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McClintock C, McAuley DF, McIlmurray L, Alnajada AAR, Connolly B, Blackwood B. Communication in critical care tracheostomy patients dependent upon cuff inflation: A scoping review. Aust Crit Care 2024; 37:971-984. [PMID: 38627116 DOI: 10.1016/j.aucc.2024.02.009] [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: 11/20/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 10/12/2024] Open
Abstract
OBJECTIVES The aim of this study was to synthesise the evidence concerning communication in critically ill tracheostomy patients dependent on cuff inflation. The aim was to identify the psychological impact on patients awake and alert with tracheostomies but unable to speak; strategies utilised to enable communication and facilitators and barriers for the success of these strategies. REVIEW METHOD USED This scoping review was conducted using the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. DATA SOURCES CINAHL, Embase, Medline, and Web of Science were searched from 1st January 2000 to 30th September 2023 and supplemented with hand searching of references from included studies. REVIEW METHODS Studies were eligible if they addressed the psychological impact of voicelessness and/or the structure, process, and outcomes of augmentative and alternative communication (AAC) systems, in addition to facilitators and barriers to effectiveness. The population of interest included critically ill tracheostomy patients dependent on cuff inflation, their families, and healthcare workers. Screening and data extraction were undertaken by two reviewers independently. Data analysis involved descriptive statistics and content analysis. RESULTS A total of 23 studies met the inclusion criteria: 11 were qualitative, nine were quantitative, and three were mixed-methods studies. Voicelessness elicited negative emotions, predominantly frustration. AAC systems, encompassing unaided and aided (low-tech and high-tech) methods, presented both advantages and drawbacks. High-tech strategies held promise for patients with physical limitations. Patients equally appreciated the support offered through unaided strategies, including eye contact and touch. Facilitating factors included speech therapy involvement and assessment. Patient-related challenges were the most frequent barriers. CONCLUSION Facilitating meaningful communication for critically ill tracheostomy patients dependent on cuff inflation is of paramount psychological significance. Whilst AAC systems are practicable, they are not without limitations, implying the absence of a universally applicable solution. This underscores the importance of continuous evaluation, reinforced by a multidisciplinary team. REVIEW PROTOCOL REGISTERED 27 July 2022. REVIEW REGISTRATION Open Science Framework Registries: https://osf.io/kbrjn/.
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Affiliation(s)
- Carla McClintock
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK; Critical Care Unit, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, BT47 6SB, UK.
| | - Daniel F McAuley
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
| | - Lisa McIlmurray
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
| | - Asem Abdulaziz R Alnajada
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
| | - Bronwen Connolly
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
| | - Bronagh Blackwood
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT7 1NN, UK
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Gentile MN, Irvine AD, King AM, Hembrom AS, Guruswamy KS, Palivela NE, Langton-Frost N, McElroy CR, Pandian V. Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes. TRACHEOSTOMY (WARRENVILLE, ILL.) 2024; 1:26-41. [PMID: 39253605 PMCID: PMC11382609 DOI: 10.62905/001c.115440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background Tracheostomy, a common procedure performed in intensive care units (ICU), is associated with communication impairment and affects patient well-being. While prior research has focused on physiological care, there is a need to address communication needs and quality of life (QOL). We aimed to evaluate how different types of communication devices affect QOL, speech intelligibility, voice quality, time to significant events, clinical response and tolerance, and healthcare utilization in patients undergoing tracheostomy. Methods Following PRISMA guidelines, a systematic review was conducted to assess studies from 2016 onwards. Eligible studies included adult ICU patients with a tracheostomy, comparing different types of communication devices. Data were extracted and synthesized to evaluate QOL, speech intelligibility, voice quality, time to significant events (initial communication device use, oral intake, decannulation), clinical response and tolerance, and healthcare utilization and facilitators/barriers to device implementation. Results Among 9,228 studies screened, 8 were included in the review. Various communication devices were employed, comprising both tracheostomy types and speaking valves, highlighting the multifaceted nature of interventions. Quality of life improvements were observed with voice restoration interventions, but challenges such as speech intelligibility impairments were noted. The median time for initial communication device usage post-intervention was 11.4 ± 5.56 days. The median duration of speech tolerance ranged between 30-60 minutes to 2-3 hours across different studies. Complications such as air trapping or breathing difficulties were reported in 15% of cases. Additionally, the median ICU length of stay post-intervention was 36.5 days. Key facilitators for device implementation included early intervention, while barriers ranged from service variability to physical intolerance issues. Conclusion Findings demonstrate that various types of communication devices can significantly enhance the quality of life, speech intelligibility, and voice quality for patients undergoing tracheostomy, aligning with the desired outcomes of improved clinical response and reduced healthcare utilization. The identification of facilitators and barriers to device implementation further informs clinical practice, suggesting a tailored, patient-centered approach is crucial for optimizing the benefits of communication devices in this population.
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Affiliation(s)
- Mary N Gentile
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Annalise D Irvine
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Annamarie M King
- Department of Physical Medicine and Rehabilitation, Indiana University Health
| | | | | | | | | | - Colleen R McElroy
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
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3
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Zaga CJ, Papasavva CS, Hepworth G, Freeman-Sanderson A, Happ MB, Hoit JD, McGrath BA, Pandian V, Rose L, Sutt AL, Tuinman PR, Wallace S, Bellomo R, Vogel AP, Berney S. Development, feasibility testing, and preliminary evaluation of the Communication with an Artificial airway Tool (CAT): Results of the Crit-CAT pilot study. Aust Crit Care 2024; 37:127-137. [PMID: 37880059 DOI: 10.1016/j.aucc.2023.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND A purpose-built outcome measure for assessing communication effectiveness in patients with an artificial airway is needed. OBJECTIVES The objective of this study was to develop the Communication with an Artificial airway Tool (CAT) and to test the feasibility and to preliminary evaluate the clinical metrics of the tool. METHODS Eligible patients with an artificial airway in the Intensive Care Unit were enrolled in the pilot study (Crit-CAT). The CAT was administered at least twice before and after the communication intervention. Item correlation analysis was performed. Participant and family member acceptability ratings and feedback were solicited. A qualitative thematic analysis was undertaken. RESULTS Fifteen patients with a mean age of 53 years (standard deviation [SD]: 19.26) were included. The clinician-reported scale was administered on 50 attempts (100%) with a mean completion time of 4.5 (SD: 0.77) minutes. The patient-reported scale was administered on 46 out of 49 attempts (94%) and took a mean of 1.5 (SD: 0.39) minutes to complete. The CAT was feasible for use in the Intensive Care Unit, with patients with either an endotracheal or tracheostomy tube, whilst receiving invasive mechanical ventilation or not, and while using either verbal or nonverbal modes of communication. Preliminary establishment of responsiveness, validity, and reliability was made. The tool was acceptable to participants and their family members. CONCLUSION The clinician-reported and patient-reported components of the study were feasible for use. The CAT has the potential to enable quantifiable comparison of communication interventions for patients with an artificial airway. Future research is required to determine external validity and reliability.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Division of Allied Health, Austin Health, Melbourne, Australia; Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Institute of Breathing and Sleep, Austin Health, Melbourne, Australia.
| | - Catherine S Papasavva
- Department of Speech Pathology, Division of Allied Health, Austin Health, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mary Beth Happ
- Center for Healthy Aging, Self-Management & Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Jeannette D Hoit
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Brendan A McGrath
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK; Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD, USA
| | - 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; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK; Division of Infection Immunity and Respiratory Medicine, University of Manchester, UK
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Adam P Vogel
- Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Redenlab Inc, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Physiotherapy, The University of Melbourne, Melbourne, Australia
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Perelló-Campaner C, González-Trujillo A, Alorda-Terrassa C, González-Gascúe M, Pérez-Castelló JA, Morales-Asencio JM, Molina-Mula J. Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses. Healthcare (Basel) 2023; 11:2645. [PMID: 37830682 PMCID: PMC10572283 DOI: 10.3390/healthcare11192645] [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: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
AIM To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN A qualitative phenomenological approach was used. METHODS Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.
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Affiliation(s)
- Catalina Perelló-Campaner
- Emergency Care Service 061, 07011 Palma, Spain
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
| | - Antonio González-Trujillo
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
- Emergency Hospital Care Service, Hospital de Manacor, 07500 Manacor, Spain
| | - Carme Alorda-Terrassa
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
| | | | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), 29016 Málaga, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
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Wallace S, McGowan S, Sutt AL. Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy. J Intensive Care Soc 2023; 24:104-111. [PMID: 36874291 PMCID: PMC9975806 DOI: 10.1177/17511437221113162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication difficulties and their effects on patients who are mechanically ventilated are commonly reported and well described. The possibility of restoring speech for patients has obvious benefits, not only for meeting patient's immediate needs, but for helping them to re-engage in relationships and participate meaningfully in their recovery and rehabilitation. This opinion piece by a group of United Kingdom (UK) based Speech and Language Therapy experts working in critical care describes the various ways by which a patient's own voice can be restored. Common barriers to using different techniques and potential solutions are explored. We therefore hope that this will encourage intensive care unit (ICU) multi-disciplinary teams to advocate and facilitate early verbal communication in these patients.
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Affiliation(s)
- Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.,Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Sue McGowan
- Therapy Services, National Hospital for Neurology and Neurosurgery, UK
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Speech and Language Therapy, The Royal London Hospital, UK
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6
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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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Newman H, Clunie G, Wallace S, Smith C, Martin D, Pattison N. What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis. J Crit Care 2022; 72:154145. [PMID: 36174431 DOI: 10.1016/j.jcrc.2022.154145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care. MATERIALS AND METHODS Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care. RESULTS 2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was 'To be seen and heard as a whole person'. Patients wanted to be treated as a human, and having a voice made this easier. CONCLUSIONS Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.
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Affiliation(s)
- Helen Newman
- University College London, Division of Surgery and Interventional Science, Royal Free Hospital, 3(rd) Floor, Pond Street, London NW3 2QG, UK; Therapies Department, Barnet Hospital, Royal Free London NHS Foundation Trust, Wellhouse Lane, Barnet EN5 3DJ, UK.
| | - Gemma Clunie
- Sackler MSK Lab, Department of Surgery and Cancer, Imperial College London, 2(nd) Floor, Michael Uren Building, White City Campus, W12 0BZ, UK; Speech and Language Therapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, W6 8RF, UK
| | - Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; Division of Infection Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Christina Smith
- Department of Language and Cognition, Psychology and Language Sciences, University College London, London, UK
| | - Daniel Martin
- University College London, Division of Surgery and Interventional Science, Royal Free Hospital, 3(rd) Floor, Pond Street, London NW3 2QG, UK; Peninsula Medical School, University of Plymouth, John Bull Building, Plymouth, Devon PL6 8BU, UK
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK
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Akroute AR, Brinchmann BS, Hovland A, Fredriksen STD. ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study. BMC Nurs 2022; 21:214. [PMID: 35927677 PMCID: PMC9354289 DOI: 10.1186/s12912-022-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit. Methods This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’. Conclusions ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.
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Affiliation(s)
- Abder Rahim Akroute
- Department of Anesthesia and Intensive Care Medicine, Nordland Hospital, N-8049, Bodø, Norway.
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway.,Nordland Hospital, 8076, Bodø, Norway
| | - Anders Hovland
- Department of Cardiology, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sven-Tore Dreyer Fredriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,, Campus Harstad, Havnegata 5, 9480, Harstad, Norway.,Huntington network, Knorrebakken 2, 9411, Harstad, Norway
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9
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Tolotti A, Cadorin L, Bonetti L, Valcarenghi D, Pagnucci N. Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review. J Clin Nurs 2022; 32:2361-2370. [PMID: 35343019 DOI: 10.1111/jocn.16296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The quality of care for tracheostomy and mechanically ventilated patients in intensive care units (ICUs) has improved considerably. However, the communication barrier attributable to these procedures generates many problems for patients, as they are unable to communicate effectively with family members and ICU healthcare professionals, especially nurses. AIMS To describe (1) tracheostomy patients' needs, emotions and difficulties when communicating with ICU nurses and (2) which strategies nurses and patients have adopted to improve their communication. METHODS A scoping review was completed using the Joanna Briggs Institute method and following the PRISMA-ScR Checklist. The research question was developed using the Population, Concept and Context framework. Five databases were searched. After screening, two researchers independently analysed the 75 papers, and finally, 19 studies were included in this review. RESULTS All studies used a qualitative design. Seven adopted a phenomenological and two a hermeneutic approach, involving a total of 265 patients. Two main themes and four subthemes were identified: (1) the tracheostomy patients' needs, emotions and difficulties communicating with ICU nurses (patients' emotions, communication needs, and their content and difficulties) and (2) strategies that nurses and patients adopted to improve communication (communication strategies). CONCLUSIONS It is essential to develop effective communication with tracheostomy patients to ensure they feel relieved, safe and considered. Communication content should focus on information relating to the person's personal condition and active involvement in care. RELEVANCE TO CLINICAL PRACTICE It is important to prioritise the communication process in tracheostomised patients and create the organisational conditions that foster effective communication processes. Developing training programmes for new or practising nurses is essential to instil greater awareness about this crucial fundamental need.
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Affiliation(s)
- Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Lucia Cadorin
- Continuing Education Office, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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10
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Al‐Shamaly HS. Patterns of communicating care and caring in the intensive care unit. Nurs Open 2022; 9:277-298. [PMID: 34536338 PMCID: PMC8685886 DOI: 10.1002/nop2.1061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 11/11/2022] Open
Abstract
AIM To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU). DESIGN A focused ethnography. METHODS This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information - over six months (April-September, 2014). The data were analysed thematically. FINDINGS This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients' psychological and emotional needs, and nurses' caring behaviours are crucial. These findings need further consideration from all stakeholders.
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11
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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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Krampe H, Denke C, Gülden J, Mauersberger VM, Ehlen L, Schönthaler E, Wunderlich MM, Lütz A, Balzer F, Weiss B, Spies CD. Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives. J Clin Med 2021; 10:jcm10173928. [PMID: 34501376 PMCID: PMC8432195 DOI: 10.3390/jcm10173928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Jakob Gülden
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Vivian-Marie Mauersberger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Lukas Ehlen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | | | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Alawi Lütz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Department of Healthcare Management, Technische Universität Berlin, 10623 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Correspondence: ; Tel.: +49-30-450-551-102
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Eyimaya AÖ, Tezel A. The effect of nursing approaches applied according to Meleis’ Transition Theory on menopause-specific quality of life. Health Care Women Int 2021; 42:107-126. [DOI: 10.1080/07399332.2020.1825440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Ayfer Tezel
- Nursing Faculty, Department of Nursing, Ankara University, Altındağ, Ankara, Turkey
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Whitmore KA, Townsend SC, Laupland KB. Management of tracheostomies in the intensive care unit: a scoping review. BMJ Open Respir Res 2020; 7:e000651. [PMID: 32723731 PMCID: PMC7390235 DOI: 10.1136/bmjresp-2020-000651] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES While there is an extensive body of literature surrounding the decision to insert, and methods for inserting, a tracheostomy, the optimal management of tracheostomies within the intensive care unit (ICU) from after insertion until ICU discharge is not well understood. The objective was to identify and map the key concepts relating to, and identify research priorities for, postinsertion management of adult patients with tracheostomies in the ICU. DESIGN Scoping review of the literature. DATA SOURCES PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature were searched from inception to 3 October 2019. Additional sources were searched for published and unpublished literature. ELIGIBILITY CRITERIA We included studies of any methodology that addressed the a priori key questions relating to tracheostomy management in the ICU. No restrictions were placed on language or year of publication. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened by two reviewers. Studies that met inclusion criteria were reviewed in full by two reviewers, with discrepancies resolved by a third. Data were extracted for included studies, and results mapped along the prespecified research questions. RESULTS 6132 articles were screened, and 102 articles were included for detailed analysis. Protocolised weaning was found to be successful in liberating patients from the ventilator in several cohort studies. Observational studies showed that strategies that use T-pieces and high-flow oxygen delivery improve weaning success. Several lines of evidence, including one clinical trial, support early cuff deflation as a safe and effective strategy as it results in a reduced time to wean, shorter ICU stays and fewer complications. Early tracheostomy downsizing and/or switching to cuffless tubes was found to be of benefit in one study. A substantial body of evidence supports the use of speaking valves to facilitate communication. While this does not influence time to wean or incidence of complications, it is associated with a major benefit in patient satisfaction and experience. Use of care bundles and multidisciplinary team approaches have been associated with reduced complications and improved outcomes in several observational studies. CONCLUSIONS The limited body of evidence supports use of weaning protocols, early cuff deflation, use of speaking valves and multidisciplinary approaches. Clinical trials examining post-tracheostomy management strategies in ICUs are a priority.
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Affiliation(s)
- Kirsty A Whitmore
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Shane C Townsend
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Barriers to and facilitators for the use of augmentative and alternative communication and voice restorative strategies for adults with an advanced airway in the intensive care unit: A scoping review. J Crit Care 2020; 57:168-176. [PMID: 32163752 DOI: 10.1016/j.jcrc.2020.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To identify barriers and facilitators for the use of augmentative and alternative communication (AAC) and voice restorative strategies for adult patients with an advanced airway in the intensive care unit (ICU). MATERIALS AND METHODS Scoping review searching five databases between 1990 and 2019. We screened 13, 167 citations and included all study types reporting barriers and/or facilitators to using communication strategies in an ICU setting. Two authors independently extracted and coded reported barriers and facilitators to the Theoretical Domains Framework (TDF) domains. RESULTS Of the 44 studies meeting inclusion criteria 18 (44%) used qualitative, 18 (44%) used quantitative, and 8 (18%) used mixed methods. In total, 39 unique barriers and 46 unique facilitators were identified and coded to the domains of the TDF. Barriers were most frequently coded to the Skills, Environmental Context and Resources, and Emotion domains. Facilitators were most frequently coded to Reinforcement, Environmental Context and Resources, and Social and Professional Roles/Identity domains. Thematic synthesis produced four potentially modifiable factors: context, emotional support, training, and decisional algorithms. CONCLUSIONS Identified barriers (skills, environment, resources, emotions) and facilitators (reinforcement, resources, roles) to ICU communication strategy use in the literature may be modified through formal training and role support.
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Nelissen V, Metzing S, Schnepp W. What it means for people to be mechanically ventilated via a tracheostomy at home: a qualitative study. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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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The work undertaken by mechanically ventilated patients in Intensive Care: A qualitative meta-ethnography of survivors’ experiences. Int J Nurs Stud 2018; 86:60-73. [DOI: 10.1016/j.ijnurstu.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
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Tantacharoenrat C, Prasopkittikun T, Rungamornrat S, Limprayoon K. Use of a User-Friendly Tablet Application to Communicate with Pediatric Patients on Mechanical Ventilators. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivos: examinar cómo el uso de una aplicación para tableta como ayuda en la comunicación con pacientes pediátricos con respirador artificial afecta el nivel de satisfacción con la comunicación por parte del personal de enfermería y en las díadas cuidador–paciente. Materiales y método: se utilizó el diseño pretest-postest de un solo grupo para analizar el nivel de satisfacción del personal de enfermería con la comunicación y se utilizó un diseño de grupo de control pretest-postest no equivalente para los cuidadores. La muestra estaba conformada por 44 miembros del personal de enfermería y 18 díadas de cuidadores y pacientes pediátricos con ventilación de dos hospitales en Tailandia. Se utilizó una prueba de T pareada para comparar al personal de enfermería, la prueba U de Mann-Whitney para comparar los cuidadores y una estadística descriptiva para describir la satisfacción de los niños. Resultados: el personal de enfermería se sintió más satisfecho con la comunicación al usar la aplicación de la tableta que los métodos de comunicación regulares (t = -9,13, df = 43, p < ,001). Los cuidadores que usaron la aplicación para tableta también reportaron una mayor satisfacción con la comunicación respecto a aquellos que usaron los métodos de comunicación regulares (U = -3,41, p < ,001). Casi el 90 % de los pacientes pediátricos reportaron sentirse completamente satisfechos con el uso de la aplicación. Conclusiones: la aplicación para tableta diseñada para facilitar la comunicación con pacientes pediátricos con respirador artificial mejoró los niveles de satisfacción con la comunicación y debe promoverse como uno de los dispositivos de comunicación de asistencia para uso amplio.
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Wallander Karlsen M, Heggdal K, Finset A, Heyn LG. Attention‐seeking actions by patients on mechanical ventilation in intensive care units: A phenomenological‐hermeneutical study. J Clin Nurs 2018; 28:66-79. [DOI: 10.1111/jocn.14633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Arnstein Finset
- Faculty of Medicine Institute of Basic Medical Sciences University of Oslo Oslo Norway
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21
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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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22
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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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Tolotti A, Bagnasco A, Catania G, Aleo G, Pagnucci N, Cadorin L, Zanini M, Rocco G, Stievano A, Carnevale FA, Sasso L. The communication experience of tracheostomy patients with nurses in the intensive care unit: A phenomenological study. Intensive Crit Care Nurs 2018; 46:24-31. [PMID: 29709466 DOI: 10.1016/j.iccn.2018.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the experience and sources of comfort and discomfort in tracheostomy patients, when they communicate with nurses in the Intensive Care Unit. RESEARCH METHODOLOGY/DESIGN Benner's interpretive phenomenology. Data were collected through: a) semi-structured interviews conducted with the patients after leaving the intensive care unit; b) participant observation; c) situated interviews with intensive care nurses. SETTING The intensive care unit of a hospital in Northern Italy. FINDINGS Eight patients and seven nurses were included in this study. Two main themes were identified 1) feeling powerless and frustrated due to the impossibility to use voice to communicate; 2) facing continual misunderstanding, resignation, and anger during moments of difficulty and/or communication misunderstandings. The main communication discomfort factors were: struggling with not knowing what was happening, feeling like others had given up on me, living in isolation and feeling invisible. The main comfort factors were: being with family members, feeling reassured by having a call bell nearby and nurses' presence. CONCLUSIONS This study highlights the important role of communication in tracheostomy patients in intensive care and how closely it is linked to all the aspects of a person's life, which cannot be underestimated as just not being able to use one's voice.
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Affiliation(s)
- Angela Tolotti
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Lucia Cadorin
- CRO Aviano National Cancer Institute, Via F. Gallini, 2, 22081 Aviano, Italy.
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Gennaro Rocco
- Italian Nurses' National Social Security Council (ENPAPI), Via A. Farnese 3, 00192 Rome, Italy
| | - Alessandro Stievano
- Centro di Eccellenza per la Cultura e la Ricerca Infermieristica, Via G. Cesare 78, 00192 Rome, Italy
| | | | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
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McGrath BA, Wallace S, Wilson M, Nicholson L, Felton T, Bowyer C, Bentley AM. Safety and feasibility of above cuff vocalisation for ventilator-dependant patients with tracheostomies. J Intensive Care Soc 2018; 20:59-65. [PMID: 30792764 DOI: 10.1177/1751143718767055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction Temporary tracheostomy is commonly used in patients admitted to intensive care units. Cuffed tubes prevent laryngeal airflow, preventing vocalisation. Sub-glottic suction tubes such as the 'Blue Line Ultra Suctionaid™' are used primarily to remove sub-glottic secretions, but retrograde gas flows via the suction port can facilitate above cuff vocalisation. The aims were to assess whether patients could achieve an audible voice using above cuff vocalisation, to demonstrate the safe use of the Blue Line Ultra Suctionaid™ tracheostomy tube for above cuff vocalisation, and to assess potential benefits of above cuff vocalisation for communication, secretion management and swallowing. Methods Our study (Reference 15/NW/0464, IRAS 178997) recruited adult intensive care unit patients who were alert, able to participate in an above cuff vocalisation trial and dependent on an inflated Blue Line Ultra Suctionaid™ cuff for ventilatory support. Consenting participants underwent fibreoptic endoscopic assessment of swallow by experienced Speech & Language Therapy staff with and without above cuff vocalisation. Clinical and fibreoptic endoscopic assessment of swallow, assessment of voice quality, swallowing and secretion management were recorded and scored. Median differences between paired observations and scores were analysed with and without above cuff vocalisation. Adverse events were identified by follow up fibreoptic endoscopic assessment of swallow and patient accounts. Results Ten patients completed the study. Above cuff vocalisation was used for a median of 15 min, during a median of nine episodes, over a median of three days. Above cuff vocalisation resulted in an audible voice in eight of the 10 patients, during 66 out of 91 above cuff vocalisation attempts. There improvements in unstimulated dry cough and swallow frequency and aspiration ratings measured by fibreoptic endoscopic assessment of swallow. No complications were reported or observed in 66 attempts with only one episode terminated prematurely. Conclusions Above cuff vocalisation can achieve effective, safe, well-tolerated vocalisation in ventilator-dependant intensive care unit patients. Above cuff vocalisation has the potential to aid earlier, more effective communication and may improve laryngeal function and rehabilitation.
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Affiliation(s)
- Brendan A McGrath
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester, UK
| | - Sarah Wallace
- Department of Speech Voice & Swallowing, University Hospital South Manchester, Manchester, UK
| | - Mark Wilson
- Department of Speech Voice & Swallowing, University Hospital South Manchester, Manchester, UK
| | - Leanne Nicholson
- Department of Speech Voice & Swallowing, University Hospital South Manchester, Manchester, UK
| | - Tim Felton
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester, UK
| | - Christine Bowyer
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester, UK
| | - Andrew M Bentley
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester, UK
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Nakarada-Kordic I, Patterson N, Wrapson J, Reay SD. A Systematic Review of Patient and Caregiver Experiences with a Tracheostomy. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 11:175-191. [DOI: 10.1007/s40271-017-0277-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Enger R, Andershed B. Nurses' experience of the transfer of ICU patients to general wards: A great responsibility and a huge challenge. J Clin Nurs 2017; 27:e186-e194. [PMID: 28598014 DOI: 10.1111/jocn.13911] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to describe nurses' experiences of patients' transition from ICUs to general wards and their suggestions for improvements. BACKGROUND In the ICU, the most seriously ill patients with life-threatening conditions and multiple organ dysfunction syndromes are cared for and carefully monitored by specially trained professionals using advanced techniques for the prevention of failure of vital functions. The transfer of ICU patients to general wards means a change from a high to a lower level, including the loss of one-to-one nursing and a reduction of visible monitoring equipment and general close attention. DESIGN A qualitative descriptive design. METHODS Eight nurses from three different inpatient units in Norway, five from a university hospital and three from a local hospital were selected through a convenience sample. Interviews with open questions were conducted, and qualitative content analysis was used to explore the data. RESULTS Nurses' experiences were described in one main category: ICU patients' transition-a great responsibility and a huge challenge, and two generic categories: (i) a challenging transition for nurses, patients and relatives and (ii) dialogue and competencies as tools for improvement, with six subcategories. CONCLUSION A number of factors affected patient care, such as poor cooperation, communication, reporting, expertise and clinical gaze. It was clear that the general wards had major challenges, and a number of improvements were suggested. RELEVANCE TO CLINICAL PRACTICE This study shows that there is still a gap between the ICU and general wards and that nurses continue to struggle with this. It is therefore important that the managers responsible for the quality of care together with the professionals take seriously the criticism in the present and previous studies and work towards a safe transition for patients.
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Affiliation(s)
- Ronny Enger
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Birgitta Andershed
- Faculty of Health, Care and Nursing, Norwegian University of Science and Technology, Gjövik, Norway
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Holm A, Dreyer P. Nurse-patient communication within the context of non-sedated mechanical ventilation: A hermeneutic-phenomenological study. Nurs Crit Care 2017; 23:88-94. [PMID: 28593721 DOI: 10.1111/nicc.12297] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/03/2017] [Accepted: 04/09/2017] [Indexed: 12/25/2022]
Abstract
AIMS AND OBJECTIVES To explore non-sedated mechanically ventilated patients' communication with nurses in the intensive care unit. BACKGROUND Mechanically ventilated patients are temporarily voiceless, making interpersonal communication complex. Both nurses and patients find communication challenging and may experience negative emotions when communication fails. In Nordic countries, sedation protocols have changed to light/non-sedation, resulting in more patients being conscious and more clinical practitioners experiencing communication difficulties. DESIGN The study was qualitative with a phenomenological-hermeneutic approach. Data were collected at two intensive care units in Denmark from January to April 2015. METHODS Data collection consisted of interviews with patients, focus group interviews with nurses and field observations concerning nurse-patient communication. Data were analysed as one collective body of data using Ricoeur's theory of interpretation. FINDINGS The main theme showed that communication is a movement between the two opposite feelings of comprehension and frustration. Sub-themes showed (1) the dynamics of power change when the patient is voiceless; (2) consciousness and voicelessness make caring difficult; and (3) the process of interpreting and structuring communication is situational. CONCLUSION These findings are important in nursing care and provide perspectives on the shift from communication towards comprehension and, thus, away from frustration. A non-sedation protocol is a major change in clinical practice in relation to communication. It requires a new way of thinking where communication becomes an integrated part of care, and the nurse has to be constantly alert and adjust his or her communication strategies to the patient's changing needs and communication ability. RELEVANCE TO CLINICAL PRACTICE Some nursing interventions may optimize communication: (1) systematic assessment of patients' communication; (2) education of nurses in Augmentative and Alternative Communication; (3) using communication tools when possible; and (4) securing time, continuity, empathy and patience in nursing care.
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Affiliation(s)
- A Holm
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, 8000 Aarhus C, Denmark
| | - P Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, 8000 Aarhus C, Denmark.,Institute of Public Health, Section of Nursing, University of Aarhus, 8000 Aarhus C, Denmark
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Kjeldsen CL, Hansen MS, Jensen K, Holm A, Haahr A, Dreyer P. Patients' experience of thirst while being conscious and mechanically ventilated in the intensive care unit. Nurs Crit Care 2017; 23:75-81. [PMID: 28124464 DOI: 10.1111/nicc.12277] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because of changes in sedation strategies, more patients in the intensive care unit (ICU) are conscious. Therefore, new and challenging tasks in nursing practice have emerged, which require a focus on the problems that patients experience. Thirst is one such major problem, arising because the mechanical ventilator prevents the patients from drinking when they have the urge to do so. To gain a deeper understanding of the patients' experiences and to contribute new knowledge in nursing care, this study focuses on the patients' experiences of thirst during mechanical ventilation (MV) while being conscious. AIMS To explore patients' experience of thirst while being conscious and mechanically ventilated. DESIGN This hermeneutic study used qualitative interviews of 12 patients. METHOD Data were analyzed based on content analysis. Interviews were conducted between September and October 2014 in two large ICUs in Denmark. RESULT Four themes relating to the patients' experiences of thirst during MV were identified: a paramount thirst, a different sense in the mouth, deprivation of the opportunity to quench thirst and difficulties associated with thirst. CONCLUSION Patients associate feelings of desperation, anxiety and powerlessness with the experience of thirst. These feelings have a negative impact on their psychological well-being. A strategy in the ICU that includes no sedation for critically ill patients in need of MV introduces new demands on the nurses who must care for patients who are struggling with thirst. RELEVANCE TO CLINICAL PRACTICE This study shows that despite several practical attempts to relieve thirst, it remains a paramount problem for the patients. ICU nurses need to increase their focus on issues of thirst and dry mouth, which are two closely related issues for the patients. Communication may be a way to involve the patients, recognize and draw attention to their problem.
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Affiliation(s)
- Caroline L Kjeldsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mette S Hansen
- Department of Heart Disease, Aarhus University Hospital, Skejby, Denmark
| | - Kamilla Jensen
- Department of Abdominal Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Anna Holm
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Anita Haahr
- Health, VIA University College, Aarhus, Denmark
| | - Pia Dreyer
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Nørrebrogade 44, building 21.1, 8000 Aarhus C, Denmark.,Institute of Public Health, Section of Nursing, Aarhus University, Høegh-Guldbergs Gade 6A, Building 1633, 8000 Aarhus C, Denmark
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Pryor LN, Ward EC, Cornwell PL, O'Connor SN, Chapman MJ. Establishing phonation using the Blom®tracheostomy tube system: A report of three cases post cervical spinal cord injury. SPEECH LANGUAGE AND HEARING 2016. [DOI: 10.1080/2050571x.2016.1196035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McGrath B, Lynch J, Wilson M, Nicholson L, Wallace S. Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient. J Intensive Care Soc 2015; 17:19-26. [PMID: 28979454 DOI: 10.1177/1751143715607549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A significant proportion of patients admitted to intensive care units require tracheostomies for a variety of indications. Continual cuff inflation to facilitate mechanical ventilatory support may mean patients find themselves awake, cooperative and attempting to communicate but unable to do so effectively. Resulting frustration and anxiety can negatively impact upon care. Through participation in the Global Tracheostomy Collaborative, our unit rapidly implemented novel techniques facilitating communication in such patients. In carefully selected and controlled situations, the subglottic suction port of routinely available tracheostomy tubes can be used to deliver a retrograde flow of gas above the cuff to exit via the larynx, facilitating speech. The resulting above cuff vocalisation is described in detail for five general ICU patients at our institution, highlighting the benefits of multidisciplinary care and the increasingly important role of the speech and language therapists in the critically ill.
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Affiliation(s)
- Brendan McGrath
- Acute ICU, University Hospital South Manchester, Manchester, UK
| | - James Lynch
- Acute ICU, University Hospital South Manchester, Manchester, UK
| | - Mark Wilson
- Speech & Language Therapy, University Hospital South Manchester, Manchester, UK
| | - Leanne Nicholson
- Speech & Language Therapy, University Hospital South Manchester, Manchester, UK
| | - Sarah Wallace
- Speech & Language Therapy, University Hospital South Manchester, Manchester, UK
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