on years of nursing experience, confidence in communicating with families, common communication challenges (such as dealing with anger, grief, or discussing prognosis), and prior formal training in communication with families. The results are compiled and analyzed to identify priority scenarios (such as goals of care conversations, life-sustaining treatment plans, and telephonic 21 updates), and the complexity of role-play exercises and instructional emphasis is tailored to the learners’ needs. This data-driven approach ensures that educational activity is responsive to the actual challenges faced by nurses in the ICU. Implementation takes place during scheduled CCEN course sessions, with the pilot educational activity taking place during the trauma didactic week. Activities include administering the pre-course survey, delivering the communication educational activity, facilitating active participation and reflection, and encouraging nurses to apply newly acquired skills in their clinical practice. The structured nature of the intervention promotes engagement and skill transfer, while ongoing support from instructors, clinical preceptors, and the nurse educator reinforces learning. Evaluation of outcomes is conducted using two methods. Learner self-assessment involves pre- and post-confidence ratings and perceived skill improvement on a Likert scale with additional comment space. Debriefing evaluations are based on role-play observation checklists and feedback from the MSN project coordinator. These evaluation methods provide a comprehensive picture of the intervention’s effectiveness and areas for further development. The final touchpoint with the program director will include discussions of the post-survey data and a plan for adopting activities in future CCEN cohorts. To ensure sustainability, the activity is revised based on evaluation findings and incorporated into future CCEN cohorts. Outcomes are shared with program leadership to promote broader adoption and implementation. Dissemination options include internal educator meetings, nurse residency or orientation programs, and professional development sessions. This systematic approach, guided by the Iowa Model of Evidence-Based Practice, ensures that the development, delivery, and evaluation of the ICU family communication teaching activity are 22 grounded in stakeholder engagement, data-driven instructional design, and measurable outcomes, ultimately supporting high-quality, family-centered nursing practice. Interdisciplinary Team The interdisciplinary team consists of the MSN project coordinator, the CCEN Program Director, and CCEN instructors, who collaborate to design, approve, and deliver a learnercentered ICU family communication teaching activity, and the CCEN nurses. Their overall goal is to ensure the activity is evidence-based, aligns with program standards, and is seamlessly integrated into the curriculum for effective nurse education. MSN Project Coordinator The MSN project coordinator, serving as the project lead, is responsible for designing the teaching activity and evaluation tools, delivering the pilot educational activity, developing and analyzing the pre-course survey, and coordinating both implementation and evaluation efforts. This collaborative approach ensures that the intervention is grounded in practical experience and educational best practices. CCEN Program Director The CCEN Program Director oversees and approves the teaching activity, ensuring it aligns with their program of instruction (POI), course objectives, and institutional standards, and authorizes its integration into the curriculum. The program director will also endorse the request for statistical analysis of the evaluations by the CCEN course’s higher command, the Army Medical Center of Excellence. Buy-in from this program director is imperative; therefore, substantiating evidence must be presented to proceed with the implementation process. CCEN Instructors CCEN Course Instructors contribute instructional input and clinical expertise, assist with 23 embedding the activity into existing content, and facilitate role-play, simulation, and debriefing sessions. Meetings are held to review the activity layout and timing, align scenarios with course objectives, and assign facilitation roles. The CCEN Instructor involvement ensures that the intervention is seamlessly integrated into the CCEN curriculum and that all instructors are prepared to support its delivery. The result is a finalized, learner-centered teaching plan ready for implementation. Critical Care Clinical Nurse Specialist Critical care clinical nurse specialists (CNSs) will serve as the primary educators for the pilot phase of this MSN project, leading the implementation of family communication education within the CCEN course. As expert facilitators, CNSs will deliver structured teaching activities and support role-play simulation exercises to help ICU nurses develop effective communication skills with patients’ families. One CNS will collaborate with the MSN project coordinator and the CCEN program director to ensure the curriculum aligns with evidence-based practice and meets learners' needs. CNSs will also participate in evaluating learner outcomes, providing feedback throughout the implementation process. Through their leadership and expertise, CNSs will help foster a supportive learning environment and promote high-quality, family-centered care in the ICU. Students or CCEN Nurses The CCEN nurses are trained in this course to manage complex patient needs across the intensive care continuum in fixed facilities and operational environments. The course accommodates thirty students, composed primarily of Active-Duty registered nurses, but also includes Reserve Component (RC) registered nurses and international students from partner nations. Students largely contribute to the implementation and evaluation of the MSN project by 24 participating as the target audience for the PowerPoint presentation and simulation activities. The students will also complete pre- and post-surveys, offering feedback on the lecture, simulation scenarios, and overall activity content, which will inform future improvements to the activity. Description and Development of Project Deliverables Seven deliverables will be used to implement this MSN project. The deliverables include 1) a PowerPoint presentation for stakeholders, 2) an instructor outline to train CCEN learners, 3) pre- and post-confidence surveys via Google Forms, 4) the V.A.L.U.E. mnemonic to be utilized during the simulation scenarios, 5) a communication simulation validation tool, 6) scripts for the actors, 7) an agenda and a timeline for the entire learning activity. This section will discuss the deliverables and their implementation within this MSN project. PowerPoint Presentation for CCEN Learners The first deliverable for this MSN project is a PowerPoint presentation (see Appendix A). This PowerPoint aims to educate CCEN students on effective family communication strategies in the ICU, emphasizing the importance of family involvement, family support, and therapeutic communication. It describes family attitudes toward ICU hospitalization, identifies barriers and motivators to family engagement, and provides key strategies to address family needs in the ICU during specific situations, including procedural consents, status updates, and transition to comfort care. The presentation provides evidence-based tools and structured frameworks for nurses to facilitate clear, compassionate, and factual communication with families throughout the ICU trajectory. This PowerPoint presentation will be presented in person by the critical care clinical nurse specialist (CNS) at the beginning of the learning activity, with simulation exercises to follow. Instructor Outline to Train the CCEN Learners 25 The second deliverable, the instructor outline (see Appendix B), is intended to help instructors deliver consistent, evidence-based training to ICU nurses on effective communication with families during critical care situations. The outline prompts instructors to allow time for student introductions and to clarify the training's purpose. Focus areas for instructors to support the learning objectives in the PowerPoint presentation are also given throughout the outline. The outline also provides discussion prompts to encourage engagement with CCEN nurses throughout the presentation. This outline will be provided to CNSs, CCEN instructors, the CCEN program director, and aids instructors to create an engaging environment throughout the presentation, with time for reflection and the sharing of ideas. Course Agenda The third deliverable, the course agenda (see Appendix C), includes a comprehensive timeline for a 45-minute block of instruction followed by three fifteen-minute simulation exercises and a five-minute post-huddle. The course agenda will be provided to the CNSs, CCEN instructors, and the CCEN program director. It is essential that CNSs receive the course agenda to prepare and, if needed, conduct rehearsals prior to beginning the learning activity. Confidence Surveys The fourth deliverable is the pre- and post-surveys (see Appendix D). The pre-survey will be administered via Google Forms to assess CCEN nurses’ baseline confidence, knowledge, and self-reported application of evidence-based family communication strategies in the ICU. Survey items focus on key domains, including emotional management, delivering difficult information, end-of-life communication using structured communication techniques, and advocacy within the interprofessional team. The post-survey will be administered via Google Forms following the educational presentation and simulation activities to evaluate positive, negative, or neutral 26 changes in nurses’ perceived confidence and readiness to apply these strategies in clinical practice. Comparison of pre- and post-survey responses will be used to measure the effectiveness of the learning activity and identify areas for refining the training. V.A.L.U.E. Mnemonic The fifth deliverable, the V.A.L.U.E. mnemonic (see Appendix E), is an evidence-based ICU communication tool designed to help nurses reduce family anxiety, depression, and posttraumatic stress symptoms after hospitalization (Jones, 2023). It guides nurses to validate family comments, acknowledge emotions, listen actively, understand the patient as a person, and elicit family questions, ensuring that families feel heard and supported during critical care situations (Jones, 2023). The V.A.L.U.E. mnemonic will be encouraged throughout the PowerPoint presentation and in all three scenarios of the simulation exercises. Communication Skills Validation Tool The sixth deliverable, Communication Skills Validation Tool (see Appendix F), is designed to evaluate and validate learners’ skills in areas such as presence, professionalism, family assessment, information delivery, and support during comfort care, using structured performance criteria and multiple evaluation methods. It provides a standardized approach for educators and clinical evaluators to assess whether staff meet required standards through observation, demonstration, verbalization, and educational sessions on ICU orientation, delivering critical information, and supporting families during transition to comfort care. Utilization of the V.A.L.U.E. mnemonic is a key component of skill checkoffs for each category. Ultimately, it ensures that staff are competent in key aspects of patient and family interaction, supporting quality care in clinical settings. 27 Scenario Scripts The seventh deliverable for this MSN project is the script for the simulation scenarios (see Appendix G). The scenarios are designed to help CCEN students practice communication and emotional support in three distinct situations: orienting families during ICU admission, updating them after a traumatic injury, and guiding them through the transition to comfort care. Each scenario provides a specific context: a sudden ICU admission, a post-surgical update after a motor vehicle crash, and a difficult decision about end-of-life care. Roles for the scenarios include the nurse (learner), family member (actor), and provider (instructor). The scripts offer opening cues and prompts for each actor. The purpose of these prompting sentences is to guide nurses to validate emotions using the V.A.L.U.E. mnemonic, clarify information, and advocate for family understanding while maintaining professional boundaries. Through these scenarios, nurses are equipped to respond empathetically and effectively to families facing uncertainty, distress, and grief in the ICU setting, with adequate repetition of evidence-based communication tools. Timeline The proposed implementation of this MSN project (see Appendix H) will occur over a six-month period to allow for stakeholder engagement, instructor preparation, delivery of the educational intervention, and evaluation of outcomes. During the first month, the project coordinator will meet with the Critical Care Emergency Nurse Course (CCEN) program director to present the project's purpose, review evidence supporting family-centered communication strategies, demonstrate alignment with the existing course objectives, and request endorsement for statistical analysis conducted by MEDCoE. Formal approval and leadership buy-in will be obtained during this phase through a memorandum of agreement (MOA), a memorandum for 28 record (MFR), and critical care clinical nurse specialists who will participate in the project will be identified. In the second month, all educational and evaluation materials will be finalized, including the didactic PowerPoint presentation, simulation scenarios and scripts, skill checkoff tools, instructor guide, and pre- and post-surveys. This phase ensures that all materials are standardized, evidence-based, and consistent. Any revisions requested by CCEN leadership or faculty will be incorporated during this time before moving forward. The third month will focus on training CNS instructors who will deliver the instructional block and facilitate simulation activities. Instructor training will include a review of the PowerPoint presentation, the V.A.L.U.E. mnemonic, expectations for simulation facilitation and debriefing, and use of the instructor guide, skill validation tool, and agenda. This step is critical to promote consistency and fidelity of the project. In the fourth month, the project’s pre-survey will be disseminated to CCEN participants via Google Forms to assess baseline confidence, knowledge, and perceived capabilities in applying family communication strategies in the ICU. Adequate time will be provided for survey completion. Pre-survey responses will be compiled to identify baseline trends and potential areas of emphasis during instruction. Therefore, the instructor guide may be revised based on trends identified in the pre-survey results. The learning activity will be delivered in the fifth month, consisting of a 90-minute session: a 45-minute didactic PowerPoint presentation followed by three 15-minute simulation scenarios with facilitated debriefing. The project lead will provide support as needed during early implementation to ensure adherence to the planned structure and learning objectives. In the final month, the project post-survey will be administered via Google Forms to 29 evaluate changes in nurses’ confidence and preparedness following the educational activity. Preand post-survey data will be compared to assess the intervention's effectiveness, and the results will be summarized and shared with CCEN leadership and key stakeholders. Findings will inform recommendations for sustainability, revision, or future expansion of the family communication training within the CCEN program. This MSN project includes seven key deliverables: a PowerPoint presentation, an instructor outline, a course agenda, pre- and post-confidence surveys, the V.A.L.U.E. mnemonic, a communication skills validation tool, and scenario scripts. The educational activities combine presentations, hands-on simulations, and structured evaluation to build and compare results for nurses’ confidence and competence in communicating with families during critical care situations. Implementation will occur over six months, with ongoing stakeholder engagement, instructor training, and evaluation to ensure the program’s effectiveness and guide future improvements. Project Evaluation The aim of this MSN project is to improve ICU nurses’ ability to communicate effectively with patients’ families through stakeholder collaboration and data-driven instructional design and evaluation. Evaluation will include both formative and summative methods to assess the intervention's effectiveness and guide ongoing revision for future cohorts. Formative evaluation will occur throughout the implementation phase and will focus on learner engagement, clarity of instructional content, and feasibility of the simulation activities provided by all stakeholders. During the educational session, instructors and the MSN project coordinator will observe learner participation and engagement behaviors during simulation scenarios and during debriefing discussions using the Communication Skills Validation Tool. 30 Informal feedback from CCEN instructors and critical care clinical nurse specialists (CNSs) will be collected during rehearsals and following the didactic presentation and simulations to identify areas requiring clarification, pacing adjustments, or modifications of the simulation scenarios. The formative data will support necessary revisions, thereby improving the fidelity of the intervention. The summative evaluation will focus on measuring changes in nurses’ perceived confidence and preparedness in communicating with families across the ICU continuum through the confidence survey results. The summative evaluation will be accomplished using pre- and post-intervention confidence surveys administered to the students electronically via Google Forms. Survey items assess categories such as delivering difficult information, managing family emotions, participating in goals-of-care discussions, and advocating for family involvement. Comparison of pre- and post-survey results will allow quantitative analysis regarding changes in self-reported confidence following the intervention. Additionally, qualitative comments from open-ended survey questions at the end of each survey will be reviewed to capture learner perceptions of relevance, applicability, and overall satisfaction with the educational activity. The findings from this project will directly inform the decision-making process regarding adoption, modification, or discontinuation of the intervention, consistent with the Iowa Model of Evidence-Based Practice. Outcome data from the pre- and post-intervention surveys will be analyzed to determine whether the educational program meaningfully improved nursing students’ confidence and perceived competence in navigating difficult conversations. If the findings demonstrate statistically significant improvement aligned with predetermined benchmarks, the Iowa Model supports transitioning the intervention from a pilot initiative to standard practice within the curriculum. Likewise, if outcomes fall short of expectations, the 31 model guides stakeholders to re-examine the intervention components, implementation fidelity, or other barriers before determining whether revisions are warranted. Findings from the summative evaluation will be shared with CCEN leadership and used to inform decisions regarding the adoption and any needed revisions of the communication training for future course cohorts. Statistical analysis will be conducted and distributed back to the MSN project coordinator by the Statistical Analysis Cell (SAC) of the CCEN course’s higher command, the Army Medical Center of Excellence (MEDCoE). Overall, the evaluation tools for this MSN project will assess the intervention’s effectiveness, guide revisions, and inform future course adoption, with results analyzed and shared with leadership. Since these processes involve data collection and participant observation, ethical considerations such as informed consent, confidentiality, and responsible data handling must be addressed. Ethical Considerations Ethical considerations for this MSN project are guided by principles of respect, social responsibility, equity, and protection of participants. Participation in the educational activity and associated surveys will be voluntary, and CCEN nurses who choose not to participate in survey components will not experience any academic or professional penalty. Participation or nonparticipation in the surveys will not influence course standing, military Academic Evaluations Reports (AERs), or matriculation through the CCEN program. This approach ensures that autonomy and fairness are upheld throughout the project. To protect participant privacy, all survey responses will be collected anonymously, with no identifying information linked to individual participants. Data will be stored securely and accessed only by the MSN project coordinator for evaluation purposes. Although no questions 32 will be asked that could identify participants, results will be reported in aggregate form to prevent the identification of individual respondents. Simulation performance data will be used solely for educational feedback and program evaluation rather than individual competency evaluation. To ensure students are well-informed about the consequences of not participating, this will be explicitly stated at the beginning and throughout the implementation phase. This project reflects non-discriminatory and socially responsible practices by emphasizing inclusive, culturally sensitive communication strategies applicable to diverse patient populations. These populations include military families, retirees, civilians, and individuals with varying cultural and health literacy levels. The educational content reinforces respectful engagement with families regardless of background, belief system, or emotional response, as outlined in the educational tools. As the project lead and an experienced critical care nurse, the MSN project coordinator acknowledges the potential for personal bias, particularly regarding perceptions of communication competence and preferred communication styles. To mitigate this risk, standardized tools such as structured surveys, scripted simulation scenarios, and validation checklists will be used to promote reliability and objectivity in evaluation. Feedback from CCEN instructors and CNS educators will further support balanced interpretation of findings and reduce the influence of individual bias on project outcomes. Ethical considerations for this MSN project emphasize respect, equity, and participant protection by ensuring voluntary, non-graded participation, anonymous and secure data collection, non-discriminatory educational practices, and the use of standardized tools and feedback. 33 Discussion This MSN project addresses a practice gap in the Critical Care Emergency Nurse (CCEN) course didactics regarding the absence of structured communication education. The literature consistently demonstrated that ineffective communication with families in the intensive care unit (ICU) contributed to family distress, dissatisfaction, and potential safety concerns, and delayed decision-making (Abdallah et al., 2024). Findings also support structured, multimodal communication education incorporating simulation and guided debriefing as an effective strategy to enhance nurse confidence and patient and family outcomes (Chia et al., 2020). The proposed intervention for this project aligns with the Iowa Model of Evidence-Based Practice by identifying current evidence and creating a pilot didactic and simulation activity tailored specifically for CCEN students. By incorporating this training activity into the CCEN curriculum, this project promotes patient- and family-centered care and improved patient and family outcomes. Evidence-Based Solutions for Dissemination Dissemination of this project will occur at both organizational and course levels to support long-term adoption. At the organizational level, results of the pilot implementation will be presented to CCEN leadership, course instructors, and other key stakeholders via a poster. If outcomes demonstrate improved nurse confidence and perceived preparedness, recommendations will be made to incorporate the educational activity as a permanent component of the CCEN course curriculum, and, if applicable, other specialty courses within the treatment facility. These dissemination strategies promote equitable access to communication training and advancing quality improvement efforts beyond a single specialty course or cohort. 34 Significance to the Advancement of Nursing Practice This MSN project elevates nursing by treating communication as a measurable clinical competency rather than a soft skill to be acquired over time. While critical care education often focuses on technical knowledge, research shows communication failures can lead to sentinel events and family dissatisfaction (Communication between Clinicians | PSNet, 2019). Integrating structured communication training bridges several clinical and interpersonal gaps, aligns with patient- and family-centered care standards, empowers patient advocacy and family support, and improves outcomes, satisfaction, and retention in critical care settings (Zare et al., 2023). Implications This project impacts education and clinical outcomes and empowers the organization to incorporate communication into its efforts to promote a culture of safety. Integrating structured communication training in specialty courses can serve as a model for other nurse residency programs within the treatment facility. Evidence-based family communication education encourages active participation, while simulation-based scenarios provide a safe environment for practicing difficult conversations and managing emotional responses before real situations arise (Bienstock & Heuer, 2022). However, limitations for this project include reliance on selfreported confidence, lack of objective outcome data, single-site implementation, and time constraints. To address reliance on self-reported confidence, future iterations could incorporate the simulation prior to the slide presentation and follow-up assessments to measure sustained communication skills. Other strategies include incorporating patient and family outcome data, expanding implementation to the Air Force critical care course hosted at the treatment facility. Protecting anonymity, maintaining consistency with leadership and instructor engagement, and standardized tools to guide the educational topic (V.A.L.U.E. mnemonic) will help mitigate 35 response bias and support sustainability for long-term adoption. Recommendations Based on the literature and project findings, several recommendations are proposed for this project. First, the intervention should be sustained within the CCEN curriculum with annual review and revision to ensure alignment with emerging evidence and course objectives. Second, simulation facilitators should receive structured training in debriefing methods to ensure consistency and safety during student reflections. Third, future evaluation efforts may expand beyond self-reported confidence to include observational evaluations during clinicals provided by clinical preceptors. Beyond the initial 12-month implementation period, sustaining this intervention indefinitely will require evidence that the program contributes value beyond short-term improvements in self-reported confidence. While increased confidence is a meaningful early indicator, long-term sustainability may be justified through the development and evaluation of additional outcome measures over time. These may include reductions in reported communication-related incidents and preceptor assessments of the students’ communication performance. Ongoing annual review and revision will allow stakeholders to examine trends in these outcomes and determine whether the intervention continues to meet educational and organizational priorities. By demonstrating both immediate and evolving benefits tied to learner performance and expressed readiness, stakeholders can more confidently determine that the initiative represents a worthwhile investment in nursing education. Continued evaluation utilizing the Iowa Model will support ongoing refinement and sustainability of the intervention. By embedding communication education into specialty nursing curricula, this project promotes a comprehensive approach to critical care nursing that integrates 36 clinical expertise with compassionate, patient- and family-centered interaction. Conclusion This MSN project addressed a critical gap in the Critical Care Emergency Nurse (CCEN) course by proposing the integration of structured family communication education into the curriculum. The literature consistently demonstrates that ineffective communication in the intensive care unit contributes to family distress, decreased satisfaction, and potential safety concerns, while structured communication training improves nurse confidence, family engagement, and overall care outcomes (Abdallah et al., 2025; Beuret & Veislinger, 2021; Cary et al., 2024; Linton, 2020; Shirasaki et al., 2023). This project outlines a systematic plan to implement a multimodal educational intervention using the Iowa Model of Evidence-Based Practice, incorporating didactic instruction, simulation, structured evaluation tools, and stakeholder collaboration. By embedding evidence-based communication strategies into specialty nursing education, this initiative promotes patient- and family-centered care and advances critical care nursing practice in military and civilian healthcare settings. 37 References Abbasi Siyah Sangi, M., Heshmati Nabavi, F., Heidarian Miri, H., Nekouei Marvi Langari, M., & Haji Abadi, F. (2023). Enhancing family nursing practice: The effect of a supportiveeducational programme on the family nursing practice, family satisfaction and family perceived support in the intensive care unit. Family Medicine & Primary Care Review, 25(2), 121–127. https://doi.org/10.5114/fmpcr.2023.127678 Abbott, N. (2025, May 19). Critical Care. https://armyrotc.army.mil/critical-care/ Abdallah, H. M. M., Amin, S. M., Hammouda, E. Y., Atta, M. H. R., El-Monshed, A. H., & Hamad, N. I. M. (2025). Family Intensive Care Unit Syndrome: Investigating the mediating role of healthcare communication in psychological well-being among family members. Nursing in Critical Care. https://doi.org/10.1111/nicc.70119 Berger, B., Vick, J., You, H., Ma, J., Haverfield, M., Cox, C., Ubel, P., & Ashana, D. (2023). 651: Shared decision-making and surrogate prognostic understanding after family meetings in the ICU. Critical Care Medicine, 52(1), S298–S298. https://doi.org/10.1097/01.ccm.0001000776.18251.68 Bienstock, J., & Heuer, A. (2022). A review on the evolution of simulation-based training to help build a safer future. Medicine, 101(25), e29503. https://doi.org/10.1097/MD.0000000000029503 Beuret, P., & Veislinger, G. (2022). Communication with relatives on prognosis of critically ill patients. Medical Research Archives, 10(1). https://doi.org/10.18103/mra.v10i1.2657 Blackmon, E., Floriano, H., Fazio, S., & Doroy, A. (2023). Improving staffing in the ICU with new graduate nurses: A novel critical care fellowship program. International Journal of Critical Care, 17(2), 11–22. https://doi.org/10.29173/ijcc65 38 Cary, K. J., Place, A., McCrum, M., Grudziak, J., & McGuire, L. (2024). Efficacy of a communication toolkit to optimize palliative care communication in the surgical intensive unit. Patient Experience Journal, 11(3), 45–52. https://doi.org/10.35680/2372-0247.1898 Chia, E. W. Y., Huang, H., Goh, S., Peries, M. T., Lee, C. C. Y., Tan, L. H. E., Khoo, M. S. Q., Tay, K. T., Ong, Y. T., Lim, W. Q., Tan, X. H., Teo, Y. H., Kow, C. S., Chin, A. M. C., Chiam, M., Zhou, J. X., & Radha Krishna, L. K. (2021). A systematic scoping review of teaching and evaluating communications in the intensive care unit. The Asia Pacific Scholar, 6(1), 3–29. https://doi.org/10.29060/TAPS.2021-6-1/RA2351 Communication Between Clinicians | PSNet. (2019, September 7). Ahrq.gov. https://psnet.ahrq.gov/primer/communication-between-clinicians Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2021). Determinants of an evidence-based practice environment: an interpretive description. Implementation Science Communications, 1(1), 1–9. https://doi.org/10.1186/s43058-020-00070-0 Elias, C. E., & Day, T. (2020). Experiences of newly qualified nurses in critical care: A qualitative systematic review. Journal of the Intensive Care Society, 21(4), 175114372092679. https://doi.org/10.1177/1751143720926794 Gorman, J., Kung, J. Y., Rewa, O., Widder, S., & Slemko, J. (2024). Methods of detection of adverse events in critical care: a protocol for a systematic review. BMJ Open, 14(11), e085545–e085545. https://doi.org/10.1136/bmjopen-2024-085545 Jones, M. (2023). Improving family communication in critical care. The Canadian Journal of Critical Care Nursing, 34(1), 15–24. https://doi.org/10.5737/23688653-34115 Joo, Y., Han, E., & Jang, Y. (2025). Educational programs to improve nursing competency of patient- and family-centered care in intensive care units: A systematic review. Nurse 39 Education Today, 151, 106699. https://doi.org/10.1016/j.nedt.2025.106699 Linton, J. (2020). Reducing stress and anger among family members. Critical Care Nurse, 40(5), 58–65. https://doi.org/10.4037/ccn2020372 Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-Based Practice in Nursing & Healthcare (5th ed.). Wolters Kluwer Health. https://wsu.vitalsource.com/books/9781975185756 North Carolina Wesleyan University. (2022). LibGuides: Nursing - RN to BSN: IOWA Model. Libguides.com. https://ncwu.libguides.com/c.php?g=978066&p=7735441 Reifarth, E., Böll, B., Kochanek, M., & Garcia Borrega, J. (2024). Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study. Intensive & Critical Care Nursing, 81, 103601. https://doi.org/10.1016/j.iccn.2023.103601 Shirasaki, K., Hifumi, T., Nakanishi, N., Nobuyuki N., Miyamoto, K., Komachi, M., Haruna, J., Inoue, S., & Otani, N. (2024). Postintensive care syndrome family: A comprehensive review. Acute Medicine & Surgery, 11(1). https://doi.org/10.1002/ams2.939 Sirianansopa, K. (2024). Evaluating students’ learning achievements using the formative assessment technique: a retrospective study. BMC Medical Education, 24(1). https://doi.org/10.1186/s12909-024-06347-5 Stewart, C. (2021). Understanding new nurses’ learning experiences in intensive care. Intensive and Critical Care Nursing, 67(103094), 103094. https://doi.org/10.1016/j.iccn.2021.103094 Tuesen, D. L., Ågård, A. S., Hans-Henrik Bülow, F., E. K., & Jensen, H. I. (2022). Decisionmaking conversations for life-sustaining treatment with seriously ill patients using a 40 Danish version of the US POLST: a qualitative study of patient and physician experiences. 40(1), 57–66. https://doi.org/10.1080/02813432.2022.2036481 Zare, F., Jamileh Farokhzadian, M. Nematollahi, Miri, S., Mohammad Ali Zakeri, & Golnaz Foroughameri. (2023). Therapeutic communication skills training: An effective tool to improve the caring behaviors of ICU nurses. Acta Medica Iranica, 61(5). https://doi.org/10.18502/acta.v61i5.13486 41 Appendix A PowerPoint Presentation for CNSs and CCEN Students Family Communication Strategies for Nurses in the Intensive Care Unit Khaleesha Williams Annie Taylor Dee School of Nursing Weber State University Jamie Wankier, EdD, MSN, RN MSN Project Terminal Learning Objective o Action: Describe family attitudes toward intensive care unit (ICU) hospitalization and identify barriers and motivators for family involvement o Condition: Simulation center conference room for classroom instruction, followed by a patient simulation room with the activity instructor and CCEN faculty o Standard: Apply evidence-based communication strategies across the ICU trajectory. Utilize structured tools to support family-centered care 42 Why Family Communication Matters in the Intensive Care Unit (ICU) o In the inpatient critical care setting: o Patients are frequently unable to verbally communicate (Beuret & Veislinger, 2022). o Approximately 20% of deaths in the U.S. occur in the ICU o Most involve family members acting as surrogates for the patient (Rhoads & Amass, n.d.). Why Family Communication Matters in the Intensive Care Unit (ICU) Cont… Poor communication is a persistent cause of sentinel events • Clinician-family communication (Communication between Clinicians | PSNet, 2019) Families involved in decisionmaking are predisposed to • Psychological burdens • Physical burdens • Socioeconomic burdens (Shirasaki et al, 2024). 43 Section I: Family Attitudes Toward ICU Hospitalization Family Perspectives in the ICU o Family Intensive Care Unit Syndrome (FICUS) (Abdallah, et al., 2025) o Erich Lindemann’s Crisis Theory (Linton, 2020) o Studies suggest that family members view clinicians' communication skills as more important than clinical skills (Rhoads & Amass, n.d.). o Information needs during critical illness (Rhoads & Amass, n.d.). • Family preferences for involvement in lifesupport decisions vary • Assess each family’s preferred role - Do not assume a one-size-fits-all approach. 44 Motivators for Family Involvement (Wong, et al., 2019) Barriers to Communication HEALTH LITERACY CULTURAL DIVERSITY ENVIRONMENTAL FACTORS (Jones, 2020) PSYCHOLOGICAL CAPACITY 45 Section II: Communication Strategies During ICU Admission First Impressions Matter ICU ADMISSION IS A CRITICAL COMMUNICATION MOMENT ESTABLISH RAPPORT AND PSYCHOLOGICAL SAFETY SET EXPECTATIONS EARLY 46 Key Strategies at Admission  ADT o Introductions and role clarification Assess understanding of purpose and expectations  POLST Assess understanding of purpose and expectations  Procedural Consents Assess understanding of purpose and expectations o Plain-language explanations o Orientation to ICU environment o Identifying primary family contacts Section III: Family Meetings in the ICU 47 Information sharing and alignment of goals Purpose of ICU Family Meetings Supporting shared decisionmaking Reducing conflict and uncertainty Nurse Role in Family Meetings 1 Preparing families for meetings 2 3 Advocating family questions and concerns Clarifying information after meetings 4 Supporting emotional processing 48 o Overview of evidence-based tools: • V.A.L.U.E. mnemonic • Useful for difficult conversations Structured Communication Frameworks • Empathy statements • Whiteboard updates • Teach-back method • Useful for teaching family members eager Participate in patient care Section IV: Communication During Palliative & Transition Care 49 Recognizing Transition Points o Shifts from curative to comfortfocused care o Changes in prognosis or goals of care o ICU to floor, hospice, or endof-life transitions Family Needs During Palliative Care Emotional validation and presence Clear, compassionate explanations Support for decision-making and grief 50 Use of silence and presence Nurse Communication Strategies in End-of-Life Care Language that avoids false hope Supporting dignity and patient values Collaboration with palliative care teams Putting It Into Practice Case Scenario A 38-year-old male was brought in by EMS for penetrating chest trauma from multiple GSW • Hospital stay complicated by Transfusion-related acute lung injury (TRALI) Ventilator-associated pneumonia (VAP) Acute kidney injury (AKI) • How do you explain these complications to the family after surgery? How can you include them? https://www.youtube.com/watch?v=eyGHFm1s0Y 51 •Communication is a clinical skill Key Takeaways •Families are essential partners in care •Nurses play a central role across the ICU continuum •Structured tools improve consistency and confidence References & Resources Abdallah, H. M. M., Amin, S. M., Hammouda, E. Y., Atta, M. H. R., El-Monshed, A. H., & Hamad, N. I. M. (2025). Family Intensive Care Unit Syndrome: Investigating the mediating role of healthcare communication in psychological well-being among family members. Nursing in Critical Care. https://doi.org/10.1111/nicc.70119 Beuret, P., & Veislinger, G. (2022). Communication with relatives on prognosis of critically ill patients. Medical Research Archives, 10(1). https://doi.org/10.18103/mra.v10i1.2657 Communication Between Clinicians | PSNet. (2019, September 7). Ahrq.gov. https://psnet.ahrq.gov/primer/communication-between-clinicians Jones, M. (2023). Improving family communication in critical care. The Canadian Journal of Critical Care Nursing, 34(1), 15–24. https://doi.org/10.5737/23688653-34115 Linton, J. (2020). Reducing stress and anger among family members. Critical Care Nurse, 40(5), 58–65. https://doi.org/10.4037/ccn2020372 Nursing Uncharted. (2022, August 1). Having Difficult Conversations With Families as an ICU Nurse | Ep. 27 | Highlight. YouTube. https://www.youtube.com/watch?v=eyGHFm-1s0Y Rhoads, S., & Amass, T. (n.d.). Communication at the End-of-Life in the Intensive Care Unit: A Review of Evidence-Based Best Practices. In UPDATES IN CRITICAL CARE MEDICINE. http://www.rimed.org/rimedicaljournal/2019/12/2019-12-30-ccm-rhoads.pdf Shirasaki, K., Hifumi, T., Nakanishi, N., Nobuyuki N., Miyamoto, K., Komachi, M. Haruna, J.,, Inoue, S., & Otani, N. (2024).Postintensive care syndrome family: A comprehensive review. Acute Medicine & Surgery, 11(1). https://doi.org/10.1002/ams2.939 Wong, P., Redley, B., Digby, R., Correya, A., & Bucknall, T. (2019). Families’ perspectives of participation in patient carein an adult intensive care unit: A qualitative study. Australian Critical Care, 33(4). https://doi.org/10.1016/j.aucc.2019.06.002 52 Appendix B Instructor Outline for Educators 53 54 Appendix C Course Agenda 55 Appendix D Family Communication in the ICU Pre- and Post Survey Family Communication in the ICU Pre-Survey https://docs.google.com/forms/d/e/1FAIpQLSeKisB7QHy1i9zuw-Mf3vtWqvnWEqZ6RpWzBGCxROp-GBqMg/viewform?usp=preview Family Communication in the ICU Post-Survey https://docs.google.com/forms/d/e/1FAIpQLSeKisB7QHy1i9zuw-Mf3vtWqvnWEqZ6RpWzBGCxROp-GBqMg/viewform?usp=header 56 Appendix E V.A.L.U.E. Mnemonic 57 Appendix F Communication Simulation Validation Tool 58 Appendix G Simulation Scripts (3 scenarios) 59 60 61 Appendix H Timeline Month 1 •Meet with CCEN Director •Present project purpose •Obtain approval and support Month 2 •Finalize PowerPoint & scenarios •Develop surveys & guides •Ready all education tools Month 3 • Train CNS instructors • Review communication tools • Practice simulations Month 4 • Distribute pre-surveys • Collect baseline data • Analyze responses Month 5 • Conduct didactic session • Facilitate simulation scenarios • Debrief and discuss Month 6 •Administer post-survey •Compare pre- & post-survey results •Report findings to leadership