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

Management of agitation in individuals with autism spectrum disorders in the emergency department

Individuals with autism spectrum disorder (ASD) presenting with acute agitation in emergency departments (ED) during a crisis situation present both diagnostic and treatment challenges for ED personnel, families, caregivers, and patients seeking treatment. This article describes the challenges that individuals with ASD face when receiving treatment in crisis and emergency settings. Additionally, this article provides information for emergency physicians, ED personnel, and crisis response teams on a systematic, minimally restrictive approach when assessing and providing treatment to patients with ASD presenting with acute agitation in ED settings.

Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting

PURPOSE

This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology.

METHODS

An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review.

FINDINGS

Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans.

CONCLUSIONS AND IMPLICATIONS

The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care.

CLINICAL RELEVANCE

The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care.

Parents and children with cerebral palsy discuss communication needs in hospital

OBJECTIVE

The aim of this study was to understand the communication needs and experiences of parents and children with cerebral palsy (CP) and complex communication needs (CCN) in hospital.

METHODS

Focus groups with 10 parents and interviews with seven children with CP and CCN were analysed for content themes.

RESULTS

Results demonstrated that children often want to communicate directly with hospital staff to: gain attention, answer yes/no, convey basic physical needs, give and receive information, control their environment and participate in preferred activities. Barriers to communication included lack of access to augmentative and alternative communication (AAC), staff preferring to communicate with parents and lack of time to communicate.

CONCLUSIONS

Results highlight strategies for successful communication, the role of the parents in supporting communication and provision of AAC systems for children in hospital. Policy and practice implications in the preparation of children with CP and CCN for communication in hospital are discussed.

Challenges in the communication between 'communication vulnerable' people and their social environment: an exploratory qualitative study

OBJECTIVE

Communication vulnerable people are often unable to communicate effectively within their social environment, hindering client-centered care and participation in daily life. This study aims to explore the experiences of communication and the factors that influence this in long term care settings.

METHODS

A qualitative study using the critical incident method. Communication vulnerable clients and people within their immediate environment were interviewed about their communication experiences.

RESULTS

Thirty-nine individuals in three settings participated in the interviews, of which 14 were clients. Specific challenges in communication were presented in different relationships. The main influencing factors in the communication between clients and professionals were: effort put into improving the communication, knowledge of the professional, augmentative and alternative communication, time for communication and the influence and power of the client.

CONCLUSION

Communication vulnerable people and people within their immediate environment face daily challenges in communicating with each other. In particular, communication among clients, can be very difficult. Augmentative and alternative communication tools are only rarely used.

PRACTICE IMPLICATIONS

Professionals need to develop adequate knowledge and skills to improve their communication. Also, more attention should be focussed on use of AAC, communication between professionals and family members, and support in the communication among clients.

Symptom communication during critical illness: the impact of age, delirium, and delirium presentation

Symptom communication is integral to quality patient care. Communication between patients and nurses in the intensive care unit (ICU) is complicated by oral or endotracheal intubation and fluctuating neurocognitive status or delirium. We report the (a) prevalence of delirium and its subtypes in non-vocal, mechanically ventilated, critically ill patients; (b) impact of age on delirium; and (c) influence of delirium and age on symptom communication. Videorecorded interactions between patients (N = 89) and nurses (N = 30) were analyzed for evidence of patient symptom communication at four time points across 2 consecutive days. Delirium was measured at enrollment and following sessions. Delirium prevalence was 23.6% at enrollment and 28.7% across sessions. Participants age >60 were more likely to be delirious on enrollment and during observational sessions. Delirium was associated with self-report of pain, drowsiness, and feeling cold. Patients were significantly less likely to initiate symptom communication when delirious. Symptom identification should be carefully undertaken in older adults with or without delirium.

Meeting the Needs of Limited English Proficiency Patients

The number of patients in U.S. hospitals with limited English proficiency (LEP) is growing. There is a body of evidence that suggests that inadequate patient-provider communication is responsible for a range of adverse events, including death. In recognition of this, the Joint Commission has set standards requiring hospitals to address the communication needs of the diverse hospitalized population. Although the optimal approach for LEP patients would involve having certified interpreters at the bedside around the clock, this is unfortunately not practically or economically feasible. Speech-generating devices (SGDs) can offer patients a means of communicating with their caregivers and an opportunity to participate more actively in their care. The University of Iowa Assistive Devices Lab has developed a series of bilingual communication templates suited for use in acute and critical care settings. They developed these templates for use by LEP patients who are speakers of diverse languages, as well as by Deaf patients who use a sign language as their primary means of communication.

A Demographic Study of AAC/AT Needs in Hospitalized Patients

In 2012, the Joint Commission issued a mandate that accredited hospitals must take into consideration the needs of patients with complex communication needs. Stemming from this mandate came recommendations for hospitals to collect baseline data of the number of individuals in their care with complex communication needs. This is a demographic study in response to their recommendation. Researchers at the University of Iowa sampled the electronic medical records of patients across 7 days to determine the number of patients who met candidacy requirements for augmentative alternative communication or assistive technology. Our census data indicate there is a significant need for patients in acute care settings to have access to alternative communication and the nurse call systems. The need appears to be greater in the intensive care units, but is not limited to this patient population. Overall, patients had greater AT needs than AAC needs in all locations. We recommend future research to investigate service delivery models to improve communication barriers that may exist between hospital staff and patients.

Perceptions of School Nurses in the Care of Students With Disabilities

Many children are surviving prematurity and serious childhood illnesses due to advances in technology and medical care. As a result, more children are entering public school systems with complex health care needs and intellectual and developmental disabilities. School nurses are responsible for caring for these children; however, many nurses feel unprepared due to a lack education on disability studies in nursing school, difficulty with effective communication, and a lack of experience. A qualitative study was conducted to explore the perceptions and challenges of school nurses who worked with students with intellectual and developmental disabilities. Participants included eight nurses who worked in a public school setting, and data were collected through personal interviews, observations, and field notes. Results were analyzed categorically, and data showed that school nurses identified that they lacked education in disability studies and encountered challenges with communication, conducting health assessments, and screenings in students with intellectual and developmental disabilities.

Non-verbal communication between Registered Nurses Intellectual Disability and people with an intellectual disability: an exploratory study of the nurse's experiences. Part 1

This is the first of two articles presenting the findings of a qualitative study which explored the experiences of Registered Nurses Intellectual Disability (RNIDs) of communicating with people with an intellectual disability who communicate non-verbally. The article reports and critically discusses the findings in the context of the policy and service delivery discourses of person-centredness, inclusion, choice and independence. Arguably, RNIDs are the profession who most frequently encounter people with an intellectual disability and communication impairment. The results suggest that the communication studied is both complicated and multifaceted. An overarching category of 'familiarity/knowing the person' encompasses discrete but related themes and subthemes that explain the process: the RNID knowing the service-user; the RNID/service-user relationship; and the value of experience. People with an intellectual disability, their families and disability services are facing a time of great change, and RNIDs will have a crucial role in supporting this transition.

Communication difficulties and psychoemotional distress in patients receiving mechanical ventilation

BACKGROUND

Difficulties in communication in intensive care patients receiving mechanical ventilation are a source of stressful experiences and psychoemotional distress.

OBJECTIVES

To examine the association between communication characteristics and psychoemotional distress among patients treated with mechanical ventilation in a medical intensive care unit and to identify factors that may be predictive of psychological outcomes.

METHODS

A total of 65 critically ill patients, extubated within the preceding 72 hours, were included in this cross-sectional study. Data were collected by using a structured interview. Separate regression analysis of data on 3 psychoemotional outcomes (psychological distress, fear, and anger) were used for baseline variables, communication characteristics, and stressful experiences.

RESULTS

Difficulty in communication was a positive predictor of patients' psychological distress, and length of anesthesia was a negative predictor. Fear and anger were also positively related to difficulty in communication. In addition, the number of communication methods was negatively associated with feelings of fear and anger. Finally, the stressful experiences associated with the endotracheal tube were positively related to feelings of anger.

CONCLUSIONS

Patients treated with mechanical ventilation experience a moderate to extreme level of psychoemotional distress because they cannot speak and communicate their needs. Nurses should be aware of the patients' need to communicate. Decreasing stressful experiences associated with the endotracheal tube and implementing more appropriate communication methods may reduce patients' distress.

Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital

BACKGROUND

Effective nurse-patient communication is an essential aspect of health care. Time to communicate, however, is limited and subject to workload demands. Little is known about how nurses manage this 'lack of time' when caring for patients with developmental disability and complex communication needs, who typically communicate at a slow rate.

AIM

The aim of this study was to investigate nurses' expressed concepts of 'time' in stories about communicating with patients with developmental disability and complex communication needs in hospital.

METHOD

In 2009, 15 hospital nurses from a range of wards in two metropolitan hospitals participated in interviews about barriers to and strategies for successful communication with patients with developmental disability and complex communication needs in hospital. The data were analysed using narrative inquiry methodology and the stories verified with the participants.

RESULTS

Nurses identified 'time' as a barrier and a facilitator to successful communication. Time as a barrier was related thematically to avoiding direct communication and preferring that family or paid carers communicated on behalf of the patient. Time as a facilitator was related to valuing communication, investing extra time, and to applying a range of adaptive communication strategies to establish successful communication.

CONCLUSIONS

Time is perceived by nurses as both an enemy and friend for improving communication. Nurses who perceive that communication takes too long may avoid communication and miss opportunities to improve communication through increased familiarity with the person's communication methods. Those who take time to communicate narrate applying a range of strategies to achieve success in basic needs communication.

Disclosure predicaments arising during the course of patient care: nurses' privacy management

At times, nurses receive patient disclosures that have the potential to create challenges resulting in needs for strategies to manage patient information and expectations. This study examines disclosure predicaments nurses experience in critical care and emergency units at a large urban hospital. Utilizing the constant comparative method to identify disclosure themes guided by the principles of communication privacy management (CPM), the findings show that nurses regulate patient privacy in the role of stakeholder confidants. Second, disclosure predicaments occur in three different contexts: during the course of nurses' professional routine; when the nurses created safe terminals or havens for patients to talk; and when family matters became an inseparable part of caring for the patient. Third, the results indicate that there are several specific strategies that nurses use to manage disclosure predicaments they encounter. The lens of CPM is used to interpret these findings and offers a context in which to better understand the needs of nurses concerning patient disclosive behavior and privacy issues for nurses.

The "Big 5" and beyond: nurses, paid carers, and adults with developmental disability discuss communication needs in hospital

Adults with developmental disability and little or no speech need to communicate with nurses in hospital to (a) express physical needs, (b) discuss health, (c) convey intelligence and emotions, (d) connect socially, and (e) control the environment. All stakeholders need access to a variety of communication strategies to support communication of these needs.

Promoting effective communication for patients receiving mechanical ventilation

Communicating effectively with ventilator-dependent patients is essential so that various basic physiological and psychological needs can be conveyed and decisions, wishes, and desires about the plan of care and end-of-life decision making can be expressed. Numerous methods can be used to communicate, including gestures, head nods, mouthing of words, writing, use of letter/picture boards and common words or phrases tailored to meet individualized patients' needs. High-tech alternative communication devices are available for more complex cases. Various options for patients with a tracheostomy tube include partial or total cuff deflation and use of a speaking valve. It is important for nurses to assess communication needs; identify appropriate alternative communication strategies; create a customized care plan with the patient, the patient's family, and other team members; ensure that the care plan is visible and accessible to all staff interacting with the patient; and continue to collaborate with colleagues from all disciplines to promote effective communication with nonvocal patients.

A systematic review of nursing rehabilitation of stroke patients with aphasia

AIM AND OBJECTIVES

To explore the evidence on rehabilitation of stroke patients with aphasia in relation to nursing care, focusing on the following themes: (1) the identification of aphasia, (2) the effectiveness of speech-language interventions.

BACKGROUND

Patients with poststroke aphasia have higher mortality rates and worse functional outcome than patients without aphasia. Nurses are well aware of aphasia and the associated problems for patients with stroke because they have daily contact with them. The challenge is to provide evidence-based care directed at the aphasia. Although rehabilitation stroke guidelines are available, they do not address the caregiving of nurses to patients with aphasia.

DESIGN

Systematic review.

METHOD

Published studies were reviewed, focusing on identification and treatment of aphasic patients after stroke in terms of the consequences for nursing care. Also, data concerning effective speech-language interventions were extrapolated into nursing practice with respect to the classification of nursing interventions.

RESULTS

Intensive speech-language therapy, which was initiated in the acute stage post stroke, showed the best rehabilitation outcomes. Trained persons other than speech-language therapists provided effective speech-language interventions. Speech-language therapy included several types of intervention that met nursing intervention classifications.

CONCLUSION

The contribution of nursing to the rehabilitation of patients with aphasia is relevant. The use of screening instruments by nurses can increase early detection of aphasia, a precondition for initiating timely speech-language therapy. Collaboration between speech-language therapists and nurses is of the utmost importance for increasing the intensity and functionality of speech-language exercises, which may enhance the quality of treatment.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study can be used to develop nursing rehabilitation guidelines for stroke patients with aphasia. Further research is necessary to explore the feasibility of using such guidelines in clinical nursing practice and to examine the experiences of patients with nursing interventions directed at aphasia.

Dietetics students' ability to choose appropriate communication and counseling methods is improved by teaching behavior-change strategies in computer-assisted instruction

Several models and theories have been proposed to help registered dietitians (RD) counsel and communicate nutrition information to patients. However, there is little time for students or interns to observe and/or participate in counseling sessions. Computer-assisted instruction (CAI) can be used to give students more opportunity to observe the various methods and theories of counseling. This study used CAI simulations of RD-client communications to examine whether students who worked through the CAI modules would choose more appropriate counseling methods. Modules were created based on information from experienced RD. They contained videos of RD-patient interactions and demonstrated helpful and less helpful methods of communication. Students in didactic programs in dietetics accessed the modules via the Internet. The intervention group of students received a pretest module, two tutorial modules, and a posttest module. The control group only received the pretest and posttest modules. Data were collected during three semesters in 2006 and 2007. Two sample t tests were used to compare pretest and posttest scores. The influence of other factors was measured using factorial analysis of variance. Statistical significance was set at P<0.05. Eleven didactic programs participated. A total of 350 students were in the intervention group and 102 students were in the control group. Pretest scores were not different (6.30+/-0.26 vs 6.21+/-0.15, control and intervention, respectively). The intervention group's posttest score was higher than its pretest score (6.21+/-0.15 vs 6.65+/-0.16, pretest and posttest, respectively). Change in score from pretest to posttest was higher for the intervention group (-0.02+/-0.20 vs 0.44+/-0.11, control and intervention, respectively). For the 21 questions in the tutorials, those who answered 19 to 21 correctly had a greater increase from pretest to posttest than those who answered <13 correctly (-0.44+/-0.37 vs 0.84+/-0.17, <13 and 19 to 21 correct, respectively). There was no effect of instructor, grade point average, school year, or prior counseling on the results. The study provides evidence that the use of CAI can improve communication and counseling methods for dietetics students.