Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial

A Scoping Review of the Evidence on Disability Accommodations Targeting Equitable Communication Access in Health Care

PURPOSE

The Americans with Disabilities Act (ADA) of 1990 protects the civil rights of people with disabilities, including their right to effective communication and equitable health care access through accommodations. The ADA website lists examples of accommodations (e.g., qualified notetaker, hearing amplifiers, cued speech interpreters), but no literature is cited to support this list. Scientific evidence is critical to advancing both the effectiveness and widespread implementation of accommodations. We scoped the literature on interventions supporting equitable communication access (accommodations) for adults with communication disabilities (CDs) in health care settings. We asked what accommodations have been studied, for what CD populations, and how they have been studied.

METHOD

We used a scoping review approach and conducted searches using MEDLINE, CINAHL, and Embase databases. Two reviewers independently screened abstracts and full texts indexed between January 1, 2003, and August 1, 2024. Data on accommodation type, CD-related health condition, setting, health care workers involved, evidence type, study design, and outcome were collected.

RESULTS

Screening of 1,614 articles identified 58 investigations of 10 communication accommodations in health care settings. The range in number of publications rose from 0-2 to 2-9 over the 11-year period. The three most studied accommodations were customized plan, communication strategies, and augmentative and alternative communication aids (each 21%-22% of studies). Most investigations addressed populations with single CD-related conditions (e.g., aphasia), were descriptive (52%), and had sample sizes ≤ 50 participants. Speech-language pathologists infrequently provided or implemented accommodations (12% of all health care workers involved, by type of worker). Findings were typically positive, but outcome measures were heterogeneous.

CONCLUSIONS

The 10 researched accommodations addressed a wider range of CD populations as compared to accommodations found in policy documents, highlighting an opportunity to align policy and evidence. While accommodation studies generally yielded positive results, their small sample sizes, descriptive focus, and limited quantity suggest this research is early in its development. We outline potential strategies to advance knowledge on the implementation and effectiveness of communication accommodations in health care settings.

Communication training program for nurses caring for patients with aphasia: a quasi-experimental study

BACKGROUND

Nurses are key communication partners for patients with aphasia. Nurses' skills are vital for improving the patients' environment and nursing performance. This study develops and evaluates the effectiveness of a communication training program for nurses who care for patients with aphasia.

METHODS

A program was developed based on the Intervention Mapping Protocol. Then, a simulation using a standardized patient with aphasia and surveys were conducted. Program effectiveness was evaluated using a quasi-experimental framework with a non-equivalent control group and pretest-posttest non-synchronized design.

RESULTS

The two groups exhibited statistical significant differences in health communication competence, knowledge of aphasia, patient advocacy, clinical decision-making, and compassionate competence.

CONCLUSION

This study developed communication training for nurses who care for patients with aphasia. The effectiveness test showed that this training affected nurses' knowledge, attitude, and skills. Clearly, communication education for nurses is important to provide comprehensive care for patients with aphasia and can enhance nursing.

Nurse perspectives on supporting children and youth who use augmentative and alternative communication (AAC) in the pediatric intensive care unit

Many children who require hospitalization in the pediatric intensive care unit (ICU) are unable to or have difficulty communicating through speech, whether because of preexisting or acute conditions. Children who are unable to be heard and understood using only speech benefit from aided augmentative and alternative communication (AAC), including in hospital settings. This qualitative interview study sought to understand the perspectives of nurses on care and support for children who use or would benefit from aided AAC in the pediatric ICU. Participants were six nurses who worked in pediatric intensive care at a tertiary care unit of a children's hospital in the United States. Three main themes were identified related to nurses' views about supporting children's communication: (a) Caring for the Whole Child, (b) Needing Support from Others and Moving between Roles, and (c) Working with Available Resources and Demands. Nurses emphasized the importance of a holistic approach to care, the impact of others' support and knowledge, and a desire for building greater capacity for promoting children's access to effective communication. Findings offer insight that could improve patient-centered care for children with complex communication needs and support for nurses themselves, particularly within the broader context of ICU liberation.

Exploring the communication access and participation of a young adult with autism spectrum disorder with limited speech and inpatient nursing staff

This study aimed to describe the nature of interactions between health care professionals and a young adult with autism spectrum disorder with limited speech during an inpatient stay. An observational study was conducted to describe the interactions between a young adult on the autism spectrum and 14 of his inpatient health care providers. Naturalistic video-recordings were taken, and behavioral coding was completed to measure the frequency and type of communication turns taken. The providers took 93% of conversational turns. Most provider turns (76%) were non-obligatory in nature and did not invite the young adult to engage in turn-taking. The young adult only had access to his communication system during one of the 27 interactions (4%); however, when he had access to his system, he demonstrated higher levels of turn-taking. Health care providers should offer patients with limited speech more communicative turns, provide adequate wait time, and ensure communication systems are available during all inpatient interactions.

Exploring Communication Needs and Challenges in the Intensive Care Unit: A Survey Study From Providers' and Patients' Perspectives

PURPOSE

Effective communication between nonspeaking patients and providers is critical for the quality of care in intensive care units (ICUs). This study aims to evaluate perspectives of health care providers and nonspeaking patients on effective communication and communication barriers in the ICU.

METHOD

Qualitative and quantitative survey methodologies were employed to evaluate providers' and patients' perspectives on effective communication. Rating scales were utilized to measure patients' frustration levels and communication effectiveness. Open-ended questions were employed to reflect on barriers to communication in the ICU, instances of ineffective communication, and recommendations for enhancing effective communication.

RESULTS

The results of the study suggest that nonspeaking patients experienced high levels of frustration due to ineffective communication. However, the data reveal that access to appropriate augmentative and alternative communication (AAC) strategies and materials could help mitigate patients' frustration. Providers mainly communicated via asking yes/no questions, which largely limited the information patients conveyed, leading to frequent communication breakdowns. Providers expressed a desire to participate in training programs to utilize appropriate AAC strategies and promote effective communication.

CONCLUSIONS

This study provides preliminary survey results on perspectives of patients and providers on effective communication in the ICU. Both providers and patients reported experiencing challenges and frustration during their communication, due to barriers such as providers' insufficient training experience and lack of access to AAC materials. Skill training is warranted to promote effective patient-provider communication in intensive care settings.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26339623.

Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review

PURPOSE

Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings.

METHOD

Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy.

RESULTS

Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes.

CONCLUSIONS

There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26506102.

Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study

AIM

To describe different patterns of communication aimed at preventing, identifying and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit.

DESIGN

We conducted a fieldwork study with triangulation of participant observation and individual interviews.

METHODS

Participant observation of nine patients and 50 clinicians: nurses, physiotherapists and physicians. Subsequent individual face-to-face interviews with nine of the clinicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview.

FINDINGS

Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress.

CONCLUSION

Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom communication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress.

IMPLICATIONS FOR PATIENT CARE

Proactive and reactive symptom assessment of non-speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alternative communication.

IMPACT

This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units.

REPORTING METHOD

We used the consolidated criteria for reporting qualitative research.

PATIENT CONTRIBUTION

A user representative was involved in the design of the study.

Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes

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.

Comparison of communication interfaces for mechanically ventilated patients in intensive care

OBJECTIVES

This study aimed to compare the use of a conventional low-tech communication board and a high-tech eye tracking device to improve communication effectiveness of mechanically ventilated patients in intensive care.

DESIGN

A prospective randomized crossover was conducted with a mixed method approach (quantitative primary method and qualitative complementary method) to compare the two technologically opposed communication interfaces.

SETTING

The mechanically ventilated patients were recruited from the general intensive care unit of the Marie Curie Civil Hospital (Charleroi University Hospital, Belgium).

MAIN OUTCOME MEASURES

The communication exchanges were assessed through effectiveness indicators covering the quantity of messages transmitted, success rate, patient satisfaction, communication content and difficulties of use.

RESULTS

The sample consisted of 44 mechanically ventilated patients, covering 88 communication exchanges. The intervention effects on the quantity of messages transmitted (two median messages per exchange for the board versus four median messages per exchange for the eye tracking, p < 0.0001), success rate (80 % for the board versus 100 % for the eye tracking, p < 0.05) and patient satisfaction (66 % "not satisfied", 32 % "satisfied" and 2 % "dissatisfied" for the board versus 52 % "satisfied" and 48 % "very satisfied" for the eye tracking, p < 0.0001) were significant. The communication content covered eight themes for the board compared to nine themes for the eye tracking and the use difficulties included four categories for the board as well as for the eye tracking.

CONCLUSION

The eye tracking device may further improve communication effectiveness of mechanically ventilated patients compared to the conventional communication board, both quantitatively and qualitatively.

IMPLICATIONS FOR CLINICAL PRACTICE

The implementation of high-tech communication devices based on eye tracking in intensive care practice can significantly contribute to patient-centered care by improving communication of mechanically ventilated patients.

The EyeControl-Med device, an alternative tool for communication in ventilated critically ill patients: A pilot study examining communication capabilities and delirium

INTRODUCTION

Communication with ventilated patients in the Intensive care unit (ICU) is challenging. This may lead to anxiety and frustration, potentially contributing to the development of delirium. Various technologies, such as eye-tracking devices, have been employed to facilitate communication with varying grades of success. The EyeControl-Med device is a novel technology that delivers audio content and allows patients to interact by eye movements and could potentially allow for better communication in this setting. The aim of this exploratory concept study was to assess communication capabilities and delirium incidence using the EyeControl-Med device in critically ill patients unable to generate speech.

MATERIAL AND METHODS

A single-arm pilot study of patients in a mixed ICU. Patients were approached for consent if they were invasively ventilated and/or tracheotomized, hence unable to generate speech, but had no severe cognitive or sensory impairment that could prevent proper usage. Patients underwent at least 3 sessions with the EyeControl-Med device administered by a speech-language pathologist. Communication and consciousness were assessed using the Loewenstein Communication Scale (LCS) tool during the first and last sessions. Delirium was assessed using a computerized CAM-ICU questionnaire.

RESULTS

15 patients were included, 40% of whom were diagnosed with COVID-19. All patients completed three to seven usage sessions. The mean LCS score improved by 19.3 points (p < 0.0001), with each of its five components showing significant improvements as well. The mean number of errors on the CAM-ICU questionnaire decreased from 6.5 to 2.5 (p = 0.0006), indicating a lower incidence of delirium. No adverse effects were observed.

CONCLUSION

The EyeControl-Med device may facilitate communication and reduce the manifestations and duration of delirium in ventilated critically ill patients. Controlled studies are required to establish this effect.

Communication functions of adult patients admitted to intensive care: A multicentre, binational point prevalence study

BACKGROUND

Patient communication is profoundly impacted during the intensive care unit (ICU) stay. While the impacts of altered communication are recognised, there is a paucity of data on the prevalence of communication attempts as well as modes utilised by patients and unit practices to manage communication function.

OBJECTIVE

The objectives of this study were to describe the prevalence and characteristics of observed communication attempts (nonverbal, verbal, and use of the staff call bell) in adult ICU patients and report on unit-level practices on communication management.

METHODS

A prospective, binational, cross-sectional point-prevalence study was conducted across 44 Australia and New Zealand adult ICUs. Data on communication attempts, modes, ICU-level guidelines, training, and resources were collected in June 2019.

RESULTS

Across 44 ICUs, 470 of 623 (75%) participants, including ventilated and nonventilated patients, were attempting to communicate on the study day. Of those invasively ventilated via an endotracheal tube for the entire study day, 42 of 172 (24%) were attempting to communicate and 39 of 45 (87%) patients with a tracheostomy were attempting to communicate. Across the cohort, the primary mode of communication was verbal communication, with 395 of 470 (84%) patients using speech; of those 371 of 395 (94%) spoke English and 24 of 395 (6%) spoke a language other than English. Participants attempting to communicate on the study day had a shorter length of stay (LOS), a mean difference of 3.8 days (95% confidence interval: 0.2; 5.1) shorter LOS in the ICU than those not attempting to communicate, and a mean difference 7.9 days (95% confidence interval: 3.1; 12.6) shorter LOS in hospital overall. Unit-level practices and supports were collected. Six of 44 (14%) ICUs had a protocol for communication management, training was available in 11 of 44 (25%) ICUs, and communication resources were available in 37 of 44 (84%) ICUs.

CONCLUSION

Three-quarters of patients admitted to the ICU were attempting to communicate on the study day, with multiple methods used to support verbal and nonverbal communication regardless of ventilation status. Guidance and training were absent from the majority of ICUs, indicating a need for development and implementation of policies, training, and resources.

Mixed-method acceptability evaluation of a co-designed bundled intervention to support communication for patients with an advanced airway in the intensive care unit during a pandemic

BACKGROUND

Although bundled communication interventions are recommended to address communication barriers for patients with an advanced airway in the intensive care unit (ICU) such interventions have not been evaluated in pandemic conditions.

AIM

To evaluate the acceptability, appropriateness, and feasibility of a co-designed bundled intervention to support communication with adult patients with an advanced airway in ICU in pandemic conditions.

STUDY DESIGN

Prospective, convergent mixed method design in a single centre medical-surgical ICU in Toronto, Canada between September 2021-March 2022. After the use of the co-designed bundled communication intervention quantitative data were collected from health care providers using validated acceptability, appropriateness, and feasibility measures and analysed using descriptive statistics. Qualitative data were collected from providers, patients and families using semi-structured interviews and analysed using content analysis applying the theoretical framework of acceptability. Joint table analysis enabled the integration of the two data sets.

RESULTS

A total of 64 (41.3%) HCPs responded to the survey: 54 (84.4%) rated the intervention acceptable; 55 (85.9%) appropriate; and 49 (76.6%) feasible for use in this context. Qualitative data (23 interviews: 13 healthcare providers, 6 families and 4 patients) and the joint table analysis extended the understanding that intervention acceptability was related to positive affective attitudes and reduced communication frustration. Appropriateness and feasibility were promoted through intervention alignment with values, ability to personalize tools, and ease of access. Recommendations to improve the acceptability included adaptation for immobilized and/or restrained patients, additional education, and integration into existing workflows.

CONCLUSIONS

This mixed method evaluation of a co-designed bundled intervention to support patient communication in the ICU during pandemic conditions demonstrated high rated and described acceptability, appropriateness, and feasibility by participants.

RELEVANCE TO CLINICAL PRACTICE

A co-designed communication intervention demonstrating stakeholder acceptability, appropriateness, and feasibility can be implemented into clinical practice in pandemic and other infection prevention and control contexts.

Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses

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.

Audiovisual Recording in the Inpatient Setting: A Method for Studying Parent-Nurse Communication

Audiovisual recordings are under-utilized for capturing interactions in inpatient settings. Standardized procedures and methods improve observation and conclusion validity drawn from audiovisual data. This article provides specific approaches for collecting, standardizing, and maintaining audiovisual data based on a study of parent-nurse communication and child and family outcomes. Data were collected using audio and video recorders at defined time points simplifying its collection. Data were downloaded, edited for size and privacy, and securely stored, then transcribed, and subsequently reviewed to ensure accuracy. Positive working relationships with families and nurses facilitated successful study recruitment, data collection, and transcript cleaning. Barriers to recruitment and data collection, such as privacy concerns and technical issues, were successfully overcome. When carefully coordinated and obtained, audiovisual recordings are a rich source of research data. Thoughtful protocol design for the successful capture, storage, and use of recordings enables researchers to take quick action to preserve data integrity when unexpected situations arise.

Symptom Assessment for Mechanically Ventilated Patients: Principles and Priorities: An Official American Thoracic Society Workshop Report

Mechanically ventilated patients experience many adverse symptoms, such as anxiety, thirst, and dyspnea. However, these common symptoms are not included in practice guideline recommendations for routine assessment of mechanically ventilated patients. An American Thoracic Society-sponsored workshop with researchers and clinicians with expertise in critical care and symptom management was convened for a discussion of symptom assessment in mechanically ventilated patients. Members included nurses, physicians, a respiratory therapist, a speech-language pathologist, a critical care pharmacist, and a former intensive care unit patient. This report summarizes existing evidence and consensus among workshop participants regarding 1) symptoms that should be considered for routine assessment of adult patients receiving mechanical ventilation; 2) key symptom assessment principles; 3) strategies that support symptom assessment in nonvocal patients; and 4) areas for future clinical practice development and research. Systematic patient-centered assessment of multiple symptoms has great potential to minimize patient distress and improve the patient experience. A culture shift is necessary to promote ongoing holistic symptom assessment with valid and reliable instruments. This report represents our workgroup consensus on symptom assessment for mechanically ventilated patients. Future work should address how holistic, patient-centered symptom assessment can be embedded into clinical practice.

Supporting Children's Communication of Choices During Inpatient Rehabilitation: Effects of a Mobile Training for Health Care Providers

PURPOSE

Children with complex medical and communication needs often experience extensive or frequent hospital stays and rely on augmentative and alternative communication (AAC) strategies to communicate in this environment. Health care providers seldom receive training to effectively communicate with these children, which may lead to limited participation opportunities for the child during inpatient interactions.

METHOD

A pretest-posttest experimental group design was completed to evaluate the effects of a brief mobile training designed to teach providers a procedure to support children with complex communication needs to communicate choices. Each provider participated in two pretest and two posttest interactions with children with complex communication needs during naturally occurring inpatient activities. Providers in the treatment group completed the video training, whereas providers in the control group did not.

RESULTS

Following the training, (a) more providers offered choices to the children during hospital routines, (b) providers implemented the trained procedure with increased accuracy, and (c) the children with complex communication needs consistently communicated their choices when given the opportunity to do so. The providers rated the training as easy to use, effective, and suited to the needs of the inpatient setting.

CONCLUSIONS

This is the first AAC training designed to promote child-provider interactions in inpatient settings that demonstrates results that are efficient, socially valid, and effective in a real-world context. Future work is needed to develop additional brief and focused AAC partner trainings to teach providers to support the participation of children with complex communication needs in health care interactions.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22029008.

Theoretical definition of nurse-conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis

Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse-conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse-patient communication," "nurse-patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

Communication with mechanically ventilated patients in intensive care units: A concept analysis

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.

Sepsis, critical illness, communication, swallowing and Sustainable Development Goals 3, 4, 10

PURPOSE

Sepsis is a major global health problem with an estimated 49 million cases globally each year causing as many as 11 million deaths. The primary objective of this commentary is to describe the impacts of sepsis and critical illness on communication and swallowing function, and to discuss management strategies considering the Sustainable Development Goals (SDGs).

RESULT

Communication and swallowing disabilities can occur with sepsis and critical illness. A holistic framework to optimise function, recovery, and future research priorities across the lifespan can be developed through the SDGs.

CONCLUSION

Communication and swallowing disabilities following critical illness associated with sepsis have global impacts. Early multidisciplinary engagement is key to optimising individuals' function. Collaborative research, education, and public awareness is urgently needed to increase equity in health outcomes across populations. This commentary paper supports progress towards good health and well-being (SDG 3), quality education (SDG 4) and reduced inequalities (SDG 10).

Evaluation of the effectiveness of a training programme for nurses regarding augmentative and alternative communication with intubated patients using Kirkpatrick's model: A pilot study

AIM

Communicating with conscious intubated patients who are unable to communicate verbally is one of the challenges faced by intensive care unit (ICU) nurses. The present study was conducted to evaluate the effectiveness of a training programme for nurses regarding augmentative and alternative communication (AAC) with intubated patients using Kirkpatrick's model.

DESIGN

This study had a one-group, before-after, quasi-experimental design.

METHODS

Totally, 45 nurses working in ICUs participated in a blended training programme using AAC strategies to communicate with intubated patients. Their contribution was evaluated based on Kirkpatrick's model at four levels. The study data were collected using the "satisfaction and ease questionnaire," "observation checklist" and "communication knowledge test." Then, the data were analysed using the SPSS 22 software and p < 0.05 was considered statistically significant.

RESULTS

Most participants were satisfied with the implementation of the programme. The nurses' mean score of communication knowledge increased after the intervention (p < 0.05). The results of evaluation of the third and fourth levels of Kirkpatrick's model also showed an increase in the success of communication, use of AAC, and satisfaction with and ease of communication (p < 0.001).

IMPLICATION

Short-term and long-term effects of the blended training programme about AAC were investigated using Kirkpatrick's model. The results indicated the positive effect of the programme on the quality of the nurses' communication with intubated patients, their understanding of the patients' messages and meeting the patients' needs at a more desirable level. Thus, nurses and other staff are recommended to use this simple method of communication with patients to provide better services. In addition, further quantitative and qualitative studies are suggested to assess these communication strategies in other patients with impaired consciousness.

What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis

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.

Communicating with mechanically ventilated patients who are awake. A qualitative study on the experience of critical care nurses in Cyprus during the COVID-19 pandemic

BACKGROUND

Modern protocols for light sedation in combination with the increased number of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients.

STUDY OBJECTIVES

The purpose of this study was to explore the strategies nurses use when taking care of conscious, intubated patients in the intensive care unit and the barriers they encounter in their effort to communicate.

METHODS

For this study, a qualitative design was employed. Data were collected using in-depth semi-structured interviews with 14 intensive care nurses working at ICUs in four different hospitals of Cyprus. The data were analyzed by applying thematic analysis.

RESULTS

We identified several strategies of unaided (movements-lips, hands, legs-facial expressions, gestures, touching) and aided forms of communication (pen and paper, boards, tablets, mobiles) used by nurses to communicate with patients. However, barriers to communication were reported by the participating nurses mainly pertaining to patients and nurses' characteristics as well as the ICU environment. The health protocols imposed by the pandemic added more obstacles to the communication between nurses and patients mostly related to the use of protective health equipment.

CONCLUSIONS

The results of this study point to the difficulties nurses in Cyprus face when trying to communicate with conscious patients during mechanical ventilation. It appears that the lack of nurses' training and of appropriate equipment to facilitate augmentative and alternative communication leave the complex communication needs of critically ill patients unaddressed. However, further research including patients' opinions, after they recover, would bring more clarity on this topic. Our study adds evidence to the communication crisis created by the protective health protocols imposed by the pandemic. As such, it highlights the need to educate nurses in augmentative and alternative ways of communication to address communication with mechanically ventilated, conscious patients during their ICU stay.

Striving Toward Equity in Health Care for People With Communication Disabilities

PURPOSE

Approximately 10% of the U.S. adult population has a speech, language, and/or voice disability, collectively referred to as communication disabilities. An increasing number of studies demonstrate that persons with communication disabilities have worse health and health care outcomes as compared to those without communication disabilities. Understanding the state of the science, including potential contributing factors is critical to begin to address the disparities.

METHOD

Applying a historical lens and integrating multiple models of disability provide a comprehensive perspective of the health and health care outcomes of persons with communication disabilities.

RESULTS

Three phases for addressing health care disparities exist: detecting, understanding, and reducing. Results from a 2012 National Health Interview Survey provide compelling population-level results of the health and health care disparities experienced by persons with communication disabilities. To understand the disparities, factors within the health care system, such as availability of communication aids and services, as well as provider and staff biases, assumptions, and lack of knowledge need to be considered. To date, few interventions exist to address disparities in care for persons with communication disabilities. Consequently, researchers need to engage with stakeholders in innovative study designs and methods to facilitate the rapid development, implementation, and dissemination of interventions that address the disparities.

CONCLUSION

To ensure equity for the large and growing population of persons with communication disabilities, researchers, policy makers, patients, and health care systems need to collaborate in identifying and addressing the factors contributing to health and health care disparities. Presentation Video: https://doi.org/10.23641/asha.21215804.

Attitudes toward the use of low-tech AAC in acute settings: a systematized review

The purpose of this systematized review was to investigate how attitudes toward low-tech AAC might be impacting its use in acute care settings. A comprehensive and systematic search of databases identified 23 articles for inclusion. Thematic analysis using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework facilitated a narrative synthesis of findings. Results suggest that in acute care settings (a) adult patients, families, nursing staff, medical team, and allied health professionals all have opportunities to use but do not regularly engage with AAC; (b) individuals reject low-tech AAC devices for a variety of reasons, including that they are not useful, necessary, suitable, or appropriate in settings such as intensive care units; (c) negative attitudes toward AAC are linked to a lack of initial training and ongoing support, perceived impersonal content, limited functionality, and a lack of consistent availability; and (d) positive attitudes toward low-tech AAC are more prevalent when training and support are offered, low-tech AAC effectiveness is demonstrated, and organizational, financial, and procedural commitments are provided. Limitations of the research are highlighted and future research opportunities are identified.

Development of a Manually Operated Communication System (MOCS) for patients in intensive care units

Nonvocal alert patients in the intensive care unit (ICU) setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. Innovation of a hand-operated non-touchscreen communication system for nonvocal ICU patients was guided by design concepts including speech output, simplicity, and flexibility. A novel communication tool, the Manually Operated Communication System (MOCS), was developed for use in intensive care settings with patients unable to speak. MOCS is a speech-output technology designed for patients with manual dexterity impairments preventing legible writing. MOCS may have the potential to improve communication for nonvocal patients with limited manual dexterity.

Patients' experiences in the intensive care unit in Jordan: A cross-sectional study

AIMS

The purpose of this study was to describe the experiences of Jordanian patients during their stay in intensive care unit (ICU) and to explore associated factors.

BACKGROUND

Various factors can negatively affect patients' experiences and lead to negative consequences that can affect their outcomes.

MATERIALS & METHODS

A descriptive, correlational design was used to collect data from 150 patients using the Intensive Care Experience Questionnaire through structured interviews after being transferred from medical and surgical ICUs to general wards.

RESULTS

The results showed that the longer the length of ICU stay (LOS) (>7 days) the higher frightening experience (r = 0.2, p < 0.05), the lower awareness of surrounding (r = -0.28, p < 0.01), and the lower satisfaction with care (r = -0.22, p < 0.01). The results showed a negative correlation between receiving sedation and awareness of surroundings (r = -0.33, p < 0.01), and recall of ICU experiences (r = -0.23, p < 0.01), and a positive correlation with frightening experiences (r = 0.2, p < 0.05).

CONCLUSION

Health care activities, clinical and socio-demographic factors can affect the psychological experiences of patients in the ICU. Longer ICU stay is associated with more negative experiences.

Nursing interventions to cover patients' basic needs in the intensive care context - A systematic review

AIM

To examine the content, theoretical frameworks and effectiveness of nursing interventions utilizing patient-reported outcome measures (PROMs) in the intensive care unit (ICU).

DESIGN

A systematic review and narrative synthesis following the guidelines of the preferred reporting items for systematic reviews and meta-analysis checklist.

METHODS

We searched the MEDLINE, CINAHL, PsycINFO, SweMed and Cochrane controlled trials register (CENTRAL) databases for studies evaluating interventions primarily delivered by nurses in the ICU. Two independent reviewers performed study selection, data extraction and risk of bias.

RESULTS

Twenty-two studies were included, whereas only seven studies used a theoretical framework. The interventions were heterogeneous in content, duration and choice of PROMs. Outcomes were related to covering patients' and families' basic needs, described by Henderson as essential functions of nursing. Several studies reported positive intervention effects, and nurses' communication and psychosocial care were considered essential components of nursing interventions in the ICU.

Patterns of communicating care and caring in the intensive care unit

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.

iPad-based Apps to Facilitate Communication in Critically Ill Patients with Impaired Ability to Communicate: A Preclinical Analysis

Background

Inability to communicate is very distressing for patients in the intensive care unit (ICU). Most communication exchanges in ICU are initiated by healthcare workers (HCWs). Touch screen apps may enable patients to initiate communication and improve their interactions.

Objectives

This study aimed to evaluate the pertinent features of iPad-based apps designed for communication in ICU.

Methods

Apple “App Store” and Google “Play Store” were searched for keywords “communication” and “intensive care.” Related app suggestions were screened. Two independent assessors evaluated iPad-based apps that were deemed useful. The assessors resolved the discrepancies by re-evaluating the apps and reaching a consensus.

Results

Nine apps met the inclusion criteria. Of these six apps were free. There were seven apps specific to intensive care. Most apps had preloaded phrases for the patient to request to see someone (e.g., family), personal hygiene (e.g., bowel care), seek help with symptoms (e.g., pain), or a comfort item (e.g., blanket). CALD Assist, Patient Communicator, VidaTalk, and YoDoc were available in more than eight languages. VidaTalk and YoDoc allowed the user to write. Four apps were deemed not suitable for routine ICU use, while the remaining five had several attractive features.

Conclusion

Several high-quality apps are available to assist with patient-initiated communication exchange in ICU. This study provides a guide for readers to choose the app most suited to their needs. In the opinion of the authors, YoDoc is the most suitable app for routine use in ICU. Among free apps, CommuniCare appears to be the most user-friendly.

How to cite this article

Dind AJ, Starr JS, Arora S. iPad-based Apps to Facilitate Communication in Critically Ill Patients with Impaired Ability to Communicate: A Preclinical Analysis. Indian J Crit Care Med 2021;25(11):1232–1240.

The Arthur App: Designing an Augmentative and Alternative Communication Method for Use With Hospitalized Patients

An innovative augmentative and alternative communication method consisting of a mobile application (app) on an Apple iPad®, such as the Arthur app, can provide patients with barriers to verbal communication an easy means to express their needs, feelings, and questions. When using this technology, it is important to consider the right patient population at the right time, as well as the proper quantity and quality of information.

Nurses' experiences of serving as a communication guide and supporting the implementation of a communication intervention in the intensive care unit

PURPOSE

: To explore the experience of serving as a nurse communication guide, supporting the bottom-up implementation of a multi-component communication intervention prototype in the intensive care unit.

METHODS

: The overall frame was Complex Interventions, and the study was conducted within the phenomenological-hermeneutic tradition. Semi-structured telephone interviews were conducted with eight nurse communication guides. Data were analysed using a Ricoeur-inspired interpretation method.

RESULTS

: Two main themes emerged: 1) "The communication intervention components provided overview, a conceptual framework, awareness and room for reflection" and 2) "Being a communication guide illuminated the barriers and challenges of implementation". Furthermore, a comprehensive understanding was established that illuminated experiences throughout the analysis: "An ICU communication intervention has to be adaptable to the specific situation and the double need for individualization but also provide overall guidance".

CONCLUSION

: Findings showed that as communication is inherent to all human beings, it can be difficult to change the communication behaviour of nurses. Therefore, a communication intervention in the intensive care unit must be sensitive to the nurse communication guides' individual communication style. Furthermore, a communication intervention should provide nurse communication guides with overall guidance while at the same time remaining adaptable to the needs of each specific situation.

A multicomponent intervention to optimise nurse-patient communication in the intensive care unit: A mixed-methods acceptability and feasibility study

BACKGROUND

Mechanically ventilated patients in intensive care units may experience communication challenges owing to intubation, which affects nurse-patient communication. Several strategies may optimise communication, but only one previous study has tested a multicomponent intervention. Implementing such an intervention can be challenging because communication strategies may be set aside by lifesaving care tasks and procedures. In a previous study, we designed a communication intervention based on pre-existing clinical methods and evidence-based approaches. The present study evaluated the intervention to determine if it was necessary to adjust its components and the implementation strategy.

OBJECTIVES

The objective of this study was to evaluate the feasibility and assess nurses' acceptability of a patient-centred, multicomponent communication intervention prototype in an intensive care unit.

METHODS

The overall frame was the Medical Research Council's framework for developing complex interventions. Indicators of feasibility and acceptability were used for the evaluation. A mixed-methods design was applied including a survey with open-ended text boxes and qualitative observations as data sources. Quantitative data were analysed descriptively, and qualitative data were explored using content analysis. Data were compiled and displayed in a side-by-side comparison. The data were collected between September 2020 and March 2021. Nurses from four intensive care units at a university hospital in Denmark participated in the study. All nurses who were on active duty during the implementation of the intervention were enrolled for the survey and participant observations.

RESULTS

Overall, the results provided insight into the feasibility based on fidelity and context as well as nurses' acceptability based on adherence, appropriateness, convenience, and effectiveness. Qualitative and quantitative results yielded partially contrasting findings but highlighted how the intervention may be optimised to enhance fit with clinical practice and overcome implementation challenges.

CONCLUSION

The intervention was feasible and acceptable. However, implementation needs to be repeated to allow nurses to fully understand and use the intervention.

Evidence-Based Communication with Critically Ill Older Adults

Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.

Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support

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.

VidaTalk™ patient communication application "opened up" communication between nonvocal ICU patients and their family

OBJECTIVES

To explore family members' perceptions of an electronic communication application, VidaTalk™, their communication experience, and emotional reactions to communication with mechanically ventilated patients in the intensive care units.

RESEARCH METHODOLOGY/DESIGN

Qualitative phase of a mixed-methods study nested within a randomised controlled trial. Family members in the intervention group received the VidaTalk™ app as a communication aid during their intensive care stay. Seven family members participated in 18 semi-structured email interviews after discharge between May and December 2018. Interviews were analysed using qualitative content analysis.

SETTING

Families were recruited in multiple intensive care units located in one university hospital.

MAIN OUTCOME MEASURES

Communication experience with the VidaTalk™ and emotions while communicating with the patient. Basic qualitative description and constant comparative techniques were used to code and analyse the text using ATLAS_ti (Version 7.5.18).

FINDINGS

The VidaTalk™ opened up family-patient communication by allowing clear communication and expanding communication content. Family members felt happy and thankful to communicate with the patient. They also expressed feelings of relief and less frustration and less stress while communicating with the patient.​ On the other hand, the patient's ability to express their worries or anxiety sometimes made families feel sad or distressed.

CONCLUSION

The VidaTalk™ was helpful for family-patient communication. The VidaTalk™ may help families reduce psychological distress. However, ​expanded communication with critically ill patients may cause other negative feelings.

Protocol for a mixed method acceptability evaluation of a codesigned bundled COmmunication intervention for use in the adult ICU during the COVID-19 PandEmic: the COPE study

INTRODUCTION

Patients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required.

METHODS AND ANALYSIS

This three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20-25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8-10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60-65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic.

ETHICS AND DISSEMINATION

The study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.

A focused ethnography of the culture of inclusive caring practice in the intensive care unit

Aim

To explore and understand the culture of nurses' multidimensional “caring‐for” practice in intensive care unit (ICU).

Design

A focused ethnography.

Methods

Data were collected from 35 Registered Nurses through participant observations, field notes, documentation reviews, interviews, informal conversations and Participants' additional information forms over 6 months in one ICU. Thematic data analysis was used.

Findings

Different dimensions of nursing caring in ICU were found. The inclusivity of a culture of nurses' “caring‐for” involved the following: oneself, patients and their families, different colleagues, and caring as ecological consciousness in the ICU environment and organization.

Giving Voice: Nurse-Patient Communication in the Intensive Care Unit

Communication is the essence of the nurse-patient relationship. The critical care nurse's role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients' messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.

Development of the nurse's communication ability with angry patients scale and evaluation of its psychometric properties

AIMS

To develop the Nurse's Communication Ability with Angry Patients Scale (NCAAPS) and evaluate its psychometric properties.

DESIGN

An instrument development and validation study.

METHODS

The survey was administered to 501 nurses from different emergency departments in China between 2 August 2019 and 3 October 2019. Data from 456 completed questionnaires were analysed to identify the factor structure of the NCAAPS.

RESULTS

The content validity index was satisfactory. Four factors were included and 71.25% of the total variance was explained by 19 items in NCAAPS. Confirmatory factor analysis supported the four-factor structure. Cronbach's α coefficient was 0.96 for the overall scale and 0.81-0.92 for its subscales. Test-retest reliability was 0.740.

CONCLUSION

We consider the NCAAPS to be a useful tool for measuring the ability of nurses to communicate with angry patients.

IMPACT

It is anticipated that this new scale will help educators to identify specific areas of deficiency that could be targeted with training to improve the ability of nursing staff to communicate with angry patients.

Nurses' perspectives on alternative communication strategies use in critical care units

BACKGROUND

Critically ill patients have the right to communicate and participate in their treatment to avoid adverse medical outcomes due to the severity of their illness, their responsiveness, and level of consciousness. This human right has often been neglected by health care professionals, as a result of limited alternative communication support provided to patients who are unable to speak due to, for example, endotracheal intubation. Despite the successful use of alternative communication strategies in critical care units (CCUs) in other countries, limited implementation in South African hospitals has been reported.

AIMS AND OBJECTIVES

This study aimed to determine the perspectives of South African nurses working in CCUs on the frequency of use of alternative communication strategies to support patient-centred communication with critically ill adult patients.

DESIGN

The study followed a quantitative non-experimental survey research design.

METHODS

A total of 210 nurses working in both private and public hospitals completed a survey on their perspectives on the use of alternative communication strategies in CCUs.

RESULTS

Nurse participants reported experience working with critically ill and communication-vulnerable patients. Nurse-patient communication mainly involved the use of pen and paper, facial expressions and gestures to obtain information relating to patients' needs and their health history. Limited use of speech-generating communication devices was reported.

CONCLUSION

Nurse training on the use and implementation of alternative communication strategies, such as communication boards or electronic speech-generating devices, should be investigated to improve nurses' communication with communication-vulnerable patients in South Africa.

RELEVANCE TO CLINICAL PRACTICE

The results are applicable in clinical practice due to patients' need for alternative communication. The nurses mainly used low-tech solutions, which are cheap and easy to access. However, there exists an opportunity to increase the use of available digital solutions.

Personalization of Patient-Provider Communication Across the Lifespan

People with disabilities are more likely to be hospitalized and use healthcare services relative to people without disabilities. They also report experiencing negative experiences interacting with health care providers during these encounters placing them at risk for preventable adverse medical events, poor quality of life, and dependence on others. Fortunately, providers and people with communication disabilities can take steps to improve these interactions by personalizing and implementing communication supports to empower people with communication disabilities to actively participate in these interactions and improve outcomes. The purpose of this article is to describe strategies that health care providers can use to develop and implement personalized communication supports for children and adults with communication disorders during health care interactions. Additional strategies are provided to guide people with disabilities as well as their community/school providers and families to prepare for health care interactions. Case examples are provided to illustrate use of these strategies in acute care, inpatient rehabilitation, and outpatient settings. The use of emerging training tools (e.g., video visual scene displays) and AAC partner training formats (e.g., just-in-time training) are also presented as future directions to expedite learning and implementation of communication supports in fast-paced and time-limited health care interactions.

A Communicative Intervention to Improve the Psychoemotional State of Critical Care Patients Transported by Ambulance

BACKGROUND

Communication is key to understanding the emotional state of critical care patients.

OBJECTIVE

To analyze the effectiveness of the communicative intervention known as CONECTEM, which incorporates basic communication skills and augmentative alternative communication, in improving pain, anxiety, and posttraumatic stress disorder symptoms in critical care patients transported by ambulance.

METHODS

This study had a quasi-experimental design with intervention and control groups. It was carried out at 4 emergency medical centers in northern Spain. One of the centers served as the intervention unit, with the other 3 serving as control units. The nurses at the intervention center underwent training in CONECTEM. Pretest and posttest measurements were obtained using a visual analog scale to measure pain, the short-version State-Trait Anxiety Inventory to measure anxiety, and the Impact of Event Scale to measure posttraumatic stress disorder symptoms.

RESULTS

In the comparative pretest-posttest analysis of the groups, significant differences were found in favor of the intervention group (Pillai multivariate, F2,110 = 57.973, P < .001). The intervention was associated with improvements in pain (mean visual analog scale score, 3.3 pretest vs 1.1 posttest; P < .001) and posttraumatic stress disorder symptoms (mean Impact of Event Scale score, 17.8 pretest vs 11.2 posttest; P < .001). Moreover, the percentage of patients whose anxiety improved was higher in the intervention group than in the control group (62% vs 4%, P < .001).

CONCLUSION

The communicative intervention CONECTEM was effective in improving psychoemotional state among critical care patients during medical transport.

Intensive Care Unit Nursing Priorities in the United States

This integrative review presents the most recent and relevant critical care nursing research publications in the United States. A comprehensive search identified publications on the topics of delirium; early mobility; communication; palliative care; tele-intensive care unit; care bundle implementation; and prevention, detection, and early management of infection. The evidence is summarized for each of these topics, as well as other research, with suggestions and guidance for end users.

Improving Nonvocal Critical Care Patients' Ease of Communication Using a Modified SPEACS-2 Program

OBJECTIVE

To evaluate the feasibility and impact of implementing the "study of patient-nurse effectiveness with assisted communication strategies-2" (SPEACS-2); a program to facilitate communication with nonvocal patients.

STUDY DESIGN

The plan-do-study-act quality improvement methodology guided the implementation of a modified SPEACS-2 program within a pre and posttest design. The Ease of Communication Scale (ECS) measured patients' communication difficulty, and care processes measured the program's success.

STUDY POPULATION

Nurses (N = 385) across 5 intensive care units were trained in SPEACS-2. We assessed 354 nonvocal patients (aged 18-95 years) requiring continued mechanical ventilation after withdrawal of heavy sedation. Patients were evaluated over one 2-week preintervention (n = 163) and two 3-week postintervention periods (n = 128; n = 63). A subsample of intervention patients (n = 204) completed the ECS.

RESULTS

Ease of Communication Scale scores improved significantly (p = .027) from baseline (mean 25.86 ± 12.2, n = 71) to postintervention period 2 (21.22 ± 12.2, n = 63). Nurses' use of communication techniques and compliance with communication plans of care incrementally increased after training.

CONCLUSIONS

Implementing SPEACS-2 demonstrated positive changes in patients' ease of communication and feasibility of incorporating evidence-based communication strategies into practice.

Evidence-Based Communication with Critically Ill Older Adults

Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.

Making explicit the development of PhD-prepared nurses to steward the discipline

Leadership is a core curricular element of PhD programs in nursing. Our PhD faculty began a dialogue about being a leader, a steward of the discipline. We asked ourselves: (a) What expertise do PhD prepared nurse needs to begin to steward the discipline? (b) How do faculty engage PhD nursing students to assume responsibility for stewarding the discipline? Lastly, (c) How do we work with PhD nursing students to create their vision for how their work contributes to stewarding the discipline, from doctoral coursework throughout their career? We support the need for PhD graduates to have the skills to generate knowledge, conserve that which is important, and transform by disseminating new knowledge to a broad audience. Examples of nurses stewarding the discipline when pioneering research, critiquing traditional approaches to inquiry or trends in nursing practice, and developing policy, are highlighted along with examples of how PhD nursing students begin to steward the discipline.