1
|
Nyhagen R, Egerod I, Rustøen T, Lerdal A, Kirkevold M. Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study. J Adv Nurs 2024; 80:2540-2551. [PMID: 38050863 DOI: 10.1111/jan.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/03/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023]
Abstract
AIM To describe different patterns of communication aimed at preventing, identifying and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit. DESIGN We conducted a fieldwork study with triangulation of participant observation and individual interviews. METHODS Participant observation of nine patients and 50 clinicians: nurses, physiotherapists and physicians. Subsequent individual face-to-face interviews with nine of the clinicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview. FINDINGS Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress. CONCLUSION Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom communication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress. IMPLICATIONS FOR PATIENT CARE Proactive and reactive symptom assessment of non-speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alternative communication. IMPACT This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units. REPORTING METHOD We used the consolidated criteria for reporting qualitative research. PATIENT CONTRIBUTION A user representative was involved in the design of the study.
Collapse
Affiliation(s)
- Ragnhild Nyhagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
2
|
Kuyler A, Heyns T, Johnson E. Critical care nurses' experiences of communication-vulnerable patients in the intensive care unit and the influence on rendering compassionate care. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2024; 40:e750. [PMID: 38989477 PMCID: PMC11232566 DOI: 10.7196/sajcc.2024.v40i1.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 07/12/2024] Open
Abstract
Background Interventions administered to critically ill patients, including mechanical ventilation, sedation or other treatments may hinder communication between patients and nurses. These communication challenges may affect critical care nurses' ability to provide compassionate, person-centred care. Objectives To identify nurses' experiences with patients who are communication-vulnerable in the intensive care unit and how they affect nurses' ability to offer compassionate care. Methods This qualitative explorative descriptive study involved nurses who worked in intensive care units from four private hospitals in Gauteng, South Africa. Focus groups were conducted with 30 critical care nurses in groups of two to six participants each. Thematic analysis was used to identify themes. Results Five main themes were identified based on nurses' reports of their experiences with critically ill patients who experience communication difficulties and their impact on rendering compassionate care. Themes were deductively identified based on the social purposes of communication categories. Participants indicated that communication-vulnerable patients influence their ability to provide compassionate care. Generally, the physical, emotional, social and communication difficulties of assisting communication-vulnerable patients caused nurses to feel frustrated and negative towards their work environment, which added to their work stress and sometimes resulted in compassion fatigue. Conclusion The study shows that various factors could impact the nurses' ability to provide compassionate care and that they require support to provide person-centred care. These factors can include the physical environment, the patient's alertness and awareness and institutional barriers. To support nurses in providing compassionate care, communication partner training may be warranted. Contribution of the study This study aims to increase awareness of the aspects that may contribute to compassion fatigue for nurses. By identifying these aspects greater support can be provided by facilities where nurses work.
Collapse
Affiliation(s)
- A Kuyler
- University of South Africa, Department of Inclusive Education, Pretoria, South Africa
| | - T Heyns
- Department of Nursing Science, University of Pretoria, South Africa
| | - E Johnson
- University of South Africa, Department of Inclusive Education, Pretoria, South Africa
| |
Collapse
|
3
|
Szymkowicz E, Bodet-Contentin L, Marechal Y, Ehrmann S. Comparison of communication interfaces for mechanically ventilated patients in intensive care. Intensive Crit Care Nurs 2024; 80:103562. [PMID: 37871352 DOI: 10.1016/j.iccn.2023.103562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES This study aimed to compare the use of a conventional low-tech communication board and a high-tech eye tracking device to improve communication effectiveness of mechanically ventilated patients in intensive care. DESIGN A prospective randomized crossover was conducted with a mixed method approach (quantitative primary method and qualitative complementary method) to compare the two technologically opposed communication interfaces. SETTING The mechanically ventilated patients were recruited from the general intensive care unit of the Marie Curie Civil Hospital (Charleroi University Hospital, Belgium). MAIN OUTCOME MEASURES The communication exchanges were assessed through effectiveness indicators covering the quantity of messages transmitted, success rate, patient satisfaction, communication content and difficulties of use. RESULTS The sample consisted of 44 mechanically ventilated patients, covering 88 communication exchanges. The intervention effects on the quantity of messages transmitted (two median messages per exchange for the board versus four median messages per exchange for the eye tracking, p < 0.0001), success rate (80 % for the board versus 100 % for the eye tracking, p < 0.05) and patient satisfaction (66 % "not satisfied", 32 % "satisfied" and 2 % "dissatisfied" for the board versus 52 % "satisfied" and 48 % "very satisfied" for the eye tracking, p < 0.0001) were significant. The communication content covered eight themes for the board compared to nine themes for the eye tracking and the use difficulties included four categories for the board as well as for the eye tracking. CONCLUSION The eye tracking device may further improve communication effectiveness of mechanically ventilated patients compared to the conventional communication board, both quantitatively and qualitatively. IMPLICATIONS FOR CLINICAL PRACTICE The implementation of high-tech communication devices based on eye tracking in intensive care practice can significantly contribute to patient-centered care by improving communication of mechanically ventilated patients.
Collapse
Affiliation(s)
- Emilie Szymkowicz
- GIGA Consciousness, Coma Science Group, University of Liège, Belgium.
| | - Laetitia Bodet-Contentin
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and methodS in Patient-centered outcomes and health ResEarch (SPHERE), INSERM UMR 1246, Université de Tours, France
| | - Yoann Marechal
- Unité de soins intensifs, CHU Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep F-CRIN Research Network, CHRU de Tours and Centre d'Étude des Pathologies Respiratoires (CEPR), INSERM UMR 1100, Université de Tours, France
| |
Collapse
|
4
|
Hu A, Wang J, Zhou Q, Xu L, Yang S, Xiang M, Wang G. Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China. Aust Crit Care 2024; 37:111-119. [PMID: 38087684 DOI: 10.1016/j.aucc.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The negative experiences of intensive care unit (ICU) patients seriously affect their quality of life and survival outcomes. Thus, it is of great significance to evaluate the monitoring experience of ICU patients for the clinical improvement of their experiences and promote interventions. OBJECTIVES The objective of this study was to investigate patients' experiences of ICU and to understand the sources of patient experience and influencing factors. METHODS From November 2021 to September 2022, a cross-sectional survey was conducted with 600 inpatients from four grade A-III hospitals in western China. Data were collected using the Chinese version of the Intensive Care Experience Questionnaire. RESULTS 585 valid questionnaires were collected, the response rate was 97.5%. ICU patients in western China scored below-the-average for their intensive care experience. Family monthly income, occupation types, medical payment method, type of ICU, ICU admission plan, ICU admission times, mechanical ventilation use, fertility status, analgesia, sedation, and Acute Physiology and Chronic Health Evaluation II scores are important factors influencing ICU patients' intensive care experience. CONCLUSIONS Medical staff need to pay attention to patient experience, improve the awareness of patient stressors and influencing factors, design nursing programs conducive to patient-positive experience, and promote interventions to further improve the long-term prognosis of patients. The results of this study can also be used as a set of nursing-sensitive indicators for evaluating nursing structure, process, and outcomes.
Collapse
Affiliation(s)
- Aiping Hu
- Department of Obstetrics and Gynecology VIP Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jia Wang
- Department of Obstetrics and Gynecology VIP Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Qimin Zhou
- Department of Obstetrics and Gynecology VIP Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lijia Xu
- Department of Obstetrics and Gynecology VIP Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shuang Yang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingfang Xiang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Guorong Wang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| |
Collapse
|
5
|
Istanboulian L, Rose L, Yunusova Y, Dale C. Adapting co-design methodology to a virtual environment: co-designing a communication intervention for adult patients in critical care. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:103. [PMID: 37957776 PMCID: PMC10644625 DOI: 10.1186/s40900-023-00514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Research co-design is recommended to reduce misalignment between researcher and end-user needs and priorities for healthcare innovation. Engagement of intensive care unit patients, clinicians, and other stakeholders in co-design has historically relied upon face-to-face meetings. Here, we report on our co-design processes for the development of a bundled intensive care unit patient communication intervention that used exclusively virtual meeting methods in response to COVID-19 pandemic social distancing restrictions. METHODS We conducted a series of virtual co-design sessions with a committee of stakeholder participants recruited from a medical-surgical intensive care unit of a community teaching hospital in Toronto, Canada. Published recommendations for co-design methods were used with exclusively virtual adaptations to improve ease of stakeholder participation as well as the quality and consistency of co-design project set-up, facilitation, and evaluation. Virtual adaptations included the use of email for distributing information, videos, and electronic evaluations as well as the use of a videoconferencing platform for synchronous meetings. We used a flexible meeting plan including asynchronous virtual methods to reduce attendance barriers for time-constrained participants. RESULTS Co-design participants included a patient and a family member (n = 2) and professionally diverse healthcare providers (n = 9), plus a facilitator. Overall, participants were engaged and reported a positive experience with the virtually adapted co-design process. Reported benefits included incorporation of diverse viewpoints in the communication intervention design and implementation plan. Challenges related to lack of hands-on time during development of the co-designed intervention and participant availability to meet regularly albeit virtually. CONCLUSIONS This report describes the methods, benefits, and challenges of adapting in-person co-design methods to a virtual environment to produce a bundled communication intervention for use in the adult intensive care unit during the COVID-19 pandemic. Adapting recommended co-design methods to a virtual environment can provide further opportunities for stakeholder participation in intervention design.
Collapse
Affiliation(s)
- Laura Istanboulian
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 288 Church St., Toronto, M5B 1Z5, Canada.
- Michael Garron Hospital, 825 Coxwell Ave., Toronto, M4C 3E7, Canada.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
- Department of Critical Care and the Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, 500 University Ave. #160, Toronto, M5G 1V7, Canada
- KITE: Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, M5G 2A2, Canada
- Harvitz Brain Sciences Program, Sunnybrook Research Institute Wellness Way, Toronto, M4N 3M5, Canada
| | - Craig Dale
- Tory Trauma Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, M4N 3M5, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, M5T 1P8, Canada
| |
Collapse
|
6
|
Holm A, Dreyer P. Nurses' experiences of the phenomenon 'isolation communication'. Nurs Crit Care 2023; 28:885-892. [PMID: 36156341 DOI: 10.1111/nicc.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/12/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes. AIM To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU. STUDY DESIGN A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method. FINDINGS Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation. CONCLUSION The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure. RELEVANCE TO CLINICAL PRACTICE As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.
Collapse
Affiliation(s)
- Anna Holm
- Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
7
|
Ghiasvand AM, Hosseini M, Atashzadeh-Shoorideh F. Theoretical definition of nurse-conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis. Acute Crit Care 2023; 38:8-20. [PMID: 36935530 PMCID: PMC10030244 DOI: 10.4266/acc.2022.01039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/16/2022] [Indexed: 03/02/2023] Open
Abstract
Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse-conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse-patient communication," "nurse-patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.
Collapse
Affiliation(s)
- Arezoo Mohamadkhani Ghiasvand
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meimanat Hosseini
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Karlsen MMW, Holm A, Kvande ME, Dreyer P, Tate JA, Heyn LG, Happ MB. Communication with mechanically ventilated patients in intensive care units: A concept analysis. J Adv Nurs 2023; 79:563-580. [PMID: 36443915 PMCID: PMC10099624 DOI: 10.1111/jan.15501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients. DESIGN The Im & Meleis approach for concept analysis guided the study. SEARCH METHODS A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references. REVIEW METHODS After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed. RESULTS We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units. CONCLUSION Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves. IMPACT A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a concept analysis of previous research.
Collapse
Affiliation(s)
| | - Anna Holm
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Monica Evelyn Kvande
- Department for postgraduate studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Judith Ann Tate
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Lena Günterberg Heyn
- Center for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Mary Beth Happ
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
| |
Collapse
|
9
|
Woodring F, Harmon MT. Augmentative and alternative communication (AAC) for nursing students; equipping the next generation of nursing professionals. NURSE EDUCATION TODAY 2023; 121:105662. [PMID: 36470039 DOI: 10.1016/j.nedt.2022.105662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/05/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Augmentative and alternative communication (AAC) is often used for patients who are temporarily non-speaking. However, considering AAC for these patients in intensive care units (ICUs) has only recently started to gain the attention of health care providers in the hospital setting. Currently, few nursing programs include content in their curricula as relates to this population. OBJECTIVES To investigate the feasibility of embedding a brief inservice into an existing undergraduate nursing course, and to determine the feasibility and relevance of AAC use during their clinical ICU rotation. DESIGN A longitudinal survey study using three time points: pre- and post-inservice, and post implementation following a clinical rotation. SETTING University nursing program classroom during an Adult Health and Illness course. PARTICIPANTS Twenty-seven undergraduate nursing students enrolled in the Adult Health and Illness course. METHODS The participants were given a brief inservice educating them on the use of AAC. The students were given AAC boards to use during their ICU clinical rotation. Survey data was collected before and after the inservice and at the end of the clinical rotation. RESULTS Pre-service nursing students responded favorably to a brief inservice embedded into an existing nursing course. Survey data indicated an increase in the students' knowledge of AAC (z = 4.52, p < .05) and awareness that AAC can improve communication between patients and staff (z = 2.24, p < .05). CONCLUSION An interdisciplinary activity between Communication Sciences and Disorders and Nursing departments about AAC could be a new and promising solution to increase communication with non-speaking patients in the ICU.
Collapse
Affiliation(s)
- Faith Woodring
- Speech Language Pathologist, Woodring Services LLC, United States of America.
| | - Mary Towle Harmon
- Communication Sciences and Disorders, Northern Arizona University, Flagstaff, United States of America
| |
Collapse
|
10
|
Pun J, Kong B. An exploratory study of communication training for Chinese medicine practitioners in Hong Kong to integrate patients' conventional medical history. BMC Complement Med Ther 2023; 23:10. [PMID: 36635666 PMCID: PMC9834674 DOI: 10.1186/s12906-022-03811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Despite Traditional Chinese medicine's (TCM) historical roles in Chinese society, few research has been investigated the nature of TCM practitioner-patient interactions. Improved communication skills among TCM practitioners will result higher-quality interactions and better clinical outcomes. METHODS To investigate the changes in TCM practitioners' communication practices after communications training focused on promoting their awareness of integrating a patient's medical history from conventional medicine in TCM treatment, Eight registered Cantonese-speaking TCM practitioners in Hong Kong were randomly recruited from local clinics and randomised into control (n = 12) and experimental groups (n = 12), with a total of 24 consultations. The experimental group was given training focused on patient-centred communication, with an internationally recognised and communication framework validated in global consultation settings (i.e. the Calgary-Cambridge Guide) on how to take a patient's medical history from conventional medicine and communicate diagnosis and treatment plans. Consultations before and after training were audio-recorded and rated. The efficacy of the training was evaluated by comparing the two groups before training (pre-test), immediately after training (post-test) and after a 3-month delay (delayed post-test). Using validated scales, the primary outcomes were measured for the practitioners' clinical communication skills and the quality of interactions. RESULTS The communication training significantly improved the TCM providers' patient-centred communication and communication proficiency. The results indicate that the team developed an effective communication model for integrating TCM and conventional medicine in Hong Kong. The framework helps trained TCM practitioners to integrate their patients' conventional medical history when delivering patient care. The findings shed light on how interpersonal relationships between TCM practitioners and patients can be constructed after communication training to better care for patients' psychological concerns in addition to their physical needs. CONCLUSION Trained TCM practitioners can provide an integrated model that takes patients' conventional medical history into account when delivering a holistic patient-centred care. The findings can enhance our understanding of better ways to train the future TCM practitioners and to develop a continuing professional training for the current TCM practitioners to expand our understanding of TCM communication in acute clinical contexts and, thus offer a firm evidence-based foundation upon which to develop communication strategies that improve their clinical cpractices.
Collapse
Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, 83, Tat Chee Avenue, Kowloon Tong, Hong Kong SAR, China.
| | - Brandon Kong
- Department of English, City University of Hong Kong, 83, Tat Chee Avenue, Kowloon Tong, Hong Kong SAR, China
| |
Collapse
|
11
|
Momennasab M, Mohammadi F, DehghanRad F, Jaberi A. Evaluation of the effectiveness of a training programme for nurses regarding augmentative and alternative communication with intubated patients using Kirkpatrick's model: A pilot study. Nurs Open 2022; 10:2895-2903. [PMID: 36577744 PMCID: PMC10077406 DOI: 10.1002/nop2.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 10/19/2022] [Accepted: 11/20/2022] [Indexed: 12/30/2022] Open
Abstract
AIM Communicating with conscious intubated patients who are unable to communicate verbally is one of the challenges faced by intensive care unit (ICU) nurses. The present study was conducted to evaluate the effectiveness of a training programme for nurses regarding augmentative and alternative communication (AAC) with intubated patients using Kirkpatrick's model. DESIGN This study had a one-group, before-after, quasi-experimental design. METHODS Totally, 45 nurses working in ICUs participated in a blended training programme using AAC strategies to communicate with intubated patients. Their contribution was evaluated based on Kirkpatrick's model at four levels. The study data were collected using the "satisfaction and ease questionnaire," "observation checklist" and "communication knowledge test." Then, the data were analysed using the SPSS 22 software and p < 0.05 was considered statistically significant. RESULTS Most participants were satisfied with the implementation of the programme. The nurses' mean score of communication knowledge increased after the intervention (p < 0.05). The results of evaluation of the third and fourth levels of Kirkpatrick's model also showed an increase in the success of communication, use of AAC, and satisfaction with and ease of communication (p < 0.001). IMPLICATION Short-term and long-term effects of the blended training programme about AAC were investigated using Kirkpatrick's model. The results indicated the positive effect of the programme on the quality of the nurses' communication with intubated patients, their understanding of the patients' messages and meeting the patients' needs at a more desirable level. Thus, nurses and other staff are recommended to use this simple method of communication with patients to provide better services. In addition, further quantitative and qualitative studies are suggested to assess these communication strategies in other patients with impaired consciousness.
Collapse
Affiliation(s)
- Marzieh Momennasab
- Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mohammadi
- Student Research Committee, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh DehghanRad
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
12
|
Pun J. The priorities, challenges, and scope of clinical communication teaching perceived by clinicians from different disciplines: a Hong Kong case study. BMC PRIMARY CARE 2022; 23:158. [PMID: 35733087 PMCID: PMC9219208 DOI: 10.1186/s12875-022-01770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022]
Abstract
Background In the absence of a well-rounded syllabus that emphasises both interpersonal and medical dimensions in clinical communication, medical students in the early stages of their career may find it challenging to effectively communicate with patients, especially when dealing with perceived priorities and challenges across different disciplines. Methods To explore the priorities, challenges, and scope of clinical communication teaching as perceived by clinicians from different clinical disciplines, we recruited nine medical educators, all experienced frontline clinicians, from eight disciplines across seven hospitals and two medical schools in Hong Kong. They were interviewed on their clinical communication teaching in the Hong Kong context, specifically its priorities, challenges, and scope. We then performed interpretative phenomenological analysis of the interview data. Results The interview data revealed five themes related to the priorities, challenges, and scope of clinical communication teaching across a wide range of disciplines in the Hong Kong context, namely (1) empathising with patients; (2) using technology to teach both the medical and interpersonal dimensions of clinical communication; (3) shared decision-making with patients and their families: the influence of Chinese collectivism and cultural attitudes towards death; (4) interdisciplinary communication between medical departments; and (5) the role of language in clinician–patient communication. Conclusions Coming from different clinical disciplines, the clinicians in this study approached the complex nature of clinical communication teaching in the Hong Kong context differently. The findings illustrate the need to teach clinical communication both specifically for a discipline as well as generically. This is particularly important in the intensive care unit, where clinicians from different departments frequently cooperate. This study also highlights how communication strategies, non-verbal social cues, and the understanding of clinical communication in the Hong Kong Chinese context operate differently from those in the West, because of differences in sociocultural factors such as family dynamics and hierarchical social structures. We recommend a dynamic teaching approach that uses role-playing tasks, scenario-based exercises, and similar activities to help medical students establish well-rounded clinical communication skills in preparation for their future clinical practice.
Collapse
|
13
|
Residents’ Perceptions of Sustainable Tourism Destination Recovery: The Case of Northern Cyprus. LAND 2022. [DOI: 10.3390/land11010094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As nations and tourism destinations are beginning to relax nonpharmaceutical measures for the prevention of the COVID-19 virus, a major quest of tourism stakeholders is to restart and restore the once viable and productive industry to its prior state. While the urge to restart and restore may necessitate a strategic plan and drastic measures, care must be taken not to undermine the sustainability of the destination. The current study seeks to understand the perceptions of residents of Northern Cyprus as key tourism stakeholders concerning the impacts of COVID-19 to the island’s tourism activities and recommendations for recovery post pandemic. To this end, the study used grounded theory and semistructured interviews to explore how residents perceive the contribution of focused advertisements and stakeholder engagement in the sustainable restoration of tourism activities post COVID-19 on the island. While divergent opinions were gathered, it can be inferred that stakeholders expect the implementation of strategic plans aided by focused advertisements to ensure the sustainability of their tourist destinations. Policy directions and academic contributions are also stated as requirements.
Collapse
|
14
|
Ull C, Hamsen U, Weckwerth C, Schildhauer TA, Gaschler R, Waydhas C, Jansen O. Approach to the basic needs in patients on invasive ventilation using eye-tracking devices for non-verbal communication. Artif Organs 2021; 46:439-450. [PMID: 34637156 DOI: 10.1111/aor.14082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the feasibility of eye-tracking (ET) devices as a communicative approach to the basic needs (BN) of intensive care unit (ICU) and invasively ventilated nonverbal patients. METHODS Prospective, monocentric, and observational study including all patients without delirium, with an endotracheal tube or tracheostomy tube, with a history of invasive ventilation for more than 48 h, and inadequate nonverbal communication skills. The investigation was performed with commercially available ET devices (Tobii Dynavox I-15+) to express BN of ICU patients following a standardized 30-item yes-or-no questionnaire. RESULTS A total of 64 patients with a mean age of 58.6 years were included. The main diagnoses for ICU admission were major trauma (43.6%), sepsis (21.8%), and acute abdomen (15.6%). Pain during repositioning (69%), thirst (69%), sleep disorders (66%), fatigue (64%), and anxiety regarding the lifelong need for assistance (64%) were the main problems reported by the patients. However, most of the patients described expectations of health improvement (78%), good family support (66%), and an improvement in quality of life due to the use of ET devices (67%). CONCLUSION The use of ET in selected ICU patients with impaired communication is feasible, allowing them to express their BN. Apart from knowing the patients' individual BN, the results of our BN questionnaire may provide guidance for improvement measures in the care of patients in the ICU who are unable to speak. We believe that ET is useful for inquiring about and expressing BN and, therefore, may be capable of improving patient-medical team interactions and patient satisfaction.
Collapse
Affiliation(s)
- Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | | | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Gaschler
- Faculty of Psychology, FernUniversität of Hagen, Hagen, Germany
| | - Christian Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
15
|
Istanboulian L, Rose L, Yunusova Y, Dale CM. Protocol for a mixed method acceptability evaluation of a codesigned bundled COmmunication intervention for use in the adult ICU during the COVID-19 PandEmic: the COPE study. BMJ Open 2021; 11:e050347. [PMID: 34518267 PMCID: PMC8438574 DOI: 10.1136/bmjopen-2021-050347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Patients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required. METHODS AND ANALYSIS This three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20-25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8-10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60-65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic. ETHICS AND DISSEMINATION The study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.
Collapse
Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Centre for Excellence in Weaning, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Critical Care and Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Abstract
Rationale: There are limited data on mechanical discontinuation practices in Asia. Objectives: To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning among Asian Intensive Care specialists. Methods: A survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. Results: Of the 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. The majority of respondents (60.5%) were from China. Of the respondents, 42% worked in intensive care units (ICUs) where respiratory therapists were present; 78.9% used a spontaneous breathing trial as the initial weaning step; 44.3% frequently/always used pressure support (PS) alone, 53.4% intermittent spontaneous breathing trials with PS in between, and 19.8% synchronized intermittent mandatory ventilation with PS as a weaning mode. Of the respondents, 56.3% routinely stopped feeds before extubation, 71.5% generally followed a sedation protocol or guideline, and 61.8% worked in an ICU with a weaning protocol. Of these, 78.2% frequently always followed the protocol. A multivariate analysis involving a modified Poisson regression analysis showed that working in an ICU with a weaning protocol and frequently/always following it was positively associated with an upper-middle-income territory, a university-affiliated hospital, or in an ICU that employed respiratory therapists; and negatively with a low-income or lower-middle-income territory or a public hospital. There was no significant association with "in-house" intensivist at night, multidisciplinary ICU, closed ICU, or nurse-patient ratio. There was heterogeneity in agreement/disagreement with the statement, "evidence clearly supports protocolized weaning over nonprotocolized weaning." Conclusions: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with the best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
Collapse
|
17
|
Kuyler A, Johnson E. Patient and nurse content preferences for a communication board to facilitate dialogue in the intensive care unit. Intensive Crit Care Nurs 2020; 63:103005. [PMID: 33358517 DOI: 10.1016/j.iccn.2020.103005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The main aim of this study was to identify patient and nurse content preferences for a communication board to facilitate effective communication (dialogue) in the critical care unit. RESEARCH DESIGN A qualitative research design focusing on explorative and descriptive components was used to address the aim of the research study. The study employed two participant groups. Semi-structured interviews and focus group discussions were conducted with critically ill patients (N = 10) and critical care nurses (N = 30). SETTING The study was conducted in four different private hospitals of the same hospital group in Gauteng, South Africa. FINDINGS Four distinct themes were identified in the research regarding the vocabulary items that participants would like to have included. CONCLUSION The findings suggest that patients perceive a communication board to be valuable in enhancing communication in the critical care unit; that cultural and linguistic diversity should be considered; and that patients and nurses have varying opinions on topics of priority during communication.
Collapse
Affiliation(s)
- Ariné Kuyler
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20 Hatfield, 0028, South Africa.
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20 Hatfield, 0028, South Africa.
| |
Collapse
|
18
|
Modrykamien AM. Strategies for communicating with conscious mechanically ventilated critically ill patients. Proc AMIA Symp 2019; 32:534-537. [PMID: 31656412 DOI: 10.1080/08998280.2019.1635413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022] Open
Abstract
Critically ill patients admitted to the intensive care unit (ICU) frequently require ventilatory support. To provide this life-saving therapy, oral intubation or tracheostomy placements are needed. Consequently, verbal ability to communicate is lost. Furthermore, depending on the severity of the clinical condition and other comorbidities, patients commonly develop ICU-acquired weakness, which may preclude gestural communication and motor abilities. Under this circumstance, the patient's inability to interact with health care providers and/or family members results in psychological alterations, as well as isolation and reduction of self-esteem. A variety of tools have been developed to improve patient-clinician communication. This article reviews patient complications due to lack of communication, available tools to enhance interactions, and current published evidence to support communication tools.
Collapse
|
19
|
Jansson S, Martin TRS, Johnson E, Nilsson S. Healthcare professionals’ use of augmentative and alternative communication in an intensive care unit: A survey study. Intensive Crit Care Nurs 2019; 54:64-70. [DOI: 10.1016/j.iccn.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/10/2023]
|
20
|
Pun J, Chor W, Zhong L. Delivery of patient-centered care in complementary medicine: Insights and evidence from the Chinese medical practitioners and patients in primary care consultations in Hong Kong. Complement Ther Med 2019; 45:198-204. [DOI: 10.1016/j.ctim.2019.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/15/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
|
21
|
Tantacharoenrat C, Prasopkittikun T, Rungamornrat S, Limprayoon K. Use of a User-Friendly Tablet Application to Communicate with Pediatric Patients on Mechanical Ventilators. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivos: examinar cómo el uso de una aplicación para tableta como ayuda en la comunicación con pacientes pediátricos con respirador artificial afecta el nivel de satisfacción con la comunicación por parte del personal de enfermería y en las díadas cuidador–paciente. Materiales y método: se utilizó el diseño pretest-postest de un solo grupo para analizar el nivel de satisfacción del personal de enfermería con la comunicación y se utilizó un diseño de grupo de control pretest-postest no equivalente para los cuidadores. La muestra estaba conformada por 44 miembros del personal de enfermería y 18 díadas de cuidadores y pacientes pediátricos con ventilación de dos hospitales en Tailandia. Se utilizó una prueba de T pareada para comparar al personal de enfermería, la prueba U de Mann-Whitney para comparar los cuidadores y una estadística descriptiva para describir la satisfacción de los niños. Resultados: el personal de enfermería se sintió más satisfecho con la comunicación al usar la aplicación de la tableta que los métodos de comunicación regulares (t = -9,13, df = 43, p < ,001). Los cuidadores que usaron la aplicación para tableta también reportaron una mayor satisfacción con la comunicación respecto a aquellos que usaron los métodos de comunicación regulares (U = -3,41, p < ,001). Casi el 90 % de los pacientes pediátricos reportaron sentirse completamente satisfechos con el uso de la aplicación. Conclusiones: la aplicación para tableta diseñada para facilitar la comunicación con pacientes pediátricos con respirador artificial mejoró los niveles de satisfacción con la comunicación y debe promoverse como uno de los dispositivos de comunicación de asistencia para uso amplio.
Collapse
|