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Soyaslan BD, Alıncak G, Ilkaz N, Zengin H. Longing for a Voice: A Qualitative Study. J Hosp Palliat Nurs 2024; 26:E92-E97. [PMID: 38421199 DOI: 10.1097/njh.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Tracheostomy involves a challenging care process in which both patients and caregivers have difficulty communicating. Loss of speaking ability negatively affects caregivers as well as patients. The objective of this study was to examine the experiences of caregivers of patients with tracheostomy during care and after the first vocal exercise. This is a qualitative interview study using in-depth interviews. We used Colaizzi's method of data analysis. The interviews were carried out with 17 caregivers from March to July 2023. Two main themes were identified: the communication process and the first time hearing the patient's voice. In addition, communication techniques, difficulty in communication, providing motivation, and emotions were considered as subthemes. A better quality of care can be provided by understanding the experiences of caregivers of patients with tracheostomy, by sharing feelings and thoughts, and by using patient-specific communication methods.
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Szymkowicz E, Bodet-Contentin L, Marechal Y, Ehrmann S. Comparison of communication interfaces for mechanically ventilated patients in intensive care. Intensive Crit Care Nurs 2024; 80:103562. [PMID: 37871352 DOI: 10.1016/j.iccn.2023.103562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
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.
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Affiliation(s)
- Emilie Szymkowicz
- GIGA Consciousness, Coma Science Group, University of Liège, Belgium.
| | - Laetitia Bodet-Contentin
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and methodS in Patient-centered outcomes and health ResEarch (SPHERE), INSERM UMR 1246, Université de Tours, France
| | - Yoann Marechal
- Unité de soins intensifs, CHU Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep F-CRIN Research Network, CHRU de Tours and Centre d'Étude des Pathologies Respiratoires (CEPR), INSERM UMR 1100, Université de Tours, France
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Zaga CJ, Papasavva CS, Hepworth G, Freeman-Sanderson A, Happ MB, Hoit JD, McGrath BA, Pandian V, Rose L, Sutt AL, Tuinman PR, Wallace S, Bellomo R, Vogel AP, Berney S. Development, feasibility testing, and preliminary evaluation of the Communication with an Artificial airway Tool (CAT): Results of the Crit-CAT pilot study. Aust Crit Care 2024; 37:127-137. [PMID: 37880059 DOI: 10.1016/j.aucc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND A purpose-built outcome measure for assessing communication effectiveness in patients with an artificial airway is needed. OBJECTIVES The objective of this study was to develop the Communication with an Artificial airway Tool (CAT) and to test the feasibility and to preliminary evaluate the clinical metrics of the tool. METHODS Eligible patients with an artificial airway in the Intensive Care Unit were enrolled in the pilot study (Crit-CAT). The CAT was administered at least twice before and after the communication intervention. Item correlation analysis was performed. Participant and family member acceptability ratings and feedback were solicited. A qualitative thematic analysis was undertaken. RESULTS Fifteen patients with a mean age of 53 years (standard deviation [SD]: 19.26) were included. The clinician-reported scale was administered on 50 attempts (100%) with a mean completion time of 4.5 (SD: 0.77) minutes. The patient-reported scale was administered on 46 out of 49 attempts (94%) and took a mean of 1.5 (SD: 0.39) minutes to complete. The CAT was feasible for use in the Intensive Care Unit, with patients with either an endotracheal or tracheostomy tube, whilst receiving invasive mechanical ventilation or not, and while using either verbal or nonverbal modes of communication. Preliminary establishment of responsiveness, validity, and reliability was made. The tool was acceptable to participants and their family members. CONCLUSION The clinician-reported and patient-reported components of the study were feasible for use. The CAT has the potential to enable quantifiable comparison of communication interventions for patients with an artificial airway. Future research is required to determine external validity and reliability.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Division of Allied Health, Austin Health, Melbourne, Australia; Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Institute of Breathing and Sleep, Austin Health, Melbourne, Australia.
| | - Catherine S Papasavva
- Department of Speech Pathology, Division of Allied Health, Austin Health, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mary Beth Happ
- Center for Healthy Aging, Self-Management & Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Jeannette D Hoit
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Brendan A McGrath
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK; Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD, USA
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK; Division of Infection Immunity and Respiratory Medicine, University of Manchester, UK
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Adam P Vogel
- Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Redenlab Inc, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Physiotherapy, The University of Melbourne, Melbourne, Australia
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Itai Bendavid I, Assi S, Sasson N, Statlender L, Hellerman M, Fishman G, Singer P, Kagan I. The EyeControl-Med device, an alternative tool for communication in ventilated critically ill patients: A pilot study examining communication capabilities and delirium. J Crit Care 2023; 78:154351. [PMID: 37348187 DOI: 10.1016/j.jcrc.2023.154351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
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.
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Affiliation(s)
- I Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
| | - Saja Assi
- Department of speech, language, swallowing, hearing & communication disorders, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noga Sasson
- Department of speech, language, swallowing, hearing & communication disorders, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Liran Statlender
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Moran Hellerman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Guy Fishman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Perelló-Campaner C, González-Trujillo A, Alorda-Terrassa C, González-Gascúe M, Pérez-Castelló JA, Morales-Asencio JM, Molina-Mula J. Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses. Healthcare (Basel) 2023; 11:2645. [PMID: 37830682 PMCID: PMC10572283 DOI: 10.3390/healthcare11192645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
AIM To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals. BACKGROUND Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies. DESIGN A qualitative phenomenological approach was used. METHODS Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed. FINDINGS Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness). CONCLUSIONS The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs. RELEVANCE TO CLINICAL PRACTICE The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.
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Affiliation(s)
- Catalina Perelló-Campaner
- Emergency Care Service 061, 07011 Palma, Spain
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
| | - Antonio González-Trujillo
- SATSE CIDEFIB, c/Antoni Marques, 4. Bjs izqda, 07003 Palma, Spain
- Emergency Hospital Care Service, Hospital de Manacor, 07500 Manacor, Spain
| | - Carme Alorda-Terrassa
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
| | | | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), 29016 Málaga, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Balearic Islands, 07122 Palma, Spain (J.M.-M.)
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van Oorsouw R, Oerlemans A, van Oorsouw G, van den Boogaard M, van der Wees P, Koenders N. Patients' lived body experiences in the intensive care unit and beyond - a meta-ethnographic synthesis. Physiother Theory Pract 2023:1-33. [PMID: 37498170 DOI: 10.1080/09593985.2023.2239903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Physical therapists supporting patients in intensive care unit (ICU) rehabilitation can improve their clinical practice with insight in patients' lived body experiences. OBJECTIVE To gain insight in patients' lived body experiences during ICU stay and in recovery from critical illness. METHODS Through a comprehensive systematic literature search, 45 empirical phenomenological studies were identified. Patients' lived body experiences were extracted from these studies and synthesized following the seven-phase interpretative approach as described by Noblit and Hare. RESULTS Three lines of argument were illuminated: 1) "recovery from critical illness starts from a situation in which patients experience the lived body as unable;" 2) "patients experience progress in recovery from critical illness when the lived body is empowered;" and 3) "recovery from critical illness results in a lived body changed for life." Eleven third-order constructs were formulated as different kinds of bodies: 1) "an intolerable body;" 2) "an alienated body;" 3) "a powerless body;" 4) "a dependent body;" 5) "a restricted body;" 6) "a muted body;" 7) "a touched body;" 8) "a transforming body;" 9) "a re-discovering body;" 10) "an unhomelike body;" and 11) "a remembering body." CONCLUSION Patients' lived body experiences during ICU stay and in recovery from critical illness have richly been described in phenomenological studies and were synthesized in this meta-ethnography.
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Affiliation(s)
- Roel van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anke Oerlemans
- IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gijs van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philip van der Wees
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
- IQ healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
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Rowland S, Mills C, Walshe M. Perspectives on speech and language pathology practices and service provision in adult critical care settings in Ireland and international settings: A cross-sectional survey. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:219-230. [PMID: 35167432 DOI: 10.1080/17549507.2022.2032346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Patients admitted to critical care (CC) are at risk of impaired swallowing and communication function. Speech-language pathologists (SLPs) play an important role in this context. In Ireland and internationally speech-language pathology CC guidelines are lacking, with possible variations in practice. To compare clinical practices in dysphagia, communication and tracheostomy management among SLPs working in adult CC units in Ireland and internationally, and explore their perspectives on training, skills and resources. METHOD Participants were SLPs working in CC. An international online survey sought information on (i) SLP workforce demographics and staffing levels, (ii) current dysphagia and communication assessment and management practices, (iii) practices and perspectives on training, skills and resources. RESULT 366 responses were received across 29 countries. 18.03% (66/366) of these respondents worked in Ireland. Findings showed similarities and differences in practices. Total CC SLP whole-time equivalent (WTE) at each staff grade was lower (mean difference: -0.21 to -0.65 WTE p <.001) than desired for optimal service delivery. Negative effects of under-staffing were reported. Recommendations that all tracheostomised patients receive SLP input was unmet in 66% (220/334) of services. CONCLUSION SLP input in CC is limited in terms of dedicated posts, multidisciplinary team (MDT) involvement, consistent management approaches and training opportunities internationally. Implications of findings are discussed.
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Affiliation(s)
- Sarah Rowland
- Department of Speech and Language Therapy, Tallaght University Hospital, Dublin, Ireland
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Claire Mills
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Counselling offered to and needed by Finnish adult intensive care unit patients based on patients' records and memories. Intensive Crit Care Nurs 2023; 76:103395. [PMID: 36738534 DOI: 10.1016/j.iccn.2023.103395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Objectives of this study were to characterize the counselling (broadly defined) that Finnish adult intensive care unit patients received and needed during intensive care according to patients' records and memories. DESIGN SETTING The study was based on retrospective analysis of patient records and documented follow-up clinics, using a descriptive, qualitative approach and deductive-inductive content analysis. FINDINGS According to both the records and documented memories of 162 patients (56 women and 106 men aged 18-75 years; mean 50.8, median 53.5 years) patients' confidence in their own recovery, including feelings of safety and ability to participate, is enhanced by counselling during intensive care. They had strong memories of counselling that gave them knowledge about their medical conditions and procedures, symptoms, care, and psychological support. At follow-up, patients did not have such strong memories of lifestyle counselling that they received during intensive care. CONCLUSION Patients need counselling during an intensive care unit stay to improve their confidence in their recovery. The counselling strategy for intensive care should be documented, and patient memories collected during follow-up clinics, to help assessment of the quality of counselling provided in intensive care. IMPLICATIONS FOR CLINICAL PRACTICE Counselling during intensive care enhances patients' confidence in their own recovery. To assess the quality of counselling it is essential to recognize the types provided and needed. Appropriate documentation is crucial for evaluating intensive care unit patient counselling, and planning its continuity.
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Ghiasvand AM, Hosseini M, Atashzadeh-Shoorideh F. Theoretical definition of nurse-conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis. Acute Crit Care 2023; 38:8-20. [PMID: 36935530 PMCID: PMC10030244 DOI: 10.4266/acc.2022.01039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/16/2022] [Indexed: 03/02/2023] Open
Abstract
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.
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Affiliation(s)
- Arezoo Mohamadkhani Ghiasvand
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meimanat Hosseini
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Karlsen MMW, Holm A, Kvande ME, Dreyer P, Tate JA, Heyn LG, Happ MB. Communication with mechanically ventilated patients in intensive care units: A concept analysis. J Adv Nurs 2023; 79:563-580. [PMID: 36443915 PMCID: PMC10099624 DOI: 10.1111/jan.15501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients. DESIGN The Im & Meleis approach for concept analysis guided the study. SEARCH METHODS A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references. REVIEW METHODS After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed. RESULTS We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units. CONCLUSION Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves. IMPACT A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a concept analysis of previous research.
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Affiliation(s)
| | - Anna Holm
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Monica Evelyn Kvande
- Department for postgraduate studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Judith Ann Tate
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Lena Günterberg Heyn
- Center for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Mary Beth Happ
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
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Jöbges S. Kommunikation mit Patientinnen auf der Intensivstation. Med Klin Intensivmed Notfmed 2022; 117:595-599. [DOI: 10.1007/s00063-022-00957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
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The Impact of Signing Do-Not-Resuscitate Orders on the Use of Non-Beneficial Life-Sustaining Treatments for Intensive Care Unit Patients: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159521. [PMID: 35954876 PMCID: PMC9367818 DOI: 10.3390/ijerph19159521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/14/2022] [Accepted: 07/30/2022] [Indexed: 02/06/2023]
Abstract
Background: Intensive care medical technology increases the survival rate of critically ill patients. However, life-sustaining treatments also increase the probability of non-beneficial medical treatments given to patients at the end of life. Objective: This study aimed to analyse whether patients with a do-not-resuscitate (DNR) order were more likely to be subject to the withholding of cardiac resuscitation and withdrawal of life-sustaining treatment in the ICU. Methods: This retrospective study collected data regarding the demographics, illness conditions, and life-sustaining treatments of ICU patients who were last admitted to the ICU between 1 January 2016 and 31 December 2017, as determined by the hospital’s electronic medical dataset. Results: We identified and collected data on 386 patients over the two years; 319 (82.6%) signed a DNR before the end. The study found that DNR patients were less likely to receive cardiac resuscitation before death than non-DNR patients. The cardiac resuscitation treatments included chest compressions, electric shock, and cardiotonic drug injections (p < 0.001). However, the life-sustaining treatments were withdrawn for only a few patients before death. The study highlights that an early-documented DNR order is essential. However, it needs to be considered that promoting discussions of time-limited trials might be the solution to helping ICU terminal patients withdraw from non-beneficial life-sustaining treatments.
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13
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van Oorsouw R, Klooster E, Koenders N, Van Der Wees PJ, Van Den Boogaard M, Oerlemans AJM. Longing for homelikeness: A hermeneutic phenomenological analysis of patients' lived experiences in recovery from COVID-19-associated intensive care unit acquired weakness. J Adv Nurs 2022; 78:3358-3370. [PMID: 35765746 PMCID: PMC9349706 DOI: 10.1111/jan.15338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 12/01/2022]
Abstract
Aims To explore lived experiences of patients recovering from COVID‐19‐associated intensive care unit acquired weakness and to provide phenomenological descriptions of their recovery. Design A qualitative study following hermeneutic phenomenology. Methods Through purposeful sampling, 13 participants with COVID‐19‐associated intensive care unit acquired weakness were recruited with diversity in age, sex, duration of hospitalization and severity of muscle weakness. Semi‐structured in‐depth interviews were conducted from 4 to 8 months after hospital discharge, between July 2020 and January 2021. Interviews were transcribed verbatim and analysed using hermeneutic phenomenological analysis. Results The analysis yielded five themes: ‘waking up in alienation’, ‘valuing human contact in isolation’, ‘making progress by being challenged’, ‘coming home but still recovering’ and ‘finding a new balance’. The phenomenological descriptions reflect a recovery process that does not follow a linear build‐up, but comes with moments of success, setbacks, trying new steps and breakthrough moments of achieving mobilizing milestones. Conclusion Recovery from COVID‐19‐associated intensive care unit acquired weakness starts from a situation of alienation. Patients long for familiarity, for security and for recognition. Patients want to return to the familiar situation, back to the old, balanced, bodily self. It seems possible for patients to feel homelike again, not only by changing their outer circumstances but also by changing the understanding of themselves and finding a new balance in the altered situation. Impact Muscle weakness impacts many different aspects of ICU recovery in critically ill patients with COVID‐19‐associated intensive care unit acquired weakness. Their narratives can help nurses and other healthcare professionals, both inside and outside of the intensive care unit, to empathize with patient experiences. When healthcare professionals connect to the lifeworld of patients, they will start to act and communicate differently. These insights could lead to optimized care delivery and meeting patients' needs in this pandemic or a possible next.
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Affiliation(s)
- Roel van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Emily Klooster
- Deventer Hospital, Department of Rehabilitation, Deventer, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Philip J Van Der Wees
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Mark Van Den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anke J M Oerlemans
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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14
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Bodet-Contentin L, Szymkowicz E, Delpierre E, Chartier D, Gadrez P, Muller G, Renault A, Ehrmann S. Eye Tracking communication with intubated critically ill patients: a proof-of-concept multicenter pilot study. Minerva Anestesiol 2022; 88:690-697. [PMID: 35546732 DOI: 10.23736/s0375-9393.22.16275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Communication is essential to establish patient-caregivers relationship in the intensive care unit. Intubated patients are not able to speak because the tracheal tube prevents vocalization. Use of communication tools such as eye tracking device could improve communication with intubated patients. The objective of this feasibility pilot study was to demonstrate that an eye tracking device specifically developed for the intensive care could be used easily by awake intubated patient with a very short training time. METHODS This prospective multicenter study was conducted in four intensive care units. We included awake adult intubated patients. The device used included an eye-tracking infrared detection and a communication interface specifically developed. RESULTS A total of 151 patients were included: the median age of patients was 66 years (56-72) and 97 (64%) were male, 97 patients (64%) succeed totally (installation; calibration, succeed to select all three icons), 124 (82%) succeed to select at least one icon, and 111 (74%) succeed to point to at least two icons. The main reasons for failure to use the device were: difficulties to open or to keep the eyes open, difficulties to installing the device occurred, and patient fatigue. CONCLUSIONS This study shows that the use of an eye tracking technology device specifically designed for the intensive care setting, with a short training is easy to use for intubated patient. Patients, relatives and caregivers showed high satisfaction.
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Affiliation(s)
- Laetitia Bodet-Contentin
- Service of Intensive Care and Resuscitation, CHRU Tours, Tours, France - .,INSERM, SPHERE, UMR1246, University of Tours and Nantes, Tours, France -
| | | | - Eric Delpierre
- Service of Resuscitation, Marne la Vallée Hospital, Marne la Vallée, France
| | - Delphine Chartier
- Service of Intensive Care and Resuscitation, CHRU Tours, Tours, France
| | - Pierrick Gadrez
- Service of Intensive Care and Resuscitation, CHR Orléans, Orléans, France
| | - Grégoire Muller
- Service of Intensive Care and Resuscitation, CHR Orléans, Orléans, France
| | - Aurélie Renault
- Service of Intensive Care and Resuscitation, CHR Orléans, Orléans, France
| | - Stephan Ehrmann
- CIC INSERM 1415, Service of Intensive Care and Resuscitation, CHRU Tours, Tours, France.,INSERM, Research Center for Respiratory Diseases (U1100), University of Tours, Tours, France
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15
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Tolotti A, Cadorin L, Bonetti L, Valcarenghi D, Pagnucci N. Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review. J Clin Nurs 2022; 32:2361-2370. [PMID: 35343019 DOI: 10.1111/jocn.16296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The quality of care for tracheostomy and mechanically ventilated patients in intensive care units (ICUs) has improved considerably. However, the communication barrier attributable to these procedures generates many problems for patients, as they are unable to communicate effectively with family members and ICU healthcare professionals, especially nurses. AIMS To describe (1) tracheostomy patients' needs, emotions and difficulties when communicating with ICU nurses and (2) which strategies nurses and patients have adopted to improve their communication. METHODS A scoping review was completed using the Joanna Briggs Institute method and following the PRISMA-ScR Checklist. The research question was developed using the Population, Concept and Context framework. Five databases were searched. After screening, two researchers independently analysed the 75 papers, and finally, 19 studies were included in this review. RESULTS All studies used a qualitative design. Seven adopted a phenomenological and two a hermeneutic approach, involving a total of 265 patients. Two main themes and four subthemes were identified: (1) the tracheostomy patients' needs, emotions and difficulties communicating with ICU nurses (patients' emotions, communication needs, and their content and difficulties) and (2) strategies that nurses and patients adopted to improve communication (communication strategies). CONCLUSIONS It is essential to develop effective communication with tracheostomy patients to ensure they feel relieved, safe and considered. Communication content should focus on information relating to the person's personal condition and active involvement in care. RELEVANCE TO CLINICAL PRACTICE It is important to prioritise the communication process in tracheostomised patients and create the organisational conditions that foster effective communication processes. Developing training programmes for new or practising nurses is essential to instil greater awareness about this crucial fundamental need.
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Affiliation(s)
- Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Lucia Cadorin
- Continuing Education Office, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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16
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Kang J, Lee M, Cho YS, Jeong JH, Choi SA, Hong J. The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey. Aust Crit Care 2021; 35:623-629. [PMID: 34844837 DOI: 10.1016/j.aucc.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/30/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Person-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined. OBJECTIVES The aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients. METHODS This study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression. RESULTS Person-centred care was associated with 'awareness of surroundings' (β = 0.29, p < .001), 'frightening experiences' (β = -0.31, p < .001), and 'satisfaction with care' (β = 0.54, p < .001). However, there was no significant association between person-centred care and 'recall of experience'. CONCLUSIONS We observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Minju Lee
- Department of Nursing, Youngsan University, 288, Junam-ro, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Young Shin Cho
- Department of Nursing, Youngsan University, 288, Junam-ro, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Jin-Heon Jeong
- Department of Intensive Care Medicine & Neurology, Dong-A University Hospital, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Sol A Choi
- Medical Intensive Care Unit, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, Republic of Korea
| | - Jiwon Hong
- College of Nursing, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
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17
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Holm A, Karlsson V, Dreyer P. Nurses' experiences of serving as a communication guide and supporting the implementation of a communication intervention in the intensive care unit. Int J Qual Stud Health Well-being 2021; 16:1971598. [PMID: 34482806 PMCID: PMC8425701 DOI: 10.1080/17482631.2021.1971598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Anna Holm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Pia Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.,Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus C, Denmark.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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18
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Ertürk Yavuz M, Gürsoy A. Computer-Based Communication Tool Provides Effective Communication for Non-speaking Patients: A Quasi-experimental Study. Clin Nurs Res 2021; 31:656-665. [PMID: 34382446 DOI: 10.1177/10547738211038638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Even though they are conscious, patients who are unable to speak while connected to a mechanical ventilator have serious difficulties in communicating with healthcare staff. This research aimed to determine the effectiveness for patients of a computer-based communication tool (CBCT) and to compare these results with patients using a routine method. This quasi-experimental study was conducted with 90 intubated patients. It was found that 20.0% of the patients using CBCT stated that they had difficulties in communicating, while this rate was 82.2% among patients not using CBCT. Compared with participants in the control group, experimental group patients reported a lower median score for the anxiety levels (23.0 [20.0-39.0], 29.0 [20.0-57.00], p < .001) and higher mean comfort levels (130.2 ± 9.0, 109.6 ± 13.3, p < .001). Positive impacts of the CBCT are its suitability for patients who are dependent upon ventilation for different reasons and their improved ability to communicate effectively.
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19
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Happ MB. Giving Voice: Nurse-Patient Communication in the Intensive Care Unit. Am J Crit Care 2021; 30:256-265. [PMID: 34195776 DOI: 10.4037/ajcc2021666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Communication is the essence of the nurse-patient relationship. The critical care nurse's role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients' messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.
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Affiliation(s)
- Mary Beth Happ
- Mary Beth Happ is Nursing Distinguished Professor of Critical Care Research and Associate Dean for Research and Innovation at The Ohio State University College of Nursing, Columbus
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20
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Kean S, Donaghy E, Bancroft A, Clegg G, Rodgers S. Theorising survivorship after intensive care: A systematic review of patient and family experiences. J Clin Nurs 2021; 30:2584-2610. [PMID: 33829568 DOI: 10.1111/jocn.15766] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVE This systematic literature review explores and maps what we know about survivorship to understand how survivorship can be theoretically defined. BACKGROUND Survivorship of critical illness has been identified as a challenge for the 21st Century. Whilst the use of the term 'survivorship' is now common in critical care, it has been borrowed from the cancer literature where the discourse on what survivorship means in a cancer context is ongoing and remains largely descriptive. In the absence of a theoretical understanding, the term 'survivorship' is often used in critical illness in a generic way, limiting our understanding of what survivorship is. The current COVID-19 pandemic adds to an urgency of understanding what intensive care unit (ICU) survivorship might mean, given the emerging long-term consequences of this patient cohort. We set out to explore how survivorship after critical illness is being conceptualised and what the implications might be for clinical practice and research. DESIGN Integrated systematic literature review. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS The three main themes around which the reviewed studies were organised are: (a) healthcare system; (b) ICU survivors' families; and (c) ICU survivor's identity. These three themes feed into an overarching core theme of 'ICU Survivorship Experiences'. These themes map our current knowledge of what happens when a patient survives a critical illness and where we are in understanding ICU survivorship. CONCLUSION We mapped in this systematic review the different pieces of the jigsaw that emerge following critical illness to understand and see the bigger picture of what happens after patients survive critical illness. It is evident that existing research has mapped these connections, but what we have not managed to do yet is defining what survivorship is theoretically. We offer a preliminary definition of survivorship as a process but are aware that this definition needs to be developed further with patients and families.
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Affiliation(s)
- Susanne Kean
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- Usher Institute of Population Health Sciences and Informatics & Edinburgh Critical Care Research Group, The University of Edinburgh, Edinburgh, UK
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Gareth Clegg
- Deanery of Clinical Sciences, Centre for Inflammation Research, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sheila Rodgers
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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21
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Tsai YL, Chiang HH, Chen YJ, Chiang HH, Chen YH, Liaw JJ. Meaning of critical traumatic injury for a patient's body and self. Nurs Ethics 2021; 28:1282-1293. [PMID: 33722074 DOI: 10.1177/0969733020988334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient's body and self. AIM To understand the meaning of traumatic injury for body and self for patients receiving intensive care. RESEARCH DESIGN A qualitative descriptive study using Giorgi's phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30-60 min. Audiotaped interviews were transcribed and analyzed. ETHICAL CONSIDERATIONS This study was approved by the Institutional Review Board of the medical center. FINDINGS The impact of the experience of traumatic injury on participants' body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. DISCUSSION AND CONCLUSION The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient's body and self that facilitates ethical care and recovery from injury.
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Affiliation(s)
- Yu-Lun Tsai
- National Defense Medical Center, Taiwan; Tri-Service General Hospital, Taiwan
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22
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Rovira A, Dawson D, Walker A, Tornari C, Dinham A, Foden N, Surda P, Archer S, Lonsdale D, Ball J, Ofo E, Karagama Y, Odutoye T, Little S, Simo R, Arora A. Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline. Eur Arch Otorhinolaryngol 2020; 278:313-321. [PMID: 32556788 PMCID: PMC7299456 DOI: 10.1007/s00405-020-06126-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
Purpose Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient. Methods This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients. Results Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise. Conclusion COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.
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Affiliation(s)
- Aleix Rovira
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK.
| | - Deborah Dawson
- Department of Critical Care, St George's Hospital NHS Foundation Trust, London, UK
| | - Abigail Walker
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Lewisham, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Alison Dinham
- Department of Physiotherapy, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Neil Foden
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Pavol Surda
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Sally Archer
- Speech and Language Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dagan Lonsdale
- Critical Care Unit, St George's Hospital NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Jonathan Ball
- Critical Care Unit, St George's Hospital NHS Foundation Trust, London, UK
| | - Enyi Ofo
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Yakubu Karagama
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Tunde Odutoye
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Sarah Little
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Ricard Simo
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Asit Arora
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
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23
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Danielis M, Povoli A, Mattiussi E, Palese A. Understanding patients' experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta-synthesis and meta-summary. J Clin Nurs 2020; 29:2107-2124. [PMID: 32243007 DOI: 10.1111/jocn.15259] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). BACKGROUND Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. DESIGN A systematic review of qualitative studies followed by a meta-synthesis and a meta-summary was performed. METHODS Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. RESULTS A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) "The effect of the intense stress on the body's systems," (b) "The induced negative emotional situations," (c) "The feeling of being cared for in a hospital setting" and (d) "The perceived support from the family and loved ones." Furthermore, the most frequent codes across studies were "Being afraid," "Feeling supervised," "Feeling comforted," "Failing to communicate," and "Experiencing difficulties in breathing," with an intensity of 66.6%. CONCLUSION Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. RELEVANCE TO CLINICAL PRACTICE Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator-tolerant patient.
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Affiliation(s)
- Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Arianna Povoli
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Elisa Mattiussi
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
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24
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Kang J, Cho YS. Cross-Cultural Validation of the Intensive Care Experience Questionnaire in Korean Critical Care Survivors. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:89-96. [PMID: 32234555 DOI: 10.1016/j.anr.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to culturally adapt the Intensive Care Experience Questionnaire (ICEQ) for Korean patients and evaluate its validity and reliability. METHODS This cross-sectional study comprised two phases. The first phase involved the cultural adaptation of the ICEQ. In the second phase, the psychometric properties of the adapted measure were evaluated. Cultural adaptation was conducted in accordance with the World Health Organization's process. The adapted questionnaire was administered to 200 Korean patients who had received treatment in an intensive care unit within the past six months. Model fit was assessed through confirmatory factor analysis, and convergent validity and discriminant validity of the items were assessed. Known-groups validity was evaluated using the t test and Cohen's effect size. Cronbach's α was used to examine internal consistency reliability. RESULTS The Korean version of the ICEQ (K-ICEQ) consists of 26 items and four subscales: Frightening Experiences, Awareness of Surroundings, Satisfaction with Care, and Recall of Experiences. The model fit indices, convergent validity, and discriminant validity of the K-ICEQ were all satisfactory. According to the results of the test of known-groups validity, intensive care unit (ICU) experience varied according to gender, planned ICU admission, mechanical ventilation, and restraints application. Cronbach's α of the K-ICEQ subscales ranged from .74 to .93. CONCLUSION The validity and reliability of the K-ICEQ reflecting the characteristics of Korean ICU patients were satisfactory. The K-ICEQ can be used to evaluate the experience of Korean ICU patients and contribute to the development of interventions to improve the ICU experience.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, Republic of Korea
| | - Young Shin Cho
- Department of Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan, Republic of Korea.
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Koszalinski RS, Heidel RE, McCarthy J. Difficulty envisioning a positive future: Secondary analyses in patients in intensive care who are communication vulnerable. Nurs Health Sci 2019; 22:374-380. [PMID: 31736225 DOI: 10.1111/nhs.12664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to report a secondary analysis of data collected through a primary study. The primary study was a, randomized, control trial that used a team-designed (nursing, speech language hearing, engineering, communication sciences, and biostatistics), nurse-led, electronic communication intervention (Speak for Myself Voice) and measured patient outcomes of symptoms of anxiety and depression in five intensive care units at a regional, magnet-status, academic medical center. A secondary analysis of data using the Hospital Anxiety and Depression scale is reported here. The extant literature supports patient expressions of frustration, anger, anxiety, and depression when unable to communicate. This secondary analysis study report adds information about Hospital Anxiety and Depression subscales in the communication-vulnerable population. Implications include emerging awareness of potential feelings of depression and anxiety in patients who are receiving mechanical ventilation or who are unable to verbally communicate for any reason (e.g. obstruction, trauma, head and neck cancer) in the intensive care unit.
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Affiliation(s)
| | - R Eric Heidel
- Department of Surgery, The University of Tennessee School of Graduate Medicine, Knoxville, Tennessee, USA
| | - Jillian McCarthy
- Department of Audiology and Speech Pathology, The University of Tennessee Health Science Center, Knoxville, Tennessee, USA
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Modrykamien AM. Strategies for communicating with conscious mechanically ventilated critically ill patients. Proc AMIA Symp 2019; 32:534-537. [PMID: 31656412 DOI: 10.1080/08998280.2019.1635413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022] Open
Abstract
Critically ill patients admitted to the intensive care unit (ICU) frequently require ventilatory support. To provide this life-saving therapy, oral intubation or tracheostomy placements are needed. Consequently, verbal ability to communicate is lost. Furthermore, depending on the severity of the clinical condition and other comorbidities, patients commonly develop ICU-acquired weakness, which may preclude gestural communication and motor abilities. Under this circumstance, the patient's inability to interact with health care providers and/or family members results in psychological alterations, as well as isolation and reduction of self-esteem. A variety of tools have been developed to improve patient-clinician communication. This article reviews patient complications due to lack of communication, available tools to enhance interactions, and current published evidence to support communication tools.
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Zengin N, Ören B, Üstündag H. The relationship between stressors and intensive care unit experiences. Nurs Crit Care 2019; 25:109-116. [PMID: 31407452 DOI: 10.1111/nicc.12465] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients in intensive care units (ICUs) face many physical and psychological stressors because of the environment of these units and their own critical conditions and experience stress in various degrees. Each stressor may affect patients' experiences in ICUs differently. AIM AND OBJECTIVES This study aimed to examine the relationship between stressors and patients' experiences in an ICU. METHODS This descriptive, cross-sectional study was conducted between September 2014 and June 2015 in a university hospital and included 116 patients who were admitted to the general ICU for at least 24 hours. Data were collected using the Intensive Care Experience Scale and a questionnaire that included questions about socio-demographic and disease-related characteristics of patients and their stressors. RESULTS The mean age of the patients was 57.81 ± 13.81 years, and the mean duration of ICU stay was 2.28 ± 3.88 days. There was a moderate positive relation between the stressors noise (r = .534; P < .01), thirst (r = .438; P < .01), loneliness (r = .410; P < .01), and pain (r = .404; P < .01) and the subscale frightening experiences. However, there was a moderate, negative relation between the stressors inability to speak (r = -.444; P < .01), surrounding speeches (r = -.458; P < .01), equipment noise (r = -.490; P < .01), and physical exercise (r = -.546; P < .01) and the subscale satisfaction with care. CONCLUSIONS The patients associated stressors with satisfaction and frightening experiences in the early period of their discharge from the ICU. As stressors increases, so do frightening experiences, and satisfaction with care is affected negatively. RELEVANCE TO CLINICAL PRACTICE Currently, stressors to which patients discharged from ICU are exposed during their admission to wards are not evaluated in practice. This study is important in that it can help health professionals be aware of effects of stressors on patients in the early period of their discharge.
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Affiliation(s)
- Neriman Zengin
- Faculty of Health Sciences, Department of Midwifery, University of Health Science, Istanbul, Turkey
| | - Besey Ören
- Faculty of Health Sciences, Department of Midwifery, University of Health Science, Istanbul, Turkey
| | - Hülya Üstündag
- Faculty of Health Sciences, Department of Nursing, İstanbul Bilgi University, Istanbul, Turkey
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Promoting a nursing team’s ability to notice intent to communicate in lightly sedated mechanically ventilated patients in an intensive care unit: An action research study. Intensive Crit Care Nurs 2019; 51:64-72. [DOI: 10.1016/j.iccn.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/16/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
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Falk AC, Schandl A, Frank C. Barriers in achieving patient participation in the critical care unit. Intensive Crit Care Nurs 2018; 51:15-19. [PMID: 30600141 DOI: 10.1016/j.iccn.2018.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/09/2018] [Accepted: 11/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. Therefore, this study aims to identify barriers to patient participation in the critical care unit, as identified by critical care nurses. DESIGN AND SETTINGS Qualitative data were collected in four focus group interviews with 17 nurses from two separate hospitals. The interviews were analyzed using qualitative content analysis. FINDINGS The results show three main categories: nurse's attitude toward caring, the organization of the critical care unit and the patient's health condition. CONCLUSION Barriers for patient participation in the ICU were found and this lead to a power imbalance between patient and nurse. In contrast to other care settings, this imbalance could be a consequence of the critical care organization and its degree of highly specialized care. The clinical application of our results is that these barriers should be considered when implementing patient participation in such a highly technological care situation as a critical care unit.
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Affiliation(s)
- A-C Falk
- Peroperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Anna Schandl
- Peroperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Catarina Frank
- School of Health and Caring Sciences, Linnaeus University, SE-351 95 äxjö, Sweden.
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Freeman-Sanderson A, Morris K, Elkins M. Characteristics of patient communication and prevalence of communication difficulty in the intensive care unit: An observational study. Aust Crit Care 2018; 32:373-377. [PMID: 30348488 DOI: 10.1016/j.aucc.2018.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/26/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To summarise the patient communication status in an intensive care unit (ICU), including methods of communication used and the frequency, degree and nature of communication breakdown. MATERIALS AND METHODS A multidisciplinary daily ward audit was conducted on ten consecutive weekdays in a 30-bed general ICU of a tertiary Australian hospital. Data included patient demographics, patients' mode of communication and the level of difficulty in communicating. Descriptive statistics and means (standard deviation)/medians (interquartile range) were used to summarise the data. RESULTS Over the audit period, data were collected from 87 patients (median age 58 years, interquartile range 43 to 67; 60% males), equivalent to 232 occupied bed days. Patients from non-English-speaking backgrounds accounted for 14% of the cohort, with Mandarin the most common non-English language. Altered cognition occurred on 11% of bed days. Staff reported difficulty in communicating with patients on 35% of bed days, with an inability to communicate with patients in 49% of these cases. Alternate modes of communication were reported, with gesture the most common, but they were not used with all suitable patients. CONCLUSIONS About one-third of the caseload in the ICU experienced difficulty in communicating. While alternate communication methods were reported, they were not used with all patients. A multidisciplinary approach to enhance communication ability may be beneficial.
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Affiliation(s)
- Amy Freeman-Sanderson
- University of Technology Sydney, Graduate School of Health, Australia; Speech Pathology Department, Royal Prince Alfred Hospital, Australia; Speech Pathology, Faculty of Health Sciences, University of Sydney, Australia.
| | - Katherine Morris
- Speech Pathology Department, Royal Prince Alfred Hospital, Australia
| | - Mark Elkins
- Sydney Medical School, University of Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Australia
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Kang J, Cho YS, Jeong YJ, Kim SG, Yun S, Shim M. [Development and Validation of a Measurement to Assess Person-centered Critical Care Nursing]. J Korean Acad Nurs 2018; 48:323-334. [PMID: 29968688 DOI: 10.4040/jkan.2018.48.3.323] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to develop a scale to measure person-centered critical care nursing and verify its reliability and validity. METHODS A total of 38 preliminary items on person-centered critical care nursing were selected using content validity analysis of and expert opinion on 72 candidate items derived through literature review and qualitative interviews. We conducted a questionnaire survey with 477 nurses who worked in intensive care units. The collected data were analyzed using exploratory factor analysis (EFA) and confirmative factor analysis (CFA) with SPSS and AMOS 24.0 program. RESULTS EFA was performed with principal axis factor analysis and Varimax rotation. The 15 items in 4 factors that accounted for 50.8% of the total variance were identified by deleting the items that were not meet the condition that the commonality should be .30 or more and the factor loading over .40. We named the factors as compassion, individuality, respect, and comfort, respectively. The correlation coefficient between this scale and the Caring Perception Scale was r=.57 (p<.001), which determined concurrent validity. The item-total correlation values ranged from .39 to .63, and the internal consistency for the scale was Cronbach's α=.84. CONCLUSION The reliability and validity of the 15 item person-centered critical care nursing scale were verified. It is expected that the use of this scale would expand person-centered care in critical care nursing.
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Affiliation(s)
- Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Korea
| | - Young Shin Cho
- Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan, Korea.
| | | | - Soo Gyeong Kim
- Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan, Korea
| | - Seonyoung Yun
- Department of Nursing, Youngsan University, Yangsan, Korea
| | - Miyoung Shim
- Nursing Department, Seoul National University Hospital, Seoul, Korea
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The work undertaken by mechanically ventilated patients in Intensive Care: A qualitative meta-ethnography of survivors’ experiences. Int J Nurs Stud 2018; 86:60-73. [DOI: 10.1016/j.ijnurstu.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
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Tantacharoenrat C, Prasopkittikun T, Rungamornrat S, Limprayoon K. Use of a User-Friendly Tablet Application to Communicate with Pediatric Patients on Mechanical Ventilators. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivos: examinar cómo el uso de una aplicación para tableta como ayuda en la comunicación con pacientes pediátricos con respirador artificial afecta el nivel de satisfacción con la comunicación por parte del personal de enfermería y en las díadas cuidador–paciente. Materiales y método: se utilizó el diseño pretest-postest de un solo grupo para analizar el nivel de satisfacción del personal de enfermería con la comunicación y se utilizó un diseño de grupo de control pretest-postest no equivalente para los cuidadores. La muestra estaba conformada por 44 miembros del personal de enfermería y 18 díadas de cuidadores y pacientes pediátricos con ventilación de dos hospitales en Tailandia. Se utilizó una prueba de T pareada para comparar al personal de enfermería, la prueba U de Mann-Whitney para comparar los cuidadores y una estadística descriptiva para describir la satisfacción de los niños. Resultados: el personal de enfermería se sintió más satisfecho con la comunicación al usar la aplicación de la tableta que los métodos de comunicación regulares (t = -9,13, df = 43, p < ,001). Los cuidadores que usaron la aplicación para tableta también reportaron una mayor satisfacción con la comunicación respecto a aquellos que usaron los métodos de comunicación regulares (U = -3,41, p < ,001). Casi el 90 % de los pacientes pediátricos reportaron sentirse completamente satisfechos con el uso de la aplicación. Conclusiones: la aplicación para tableta diseñada para facilitar la comunicación con pacientes pediátricos con respirador artificial mejoró los niveles de satisfacción con la comunicación y debe promoverse como uno de los dispositivos de comunicación de asistencia para uso amplio.
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Page P, Simpson A, Reynolds L. Constructing a grounded theory of critical illness survivorship: The dualistic worlds of survivors and family members. J Clin Nurs 2018; 28:603-614. [DOI: 10.1111/jocn.14655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/10/2018] [Accepted: 08/29/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Pamela Page
- Faculty of Health Social Care & Education; School of Nursing & Midwifery; Anglia Ruskin University; Chelmsford UK
| | - Alan Simpson
- Collaborative Mental Health Nursing; Centre for Mental Health Research; School of Health Sciences; City, University of London; London UK
| | - Lisa Reynolds
- Nursing Division; School of Health Sciences; City, University of London; London UK
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Duffy EI, Garry J, Talbot L, Pasternak D, Flinn A, Minardi C, Dookram M, Grant K, Fitzgerald D, Rubano J, Vosswinkel J, Jawa RS. A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards. Trauma Surg Acute Care Open 2018; 3:e000180. [PMID: 30246152 PMCID: PMC6144907 DOI: 10.1136/tsaco-2018-000180] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
Background Mechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing. Methods This was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of −1 to +1, without cognitive impairment, were eligible. We asked patients four yes-or-no questions to assess basic needs regarding presence of pain, need for endotracheal suction, satisfactory room temperature, and position comfort. Patients were then asked if there was anything else that they wanted to communicate. All responses were confirmed by head nodding. Results The median accuracy of the CB (100% (IQR 100%–100%)) for basic needs communication (yes/no questions) was comparable with that of the ETD (100% (IQR 68.8%–100%); p=0.14) in the 12 enrolled patients. Notably, 83% of patients desired to communicate additional information, ranging from spiritual (eg, desire for prayer/chaplain), emotional (eg, frustration, desire for comfort), physical/environmental (eg, television), to physiological (eg, thirst/hunger) needs. Discussion The majority of patients desired to communicate something other than basic needs. Unless specifically assessed via an assistive communication device (eg, CB or ETD), some of these other needs would have been difficult to discern. Level of evidence IV therapeutic care/management.
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Affiliation(s)
- Erin I Duffy
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Jonah Garry
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Lillian Talbot
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - David Pasternak
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ashley Flinn
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Casey Minardi
- Department of Inpatient Occupational Therapy, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Michele Dookram
- Department of Inpatient Occupational Therapy, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Kathleen Grant
- Department of Inpatient Occupational Therapy, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Debbie Fitzgerald
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Jerry Rubano
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - James Vosswinkel
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Randeep S Jawa
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
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Use of Communication Tools for Mechanically Ventilated Patients in the Intensive Care Unit. ACTA ACUST UNITED AC 2018; 36:398-405. [DOI: 10.1097/cin.0000000000000449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karlsen MMW, Ølnes MA, Heyn LG. Communication with patients in intensive care units: a scoping review. Nurs Crit Care 2018; 24:115-131. [PMID: 30069988 DOI: 10.1111/nicc.12377] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/02/2018] [Accepted: 06/13/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients in intensive care units are generally more conscious and alert when they are on mechanical ventilation than in previous years because of the many potential benefits of being under less sedation. The endotracheal tube blocks the vocal cords when patients are on ventilation, thus making it impossible to speak. Many patients report that they struggle to make themselves understood. AIM The aim of this study was to assess previous knowledge about interaction and communication between health care personnel and conscious and alert patients under mechanical ventilation in intensive care units. DESIGN AND METHODS A literature review was performed following the steps of a scoping review. Studies published between 1998 and 2017 were identified in several databases: Cinahl, Embase, Medline, PsycINFO and Scopus. The first search returned 7386 unique references. The inclusion criteria consisted of empirical studies or studies related to interactions between health care personnel and patients over 18 years of age on mechanical ventilation. The relevant studies were summarized in a standardized data-charting sheet. RESULTS The inclusion criteria were met by 46 articles; 16 were qualitative studies, 17 were quantitative, 6 were mixed-methods studies, and 7 were pilot or feasibility studies. Of the studies, 37 were from nurses, 4 from physicians, 4 from speech language pathologists and 1 from psychologists. The most common topics investigated in the studies were 'experiences with communication on mechanical ventilation' and 'communication exchanges'. CONCLUSIONS A variety of communication aids that appear to have some effect on patients should be made available in intensive care units. More multidisciplinary approaches in future studies could enhance the knowledge in the field. RELEVANCE TO CLINICAL PRACTICE The education of intensive care unit personnel in the use of such aids should be a prioritized field, as should be the implementation of a variety of communication aids.
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Affiliation(s)
| | - Mia Alexandra Ølnes
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway
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Hajiabadi F, Heydari A, Manzari ZS. Enclosed in the synergistic rings of suffering: The experience of conscious patients under mechanical ventilation in the intensive care unit of the causes of suffering. Electron Physician 2018; 10:6697-6706. [PMID: 29881533 PMCID: PMC5984025 DOI: 10.19082/6697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
Background Patients undergoing mechanical ventilation in intensive care units are in a special position of suffering, and discovering their experiences in the painful situations of the intensive care unit can contribute greatly to improve the quality of nursing care for them. Objective The present study was performed aiming to explain the experience of conscious patients receiving mechanical ventilation in the intensive care units of the causes of suffering. Methods This is a qualitative content analysis study conducted in Iran in 2017. Participants of this study included 15 conscious mechanically ventilated patients in the intensive care unit. Semi-structured interviews and observations were used to collect data. For sampling, first, the purposeful and then theoretical methods (guided by the created categories) were used and the procedure continued until saturation of the data. The text of the handwritten notes of recorded interviews were analyzed using conventional qualitative content analysis. Results Four subclasses of “unpleasant consequences of disease”, “bitter elixir of therapy”, “an inconvenient environment” and “understanding the threat to family safety and comfort” all under the general category “enclosed in the synergistic rings of suffering” were extracted from the profound descriptions of contributors. Conclusion Mechanically ventilated patients in the intensive care unit are enclosed in the rings of suffering, so that each of these rings imposes a great deal of pain and suffering on the patient and have a synergic and intensifying effect on each other. Therefore, design and application of strategies and nursing care is essential to reduce the severity of the suffering and discomfort of these patients.
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Affiliation(s)
- Fatemeh Hajiabadi
- Instructor of Nursing, PhD Candidate, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Ph.D. of Nursing, Professor, Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Ph.D. of Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs 2018; 46:10-16. [PMID: 29551223 DOI: 10.1016/j.iccn.2018.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES A tracheostomy tube can profoundly impact ability to communicate. The impact of this on patients' self-esteem and quality of life in the care continuum from the intensive care unit to after decannulation has not been reported. Therefore, the aim was to investigate the patient-reported experience regarding change in communication function, communication-related self-esteem and quality of life. RESEARCH DESIGN A mixed methods approach was utilised. Quantitative data were obtained using validated measures of self-esteem related to communication-related quality of life and general health. Data were measured before return of voice, within 48 hours of voice return and six months after tracheostomy decannulation. Qualitative data were collected through structured interviews six months after tracheostomy. RESULTS Seventeen participants completed the study. Four themes emerged from the interviews: It's hard communicating without a voice; What is happening to me?; A storm of dark emotions and More than a response…it's participating and recovering. Significant positive change occurred in six items of self-esteem related to communication from baseline to return of voice. Overall, positive changes in quality of life scores were observed. CONCLUSIONS Voice loss with tracheostomy significantly affected participants' abilities to effectively communicate their care and comfort needs. Restoration of voice occurred in conjunction with patient-reported improved mood, outlook and sense of recovery.
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Affiliation(s)
- Amy L Freeman-Sanderson
- Royal Prince Alfred Hospital, Australia; Faculty of Health Sciences University of Sydney, Australia.
| | - Leanne Togher
- Faculty of Health Sciences University of Sydney, Australia
| | - Mark Elkins
- Sydney Medical School, University of Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Australia
| | - Belinda Kenny
- Faculty of Health Sciences University of Sydney, Australia
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Leung CCH, Pun J, Lock G, Slade D, Gomersall CD, Wong WT, Joynt GM. Exploring the scope of communication content of mechanically ventilated patients. J Crit Care 2017; 44:136-141. [PMID: 29102851 DOI: 10.1016/j.jcrc.2017.10.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Ineffective communication during mechanical ventilation (MV) and critical illness is distressing to many patients. This study aimed to describe the scope of communication content of ventilated critically ill patients. MATERIALS AND METHODS We performed a prospective qualitative interview study in a multidisciplinary intensive care unit. Ten alert, orientated adult patients who previously underwent MV for at least 24h and were able to speak at the time of interview were recruited. Semi-structured interviews with stimulated recall technique were conducted. A descriptive thematic analysis was performed of the patient-generated content using a free coding technique, where recurrent themes and subthemes were noted, coded and analyzed. RESULTS Patients' communication content included medical discussions with clinicians; communication with family to provide advice or comfort, make requests and plans, express feelings and convey personal perspectives on medical care; and expression of their own psychoemotional needs. CONCLUSIONS The scope of communication content of ventilated ICU patients was broad, extending far beyond task-focused subject matter. Content ranged from conveying symptom-related messages to active participation in medical discussions, to conversing with family about a range of complex multi-dimensional issues, to sharing their own psychoemotional experiences. These patient-centered needs should be recognized and addressed in communication strategies.
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Affiliation(s)
- Czarina C H Leung
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Jack Pun
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Graham Lock
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Diana Slade
- International Research Centre for Communication in Healthcare (IRCCH), Department of English, 4/F, A Core, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Charles D Gomersall
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Wai Tat Wong
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
| | - Gavin M Joynt
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, 4/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong.
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Laerkner E, Egerod I, Olesen F, Hansen HP. A sense of agency: An ethnographic exploration of being awake during mechanical ventilation in the intensive care unit. Int J Nurs Stud 2017; 75:1-9. [DOI: 10.1016/j.ijnurstu.2017.06.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 02/07/2023]
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Martinho CIF, Rodrigues ITRM. Communication of mechanically ventilated patients in intensive care units. Rev Bras Ter Intensiva 2017; 28:132-40. [PMID: 27410408 PMCID: PMC4943050 DOI: 10.5935/0103-507x.20160027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/29/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. METHODS This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. RESULTS Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). CONCLUSION This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the presence of other clinical and/or sociodemographic variables.
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Dithole KS, Sibanda S, Moleki MM, Thupayagale-Tshweneagae G. Nurses' communication with patients who are mechanically ventilated in intensive care: the Botswana experience. Int Nurs Rev 2016; 63:415-21. [PMID: 27146021 DOI: 10.1111/inr.12262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Communication is an integral part of nursing practice not just only for therapeutic reasons but also for sharing information. Nurses working in intensive care experience challenges when communicating with patients who are mechanically ventilated due to lack of knowledge and skill. These challenges infringe on the patients' rights to receive information and as such they may impact negatively on the patients' outcomes. AIM This study determined the existing knowledge and skills of intensive care nurses working with mechanically ventilated patients in Botswana. METHODS A retrospective descriptive and explorative research design with a quantitative approach was used to audit patients' records. This was augmented by further interviewing nurses for their knowledge and skills when communicating with ventilated patients within the two intensive care units in Botswana. The American Association of Critical Nurses Synergy Model was used to guide the study. One hundred and fifty-nine (159) patients' files were audited and 50 nurses chosen by purposive sampling completed a self-administered 42-item questionnaire. Statistical Package for Social Sciences version 10 and Microsoft Excel were used to analyse the data. RESULTS Assessment of patients' ability to communicate was recorded in more than 90% of files audited. Four per cent (4%) of the respondents only communicated essential information and no other strategies or devices were used to aid communication. CONCLUSION Communication with ventilated patients can be quite challenging to nurses working in the intensive care unit. There is a need for communication skills training to ensure that all nurses working with mechanically ventilated patients are properly trained, equipped and capable of communicating effectively with the patient. IMPLICATIONS FOR NURSING AND HEALTH POLICY A greater understanding of communication dynamics with the intensive care unit with patients who are mechanically ventilated is crucial to enable nurses to improve their care and improve patients' comfort. Incorporating communication in the nursing standards would ensure that patients are treated with dignity which would help improve patient outcomes.
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Affiliation(s)
- K S Dithole
- School of Nursing, University of Botswana, Pretoria, South Africa
| | - S Sibanda
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - M M Moleki
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Quality of life improves with return of voice in tracheostomy patients in intensive care: An observational study. J Crit Care 2016; 33:186-91. [PMID: 26971032 DOI: 10.1016/j.jcrc.2016.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure patient-reported change of mood, communication-related quality of life, and general health status with return of voice among mechanically ventilated tracheostomy patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS A prospective observational study in a tertiary ICU was conducted. Communication-related quality of life was measured daily using the Visual Analogue Self-Esteem Scale. General health status was measured weekly using the EuroQol-5D. RESULTS Aspects of communication self-esteem that significantly improved with the return of voice were ability to be understood by others (P = .006) and cheerfulness (P = .04), both with a median difference from before to after return of voice of 1 on the 5-point scale. Return of voice was not associated with a significant improvement in confidence, sense of outgoingness, anger, sense of being trapped, optimism, or frustration. Reported general health status did not significantly improve. CONCLUSIONS Return of voice was associated with significant improvement in patient reported self-esteem, particularly in being understood by others and in cheerfulness. Improved self-esteem may also improve quality of life; however, further research is needed to confirm this relationship. Early restoration of voice should be investigated as a way to improve the experience of ICU for tracheostomy patients.
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Affiliation(s)
- Amy L Freeman-Sanderson
- Speech Pathology Department, Royal Prince Alfred Hospital, Camperdown, Australia; Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Mark R Elkins
- Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Sydney, Australia
| | - Paul R Phipps
- Department of Intensive Care Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
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