A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Relationship between communication skills and care behaviors of nurses

PURPOSE

In this study, we aimed to determine the relationship between communication competence and patient care behaviors of nurses.

DESIGN AND METHODS

The study was designed as a descriptive relational study and conducted in Akdeniz University Hospital between March 2018 and May 2018. Data of this study were collected from clinical nurses working in Akdeniz University Hospital. The study was carried out with 262 nurses who accepted to agreed participate in the study.

FINDINGS

Of all nurses, 97% were college graduates, 63% were married, and 35% had working experience between 5 and 9 years. There was a moderate positive correlation between communicative competence and care behaviors of nurses (r = 0.5, P < 0.01).

PRACTICE IMPLICATIONS

More training can be implemented to educate nurses about communication barriers to equip them with effective communication skills and strategies. The nursing process is a scientific method of exercising and implementing of nursing care, this is only achieved through dialogue, interpersonal environment, and specific verbal and nonverbal communication skills. In service training of nurses on effective communicative techniques will inevitably have a positive impact rather than reflection on patient care.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study

Background

Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support.

Aim

This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session.

Setting

A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting.

Methods

A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital.

Results

Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses’ perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board.

Conclusions

Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised.

Providing Services to Individuals With Complex Communication Needs in the Inpatient Rehabilitation Setting: The Experiences and Perspectives of Speech-Language Pathologists

Purpose To guide the development of future trainings in the inpatient rehabilitation setting, this study aimed to expand the current understanding of (a) the experiences of speech-language pathologists (SLPs) who work in inpatient rehabilitation settings when providing augmentative and alternative communication (AAC) services to individuals with complex communication needs and (b) the challenges and facilitating factors related to AAC services within this context. Method An online focus group was used to explore experiences of 11 SLPs who work within the inpatient rehabilitation setting. Information was gathered about (a) the role of the inpatient SLP in AAC service delivery, (b) rehabilitation team service delivery, (c) successes and challenges to supporting individuals with complex communication needs within this setting, and (d) communication training opportunities. Results Themes that emerged related to (a) the complicated logistics of rehabilitation; (b) the centrality of the rehabilitation team; (c) the limited AAC tools, knowledge, and trainings for rehabilitation providers; and (d) SLPs' attitudes. Participants reported navigating complicated logistics unique to the inpatient rehabilitation related to time constraints, limited AAC funding, the continuum of rehabilitation care, and limited AAC policies in attempting to meet patient needs. Generally, participants suggested successful team collaboration, yet limited time, expertise, tools, and training opportunities challenged attempts to support individuals with complex communication needs. Conclusions Increased access to AAC tools and the development of AAC trainings are recommended to equip rehabilitation professionals with skills to build interprofessional and AAC skills so patients with complex communication needs can maximally participate in the rehabilitation experience. Supplemental Material https://doi.org/10.23641/asha.7728710.

Communication with patients in intensive care units: a scoping review

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.

Caring for non-sedated mechanically ventilated patients in ICU: A qualitative study comparing perspectives of expert and competent nurses

BACKGROUND

Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction.

OBJECTIVE

We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients.

METHOD

The study had a qualitative comparative design applying semi-structured dyadic interviews. We interviewed five pairs of expert and competent ICU nurses with respectively >8 and 2-3 years of ICU experience and performed qualitative content analysis to explore the two perspectives.

FINDINGS

We identified four main categories illustrating complexities of nurse-patient interaction: Managing frustration, Attempting dialogue, Negotiating reality and Alleviating discomfort. Expert nurses expressed more frustration and ambivalence towards light sedation than competent nurses, who took awake patients for granted. All nurses experienced communication issues, demanding patients, and inability to provide adequate patient comfort.

CONCLUSION

Our study added to the knowledge of nurse-patient interaction by describing issues of frustration, ambivalence and insecurity in a contemporary context of minimal sedation. Expert nurses were mere concerned by awake patients than competent nurses. Lighter sedation in ICU requires better staffing and improved communication tools.

Perceptions of health professionals about the quality of communication and deliberation with the patient and its impact on the health decision making process

The information process is considered a core element in decision- making and an obligatory matter of concern for the health professional. Rather than information per se, we should perhaps mention the need for communication between the health professional and the patient, which should be appropriate to each specific case and situation. Interaction and communication during the relationship generates a degree of trust that contributes to improving care quality and health-related results. The aim of this study is to know the perception of professionals on the quality of communication and its impact on the decision-making process of the patient and the degree of involvement of health professionals in the process of communication with the patient. A sample of 2186 health professionals (1578 nurses, 586 physicians, and 22 pharmacists) was studied. A questionnaire composed of 20 items dealing with the process of communication with the patient and obtaining informed consent was administered. Our study revealed the high consideration that professionals hold of their communication skills with patients since almost 80% of those surveyed, think they are sufficiently skilled in this area. Professionals refers that nurses are most skilled at communicating with patients. Communication in the clinical relationship must not only serve as a way for the professional to obtain information from the patient on their pathology, but also as a means to inform patients so that they understand their illness. Patients also like to feel that they are being listened to and are co-participants in the care process. Communication should be a continuous object of study for all health professionals, both in primary and specialised attention.

Engaging people experiencing communication disability in stroke rehabilitation: a qualitative study

BACKGROUND

Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research indicates the practitioner influences engagement through their ways of relating, communicating and working with the patient. People experiencing communication disability may face particular challenges with engagement as a practitioner's communication and interactional patterns may limit their ability to engage.

AIMS

To understand how rehabilitation practitioners worked to engage people experiencing communication disability throughout the course of rehabilitation.

METHODS & PROCEDURES

A qualitative study using the Voice Centred Relational Approach. Longitudinal observational and interview data were gathered from 28 practitioners and three people experiencing communication disability in inpatient and community stroke rehabilitation services. Data were analyzed using the Listening Guide.

OUTCOMES & RESULTS

Engagement was a relational practice on the part of the rehabilitation practitioner. It was underpinned by a relational philosophy and characterized by three core processes: embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation. Practitioners wove these together with their technical, disciplinary-based work and rehabilitation tasks.

CONCLUSIONS & IMPLICATIONS

Patient engagement was constructed through relationships and strongly influenced by the practitioners' way of thinking about and enacting practice, challenging the idea that engagement is solely an intrinsic patient state and behaviour. The findings raise questions about which aspects of rehabilitation work and communication are most valuable when working to engage people experiencing communication disability. Viewing engagement as a relational practice and understanding the different ways this is enacted may support practitioners to reflect on their understandings of engagement, their patient's engagement, their ways of working, and the frames and philosophies that surround and influence their practice.

A systematic review of the barriers and facilitators to the provision and use of low-tech and unaided AAC systems for people with complex communication needs and their families

PURPOSE

Speech-language pathologists may introduce augmentative or alternative communication (AAC) systems to people who are unable to use speech for everyday communication. Despite the benefits of AAC systems, they are significantly underutilized by the people with complex communication needs. The current review aimed to synthesize the barriers and facilitators to the provision and use of low-tech and unaided AAC systems.  Materials and methods: Relevant literature was identified via a systematic search strategy. Included articles (n = 43) were evaluated using the Critical Appraisal Skills Programme. Qualitative framework analysis was then completed with reference to the International Classification of Functioning, Disability, and Health (ICF).  Results and conclusion: Most barriers and facilitators were coded as contextual factors within the ICF. Of most prominence were environmental factors, including attitudes of and supports provided by professionals, family members, and the society at large. Themes were also identified which related to the personal factors, including the user's own attitude, socioeconomic status, and culture. Beyond these contextual factors, the remaining codes related to body functions such as cognition and movement. There are numerous barriers to the provision and use of low-tech and unaided AAC systems, which may contribute to the inadequate use of these systems by people with complex communication needs. Suggestions for reducing these barriers are presented with regards to the person with complex communication needs, their family, and the professionals involved in their care. Implications for Rehabilitation AAC systems can reduce participation restrictions for people with complex communication needs. The provision and use of AAC systems is influenced by environmental factors, personal factors, and features of a person's body function. SLPs may need to collaborate with a large multidisciplinary team to successfully introduce AAC systems. SLP, teaching, and nursing students require theoretical and practical experience in AAC throughout their training to enable the provision and use of these systems.

Care Complexity Individual Factors Associated With Hospital Readmission: A Retrospective Cohort Study

PURPOSE

To determine the frequency of care complexity individual factors documented in the nursing assessment and to identify the risk factors associated with hospital readmission within 30 days of hospital discharge.

DESIGN

Observational analysis of a retrospective cohort at a 700-bed university hospital in Barcelona, Spain. A total of 16,925 adult patient admissions to a ward or intermediate care units were evaluated from January to December 2016. Most patients were admitted due to cardiocirculatory and respiratory disorders (29.3%), musculoskeletal and nervous system disorders (21.8%), digestive and hepatobiliary conditions (17.9%), and kidney or urinary disorders (11.2%).

METHODS

Readmission was defined as rehospitalization for any reason within 30 days of discharge. Patients who required hospital readmission were compared with those who did not. The individual factors of care complexity included five domains (developmental, mental-cognitive, psycho-emotional, sociocultural, and comorbidity or complications) and were reviewed using the electronic nursing assessment records. Multivariate logistic analysis was performed to determine factors associated with readmission.

FINDINGS

A total of 1,052 patients (6.4%) were readmitted within 30 days of hospital discharge. Care complexity individual factors from the comorbidity or complications domain were found to be the most frequently e-charted (88.3%). Care complexity individual factors from developmental (33.2%), psycho-emotional (13.2%), mental-cognitive (7.2%), and sociocultural (0.7%) domains were less frequently documented. Independent factors associated with hospital readmission were old age (≥75 years), duration of first hospitalization, admission to a nonsurgical ward, major chronic disease, hemodynamic instability, immunosuppression, and relative weight of diagnosis-related group.

CONCLUSIONS

A substantial number of patients required readmission within 30 days after discharge. The most frequent care complexity individual factors recorded in the nursing assessment at index admission were related to comorbidity or complications, developmental, and psycho-emotional domains. Strategies related to transition of care that include clinical characteristics and comorbidity or complications factors should be a priority at hospital discharge and after leaving hospital, but other factors related to developmental and psycho-emotional domains could have an important effect on the use of healthcare resources.

CLINICAL RELEVANCE

Nurses should identify patients with comorbidity or complications, developmental, and psycho-emotional complexity factors during the index admission in order to be able to implement an effective discharge process of care.

The development and psychometric validation of an instrument to evaluate nurses' attitudes towards communication with the patient (ACO)

BACKGROUND

Patient communication is a key skill for nurses involved in clinical care. Its measurement is a complex phenomenon that can be addressed through attitude evaluation.

OBJECTIVES

To develop and psychometrically test a measure of nurses' attitudes towards communication with patients (ACO), to study the relationship between these dimensions, and to analyse nursing attitudes.

DESIGN

To develop and psychometrically test the ACO questionnaire.

SETTINGS

All hospitals in the province of Valencia were invited by e-mail to distribute the ACO instrument. Ten hospitals took part in the study.

PARTICIPANTS

The study population was composed of a convenience sample of 400 hospital nurses on general or special services. The inclusion criteria were nurses at the selected centres who had previously provided an informed consent to participate.

METHODS

A literature review and expert consultation (N = 10) was used to develop the content of the questionnaire. The 62-item version of the instrument was applied to a convenience sample of 400 nurses between May 2015 and March 2016. Factor structure was evaluated with exploratory and confirmatory factor analysis (EFA, CFA), and reliability was evaluated with Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE).

RESULTS

The final instrument (ACO), composed of 25 items grouped into three attitude dimensions (cognitive, affective and behavioural), had good psychometric properties. In the study sample, nurses had a favourable attitude towards communication. The cognitive and affective dimensions of the ACO should be able to predict the behaviour dimension.

CONCLUSION

The ACO is useful for evaluating current clinical practices, identifying educational needs and assessing the effectiveness of communication training or other interventions intended to improve communication.

A Systematic Review of Patient and Caregiver Experiences with a Tracheostomy

BACKGROUND

A tracheostomy is a surgically created opening through the anterior neck tissues and the trachea, into which a tube is inserted. Despite its influence on basic human needs such as respiration, communication and nutrition, little is known about the impact of tracheostomy on patients and their caregivers or what could be done to enable better care and quality of life (QoL) for these individuals.

OBJECTIVE

The aim of this review was to better understand the current knowledge related to the experience and QoL of adults living with a tracheostomy and their caregivers so as to be able to improve these experiences.

METHOD

A systematic review of the English-language, peer-reviewed literature was conducted in PubMed, Scopus, PsychINFO, Google Scholar, and CINAHL databases. Articles were eligible if they included adult patient or lay caregiver-reported experiences of tracheostomy.

RESULTS

Overall, 1080 articles were identified and 17 eligible for inclusion. Fourteen articles reported on experiences of tracheostomy patients, while three focused on those of their caregivers. Studies were conducted in the home setting (n = 5), on a hospital ward (n = 4), in an intensive care unit (n = 3), in an outpatient clinic (n = 3), in a rehab facility (n = 1), and online (n = 1). Patients and their caregivers reported a range of mostly negative experiences related to the care, support, and management of a tracheostomy, speech and communication, wellbeing and QoL, disfigurement and body image, and stigma and social withdrawal.

CONCLUSION

Few studies have published data on the patient and caregiver experiences with tracheostomy, especially in the community setting. There is a need to better understand these experiences in order to be able to formulate strategies and provide resources to improve the quality of care and overall QoL of patients with a tracheostomy and their caregivers in-hospital and in the community.

Role of the Speech-Language Pathologist (SLP) in the Head and Neck Cancer Team

While treatments for head and neck cancer are aimed at curing patients from disease, they can have significant short- and long-term negative impacts on speech and swallowing functions. Research demonstrates that early and frequent involvement of Speech-Language Pathologists (SLPs) is beneficial to these functions and overall quality of life for head and neck cancer patients. Strategies and tools to optimize communication and safe swallowing are presented in this chapter.

What is good communication for people living with dementia? A mixed-methods systematic review

BACKGROUND

Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included.

METHODS

A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases.

RESULTS

After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, "open exploration," or through examining experiences of strategies, "exploration of strategies." A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication.

CONCLUSIONS

The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.

Somali Older Adults' and Their Families' Perceptions of Adult Home Health Services

Many studies have identified the vulnerability of ethnic elders, and there is promising evidence indicating home health care (HHC) services can improve the health outcomes of Somali older adults. This study used a community-engaged qualitative descriptive approach with the participation of non-profit organization Refugees Helping Refugees. The purpose of this study was to explore and describe Somali older adults' and their families' perceptions of and experiences with HHC services in order to improve its use and access. Data collection included home visits (n = 15), semi-structured interviews (n = 17) and debriefing sessions (n = 16) with 19 individuals from 14 Somali families. Somali families recognized HHC services were needed and believed having services in the home facilitated learning but HHC agencies should work more with the Somali community. HHC agencies need to work with community organizations to facilitate cultural and health understanding, and better health care for Somali older adults.

Improving communication between staff and disabled children in hospital wards: testing the feasibility of a training intervention developed through intervention mapping

OBJECTIVE

To develop and test the feasibility of a novel parent-inspired training intervention for hospital ward staff to improve communication with disabled children when inpatients.

DESIGN

Training content and delivery strategies were informed by the iterative process of Intervention Mapping and developed in collaboration with parents of disabled children.

SETTING

UK University Hospital children's ward.

SUBJECTS

80 medical, nursing, allied health professionals, clerical and housekeeping staff on a children's ward.

METHODS

Themes identified in previous qualitative research formed the basis of the training. Learning objectives included prioritising communication, cultivating empathy, improving knowledge and developing confidence. Participant feedback was used to refine content and delivery. Intervention documentation adheres to the Template for Intervention Description and Replication checklist.

RESULTS

Highlighting mandated National Health Service policies and involving the hospital Patient and Carer Experience Group facilitated management support for the training. Eighty staff participated in one of four 1-hour sessions. A paediatric registrar and nurse delivered sessions to mixed groups of staff. General feedback was very positive. The intervention, fully documented in a manual, includes videos of parent carers discussing hospital experiences, interactive tasks, small group discussion, personal reflection and intention planning. Generic and local resources were provided.

CONCLUSION

It was feasible to deliver this new communication training to hospital ward staff and it was positively received. Early feedback was encouraging and indicates a commitment to behaviour change. Further piloting is required to establish the transferability of the intervention to other hospitals, followed by consideration of downstream markers to evaluate the effects on disabled children's inpatient experience. Organisational and cultural change is required to support individual behaviour change.

A tool for assessing the quality of nursing handovers: a validation study

AIM

Handover, in particular between two shifts, is a crucial aspect of nursing for patient safety, aimed at ensuring continuity of care. During this process, several factors can affect quality of care and cause errors. This study aimed to assess quality of handovers, by validating the Handoff CEX-Italian scale.

METHOD

The scale was translated from English into Italian and the content validity index was calculated and internal consistency assessed. The scale was used in several units of the San Paolo Teaching Hospital in Milan, Italy.

RESULTS

A total of 48 reports were assessed (192 evaluations). The median score was 6, interquartile range (IQR) [5;7] and was not influenced by specific (p=0.21) or overall working experience (p=0.13). The domains showing the lowest median values (median=6, IQR [4;8]) were context, communication, and organisation. Night to morning handovers obtained the lowest scores. CVI-S was 0.96, Cronbach's alpha was 0.79.

DISCUSSION

The Handoff CEX-Italian scale is valid and reliable and it can be used to assess the quality of nurse handovers.

Delirium prevention in critically ill adults through an automated reorientation intervention - A pilot randomized controlled trial

OBJECTIVES

Explore the effect of an automated reorientation intervention on ICU delirium in a prospective randomized controlled trial.

BACKGROUND

Delirium is common in ICU patients, and negatively affects outcomes. Few prevention strategies have been tested.

METHODS

Thirty ICU patients were randomized to 3 groups. Ten received hourly recorded messages in a family member's voice during waking hours over 3 ICU days, 10 received the same messages in a non-family voice, and 10 (control) did not receive any automated reorientation messages. The primary outcome was delirium free days during the intervention period (evaluated by CAM-ICU). Groups were compared by Fisher's Exact Test.

RESULTS

The family voice group had more delirium free days than the non-family voice group, and significantly more delirium free days (p = 0.0437) than the control group.

CONCLUSIONS

Reorientation through automated, scripted messages reduced incidence of delirium. Using identical scripted messages, family voice was more effective than non-family voice.

Nurse-patient communication within the context of non-sedated mechanical ventilation: A hermeneutic-phenomenological study

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.

Intensive care nursing students' perceptions of simulation for learning confirming communication skills: A descriptive qualitative study

AIM

The aim of this study was to explore intensive care nursing students experiences with confirming communication skills training in a simulation-based environment.

RESEARCH METHODOLOGY

The study has a qualitative, exploratory and descriptive design. The participants were students in a post-graduate program in intensive care nursing, that had attended a one day confirming communication course. Three focus group interviews lasting between 60 and 80min were conducted with 14 participants. The interviews were transcribed verbatim. Thematic analysis was performed, using Braun & Clark's seven steps.

FINDINGS

The analysis resulted in three main themes: "awareness", "ice-breaker" and "challenging learning environment". The participants felt that it was a challenge to see themselves on the video-recordings afterwards, however receiving feedback resulted in better self-confidence in mastering complex communication.

CONCLUSION

The main finding of the study is that the students reported improved communication skills after the confirming communication course. However; it is uncertain how these skills can be transferred to clinical practice improving patient outcomes.

Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

AIMS AND OBJECTIVES

To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

BACKGROUND

Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

DESIGN

A qualitative study using semi-structured interviews and thematic analysis to examine data.

METHODS

Twenty-four registered nurses caring for people dying with advanced dementia were recruited from 10 nursing homes, three hospices and two acute hospitals across a region of the UK. Interviews were conducted between June 2014-September 2015.

RESULTS

Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.

CONCLUSIONS

Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

RELEVANCE TO CLINICAL PRACTICE

Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.

Role of the speech-language pathologist: augmentative and alternative communication for acute care patients with severe communication impairments

BACKGROUND

Severe communication deficits occur frequently in acute care. Augmentative and alternative communication (AAC) may improve patient-nurse communication, yet it remains underutilized.

OBJECTIVE

The objective of this study was to assess the impact of training student nurses (SNs) in acute and critical care on the use of AAC with regard to confidence levels and likelihood of implementation of AAC by SNs in acute care.

METHODS

Training in AAC techniques was provided to SNs. A pretraining and posttraining assessment was completed along with follow-up surveys conducted after the SNs had an opportunity to use AAC.

RESULTS

A 6-fold increase in confidence (P < .01) was reported by the SNs after AAC training, as was an approximately 3-fold increase in likelihood of use (P < .01). The reliable yes/no was the most reported AAC technique (34.7% of the students).

DISCUSSION

Providing SNs with AAC tools accompanied by brief training increases their confidence in the use of AAC and the likelihood that they will use them. Inclusion of AAC education in nursing curricula and nursing orientations could be an important step in risk reduction among patients with severe communication disorders. Further study is needed of the relationship between training student nurses in the use of AAC as a way to change practice and improve communication outcomes.

Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study

Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication. The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach. Four themes have emerged: (a) experiencing a common vulnerability: the need for reciprocal understanding and sensitivity, (b) being outside the comfort zone: feeling discriminated against once again, (c) perceiving a lack of consonance between care and needs and (d) developing a sense of progressively disempowerment. The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level.

Strategies that assist children with communicative disability during hospital stay: Parents' perceptions and ideas

There is a lack of research on the use of augmentative and alternative communication (AAC) in paediatric care, despite the fact that most children in need of AAC frequently need to visit hospitals and sometimes have to stay for long periods. The aim of this study was to investigate parents' experiences of the hospital visits with their children with communicative disabilities and to collect their ideas about how to optimize communication in this situation. Ten parents who had children with communicative disability took part in three focus group interviews. The analysis had a retrospective qualitative content theory. In the qualitative content analysis of the focus group interviews, 4 categories and 17 subcategories were identified. Overall, the results highlighted the importance of enabling direct communication between the child and the staff during the hospital stay. Parents of children with communication difficulties highlighted the importance of listening to their children and understanding their needs during hospital care and that hospital staff are in need of more knowledge in communicative disability and AAC to accomplish this. Training programmes for health-care professionals should be established to facilitate these requirements and connect to the United Nations conventions. Hospitals should provide and use AAC/communicative support.

Communicating with disabled children when inpatients: barriers and facilitators identified by parents and professionals in a qualitative study

BACKGROUND

Communication is a fundamental part of health care, but can be more difficult with disabled children. Disabled children are more frequently admitted to hospital than other children.

AIMS

To explore experiences of ward staff and families to identify barriers and facilitators to effective communication with disabled children whilst inpatients.

DESIGN

This was an exploratory qualitative study.

METHODS

We consulted 25 staff working on paediatric wards and 15 parents of disabled children recently admitted to those wards. We had difficulty in recruiting children and evaluating their experiences. Data were collected through interviews and focus groups. A thematic analysis of the data supported by the Framework Approach was used to explore experiences and views about communication. Emerging themes were subsequently synthesised to identify barriers and facilitators to good communication.

RESULTS

Barriers to communication included time, professionals not prioritising communication in their role and poor information sharing between parents and professionals. Facilitators included professionals building rapport with a child, good relationships between professionals and parents, professionals having a family-centred approach, and the use of communication aids.

CONCLUSIONS

Communication with disabled children on the ward was perceived as less than optimal. Parents are instrumental in the communication between their children and professionals. Although aware of the importance of communication with disabled children, staff perceived time pressures and lack of priority given to communicating directly with the child as major barriers.

Evaluating the Impact of AAC Interventions in Reducing Hospitalization-related Stress: Challenges and Possibilities

Hospitalization is a stressful context for all children and their families, but especially for children with communication difficulties. Effective communication using augmentative and alternative communication (AAC) strategies can play a critical role in preparing and supporting everyone involved in such situations to have discussions that minimize insecurity, allow children to express their concerns, and so decrease negative stress and anxiety. However, there is a critical need to identify robust and reliable ways of evaluating the effectiveness of interventions that seek to achieve this aim. This research note illustrates some of the challenges and problems that require attention and suggests possible new research tools, for example, the use of physiological measures. The evaluation of an AAC intervention on a day surgery ward is described and used to illustrate one potential physiological measure for evaluating the impact of an intervention.

Child to nurse communication in paediatric post-acute hospital care: evaluation of the VerbalCare tablet application

VerbalCare is a mobile software platform for hospital patients and nursing staff to communicate in real-time. The purposes of this study were to (1) identify and evaluate icons for the VerbalCare tablet application and (2) examine use and satisfaction with this tablet application in a paediatric post-acute hospital. Hospital nursing staff were surveyed to identify the most common reasons children use the "nursing call bell". Icons for the VerbalCare tablet application were developed to match the identified call bell requests and be understood by children. Through structured interview, three children provided feedback on the icons. Following staff training, the system was implemented for five patients (8-18 years). Data on frequency of use, types and timing of requests were collected via the internal software. Satisfaction surveys were completed at discharge. The VerbalCare application was used most frequently to communicate the need to use the bathroom (24%) and the need to get something (21%). Request frequency was consistent across morning, afternoon and evening and the tablet was used 40% of available days. These results indicate that children in a paediatric post-acute care hospital were able to use a tablet application for communicating with their nurse and reported satisfaction with the experience. Implications for Rehabilitation The VerbalCare tablet application was developed to allow patients to convey specific messages to nursing staff who are not in the patient's room. Children of varying ages were able to use the VerbalCare tablet application to communicate varying messages to hospital nursing staff and were satisfied with its use.

An integrative review of patient safety in studies on the care and safety of patients with communication disabilities in hospital

OBJECTIVE

To review the research literature on the experiences of patients with communication disabilities in hospital according to the Generic Model of patient safety.

METHODS

In 2014 and 2015, we searched four scientific databases for studies with an aim or result relevant to safety of hospital patients with communication disabilities. The review included 27 studies.

RESULTS

A range of adverse event types were outlined in qualitative research. Little detail was provided about contributing or protective factors for safety incidents in hospital for these patients or the impact of the incidents on the patient or organisations involved.

CONCLUSION

Further research addressing the safety of patients with communication disabilities is needed. Sufficient detail is required to identify the nature, timing, and detection of incidents; factors that contribute to or prevent adverse events; and detail the impact of the adverse events.

PRACTICE IMPLICATIONS

In order to provide safe and effective care to people with communication disabilities in hospital, a priority for health and disability services must be the design and evaluation of ecologically appropriate and evidence-based interventions to improve patient care, communication, and reduce the risk of costly and harmful patient safety incidents.

Communicating with Patients with Special Health Care Needs

People with special health care needs (PSHCN) often have difficulty communicating with providers in health care settings, including dental practices. This difficulty can affect access to care as well as the quality of care received. This article provides practical tips and tools dental professionals can use to facilitate communication for a diverse population of PSHCNs. The article discusses communication needs of patients with communication disorders; augmentative and alternative communication; and communication for patients with intellectual disability, psychiatric conditions; and dental fears. Examples are given of communication breakdowns, and descriptions of how communication challenges can be resolved.

Using Picture and Text Schedules to Inform Children: Effects on Distress and Pain during Needle-Related Procedures in Nitrous Oxide Sedation

During hospital visits, children often undergo examinations and treatments that may involve an experience of pain and distress that is also connected to the staff's treatment. The United Nation's Convention on the Rights of Persons with Disability advocates the use of Universal Design. One way of implementing this idea within paediatric nursing is to increase the use of pictorial supports, and the few studies that have been published show promising results. The aim of this study was to do a comparison between two groups of children in regard to the pre- and postconditions of implementing an intervention including staff instruction and the use of pictorial support. The support consisted of a visual schedule with pictures and text, used both preparatory to and during the hospital visit. One hundred children aged 5-15 (50 children during the preinterventional data collection and 50 children postinterventionally) reported pain intensity and distress during needle-related procedures in nitrous oxide sedation. The results showed that the intervention had a positive effect in significantly lowering the level of preprocedural distress. The results showed that the pain intensity was also lowered however not reaching statistical significance. This confirms other positive research results on the use of visual supports within paediatric care, a topic that has to be further studied.

Stigma and Developmental Disabilities in Nursing Practice and Education

Individuals with developmental disabilities (DD) experience stigma, discrimination, and barriers, including access to appropriate health care, that restrict their ability to be equal participants in society. In this study, underlying contexts, assumptions, and ways of acting are investigated that perpetuate inequalities and pejorative treatment toward those with disabilities. Several nurse researchers and educators suggest specific content for, or approaches to, education about DD. Critical pedagogy that employs cultural competency and a disability studies' framework to guide curriculum and course development will allow assumptions underlying common health care practices that oppress and "other" people with disabilities to be exposed and changed.

Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication

Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.

Transitions in the communication experiences of tracheostomised patients in intensive care: a qualitative descriptive study

AIMS AND OBJECTIVES

To describe how tracheostomised patients in intensive care experience acts of communication and to better understand their experiences in the context of the transitions theory.

BACKGROUND

Waking up in an intensive care unit unable to speak because of mechanical ventilation can be challenging. Communication aids are available, but patients still report difficulties communicating. Investigating how mechanically ventilated patients experience communication in the context of the transitions theory might elucidate new ways of supporting them during their transitions while being ventilated.

DESIGN

A qualitative, descriptive design.

METHODS

Eleven patients who had previously been tracheostomised in an intensive care unit were included in this quality improvement project conducted in a university hospital in Norway. Participants were tracheostomised from 3-27 days. Semistructured interviews were conducted from June 2013-August 2013, 3-18 months after hospital discharge. Transcripts were analysed using inductive content analysis.

RESULTS

Participants reported a great diversity of emotions and experiences attempting to communicate while being tracheostomised. One overarching theme emerging from the analysis was the 'Experience of caring and understanding despite having uncomfortable feelings due to troublesome communication.' The theme consists of three categories. The category 'Emotionally challenging' shows that patients struggled initially. With time, their coping improved, as revealed in the category 'The experience changes with time.' Despite difficulties, participants described positive experiences, as shown in the category 'Successful communication.'

CONCLUSION

The importance of patients experiencing caring and understanding despite their difficult situation constitutes the core finding. The findings suggest that participants went through different transitions. Some reached the end of their transition, experiencing increased stability.

RELEVANCE TO CLINICAL PRACTICE

Despite challenges with communication, participants reported that caring and safety provided by health care professionals were significant experiences. They viewed nonverbal communication as being very important.

"Not being able to talk was horrid": A descriptive, correlational study of communication during mechanical ventilation

OBJECTIVES

The purpose of this study was to describe the patient experience of communication during mechanical ventilation.

RESEARCH METHODOLOGY

This descriptive study is a secondary analysis of data collected to study the relationship between sedation and the MV patients' recall of the ICU. Interviews, conducted after extubation, included the Intensive Care Experience Questionnaire. Data were analysed with Spearman correlation coefficients (rs) and content analysis.

SETTING

Participants were recruited from a medical-surgical intensive care unit in the Midwest United States.

RESULTS

Participants (n = 31) with a mean age of 65 ± 11.9 were on the ventilator a median of 5 days. Inability to communicate needs was associated with helplessness (rs = .43). While perceived lack of information received was associated with not feeling in control (rs = 41) and helplessness (rs = 41). Ineffective communication impacted negatively on satisfaction with care. Participants expressed frustration with failed communication and a lack of information received. They believed receipt of information helped them cope and desired a better system of communication during mechanical ventilation.

CONCLUSION

Communication effectiveness impacts patients' sense of safety and well-being during mechanical ventilation. Greater emphasis needs to be placed on the development and integration of communication strategies into critical care nursing practice.

A metasynthesis of patient-provider communication in hospital for patients with severe communication disabilities: informing new translational research

Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.

Nursing students' knowledge of and performance in communicating with patients with hearing impairment

AIM

The present study aimed to investigate nursing students' knowledge of and performance in communicating with patients with hearing impairment.

METHODS

A cross-sectional study was conducted on all senior nursing students (n = 71) in a nursing school in Iran in 2013. Data collection was performed with a demographics questionnaire, knowledge questionnaire, and performance assessment checklist. Two stages were designed to evaluate the students. In the first stage, students conducted an interview with a simulated patient with hearing impairment who experienced chest pain. In the second stage, students answered the knowledge questionnaire. Descriptive statistics, independent sample Student's t-test, and Pearson correlation coefficient were used to analyze the data.

RESULTS

In total, 11.3% of participants had a history of caring for a patient with hearing impairment. The majority of students evaluated their performance in communicating with such patients at a moderate level. A significant difference was observed between the mean score of knowledge in men and women (P = 0.05), and male students gained higher scores. In total, 61.5% of the students had low to very low levels of knowledge and 87.3% of them had weak to very weak performance in communicating with patients with hearing impairment.

CONCLUSION

Nursing students are lacking in knowledge and skills required for effective communication with patients with hearing impairment. Nurse educators should pay more attention to this issue as it is their responsibility to prepare nurses who are competent to deal with common issues they will face in practice.

Scoping review of patient-centered care approaches in healthcare

BACKGROUND

The purpose of this scoping review was to describe how three tenants of patient-centered care provision: communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the literature.

METHODS

A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and EMBASE. A key term search strategy was employed using "patient-centered care", "client-centered care", "framework" and "model" to identify relevant studies.

RESULTS

Application of the search strategy resulted in a hit total of 101 articles. Nineteen articles met inclusion criteria, of which 12 were review articles; 5 were qualitative research papers; one was a randomized control trial; and one was a prospective study. From these articles, 25 different patient-centered care frameworks/models were identified.

CONCLUSIONS

The fact that all identified approaches to patient-centered care incorporated strategies to achieve effective communication, partnership, and health promotion indicates that clinicians can select a patient-centered approach from the literature that best suits their patient's needs, and be confident that it will satisfy the three core elements of patient-centered care provision. While empirical literature on specific patient-centric frameworks and models was limited, much empiric evidence was sourced for the most consistently defined component of patient-centered care, communication.

Communication between the Nursing Team and Patients on Invasive Mechanical Ventilation in an Intensive Care Unit

La comunicación se basa en la utilización de herramientas e involucra la interacción recíproca de dos interlocutores. En las Unidades de Cuidados Intensivo (UCI), la aplicación de ventilación mecánica invasiva (VMI), genera condiciones especiales en el paciente que dificultan su comunicación. La ausencia de comunicación entre el equipo de enfermería (EE) y los pacientes con VMI es atribuida a múltiples barreras y produce efectos negativos que afectan la recuperación y el bienestar. Objetivo: conocer las características de la comunicación con pacientes con VMI que aplica elementos de la Teoría Fundada para el proceso de análisis y que utilizó como técnica de recolección de datos grupos focales de enfermeras y técnicos de enfermería que realizan cuidado directo a pacientes con VMI en una UCI. Método: Investigación de diseño cualitativo, orientada por la Teoría Fundada, para el análisis y la asociación de conceptos, que utilizó grupos focales como técnica de recolección de la información. Resultados: si bien los hallazgos permiten describir las principales características de la comunicación con estos pacientes identificando los medios y las formas utilizados por el EE para hacerlo, los momentos en que ocurre la comunicación, los beneficios y las barreras percibidas por el grupo de participantes, no se llega a establecer una categoría central con las estructuras y definiciones del proceso dentro de la misma, para lo que se requerirían nuevas investigaciones. Conclusión: a partir de estos hallazgos se espera contribuir al cuerpo de conocimientos de la disciplina de enfermería y fortalecer la gestión del cuidado que realiza el EE en las UCI.

Communication Strategies Of The Nursing Team In The Aphasia After Cerebrovascular Accident

This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.


Parent and provider perspectives on procedural care for children with autism spectrum disorders

OBJECTIVE

Children with autism spectrum disorders (CWASDs) have more difficulty tolerating hospital procedures than many other children. The aim of this study was to identify parent and provider perspectives on barriers and facilitators to procedural care for CWASDs.

METHODS

Semistructured interviews were conducted with medical staff and parents of CWASDs. Those parents whose child with autism required a procedure in a tertiary care sedation unit and those whose child was enrolled in autismMatch (a research registry for individuals with autism) were recruited. Staff providing direct patient care in the tertiary care sedation unit were recruited. Participants were asked open-ended questions about factors contributing to or interfering with successful completion of medical procedures for CWASDs. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using modified grounded theory techniques.

RESULTS

Twenty mothers and 20 medical staff members were interviewed. Participants described 2 domains essential to care of CWASDs but in which barriers existed: (1) productive interactions between providers and families, largely dependent on advanced preparation and (2) modifications to healthcare organization and delivery in the areas of patient flow and clinical environment. Individualized care is essential to quality care in both domains.

CONCLUSIONS

Children with autism spectrum disorders require individualized interventions to maximize the quality of procedural care. However, many hospitals and providers are not sufficiently equipped to accommodate these children's needs. This study suggests that targeted improvements in preparation and communication between providers and families as well as modifications in patient flow and clinical environments have the potential to improve the quality and successful completion of procedures.