Comparison of communication interfaces for mechanically ventilated patients in intensive care

Feasibility of implementing a communication board to improve communication interactions of mechanically ventilated patients in intensive care units at one Sri Lankan hospital - A pilot randomised controlled trial

OBJECTIVE

To evaluate the feasibility of implementing a communication board in intensive care units in terms of participant recruitment and retention, intervention fidelity, and ability to collect patient outcome data.

DESIGN

A prospective, two-arm, unblinded, pilot randomised controlled trial.

RESEARCH METHODOLOGY

Adult, conscious, mechanically ventilated intensive care patients were recruited between August and November 2023. All participants received routine communication practices; the intervention group also received the communication board. Prior to the study, all nurses were trained on using the communication board. Patient or proxy consent was obtained. Data were collected from patients, nurses, patients' medical records, and screening, tracking, intervention fidelity, and contamination logs.

MAIN OUTCOME MEASURES

The primary outcome data was feasibility of participant recruitment, retention, and intervention fidelity, which was recorded daily until seven days of follow-up or pre-defined trial endpoints. Secondary patient outcomes (anxiety, satisfaction, ease of communication) were assessed at recruitment and approximately 24 h after recruitment or soon after extubation, whichever occurred first.

SETTING

Two intensive care units in one Sri Lankan tertiary care hospital.

RESULTS

Of the 123 patients, 60 (75.0%) were recruited and randomised (30 control; 30 intervention). All intervention group patients received the communication board (100% intervention fidelity), and 58 (96.7%) completed the follow-up. On recruitment, 12.5% of secondary patient outcome data was missing, and 9.9% on follow-up, predominantly associated with the 10-item ease of communication scale.

CONCLUSIONS

Conducting a larger, definitive communication board trial is feasible but collecting secondary patient outcome data, especially ease of communication was challenging. Study procedures need to be refined prior to a larger trial.

IMPLICATIONS FOR CLINICAL PRACTICE

The use of communication boards in intensive care units may improve patient-centred care for ventilated patients but requires further, high quality effectiveness trials.

Effectiveness of Communication Board on Level of Satisfaction among Mechanically Ventilated Patients at Intensive Care Unit in a Tertiary Hospital

Introduction

Critical care nurses are crucial in managing critical patients, facing challenges with advanced technology, alarms, ventilators, and multiple laboratory investigations. They must effectively communicate and manage patients on mechanical ventilation (MV), a lifesaving intervention for those needing oxygenation and ventilation support to ensure patient satisfaction.

Materials and Methods

The study employed a quasi-experimental design with 80 mechanically ventilated patients selected through purposive sampling. Data were collected using demographic and clinical pro forma and a predesigned four-point Likert satisfaction scale comprised 14 items. The intervention group utilized a communication board, while the conventional group received routine care. The aim was to evaluate satisfaction levels in both groups, followed by a posttest on the 5th day using the same instrument.

Results

The pretest revealed mean satisfaction scores of 32.47 ± 6.48 and 33.95 ± 6.41 for the intervention and conventional groups, respectively, with a mean difference of 1.47, considered statistically nonsignificant (t 78 = 1.023, P = 0.310). Conversely, posttest scores showed 37.85 ± 8.23 and 34.32 ± 6.18 for the intervention and conventional groups, respectively, with a mean difference of 3.53, indicating statistical significance (t 78 = 2.164, P = 0.034). Hence, the communication board intervention significantly enhanced satisfaction scores among mechanically ventilated patients, underscoring its positive impact on nursing care in terms of patients' satisfaction.

Conclusion

Effective communication is crucial in intensive care unit patient care, especially for those unable to speak due to MV. Utilizing communication boards significantly enhances patient satisfaction, highlighting the need for ongoing innovation in critical care nursing.

Facilitators, barriers and acceptability of implementing a communication board in Sri Lankan intensive care units: A qualitative descriptive study

OBJECTIVES

To explore patients' and nurses' views of potential facilitators, barriers, and prospective acceptability of implementing a communication board in Sri Lankan intensive care units.

DESIGN

A qualitative, descriptive study.

RESEARCH METHODOLOGY

Eight patients who received mechanical ventilation and nine nurses who worked in adult medical and surgical intensive care units were purposively selected. Data were collected via audio-taped, semi-structured, face-to-face interviews in January/February 2023. Interview guide questions were informed by the knowledge-to-action framework and the theoretical framework of acceptability. Data were analysed using inductive and deductive content analysis. The 32-item checklist of the consolidated criteria for reporting qualitative research (COREQ) was used to ensure the quality of reporting.

SETTING

A 3,000 bed Sri Lankan teaching hospital with 18 intensive care units.

FINDINGS

Four categories reflecting patients' and nurses' anticipated use of the board were found. The first category described patients' and nurses' 'readiness to use the communication board' and their positive attitudes towards it. The second category focused on the 'potential benefits of the communication board', while the third category emphasised the 'individual patient characteristics' that should be taken into consideration when implementing communication boards. The final category described practical aspects related to 'integrating communication boards into routine practice'.

CONCLUSION

This study demonstrates communication boards may improve communication between ventilated patients and nurses, and they are acceptable to end users. Adopting these tools may be a pivotal step to enhancing patient-centred care in demanding intensive care settings.

IMPLICATIONS FOR CLINICAL PRACTICE

An inability to communicate effectively with ventilated intensive care patients creates negative experiences for both patients and nurses. Communication boards may act as a medium to better understand patients' needs during mechanical ventilation.Understanding patients' and nurses' views is beneficial when designing patient-centred communication interventions in intensive care units.

The impact of patient communication software app on facilitating communication with mechanically ventilated patients: A randomized clinical trial

Background & Aim

The use of mechanical ventilation devices as a supportive respiratory system for hospitalized patients in intensive care units is often accompanied by the inability of alert patients to establish verbal communication. This study aims to determine the impact of patient communication software on facilitating communication for mechanically ventilated patients in the intensive care unit.

Methodology

This clinical trial was conducted with two groups, each comprising 60 alert, mechanically ventilated patients hospitalized in medical universities in Mashhad, from December 2022 to January 2023. Patients were randomly assigned to the intervention and control groups. In the intervention group, communication with the patient was established using specially designed software, while in the control group, conventional methods were used to identify patient needs. Data collection tools included a demographic questionnaire and the Ease of Communication Scale. SPSS software (version 20) was utilized for data analysis, employing chi-square, independent t-test, Mann-Whitney, Wilcoxon and paired t-tests. Cohen's d was also used to evaluate the magnitude of the effect size.

Results

The composition of the groups, including gender and marital status, was comparable, as was their baseline demographic and clinical characteristics (age, gender, education level, marital status, underlying diseases, airway type, hospital stay length, sedative medication, and mechanical ventilation duration), with no significant differences found (p > 0.05). Before the intervention, there was no difference in communication ease scores between the groups. Post-intervention, the intervention group showed significantly improved communication ease scores compared to the control group (P < 0.001) The Wilcoxon test results indicated a significant reduction in the average communication ease score after the intervention within both the intervention and control groups.

Conclusion

Software designed to assist communication for patients on mechanical ventilation with artificial airways could enhance their ability to communicate their needs more effectively, offering an alternative to methods such as lip-reading, writing, alphabet boards and communication boards.