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LaValley M, Chavers-Edgar T, Wu M, Schlosser R, Koul R. Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-20. [PMID: 39146218 DOI: 10.1044/2024_ajslp-23-00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings. METHOD Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy. RESULTS Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes. CONCLUSIONS There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26506102.
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Affiliation(s)
- Mimi LaValley
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | | | - Mengxuan Wu
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Ralf Schlosser
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA
| | - Rajinder Koul
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
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Alodan HA, Sutt AL, Hill R, Alsadhan J, Cross JL. Effectiveness, experience, and usability of low-technology augmentative and alternative communication in intensive care: A mixed-methods systematic review. Aust Crit Care 2024:S1036-7314(24)00085-7. [PMID: 38866691 DOI: 10.1016/j.aucc.2024.04.006] [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: 02/12/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them nonverbal. Low-technology augmentative and alternative communication (AAC) strategies are simple and effective ways to enhance communication between patients and their communication partners but are underutilised. AIM The aim of this study was to systematically review current evidence regarding the effectiveness, experience of use, and usability of low-technology AAC with nonverbal patients and their communication partners in the ICU. METHODS This review included quantitative, qualitative, and mixed-methods studies of adult ICU patients aged 18 or older who were nonverbal due to mechanical ventilation and their communication partners. Studies using low-technology AAC, such as communication boards and pen and paper, were included. Six databases were searched, and the review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A convergent segregated approach was used for data synthesis. RESULTS Thirty-two studies were included. Low-technology AAC improved patient satisfaction, facilitated communication, and met patients' physical and psychological needs. Communication boards with mixed content (e.g., pictures, words, and letters) were preferred but were used less frequently than unaided strategies due to patients' medical status, tool availability, and staff attitudes. Boards should be user-friendly, tailored, include pen/paper, and introduced preoperation to increase patient's comfort when using them postoperatively. CONCLUSION Existing evidence support low-technology AAC's efficacy in meeting patients' needs. Better usability hinges on proper implementation and addressing challenges. Further research is crucial for refining communication-board design, ensuring both user-friendliness and sophistication to cater to ICU patients' diverse needs. REGISTRATION The review protocol was registered in the International Prospective Register of Systematic Reviews, with registration number CRD42022331566.
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Affiliation(s)
- Hissah A Alodan
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK; College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Anna-Liisa Sutt
- Institute of Molecular Bioscience, University of Queensland, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Rebekah Hill
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Joud Alsadhan
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Jane L Cross
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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Oh E, Shin S, Kim SP. Brain-computer interface in critical care and rehabilitation. Acute Crit Care 2024; 39:24-33. [PMID: 38224957 PMCID: PMC11002623 DOI: 10.4266/acc.2023.01382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
This comprehensive review explores the broad landscape of brain-computer interface (BCI) technology and its potential use in intensive care units (ICUs), particularly for patients with motor impairments such as quadriplegia or severe brain injury. By employing brain signals from various sensing techniques, BCIs offer enhanced communication and motor rehabilitation strategies for patients. This review underscores the concept and efficacy of noninvasive, electroencephalogram-based BCIs in facilitating both communicative interactions and motor function recovery. Additionally, it highlights the current research gap in intuitive "stop" mechanisms within motor rehabilitation protocols, emphasizing the need for advancements that prioritize patient safety and individualized responsiveness. Furthermore, it advocates for more focused research that considers the unique requirements of ICU environments to address the challenges arising from patient variability, fatigue, and limited applicability of current BCI systems outside of experimental settings.
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Affiliation(s)
- Eunseo Oh
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, Korea
| | - Seyoung Shin
- Department of Mechanical Engineering, Sungkyunkwan University, Suwon, Korea
| | - Sung-Phil Kim
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, Korea
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Karlsen MW, 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] [MESH Headings] [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.
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Affiliation(s)
| | - Anna Holm
- Department of Public HealthAarhus UniversityAarhus CDenmark
- Department of Intensive CareAarhus University HospitalAarhusDenmark
| | - Monica Evelyn Kvande
- Department for postgraduate studiesLovisenberg Diaconal University CollegeOsloNorway
| | - Pia Dreyer
- Department of Public HealthAarhus UniversityAarhus CDenmark
- Department of Intensive CareAarhus University HospitalAarhusDenmark
| | - Judith Ann Tate
- Center of Healthy Aging, Self‐Management and Complex CareThe Ohio State University College of NursingColumbusOhioUSA
| | - Lena Günterberg Heyn
- Center for Health and Technology, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayDrammenNorway
| | - Mary Beth Happ
- Center of Healthy Aging, Self‐Management and Complex CareThe Ohio State University College of NursingColumbusOhioUSA
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Kyranou M, Cheta C, Pampoulou E. Communicating with mechanically ventilated patients who are awake. A qualitative study on the experience of critical care nurses in Cyprus during the COVID-19 pandemic. PLoS One 2022; 17:e0278195. [PMID: 36454794 PMCID: PMC9714938 DOI: 10.1371/journal.pone.0278195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Modern protocols for light sedation in combination with the increased number of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients. STUDY OBJECTIVES The purpose of this study was to explore the strategies nurses use when taking care of conscious, intubated patients in the intensive care unit and the barriers they encounter in their effort to communicate. METHODS For this study, a qualitative design was employed. Data were collected using in-depth semi-structured interviews with 14 intensive care nurses working at ICUs in four different hospitals of Cyprus. The data were analyzed by applying thematic analysis. RESULTS We identified several strategies of unaided (movements-lips, hands, legs-facial expressions, gestures, touching) and aided forms of communication (pen and paper, boards, tablets, mobiles) used by nurses to communicate with patients. However, barriers to communication were reported by the participating nurses mainly pertaining to patients and nurses' characteristics as well as the ICU environment. The health protocols imposed by the pandemic added more obstacles to the communication between nurses and patients mostly related to the use of protective health equipment. CONCLUSIONS The results of this study point to the difficulties nurses in Cyprus face when trying to communicate with conscious patients during mechanical ventilation. It appears that the lack of nurses' training and of appropriate equipment to facilitate augmentative and alternative communication leave the complex communication needs of critically ill patients unaddressed. However, further research including patients' opinions, after they recover, would bring more clarity on this topic. Our study adds evidence to the communication crisis created by the protective health protocols imposed by the pandemic. As such, it highlights the need to educate nurses in augmentative and alternative ways of communication to address communication with mechanically ventilated, conscious patients during their ICU stay.
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Affiliation(s)
- Maria Kyranou
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Chariklia Cheta
- American Medical Center/American Heart Institute, Strovolos, Cyprus
| | - Eliada Pampoulou
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
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Zaga CJ, Cigognini B, Vogel AP, Berney S. Outcome measurement tools for communication, voice and speech intelligibility in the ICU and their clinimetric properties: A systematic review. J Intensive Care Soc 2022; 23:459-472. [PMID: 36751341 PMCID: PMC9679912 DOI: 10.1177/1751143720963757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To identify outcome measurement tools used to evaluate communication, voice and speech intelligibility in the mechanically ventilated ICU population. Secondly, to evaluate, synthesise and compare the clinimetric properties of the tools identified. Materials and methods A systematic review of articles was undertaken via electronic databases in two parts. Eligibility criteria for selection: part one - quantitative or mixed methods studies which assessed communication, voice or speech intelligibility; part two - studies which evaluated a clinimetric property for one of the tools identified in part one. Two independent reviewers assessed articles for inclusion and used the consensus-based standards for health status measurement instruments (COSMIN) risk of bias checklist. Results The part one search yielded five included studies comprised of eight outcome measurement tools. The part two search yielded 22 included studies comprised of nine tools. Few studies had adequate reliability and measurement error properties. No studies established responsiveness. A notable proportion of studies utilised tools that have no clinimetric properties. Conclusions There is a relatively small number of studies which have established clinimetric properties for outcome measurement tools that evaluate communication, voice and/or speech intelligibility, and a fewer number which have done so in the mechanically ventilated ICU population.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Austin Health,
Melbourne, Australia,Centre for Neuroscience of Speech, University
of Melbourne, Melbourne, Australia,Charissa J Zaga, Austin Health, 145 Studley Road,
Heidelberg, Melbourne, Australia.
| | - Bridie Cigognini
- Department of Speech Pathology, Austin Health,
Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University
of Melbourne, Melbourne, Australia,Department of Neurodegeneration, Hertie
Institute for Clinical Brain Research, Tübingen, Germany,Redenlab, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Austin Health,
Melbourne, Australia,Department of Physiotherapy, School of Health
Sciences, University of Melbourne, Melbourne, Australia
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Goldberg MA, Hochberg LR, Carpenter D, Walz JM. Development of a Manually Operated Communication System (MOCS) for patients in intensive care units. Augment Altern Commun 2022; 37:261-273. [PMID: 35023431 DOI: 10.1080/07434618.2021.2016958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nonvocal alert patients in the intensive care unit (ICU) setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. Innovation of a hand-operated non-touchscreen communication system for nonvocal ICU patients was guided by design concepts including speech output, simplicity, and flexibility. A novel communication tool, the Manually Operated Communication System (MOCS), was developed for use in intensive care settings with patients unable to speak. MOCS is a speech-output technology designed for patients with manual dexterity impairments preventing legible writing. MOCS may have the potential to improve communication for nonvocal patients with limited manual dexterity.
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Affiliation(s)
- Miriam A Goldberg
- MD/PhD Program, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Leigh R Hochberg
- Carney Institute for Brain Science and School of Engineering, Brown University, Providence, RI, USA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA.,Rehabilitation R&D Service, US Department of Veterans Affairs, VA RR&D Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - Dawn Carpenter
- Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Surgical/Trauma Critical Care, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - J Matthias Walz
- Department of Anesthesiology & Perioperative Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Rose L, Sutt AL, Amaral AC, Fergusson DA, Smith OM, Dale CM. Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support. Cochrane Database Syst Rev 2021; 10:CD013379. [PMID: 34637143 PMCID: PMC8507432 DOI: 10.1002/14651858.cd013379.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inability to communicate in a manner that can be understood causes extreme distress for people requiring an artificial airway and has implications for care quality and patient safety. Options for aided communication include non-vocal, speech-generating, and voice-enabling aids. OBJECTIVES To assess effectiveness of communication aids for people requiring an artificial airway (endotracheal or tracheostomy tube), defined as the proportion of people able to: use a non-vocal communication aid to communicate at least one symptom, need, or preference; or use a voice-enabling communication aid to phonate to produce at least one intelligible word. To assess time to communication/phonation; perceptions of communication; communication quality/success; quality of life; psychological distress; length of stay and costs; and adverse events. SEARCH METHODS We searched the Cochrane Library (Wiley version), MEDLINE (OvidSP), Embase (OvidSP), three other databases, and grey literature from inception to 30 July 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs, controlled non-randomised parallel group, and before-after studies evaluating communication aids used in adults with an artificial airway. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Two review authors independently performed data extraction and assessment of risk of bias. MAIN RESULTS We included 11 studies (1931 participants) conducted in intensive care units (ICUs). Eight evaluated non-vocal communication aids and three voice-enabling aids. Usual care was the comparator for all. For six studies, this comprised no aid; usual care in the remaining five studies comprised use of various communication aids. Overall, our confidence in results regarding effectiveness of communication interventions was very low due to imprecision, measurement heterogeneity, inconsistency in results, and most studies at high or unclear risk of bias across multiple domains. No non-vocal aid studies reported our primary outcome. We are uncertain of the effects of early use of a voice-enabling aid compared to routine use on ability to phonate at least one intelligible word (risk ratio (RR) 3.03, 95% confidence interval (CI) 0.18 to 50.08; 2 studies; very low-certainty evidence). Compared to usual care without aids, we are uncertain about effects of a non-vocal aid (communication board) on patient satisfaction (standardised mean difference (SMD) 2.92, 95% CI 1.52 to 4.33; 4 studies; very low-certainty evidence). No studies of non-vocal aids reported quality of life. Low-certainty evidence from two studies suggests early use of a voice-enabling aid may have no effect on quality of life (MD 2.27, 95% CI -7.21 to 11.75). Conceptual differences in measures of psychological distress precluded data pooling; however, intervention arm participants reported less distress suggesting there might be benefit, but our certainty in the evidence is very low. Low-certainty evidence suggest voice-enabling aids have little or no effect on ICU length of stay; we were unable to determine effects of non-vocal aids. Three studies reported different adverse events (physical restraint use, bleeding following tracheostomy, and respiratory parameters indicating respiratory decompensation). Adverse event rates were similar between arms in all three studies. However, uncertainty remains as to any harm associated with communication aids. AUTHORS' CONCLUSIONS Due to a lack of high-quality studies, imprecision, inconsistency of results, and measurement heterogeneity, the evidence provides insufficient information to guide practice as to which communication aid is more appropriate and when to use them. Understanding effectiveness of communication aids would benefit from development of a core outcome measurement set.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | | | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Orla M Smith
- Critical Care, St Michael's Hospital, Toronto, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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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.
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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
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10
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Happ MB. Giving Voice: Nurse-Patient Communication in the Intensive Care Unit. Am J Crit Care 2021; 30:256-265. [PMID: 34195776 DOI: 10.4037/ajcc2021666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Communication is the essence of the nurse-patient relationship. The critical care nurse's role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients' messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.
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Affiliation(s)
- Mary Beth Happ
- Mary Beth Happ is Nursing Distinguished Professor of Critical Care Research and Associate Dean for Research and Innovation at The Ohio State University College of Nursing, Columbus
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11
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Al-Yahyai Rn Bsn ANS, Arulappan Rn Rm Bsc N Msc N PhD N DNSc J, Matua GA, Al-Ghafri Rn Bsn SM, Al-Sarakhi Rn Bsn SH, Al-Rahbi Rn Bsn KKS, Jayapal SK. Communicating to Non-Speaking Critically Ill Patients: Augmentative and Alternative Communication Technique as an Essential Strategy. SAGE Open Nurs 2021; 7:23779608211015234. [PMID: 34159256 PMCID: PMC8186114 DOI: 10.1177/23779608211015234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Communication with hospitalized patients is crucial to improve the quality and safety of health care. Methods The study assessed the communication methods used by nurses while communicating to non-speaking critically ill patients. The participants included staff nurses working in ICU, CICU, HD units of neuro- surgical, orthopedic, medical and oncology wards. Purposive sampling technique was used to recruit a total number of 194 nurses. The communication methods used were assessed by a questionnaire comprised of a list of 21 strategies used to communicate with non-speaking patients. Results The most commonly used strategies were reading the patient’s mouthing words, encouraging the patient by telling them that they are doing well and nurses helping them to get better, assessing the patients for their communication ability, “thumps up” to indicate “yes”, “shake head” indicating “no”, use OK, or point to body parts, speaking slowly and waiting for the patient’s response, spending time to listen patiently to what the patient say and touching the non-speaking critically ill patient when the nurse speaks with the patient. Conclusion The study reported that the nurses used variety of communication strategies while communicating to non- speaking critically ill patients. However very few nurses used Augmentative and alternative communication strategies to communicate to non-speaking critically ill patients. The study recommends the importance of establishing Augmentative and Alternative Communication strategies in the hospitals.
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Affiliation(s)
| | | | - Gerald Amandu Matua
- Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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12
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Development of a brain-computer interface for patients in the critical care setting. PLoS One 2021; 16:e0245540. [PMID: 33481888 PMCID: PMC7822274 DOI: 10.1371/journal.pone.0245540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/30/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Behaviorally unresponsive patients in intensive care units (ICU) are unable to consistently and effectively communicate their most fundamental physical needs. Brain-Computer Interface (BCI) technology has been established in the clinical context, but faces challenges in the critical care environment. Contrary to cue-based BCIs, which allow activation only during pre-determined periods of time, self-paced BCI systems empower patients to interact with others at any time. The study aims to develop a self-paced BCI for patients in the intensive care unit. Methods BCI experiments were conducted in 18 ICU patients and 5 healthy volunteers. The proposed self-paced BCI system analyzes EEG activity from patients while these are asked to control a beeping tone by performing a motor task (i.e., opening and closing a hand). Signal decoding is performed in real time and auditory feedback given via headphones. Performance of the BCI system was judged based on correlation between the optimal and the observed performance. Results All 5 healthy volunteers were able to successfully perform the BCI task, compared to chance alone (p<0.001). 5 of 14 (36%) conscious ICU patients were able to perform the BCI task. One of these 5 patients was quadriplegic and controlled the BCI system without any hand movements. None of the 4 unconscious patients were able to perform the BCI task. Conclusions More than one third of conscious ICU patients and all healthy volunteers were able to gain control over the self-paced BCI system. The initial 4 unconscious patients were not. Future studies will focus on studying the ability of behaviorally unresponsive patients with cognitive motor dissociation to control the self-paced BCI system.
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Improving Nonvocal Critical Care Patients' Ease of Communication Using a Modified SPEACS-2 Program. J Healthc Qual 2020; 42:e1-e9. [PMID: 30648998 DOI: 10.1097/jhq.0000000000000163] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility and impact of implementing the "study of patient-nurse effectiveness with assisted communication strategies-2" (SPEACS-2); a program to facilitate communication with nonvocal patients. STUDY DESIGN The plan-do-study-act quality improvement methodology guided the implementation of a modified SPEACS-2 program within a pre and posttest design. The Ease of Communication Scale (ECS) measured patients' communication difficulty, and care processes measured the program's success. STUDY POPULATION Nurses (N = 385) across 5 intensive care units were trained in SPEACS-2. We assessed 354 nonvocal patients (aged 18-95 years) requiring continued mechanical ventilation after withdrawal of heavy sedation. Patients were evaluated over one 2-week preintervention (n = 163) and two 3-week postintervention periods (n = 128; n = 63). A subsample of intervention patients (n = 204) completed the ECS. RESULTS Ease of Communication Scale scores improved significantly (p = .027) from baseline (mean 25.86 ± 12.2, n = 71) to postintervention period 2 (21.22 ± 12.2, n = 63). Nurses' use of communication techniques and compliance with communication plans of care incrementally increased after training. CONCLUSIONS Implementing SPEACS-2 demonstrated positive changes in patients' ease of communication and feasibility of incorporating evidence-based communication strategies into practice.
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Karlsen MMW, Happ MB, Finset A, Heggdal K, Heyn LG. Patient involvement in micro-decisions in intensive care. PATIENT EDUCATION AND COUNSELING 2020; 103:2252-2259. [PMID: 32493611 DOI: 10.1016/j.pec.2020.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The objective of this study was to explore how bedside micro-decisions were made between conscious patients on mechanical ventilation in intensive care and their healthcare providers. METHODS Using video recordings to collect data, we explored micro-decisions between 10 mechanically ventilated patients and 60 providers in interactions at the bedside. We first identified the types of micro-decisions before using an interpretative approach to analyze the decision-making processes and create prominent themes. RESULTS We identified six types of bedside micro-decisions; non-invited, substituted, guided, invited, shared and self-determined decisions. Three themes were identified in the decision-making processes: 1) being an observer versus a participant in treatment and care, 2) negotiating decisions about individualized care (such as tracheal suctioning or medication),and 3) balancing empowering activities with the need for energy restoration. CONCLUSION This study revealed that bedside decision-making processes in intensive care were characterized by a high degree of variability between and within patients. Communication barriers influenced patients' ability to express their preferences. An increased understanding of how micro-decisions occur with non-vocal patients is needed to strengthen patient participation. PRACTICE IMPLICATIONS We advise providers to make an effort to solicit patients' preferences when caring for critically ill patients.
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Affiliation(s)
- Marte Marie Wallander Karlsen
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway; Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1100 Blindern, 0137 Oslo, Norway; Department of Emergencies and Critical Care, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
| | - Mary Beth Happ
- The Ohio State University, College of Nursing, 352 Newton Hall, 1585 Neil Avenue Columbus, OH 43210 USA.
| | - Arnstein Finset
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1100 Blindern, 0137 Oslo, Norway.
| | - Kristin Heggdal
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway.
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Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review. Crit Care Explor 2020; 2:e0121. [PMID: 32695990 PMCID: PMC7314319 DOI: 10.1097/cce.0000000000000121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives: With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure. These problems can lead to noninvasive ventilation failure, which is often linked to worse outcomes than first initiating invasive mechanical ventilation and can lead to increased hospitalization costs. Data Sources: We searched MEDLINE and Google Scholar for “speech,” “communication,” “impairment,” “failure,” “complications,” “NIPPV,” “NIV,” and “noninvasive ventilation.” Study Selection: We included articles with patients in acute respiratory failure. We excluded articles for patients using noninvasive ventilation therapy for obstructive sleep apnea. Data Synthesis: Communication impairment has been associated with increasing noninvasive ventilation anxiety (odds ratio, 1.25). Of patients using noninvasive ventilation, 48% require early discontinuation, 22% refuse noninvasive ventilation, and 9% are ultimately intubated. Improvements to communication have been shown to reduce fear and anxiety in invasive mechanical ventilation patients. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes. Conclusions: Communication impairment is an underappreciated cause of noninvasive ventilation complications and failure and requires further characterization. Analogous solutions—such as throat microphones and mask-based microphones—that can be easily implemented show potential as cost-effective methods to reduce noninvasive ventilation failure.
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McRae J, Montgomery E, Garstang Z, Cleary E. The role of speech and language therapists in the intensive care unit. J Intensive Care Soc 2019; 21:344-348. [PMID: 34093737 DOI: 10.1177/1751143719875687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
National guidance recommends the involvement of speech and language therapists in intensive care particularly for those requiring tracheostomy and ventilation. However, the role of speech and language therapists is poorly understood especially in the context of critical care. This article aims to increase awareness of the background training and skills development of speech and language therapists working in this context to demonstrate their range of specialist abilities. Speech and language therapists support and enhance the process of laryngeal weaning alongside the rehabilitation of speech and swallowing as part of the multidisciplinary team. Examples are provided of the types of interventions that are used and technological innovations that may enhance rehabilitation of oropharyngeal impairments.
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Affiliation(s)
- Jackie McRae
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK.,School of Allied Health, Midwifery and Social Care, Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Elizabeth Montgomery
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Zoë Garstang
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Eibhlin Cleary
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
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Zaga CJ, Berney S, Vogel AP. The Feasibility, Utility, and Safety of Communication Interventions With Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1335-1355. [PMID: 31296037 DOI: 10.1044/2019_ajslp-19-0001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to conduct a systematic review of the literature relating to the feasibility, utility, and safety of augmentative and alternative communication (AAC) interventions and tracheostomy-related communication interventions with mechanically ventilated adult patients in the intensive care unit (ICU). Method MEDLINE, Embase, and PsycINFO databases were searched for relevant articles. Studies were included if (a) they were performed in the ICU, (b) they involved participants > 18 years of age, (c) > 85% of participants were mechanically ventilated, and (d) they reported on content that related to the feasibility and/or utility and/or safety of AAC intervention and/or tracheostomy-related communication intervention. Studies were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The levels of evidence for included studies were assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Results Forty-eight studies met the inclusion criteria. Different communication interventions relating to intubated and tracheostomized mechanically ventilated patients were reviewed, including (a) communication boards, (b) electrolarynx, (c) high-technology AAC devices, (d) tracheostomy tubes with communication-enabling features, (e) one-way valve in line with the ventilator, (f) ventilator-adjusted leak speech, (g) ventilator adjustments and one-way valve, and (h) multiple interventions. Forty-seven of 48 studies examined the feasibility and utility of the interventions. Sixteen studies examined the safety of the interventions. The included studies were composed of randomized controlled trials (n = 2), quasi-experimental studies (n = 7), cohort studies (n = 8), case-control (n = 1), case series (n = 23), and case reports (n = 7). The levels of evidence varied and ranged from high (n = 2), moderate (n = 7), low (n = 9), and very low (n = 30). Conclusions There is developing evidence that communication interventions with mechanically ventilated ICU patients are feasible, have utility, and are safe. Further research is warranted to guide speech pathologist-directed intervention to improve patient outcomes and the patient experience in the ICU.
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Affiliation(s)
- Charissa J Zaga
- Speech Pathology Department, Austin Health, Melbourne, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
- Tracheostomy Review and Management Service, Austin Health, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Melbourne, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Australia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen Germany
- Redenlab, Melbourne, Australia
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18
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Rose L, Sutt AL, Amaral AC, Fergusson DA, Hart N, Smith OM, Dale CM. Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support. Hippokratia 2019. [DOI: 10.1002/14651858.cd013379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute; Department of Critical Care Medicine; Toronto Canada
- Kings College London; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care; London UK
| | - Anna-Liisa Sutt
- The Prince Charles Hospital; Critical Care Research Group; Brisbane Australia
- The University of Queensland; School of Clinical Medicine; Brisbane Australia
| | | | - Dean A Fergusson
- Ottawa Hospital Research Institute; Clinical Epidemiology Program; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Nicholas Hart
- National Institute of Health Research, Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust and King's College London; Respiratory & Critical Care Medicine; Lane Fox Respiratory Unit St Thomas's Hospital, Westminster Bridge Road London UK SE1 7EH
| | - Orla M Smith
- St Michael's Hospital; Critical Care; 30 Bond Street Toronto Canada
| | - Craig M Dale
- University of Toronto; Lawrence S. Bloomberg Faculty of Nursing; 155 College Street Toronto Canada
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Rohaut B, Eliseyev A, Claassen J. Uncovering Consciousness in Unresponsive ICU Patients: Technical, Medical and Ethical Considerations. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:78. [PMID: 30850022 PMCID: PMC6408788 DOI: 10.1186/s13054-019-2370-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Benjamin Rohaut
- Neurocritical Care, Department of Neurology, Columbia University, New York, NY, USA
| | - Andrey Eliseyev
- Neurocritical Care, Department of Neurology, Columbia University, New York, NY, USA
| | - Jan Claassen
- Neurocritical Care, Department of Neurology, Columbia University, New York, NY, USA.
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IJssennagger CE, Ten Hoorn S, Van Wijk A, Van den Broek JM, Girbes AR, Tuinman PR. Caregivers' perceptions towards communication with mechanically ventilated patients: The results of a multicenter survey. J Crit Care 2018; 48:263-268. [PMID: 30245368 DOI: 10.1016/j.jcrc.2018.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate ICU health care providers' perception towards communication and associated problems with mechanically ventilated (MV) patients. The primary aim was to quantify the extent of the problem and to determine its effect on patient care and job satisfaction. METHODS A multicenter survey study was conducted among nurses, residents and intensivists of 15 ICUs in the Netherlands using an online questionnaire. RESULTS Out of 1740 caregivers, 457 responses were received. Communication difficulties were experienced in half of the interactions with MV patients. Over 75% of participants indicated that patient care was negatively affected. Job satisfaction was negatively affected in 43% of the participants, primarily with feelings of unfulfillment (76%) and frustration (72%). Patient factors considered relevant to communication difficulties were delirium, disease severity and anxiety, among others. To facilitate communication, the use of basic gestures remained the most preferred method. CONCLUSIONS In half of the interactions with MV patients, health care professionals experience significant communication difficulties. The respondents indicated that these difficulties frequently lead to negative effects on patient care and job satisfaction. These results emphasize the need for improvements such as the development of communication protocols, skills training and continued research into new communication methods.
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Affiliation(s)
- C E IJssennagger
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
| | - S Ten Hoorn
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - A Van Wijk
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - J M Van den Broek
- Zaans Medisch Centrum, Department of Intensive Care Medicine, Zaandam, the Netherlands
| | - A R Girbes
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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21
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Nilsen ML, Morrison A, Lingler JH, Myers B, Johnson JT, Happ MB, Sereika SM, DeVito Dabbs A. Evaluating the Usability and Acceptability of Communication Tools Among Older Adults. J Gerontol Nurs 2018; 44:30-39. [DOI: 10.3928/00989134-20180808-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/19/2018] [Indexed: 11/20/2022]
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Karlsen MMW, Ølnes MA, Heyn LG. Communication with patients in intensive care units: a scoping review. Nurs Crit Care 2018; 24:115-131. [PMID: 30069988 DOI: 10.1111/nicc.12377] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/02/2018] [Accepted: 06/13/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients in intensive care units are generally more conscious and alert when they are on mechanical ventilation than in previous years because of the many potential benefits of being under less sedation. The endotracheal tube blocks the vocal cords when patients are on ventilation, thus making it impossible to speak. Many patients report that they struggle to make themselves understood. AIM The aim of this study was to assess previous knowledge about interaction and communication between health care personnel and conscious and alert patients under mechanical ventilation in intensive care units. DESIGN AND METHODS A literature review was performed following the steps of a scoping review. Studies published between 1998 and 2017 were identified in several databases: Cinahl, Embase, Medline, PsycINFO and Scopus. The first search returned 7386 unique references. The inclusion criteria consisted of empirical studies or studies related to interactions between health care personnel and patients over 18 years of age on mechanical ventilation. The relevant studies were summarized in a standardized data-charting sheet. RESULTS The inclusion criteria were met by 46 articles; 16 were qualitative studies, 17 were quantitative, 6 were mixed-methods studies, and 7 were pilot or feasibility studies. Of the studies, 37 were from nurses, 4 from physicians, 4 from speech language pathologists and 1 from psychologists. The most common topics investigated in the studies were 'experiences with communication on mechanical ventilation' and 'communication exchanges'. CONCLUSIONS A variety of communication aids that appear to have some effect on patients should be made available in intensive care units. More multidisciplinary approaches in future studies could enhance the knowledge in the field. RELEVANCE TO CLINICAL PRACTICE The education of intensive care unit personnel in the use of such aids should be a prioritized field, as should be the implementation of a variety of communication aids.
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Affiliation(s)
| | - Mia Alexandra Ølnes
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway
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Rose L, Istanboulian L, Smith OM, Silencieux S, Cuthbertson BH, Amaral ACKB, Fraser I, Grey J, Dale C. Feasibility of the electrolarynx for enabling communication in the chronically critically ill: The EECCHO study. J Crit Care 2018; 47:109-113. [PMID: 29945066 DOI: 10.1016/j.jcrc.2018.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/29/2018] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators. METHODS We included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction. Interviews explored barriers/facilitators. MEASUREMENTS AND MAIN RESULTS We recruited 24 participants (Jan2015-Dec2016). Mean (SD) intelligibility was 45%(18%) words correct: 57%(21%) when facing. Mean comprehension difficulty was 6.4(2.0) overall, indicating moderate difficulty (5.5(2.5) scored visualizing). Mean EES was 2.9(1.0) (3 = improved lip-reading through recognizable sounds). Anxiety decreased from median 3.8 to 2.0 (P = .007). Communication was rated easier (median 15 vs 12, P = .04) whereas satisfaction remained similar (P = .06). Facilitators included device friendliness, patient independence, and word intelligibility. Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility. CONCLUSION The electrolarynx may aid intelligible speech for some tracheostomized patients if the communication partner can visualize the users face, and reduce anxiety and make patient perceived communication easier.
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Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada; Michael Garron Hospital, 825 Coxwell Ave, Toronto M4C 3E7, Canada; Kings College London, 57 Waterloo Bridge Rd, London.
| | | | - Orla M Smith
- St. Michael's Hospital, 30 Bond St, Toronto M5B 1W8, Canada; Li Ka Shing Knowledge Institute, 209 Victoria St., Toronto M5B 1T8, Canada
| | | | - Brian H Cuthbertson
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada
| | - Andre Carlos Kajdacsy-Balla Amaral
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada
| | - Ian Fraser
- University of Toronto, 155 College St, Toronto M5T 1P8, Canada; Michael Garron Hospital, 825 Coxwell Ave, Toronto M4C 3E7, Canada
| | - Joanne Grey
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada
| | - Craig Dale
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada
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Dehzangi O, Farooq M. Portable Brain-Computer Interface for the Intensive Care Unit Patient Communication Using Subject-Dependent SSVEP Identification. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9796238. [PMID: 29662908 PMCID: PMC5832111 DOI: 10.1155/2018/9796238] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/17/2022]
Abstract
A major predicament for Intensive Care Unit (ICU) patients is inconsistent and ineffective communication means. Patients rated most communication sessions as difficult and unsuccessful. This, in turn, can cause distress, unrecognized pain, anxiety, and fear. As such, we designed a portable BCI system for ICU communications (BCI4ICU) optimized to operate effectively in an ICU environment. The system utilizes a wearable EEG cap coupled with an Android app designed on a mobile device that serves as visual stimuli and data processing module. Furthermore, to overcome the challenges that BCI systems face today in real-world scenarios, we propose a novel subject-specific Gaussian Mixture Model- (GMM-) based training and adaptation algorithm. First, we incorporate subject-specific information in the training phase of the SSVEP identification model using GMM-based training and adaptation. We evaluate subject-specific models against other subjects. Subsequently, from the GMM discriminative scores, we generate the transformed vectors, which are passed to our predictive model. Finally, the adapted mixture mean scores of the subject-specific GMMs are utilized to generate the high-dimensional supervectors. Our experimental results demonstrate that the proposed system achieved 98.7% average identification accuracy, which is promising in order to provide effective and consistent communication for patients in the intensive care.
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Affiliation(s)
- Omid Dehzangi
- Computer and Information Science Department, University of Michigan-Dearborn, 4901 Evergreen Rd., CIS 112, Dearborn, MI, USA
| | - Muhamed Farooq
- Computer and Information Science Department, University of Michigan-Dearborn, 4901 Evergreen Rd., CIS 112, Dearborn, MI, USA
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Leung CCH, Pun J, Lock G, Slade D, Gomersall CD, Wong WT, Joynt GM. Exploring the scope of communication content of mechanically ventilated patients. J Crit Care 2017; 44:136-141. [PMID: 29102851 DOI: 10.1016/j.jcrc.2017.10.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Ineffective communication during mechanical ventilation (MV) and critical illness is distressing to many patients. This study aimed to describe the scope of communication content of ventilated critically ill patients. MATERIALS AND METHODS We performed a prospective qualitative interview study in a multidisciplinary intensive care unit. Ten alert, orientated adult patients who previously underwent MV for at least 24h and were able to speak at the time of interview were recruited. Semi-structured interviews with stimulated recall technique were conducted. A descriptive thematic analysis was performed of the patient-generated content using a free coding technique, where recurrent themes and subthemes were noted, coded and analyzed. RESULTS Patients' communication content included medical discussions with clinicians; communication with family to provide advice or comfort, make requests and plans, express feelings and convey personal perspectives on medical care; and expression of their own psychoemotional needs. CONCLUSIONS The scope of communication content of ventilated ICU patients was broad, extending far beyond task-focused subject matter. Content ranged from conveying symptom-related messages to active participation in medical discussions, to conversing with family about a range of complex multi-dimensional issues, to sharing their own psychoemotional experiences. These patient-centered needs should be recognized and addressed in communication strategies.
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Affiliation(s)
- Czarina C H Leung
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Jack Pun
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Graham Lock
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Diana Slade
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Charles D Gomersall
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Wai Tat Wong
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Gavin M Joynt
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
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Brunner TH, DiFortuna K, LeTang M, Murphy J, Stemplewicz K, Kovacs M, DeRosa AP, Gibson DS, Ginex PK. Feasibility of an iPad to Facilitate Communication in Postoperative Patients With Head and Neck Cancer. J Perianesth Nurs 2017; 33:399-406. [PMID: 30077281 DOI: 10.1016/j.jopan.2016.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To measure the feasibility of a communication application and an iPad to facilitate communication in postoperative patients with head and neck cancer. DESIGN A prospective feasibility study. METHODS This IRB-approved study was conducted in the postanesthesia care unit at an urban comprehensive cancer center. The participants included patients with head and neck cancer who underwent surgery that resulted in altered communication. Questionnaires were developed and administered to measure feasibility and patient satisfaction at different time points (preoperative, postoperative, and 1 to 4 days postoperatively). FINDINGS Of 38 patients in the study, 25 (66%) were able to use the customized iPad. Of these 25 patients, 15 (60%) were satisfied or somewhat satisfied with it. 84% found the customized iPad to be very or somewhat helpful for communication after surgery. CONCLUSIONS Patients were satisfied with the customized iPad, and the study found that using technology such as this was feasible in the immediate postoperative period.
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Koszalinski RS, Tappen RM, Hickman C, Melhuish T. Communication Needs of Critical Care Patients Who Are Voiceless. Comput Inform Nurs 2017; 34:339-44. [PMID: 27315366 DOI: 10.1097/cin.0000000000000266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Voice is crucial for communication in all healthcare settings. Evidence-based care highlights the need for clear communication. Clear communication methods must be applied when caring for special populations in order to assess pain effectively. Communication efforts also should be offered to patients who are in end-of-life care and would like to make independent decisions. A computer communication application was offered to patients in intensive care/critical care units in three hospitals in South Florida. Inclusion criteria included the age of 18 years or older, Richmond Agitation Sedation Scale between -1 and +1, ability to read and write English, and willingness to use the computer application. Exclusion criteria included inability to read and write English, agitation as defined by the Richmond Agitation Sedation Scale, and any patient on infection isolation protocol. Four qualitative themes were revealed, which directly relate to two published evidence-based guidelines. These are the End of Life Care and Decision Making Evidence-Based Care Guidelines and the Pain Assessment in Special Populations Guidelines. This knowledge is important for developing effective patient-healthcare provider communication.
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Affiliation(s)
- Rebecca S Koszalinski
- Author Affiliations: College of Nursing, University of Tennessee Knoxville (Dr Koszalinski); Florida Atlantic University, Boca Raton (Dr Tappen); Boca Raton Regional Hospital, Florida (Ms Hickman); and CVICU, CCU, and NSICU, Holy Cross Hospital, Fort Lauderdale, Florida (Ms Melhuish).The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article
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Martinho CIF, Rodrigues ITRM. Communication of mechanically ventilated patients in intensive care units. Rev Bras Ter Intensiva 2017; 28:132-40. [PMID: 27410408 PMCID: PMC4943050 DOI: 10.5935/0103-507x.20160027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/29/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. METHODS This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. RESULTS Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). CONCLUSION This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the presence of other clinical and/or sociodemographic variables.
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Ten Hoorn S, Elbers PW, Girbes AR, Tuinman PR. Communicating with conscious and mechanically ventilated critically ill patients: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:333. [PMID: 27756433 PMCID: PMC5070186 DOI: 10.1186/s13054-016-1483-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
Abstract
Background Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. We summarized the current evidence on communication methods with mechanically ventilated patients in the ICU. Secondly, we developed an algorithm for communication with these patients based on current evidence. Methods We performed a systematic review. PubMed, Embase, Cochrane, Cinahl, PsychInfo, and Web of Science databases were systematically searched to November 2015. Studies that reported a communication intervention with conscious nonverbal mechanically ventilated patients in the ICU aged 18 years or older were included. The methodological quality was assessed using the Quality Assessment Tool. Results The search yielded 9883 publications, of which 31 articles, representing 29 different studies, fulfilled the inclusion criteria. The overall methodological quality varied from poor to moderate. We identified four communication intervention types: (1) communication boards were studied in three studies—they improved communication and increased patient satisfaction, but they can be time-consuming and limit the ability to produce novel utterances; (2) two types of specialized talking tracheostomy tubes were assessed in eight studies—audible voicing was achieved in the majority of patients (range 74–100 %), but more studies are needed to facilitate safe and effective use; (3) an electrolarynx improved communication in seven studies—its effectiveness was mainly demonstrated with tracheostomized patients; and (4) “high-tech” augmentative and alternative communication (AAC) devices in nine studies with diverse computerized AAC devices proved to be beneficial communication methods—two studies investigated multiple AAC interventions, and different control devices (e.g., touch-sensitive or eye/blink detection) can be used to ensure that physical limitations do not prevent use of the devices. We developed an algorithm for the assessment and selection of a communication intervention with nonverbal and conscious mechanically intubated patients in the ICU. Conclusions Although evidence is limited, results suggest that most communication methods may be effective in improving patient–healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an algorithm to standardize the approach for selection of communication techniques. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1483-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Ten Hoorn
- Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.,Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P W Elbers
- Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.,Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - A R Girbes
- Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.,Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands. .,Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
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Abstract
This metasynthesis presents an enlarged interpretation and understanding of nonvocal mechanically ventilated patients’experiences with communication. Peplau’s interpersonal relations theory provided the theoretical framework for the metasynthesis. The final sample included 12 qualitative studies, for a total of 111 participants. The data, methods, and theoretical frameworks were critically interpreted. Commonthreads detected across study participants’individual experiences were synthesized to form a greater understanding of nonvocal ventilated patients’ perceptions of being understood. Five overarching themes were divided into two groups. The first group of themes was categorized as the characteristics of nonvocal ventilated patients’communication experiences. Nonvocal individuals were often not understood, which resulted in loss of control and negative emotional responses. The second group of themes was categorized as the kind of nursing care desired by nonvocal patients in order to be understood. Nonvocal patients wanted nursing care that was delivered in an individualized, caring manner. This facilitated positive interpersonal relations between the patient and the nurse. Findings are discussed in relation to the current state of knowledge on this topic.
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Rodriguez CS, Rowe M, Thomas L, Shuster J, Koeppel B, Cairns P. Enhancing the Communication of Suddenly Speechless Critical Care Patients. Am J Crit Care 2016; 25:e40-7. [PMID: 27134237 DOI: 10.4037/ajcc2016217] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sudden speechlessness is common in critically ill patients who are intubated or have had surgery for head and neck cancer. Sudden inability to speak poses challenges for hospitalized patients because strategies to facilitate communication are often limited and unreliable. OBJECTIVE To determine the impact of a technology-based communication intervention on patients' perception of communication difficulty, satisfaction with communication methods, and frustration with communication. METHODS A quasi-experimental, 4-cohort (control and intervention) repeated-measures design was used. Data were collected daily for up to 10 days. Patients in adult critical care units were followed up as they were transferred to other units within the institutions selected for the study. The impact of a technology-based communication system (intervention) was compared with usual care (control). Patients' communication outcomes pertinent to communication with nursing staff that were evaluated included perception of communication ease, satisfaction with methods used for communication, and frustration with communication. RESULTS Compared with participants in the control group, participants in the intervention group reported lower mean frustration levels (-2.68; SE, 0.17; 95% CI, -3.02 to -2.34; P < .001) and higher mean satisfaction levels (0.59; SE, 0.16; 95% CI, 0.27 to 0.91; P < .001) with use of the communication intervention. Participants in the intervention group reported a consistent increase in perception of communication ease during the hospital stay. CONCLUSIONS The results facilitated evaluation of a bedside technology-based communication intervention tailored to the needs of suddenly speechless critically ill patients.
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Affiliation(s)
- Carmen S. Rodriguez
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Meredeth Rowe
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Loris Thomas
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Jonathan Shuster
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Brent Koeppel
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Paula Cairns
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
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Van Rompaey B, Van Hoof A, van Bogaert P, Timmermans O, Dilles T. The patient's perception of a delirium: A qualitative research in a Belgian intensive care unit. Intensive Crit Care Nurs 2016; 32:66-74. [DOI: 10.1016/j.iccn.2015.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/27/2015] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
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Rodriguez CS, Spring HJ, Rowe M. Nurses' experiences of communicating with hospitalized, suddenly speechless patients. QUALITATIVE HEALTH RESEARCH 2015; 25:168-178. [PMID: 25225048 DOI: 10.1177/1049732314550206] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We used a qualitative focus group design to explore the experiences and challenges of nurses who work with hospitalized patients experiencing the sudden inability to verbalize their needs, also known as sudden speechlessness. In response to open-ended questions in facilitated focus groups, 18 nurses discussed issues around the care and communication needs of suddenly speechless (SS) patients. Nurses identified multiple, commonly occurring communication challenges when caring for SS patients. They believed these challenges led to poorer recognition of patient needs, with the potential for compromised patient care. Nurses described how the lack of reliable strategies to facilitate communication sometimes resulted in negative patient outcomes, including unmet psychosocial needs and the potential that informed consent and educational issues were being inadequately addressed for the SS patients. Even experienced nurses indicated ongoing problems in communicating with SS patients, despite using a multitude of strategies, leaving many to deal with issues of frustration and role conflict.
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Wang Y, Li H, Zou H, Li Y. Analysis of Complaints from Patients During Mechanical Ventilation After Cardiac Surgery: A Retrospective Study. J Cardiothorac Vasc Anesth 2015; 29:990-4. [PMID: 25939965 DOI: 10.1053/j.jvca.2015.01.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study analyzed major complaints from patients during mechanical ventilation after cardiac surgery and identified the most common complaints to reduce adverse psychologic responses. DESIGN Retrospective. SETTING A single tertiary university hospital. PARTICIPANTS Patients with heart disease who were on mechanical ventilation after cardiac surgery (N = 800). INTERVENTIONS The major complaints of the patients during mechanical ventilation after cardiac surgery were analyzed. MEASUREMENTS AND MAIN RESULTS Patients' comfort was evaluated using a visual analog scale, and the factors affecting comfort were analyzed. The average visual analog scale score in all patients was 5.8±2.0, and most patients presented moderate discomfort. The factors affecting comfort included dry mouth, thirst, tracheal intubation, aspiration of sputum, communication barriers, limited mobility, fear/anxiety, patient-ventilator dyssynchrony, and poor environmental conditions. Of these factors, 8 were independent predictors of the visual analog scale score. Patients considered mechanical ventilation to be the worst part of their hospitalization. CONCLUSIONS The study identified 8 independent factors causing discomfort in patients during mechanical ventilation after cardiac surgery. Clinicians should take appropriate measures and implement nursing interventions to reduce suffering, physical and psychologic trauma, and adverse psychologic responses and to promote recovery.
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Affiliation(s)
- Yi Wang
- Department of Heart Vascular Surgery, Yan'An Hospital Affiliated to Kunming Medical University, Kunming, Yunnan Province, China
| | - Hua Li
- Department of Heart Vascular Surgery, Yan'An Hospital Affiliated to Kunming Medical University, Kunming, Yunnan Province, China
| | - Honglin Zou
- Department of Heart Vascular Surgery, Yan'An Hospital Affiliated to Kunming Medical University, Kunming, Yunnan Province, China
| | - Yaxiong Li
- Department of Heart Vascular Surgery, Yan'An Hospital Affiliated to Kunming Medical University, Kunming, Yunnan Province, China.
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El-Soussi AH, Elshafey MM, Othman SY, Abd-Elkader FA. Augmented alternative communication methods in intubated COPD patients: Does it make difference. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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The number of mechanically ventilated ICU patients meeting communication criteria. Heart Lung 2014; 44:45-9. [PMID: 25261939 PMCID: PMC5935242 DOI: 10.1016/j.hrtlng.2014.08.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/29/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES (1) Estimate the proportion of mechanically ventilated (MV) intensive care unit (ICU) patients meeting basic communication criteria who could potentially be served by assistive communication tools and speech-language consultation. (2) Compare characteristics of patients who met communication criteria with those who did not. DESIGN Observational cohort study in which computerized billing and medical records were screened over a 2-year period. SETTING Six specialty ICUs across two hospitals in an academic health system. PARTICIPANTS Eligible patients were awake, alert, and responsive to verbal communication from clinicians for at least one 12-h nursing shift while receiving MV ≥ 2 consecutive days. MAIN RESULTS Of the 2671 MV patients screened, 1440 (53.9%) met basic communication criteria. The Neurological ICU had the lowest proportion of MV patients meeting communication criteria (40.82%); Trauma ICU had the highest proportion (69.97%). MV patients who did not meet basic communication criteria (n = 1231) were younger, had shorter lengths of stay and lower costs, and were more likely to die during the hospitalization. CONCLUSIONS We estimate that half of MV patients in the ICU could potentially be served by assistive communication tools and speech-language consultation.
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Breckenridge SJ, Chlan L, Savik K. Impact of tracheostomy placement on anxiety in mechanically ventilated adult ICU patients. Heart Lung 2014; 43:392-8. [PMID: 24559754 DOI: 10.1016/j.hrtlng.2014.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 01/10/2014] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine if self-reported anxiety levels decreased after tracheostomy placement in a sample of mechanically ventilated intensive care unit patients. BACKGROUND There is limited research regarding the impact of a tracheostomy on patients' anxiety. Elevated anxiety delays healing and contributes to long-term mental health complications. METHODS This was a secondary analysis of data from a large clinical trial conducted in urban Minnesota. Fifty-one of 116 patients received a tracheostomy. Anxiety scores were obtained daily using the Visual Analog Scale-Anxiety. Mixed model analysis was used to compare anxiety ratings pre- and post-tracheostomy. RESULTS There was no significant decrease in anxiety following tracheostomy after controlling for time and gender (all p > .16). Age was the only variable to impact anxiety levels: anxiety scores increased as age increased (p = .02). CONCLUSIONS Prospective studies are needed to more accurately assess the impact of tracheostomy placement on patient anxiety and salient outcomes.
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Affiliation(s)
| | - Linda Chlan
- Symptom Management Research, College of Nursing, Ohio State University, 398 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA
| | - Kay Savik
- School of Nursing, University of Minnesota, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
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Nilsen ML, Sereika SM, Hoffman LA, Barnato A, Donovan H, Happ MB. Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU. Res Gerontol Nurs 2014; 7:113-25. [PMID: 24496114 DOI: 10.3928/19404921-20140127-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 12/05/2013] [Indexed: 01/26/2023]
Abstract
The study purposes were to (a) describe interaction behaviors and factors that may effect communication and (b) explore associations between interaction behaviors and nursing care quality indicators among 38 mechanically ventilated patients (age ≥60 years) and their intensive care unit nurses (n = 24). Behaviors were measured by rating videorecorded observations from the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction. All positive behaviors occurred at least once. Significant (p < 0.05) associations were observed between (a) positive nurse and positive patient behaviors, (b) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, (c) individual patient unaided AAC strategies and individual nurse positive behaviors, (d) positive nurse behaviors and pain management, and (e) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors effect communication and may be associated with nursing care quality.
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Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial. Heart Lung 2014; 43:89-98. [PMID: 24495519 PMCID: PMC4053558 DOI: 10.1016/j.hrtlng.2013.11.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients. DESIGN Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurse-patient dyad for communication frequency, quality and success. Patients self-rated communication ease. SETTING Two ICUs in a university-affiliated medical center. PARTICIPANTS 89 intubated patients awake, responsive and unable to speak and 30 ICU nurses. MAIN RESULTS Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC + SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p < .01). CONCLUSIONS This study provides support for the feasibility, utility and efficacy of a multi-level communication skills training, materials and SLP consultation intervention in the ICU.
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Nilsen ML, Happ MB, Donovan H, Barnato A, Hoffman L, Sereika SM. Adaptation of a communication interaction behavior instrument for use in mechanically ventilated, nonvocal older adults. Nurs Res 2014; 63:3-13. [PMID: 24335909 PMCID: PMC4006953 DOI: 10.1097/nnr.0000000000000012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Valid and reliable instruments are needed to measure communication interaction behaviors between nurses and mechanically ventilated intensive care unit patients who are without oral speech. OBJECTIVES The aim of this study was to refine and evaluate preliminary validity and reliability of a Communication Interaction Behavior Instrument (CIBI) adapted for use with mechanically ventilated, nonvocal patients in the intensive care unit. METHODS Raters observed nurse-patient communication interactions using a checklist of nurse and patient behaviors, categorized as positive and negative behaviors. Three-minute video-recorded observations of five mechanically ventilated adults (<60 years old) in the intensive care unit and their nurses were used to establish preliminary interrater reliability and confirm appropriateness of definitions (four observations per dyad, n = 20). On the basis of expert input and reliability results, the behaviors and item definitions on the CIBI were revised. The revised tool was then tested in a larger sample of 38 mechanically ventilated intensive care patients (> 60 years old) and their nurses (four observations per dyad, n = 152) to determine interrater reliability. RESULTS For preliminary testing, percent agreement for individual items ranged from 60% to 100% for nurse behaviors and 20% to 100% for patient behaviors across the five pilot cases. On the basis of these results, 11 definitions were modified and four items were dropped. Using the revised 29-item instrument, percent agreement improved for nurse behaviors (73%-100%) and patient behaviors (68%-100%). Kappa coefficients ranged from 0.13 to 1.00, with lower coefficients for patient behaviors. CONCLUSION Preliminary results suggest that the revised CIBI has good face validity and shows good interrater reliability for many of the behaviors, but further refinement is needed. The use of dual raters with adjudication of discrepancies is the recommended method of administration for the revised CIBI.
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Affiliation(s)
- Marci Lee Nilsen
- Marci Lee Nilsen, PhD, MSN, RN, is T32 Postdoctoral Fellow; Heidi Donovan, PhD, RN, is Associate Professor; Leslie Hoffman, PhD, RN, is Professor Emerita; and Susan M. Sereika PhD, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Amber Barnato, MD, MPH, MS, is Associate Professor, School of Medicine, University of Pittsburgh, Pennsylvania. Mary Beth Happ, PhD, RN, FAAN, is Distinguished Professor, College of Nursing, The Ohio State University, Columbus
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Otuzoğlu M, Karahan A. Determining the effectiveness of illustrated communication material for communication with intubated patients at an intensive care unit. Int J Nurs Pract 2013; 20:490-8. [DOI: 10.1111/ijn.12190] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Münevver Otuzoğlu
- Ankara Child Health and Disease; Hematology and Oncology Research and Education Hospital; Ankara Turkey
| | - Azize Karahan
- Nursing Department; Başkent University Faculty of Health Sciences; Ankara Turkey
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Nilsen ML, Sereika S, Happ MB. Nurse and patient characteristics associated with duration of nurse talk during patient encounters in ICU. Heart Lung 2013; 42:5-12. [PMID: 23305914 DOI: 10.1016/j.hrtlng.2012.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication interactions between nurses and mechanically ventilated patients in the intensive care unit (ICU) are typically brief. Factors associated with length of nurses' communication have not been explored. OBJECTIVE To examine the association between nurse and patient characteristics and duration of nurse talk. METHODS In this secondary analysis, we calculated duration of nurse talk in the first 3-min of video-recorded communication observation sessions for each nurse-patient dyad (n = 89) in the SPEACS study (4 observation sessions/dyad, n = 356). In addition, we explored the association between nurses' characteristics (age, gender, credentials, nursing experience, and critical care experience) and patients' characteristics (age, gender, race, education, delirium, agitation-sedation, severity of illness, level of consciousness, prior intubation history, days intubated prior to study enrollment, and type of intubation) on duration of nurse talk during the 3-min interaction observation. RESULTS Duration of nurse talk ranged from 0-123 s and varied significantly over the 4 observation sessions (p = .007). Averaging the duration of nurse talk over the observation sessions, differences in talk time between the units varied significantly by study group (p < .001). Talk duration was negatively associated with a Glasgow Coma Scale ≤14 (p = .008). Length of intubation prior to study enrollment had a curvilinear relationship with talking duration (linear p = .002, quadratic p = .013); the point of inflection was at 23 days. Nurse characteristics were not significantly related to duration of nurse talk. CONCLUSION Length of time the patient is intubated, and the patient's level of consciousness may influence duration of nurse communication in ICU.
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Affiliation(s)
- Marci Lee Nilsen
- University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
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Rodriguez CS, Rowe M, Koeppel B, Thomas L, Troche MS, Paguio G. Development of a communication intervention to assist hospitalized suddenly speechless patients. Technol Health Care 2013. [PMID: 23187014 DOI: 10.3233/thc-2012-0695] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Healthcare staff face significant challenges while caring for hospitalized patients experiencing sudden inability to verbalize their needs (sudden speechlessness). Familiar methods of communication such as non-verbal strategies are limited and often fail to assist suddenly speechless patients (SS) communicate their needs. Consequently, strategies tailored to the needs of hospitalized speechless patients are necessary, and must consider factors intrinsic to the patients and the complexities of the acute care environment. The feasibility and usability of a multi-functional prototype communication system (speech-generating device) tailored to the needs of hospitalized SS patients was evaluated in this pilot study. Adult SS patients admitted to the intensive care setting (n=11) demonstrated independent use of a multi-functional communication system that integrated messages and strategies tailored to the needs of the hospitalized SS patient. Participants reported high satisfaction levels and considered the use of the technology of high importance during an SS event. Additional research should focus on evaluating the impact of technology specific communication interventions on enhancing the communication process between SS patients and healthcare staff.
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Affiliation(s)
- Carmen S Rodriguez
- Adult and Elderly Department, College of Nursing, University of Florida, Gainesville, FL 32610, USA.
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Balas MC, Rice M, Chaperon C, Smith H, Disbot M, Fuchs B. Management of delirium in critically ill older adults. Crit Care Nurse 2013; 32:15-26. [PMID: 22855075 DOI: 10.4037/ccn2012480] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients' family members.
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Affiliation(s)
- Michele C Balas
- University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA.
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Meriläinen M, Kyngäs H, Ala-Kokko T. Patients' interactions in an intensive care unit and their memories of intensive care: a mixed method study. Intensive Crit Care Nurs 2012; 29:78-87. [PMID: 23021148 DOI: 10.1016/j.iccn.2012.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 04/25/2012] [Accepted: 05/15/2012] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to describe the interaction between intensive care patients and the intensive care unit (ICU) environment from the perspective of the hospital bed and patients' memories of the ICU. METHODS Four adult patients in an intensive care unit were each recorded on DVD over a 24 hour period. The patients were also interviewed three months and six months after discharge from hospital. The data generated regarding their interactions with the ICU environment were then analysed using qualitative and quantitative content analysis. RESULTS The ICU patient has short, direct and indirect contacts during treatment. In addition, the patient reacts to events in the ICU environment that do not include contact. Patients' memories were divided into two main categories: internal and external. Internal memories included physical and mental memories, which were experienced as surreal, unpleasant feelings or physical symptoms such as pain or the experience of being cold or thirsty. External experiences included events that the patient experienced through participation or observation, for example during nursing routines, or through hearing or observing other people, communication and the surroundings. CONCLUSION The patient's day in ICU is occupied with episodes of brief contact with nursing staff in an environment that the patient experiences as confusing or incomprehensible. The day and night rhythm is disturbed while the patient's opportunities for rest or concentration are limited. Most interactions affect the patient and it is important for staff to be aware of the impact of potentially unsettling events.
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Affiliation(s)
- Merja Meriläinen
- Division of Intensive Care Medicine, Department of Anaesthesiology, PL 21, FIN-90029, Oulu University Hospital, Finland.
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Khalaila R, Zbidat W, Anwar K, Bayya A, Linton DM, Sviri S. Communication difficulties and psychoemotional distress in patients receiving mechanical ventilation. Am J Crit Care 2011; 20:470-9. [PMID: 22045144 DOI: 10.4037/ajcc2011989] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Difficulties in communication in intensive care patients receiving mechanical ventilation are a source of stressful experiences and psychoemotional distress. OBJECTIVES To examine the association between communication characteristics and psychoemotional distress among patients treated with mechanical ventilation in a medical intensive care unit and to identify factors that may be predictive of psychological outcomes. METHODS A total of 65 critically ill patients, extubated within the preceding 72 hours, were included in this cross-sectional study. Data were collected by using a structured interview. Separate regression analysis of data on 3 psychoemotional outcomes (psychological distress, fear, and anger) were used for baseline variables, communication characteristics, and stressful experiences. RESULTS Difficulty in communication was a positive predictor of patients' psychological distress, and length of anesthesia was a negative predictor. Fear and anger were also positively related to difficulty in communication. In addition, the number of communication methods was negatively associated with feelings of fear and anger. Finally, the stressful experiences associated with the endotracheal tube were positively related to feelings of anger. CONCLUSIONS Patients treated with mechanical ventilation experience a moderate to extreme level of psychoemotional distress because they cannot speak and communicate their needs. Nurses should be aware of the patients' need to communicate. Decreasing stressful experiences associated with the endotracheal tube and implementing more appropriate communication methods may reduce patients' distress.
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Affiliation(s)
- Rabia Khalaila
- Rabia Khalaila is a head nurse, Wajdi Zbidat and Kabaha Anwar are staff nurses, Abed Bayya and Sigal Sviri are senior doctors, and David M. Linton is a professor and the medical manager in the medical intensive care unit at Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Wajdi Zbidat
- Rabia Khalaila is a head nurse, Wajdi Zbidat and Kabaha Anwar are staff nurses, Abed Bayya and Sigal Sviri are senior doctors, and David M. Linton is a professor and the medical manager in the medical intensive care unit at Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kabaha Anwar
- Rabia Khalaila is a head nurse, Wajdi Zbidat and Kabaha Anwar are staff nurses, Abed Bayya and Sigal Sviri are senior doctors, and David M. Linton is a professor and the medical manager in the medical intensive care unit at Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abed Bayya
- Rabia Khalaila is a head nurse, Wajdi Zbidat and Kabaha Anwar are staff nurses, Abed Bayya and Sigal Sviri are senior doctors, and David M. Linton is a professor and the medical manager in the medical intensive care unit at Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David M. Linton
- Rabia Khalaila is a head nurse, Wajdi Zbidat and Kabaha Anwar are staff nurses, Abed Bayya and Sigal Sviri are senior doctors, and David M. Linton is a professor and the medical manager in the medical intensive care unit at Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Rabia Khalaila is a head nurse, Wajdi Zbidat and Kabaha Anwar are staff nurses, Abed Bayya and Sigal Sviri are senior doctors, and David M. Linton is a professor and the medical manager in the medical intensive care unit at Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Vouzavali FJD, Papathanassoglou EDE, Karanikola MNK, Koutroubas A, Patiraki EI, Papadatou D. 'The patient is my space': hermeneutic investigation of the nurse-patient relationship in critical care. Nurs Crit Care 2011; 16:140-51. [PMID: 21481116 DOI: 10.1111/j.1478-5153.2011.00447.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The nurse-patient relationship has been postulated to lie at the core of nursing care. However, it is unclear how this concept applies in critical care, as a great majority of critically ill patients are unable to communicate. AIMS Through a phenomenological hermeneutical perspective, we aimed to explore intensive care nurses' perceptions and meanings regarding their interpersonal relationship with critically ill individuals. METHODS A Heideggerian hermeneutical approach was used to design the study and analyse the data, which were collected through repetitive interviews with 12 intensive care nurses. RESULTS Critical care nurses report to experience deep relationships with patients, which seem to be mediated by the ongoing contact with patients' bodies. These relationships evoke intense feelings of love, empathy and care and affect how nurses perceive and make sense of their role and their world. The identified core theme of their experience is entitled 'syncytium', which describes a network of closely connected cells. According to participants' perceptions, nurse and patient affect each other reciprocally and are mutually dependent upon each other. In Heideggerian terms patients provide nurses with opportunities to experience 'authentic care' and they participate in their 'being-in-the-world', thus they are central in nurses' meanings about their role and existence. Other elicited themes that account for the perceived nurse-patient relationship include the spatiality/temporality of the relationship, nurses' perceptions and meanings attributed to their role and nurses' perceptions of death. CONCLUSIONS Critical care nurses appear to experience their relationships with patients intensely. These relationships are invested with meanings and elicit powerful feelings over a shared course with patients. Patients are central in nurses' meaning-making process and role perception. RELEVANCE TO CLINICAL PRACTICE These findings have implications for the educational preparation of critical care nurses and their psychological support.
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Affiliation(s)
- Foteini J D Vouzavali
- Technological Educational Institute of Athens, Department of Nursing, Cholargos, Athens, Greece
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Happ MB, Garrett K, Thomas DD, Tate J, George E, Houze M, Radtke J, Sereika S. Nurse-patient communication interactions in the intensive care unit. Am J Crit Care 2011; 20:e28-40. [PMID: 21362711 PMCID: PMC3222584 DOI: 10.4037/ajcc2011433] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. OBJECTIVES To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. METHODS Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. RESULTS Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). CONCLUSIONS Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.
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Affiliation(s)
- Mary Beth Happ
- School of Nursing, University of Pittsburgh, Pennsylvania, USA.
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Abstract
Ascertaining the symptom experience of chronically critically ill (CCI) patients is difficult because of communication impairment and fluctuations in patient cognition and physiologic conditions. The use of checklist self-report ratings is hampered by the inability of most CCI patients to respond verbally to symptom queries. In addition to the communication problems caused by mechanical ventilation, the apparently diverse idioms of symptom expression add to the potential for miscommunication regarding symptom experience. Although patient communication impairment is a major barrier to symptom identification, symptom assessment and treatment are fundamental components of nursing care for CCI. This article reviews and describes the unique constellation of symptoms experienced by many critically ill patients. We report our observations of symptom communication among CCI patients and nurses and discuss inconsistency in the language of symptom expression among nurses and patients. Clinically applicable strategies to improve nurse-patient symptom communication and suggestions for refinement of symptom assessment in chronic critical illness are provided.
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