1
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Holm A, Dreyer P. Nurses' experiences of the phenomenon 'isolation communication'. Nurs Crit Care 2023; 28:885-892. [PMID: 36156341 DOI: 10.1111/nicc.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/12/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes. AIM To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU. STUDY DESIGN A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method. FINDINGS Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation. CONCLUSION The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure. RELEVANCE TO CLINICAL PRACTICE As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.
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Affiliation(s)
- Anna Holm
- Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Aarhus University Hospital, Aarhus, Denmark
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2
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Kyranou M, Cheta C, Pampoulou E. Communicating with mechanically ventilated patients who are awake. A qualitative study on the experience of critical care nurses in Cyprus during the COVID-19 pandemic. PLoS One 2022; 17:e0278195. [PMID: 36454794 PMCID: PMC9714938 DOI: 10.1371/journal.pone.0278195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Modern protocols for light sedation in combination with the increased number of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients. STUDY OBJECTIVES The purpose of this study was to explore the strategies nurses use when taking care of conscious, intubated patients in the intensive care unit and the barriers they encounter in their effort to communicate. METHODS For this study, a qualitative design was employed. Data were collected using in-depth semi-structured interviews with 14 intensive care nurses working at ICUs in four different hospitals of Cyprus. The data were analyzed by applying thematic analysis. RESULTS We identified several strategies of unaided (movements-lips, hands, legs-facial expressions, gestures, touching) and aided forms of communication (pen and paper, boards, tablets, mobiles) used by nurses to communicate with patients. However, barriers to communication were reported by the participating nurses mainly pertaining to patients and nurses' characteristics as well as the ICU environment. The health protocols imposed by the pandemic added more obstacles to the communication between nurses and patients mostly related to the use of protective health equipment. CONCLUSIONS The results of this study point to the difficulties nurses in Cyprus face when trying to communicate with conscious patients during mechanical ventilation. It appears that the lack of nurses' training and of appropriate equipment to facilitate augmentative and alternative communication leave the complex communication needs of critically ill patients unaddressed. However, further research including patients' opinions, after they recover, would bring more clarity on this topic. Our study adds evidence to the communication crisis created by the protective health protocols imposed by the pandemic. As such, it highlights the need to educate nurses in augmentative and alternative ways of communication to address communication with mechanically ventilated, conscious patients during their ICU stay.
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Affiliation(s)
- Maria Kyranou
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
- * E-mail:
| | - Chariklia Cheta
- American Medical Center/American Heart Institute, Strovolos, Cyprus
| | - Eliada Pampoulou
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
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3
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Akroute AR, Brinchmann BS, Hovland A, Fredriksen STD. ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study. BMC Nurs 2022; 21:214. [PMID: 35927677 PMCID: PMC9354289 DOI: 10.1186/s12912-022-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit. Methods This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’. Conclusions ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.
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Affiliation(s)
- Abder Rahim Akroute
- Department of Anesthesia and Intensive Care Medicine, Nordland Hospital, N-8049, Bodø, Norway.
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway.,Nordland Hospital, 8076, Bodø, Norway
| | - Anders Hovland
- Department of Cardiology, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sven-Tore Dreyer Fredriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,, Campus Harstad, Havnegata 5, 9480, Harstad, Norway.,Huntington network, Knorrebakken 2, 9411, Harstad, Norway
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4
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Goldberg MA, Hochberg LR, Carpenter D, Walz JM. Development of a Manually Operated Communication System (MOCS) for patients in intensive care units. Augment Altern Commun 2022; 37:261-273. [PMID: 35023431 DOI: 10.1080/07434618.2021.2016958] [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: 10/19/2022] Open
Abstract
Nonvocal alert patients in the intensive care unit (ICU) setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. Innovation of a hand-operated non-touchscreen communication system for nonvocal ICU patients was guided by design concepts including speech output, simplicity, and flexibility. A novel communication tool, the Manually Operated Communication System (MOCS), was developed for use in intensive care settings with patients unable to speak. MOCS is a speech-output technology designed for patients with manual dexterity impairments preventing legible writing. MOCS may have the potential to improve communication for nonvocal patients with limited manual dexterity.
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Affiliation(s)
- Miriam A Goldberg
- MD/PhD Program, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Leigh R Hochberg
- Carney Institute for Brain Science and School of Engineering, Brown University, Providence, RI, USA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA.,Rehabilitation R&D Service, US Department of Veterans Affairs, VA RR&D Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - Dawn Carpenter
- Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Surgical/Trauma Critical Care, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - J Matthias Walz
- Department of Anesthesiology & Perioperative Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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5
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Özkaya Sağlam B, Sözeri Eser İ, Ayvaz S, Çağı N, Mert H, Küçükgüçlü Ö. Intensive care experiences of intern nurse students: A qualitative study. NURSE EDUCATION TODAY 2021; 107:105098. [PMID: 34464908 DOI: 10.1016/j.nedt.2021.105098] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/15/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to describe the experiences of nursing interns in the intensive care unit (ICU). DESIGN This study was a descriptive qualitative research. SETTINGS, PARTICIPANTS, METHODS The study data were collected via focus group interviews of 25 nursing interns in the two different ICUs of a university hospital who had volunteered to participate in the study. There were four focus group interviews in all, one for each of four different groups of nursing interns. The semi-structured interview form was used in the study. RESULTS Seven themes emerged in the study: fear, awareness of nurses' roles, finding opportunities for self-improvement, difficulty in caregiving, difficulty in communicating with the patients and the care team, experiencing ambivalent feelings related to death, and adaptation to the clinical environment. CONCLUSIONS Doing one's internship in the ICU was evaluated by the nursing interns in this study as a beneficial practice despite the difficulties involved in it. It is recommended, that intensive-care practices be included in the undergraduate education program for nurses and that appropriate guidance and monitoring be given to the nursing interns in ICUs.
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Affiliation(s)
- Bilgehan Özkaya Sağlam
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey; Department of Internal Medicine Nursing, Institute of Health Sciences, Dokuz Eylul University, İzmir, Turkey.
| | - İzlem Sözeri Eser
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey; Department of Internal Medicine Nursing, Institute of Health Sciences, Dokuz Eylul University, İzmir, Turkey.
| | - Sermin Ayvaz
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Neslihan Çağı
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Hatice Mert
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey.
| | - Özlem Küçükgüçlü
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey.
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6
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Holm A, Nikolajsen L, Dreyer P. A multicomponent intervention to optimise nurse-patient communication in the intensive care unit: A mixed-methods acceptability and feasibility study. Aust Crit Care 2021; 35:616-622. [PMID: 34802842 DOI: 10.1016/j.aucc.2021.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Mechanically ventilated patients in intensive care units may experience communication challenges owing to intubation, which affects nurse-patient communication. Several strategies may optimise communication, but only one previous study has tested a multicomponent intervention. Implementing such an intervention can be challenging because communication strategies may be set aside by lifesaving care tasks and procedures. In a previous study, we designed a communication intervention based on pre-existing clinical methods and evidence-based approaches. The present study evaluated the intervention to determine if it was necessary to adjust its components and the implementation strategy. OBJECTIVES The objective of this study was to evaluate the feasibility and assess nurses' acceptability of a patient-centred, multicomponent communication intervention prototype in an intensive care unit. METHODS The overall frame was the Medical Research Council's framework for developing complex interventions. Indicators of feasibility and acceptability were used for the evaluation. A mixed-methods design was applied including a survey with open-ended text boxes and qualitative observations as data sources. Quantitative data were analysed descriptively, and qualitative data were explored using content analysis. Data were compiled and displayed in a side-by-side comparison. The data were collected between September 2020 and March 2021. Nurses from four intensive care units at a university hospital in Denmark participated in the study. All nurses who were on active duty during the implementation of the intervention were enrolled for the survey and participant observations. RESULTS Overall, the results provided insight into the feasibility based on fidelity and context as well as nurses' acceptability based on adherence, appropriateness, convenience, and effectiveness. Qualitative and quantitative results yielded partially contrasting findings but highlighted how the intervention may be optimised to enhance fit with clinical practice and overcome implementation challenges. CONCLUSION The intervention was feasible and acceptable. However, implementation needs to be repeated to allow nurses to fully understand and use the intervention.
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Affiliation(s)
- Anna Holm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Pia Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Public Health, Section of Nursing Science, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark; Department of Global Public Health and Primary Care, University of Bergen, Alrek Helseklynge, Blokk D, Årstadveien 17, NO-5020, Bergen, Norway.
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7
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Holm A, Karlsson V, Nikolajsen L, Dreyer P. Strengthening and supporting nurses’ communication with mechanically ventilated patients in the intensive care unit: Development of a communication intervention. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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8
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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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9
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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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10
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Hurtig RR, Alper R, Altschuler T, Gendreau S, Gormley J, Marshall S, Santiago R, Scibilia S. Improving Outcomes for Hospitalized Patients Pre- and Post-COVID-19. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-20-00144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Barriers to effective patient–provider communication increase the risk that a patient will experience a hospital-acquired condition (HAC) that will negatively impact the patient's health outcomes. Providing patients with communication tools can significantly reduce the risks of experiencing HACs. This article describes how barriers to effective patient–provider communication can impact patient outcomes and reports on the incidence of HACs in patients who received assistive technology to address barriers to patient–provider communication. This topic is of critical relevance, as the COVID-19 pandemic has dramatically increased the number of patients who face communication barriers and the accompanying challenges encountered by their health care providers.
Method/Approach
The researchers compared the number of expected HACs based on previously obtained data to the number of HACs reported among patients who received an assistive technology intervention. Additionally, the impact of COVID-19 on patient–provider communication was discussed through the provision of case descriptions from frontline speech-language pathologists who have worked in COVID-19 intensive care units.
Results
The patients who received the assistive technology intervention had a significantly lower incidence of HACs than what would be expected in hospital settings. Clinicians working directly with patients with COVID-19 identified suggestions on how both patients and providers can address the barriers to effective patient–provider communication.
Conclusion
A key to better patient outcomes and lower health care costs will require making the provision of communication tools part of the standard of care for all patients facing barriers to communication.
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Affiliation(s)
- Richard R. Hurtig
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Rebecca Alper
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Tami Altschuler
- Department of Speech-Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, NY
| | - Sarah Gendreau
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston
| | - Jessica Gormley
- Department of Speech-Language Pathology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha
| | - Sarah Marshall
- Communication Aids & Systems Clinic, Waisman Center, University of Wisconsin–Madison
| | - Rachel Santiago
- Inpatient Augmentative Communication Program, Boston Children's Hospital, MA
| | - Stephanie Scibilia
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston
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Holm A, Viftrup A, Karlsson V, Nikolajsen L, Dreyer P. Nurses' communication with mechanically ventilated patients in the intensive care unit: Umbrella review. J Adv Nurs 2020; 76:2909-2920. [PMID: 32893350 DOI: 10.1111/jan.14524] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Abstract
AIM To conduct a review summarizing evidence concerning communication with mechanically ventilated patients in the intensive care unit (ICU). BACKGROUND ICU patients undergoing mechanical ventilation are unable to communicate verbally, causing many negative emotions. Due to changes in sedation practice, a growing number of patients are conscious and experience communication difficulties. DESIGN The umbrella review method guided by the Joanna Briggs Institute was applied. DATA SOURCES A systematic search was done in the Cochrane Library, the Joanna Briggs Institute database, Cinahl, Pubmed, PsycINFO and Scopus between January -April 2019. Search terms were 'nurse-patient communication', 'mechanical ventilation', 'intensive care', and 'reviews as publication type'. Literature from 2009-2019 was included. REVIEW METHODS Following recommendations by the Joanna Briggs Institute, a quality appraisal, data extraction, and synthesis were done. RESULTS Seven research syntheses were included. There were two main themes and six subthemes: (1) Characterization of the nurse-patient communication: (a) Patients' communication; (b) Nurses' communication; (2) Nursing interventions that facilitate communication: (a) Communication assessment and documentation; (b) Communication methods and approaches; (c) Education and training of nurses; and (d) Augmentative and alternative communication. CONCLUSION Nurse-patient communication was characterized by an unequal power relationship with a common experience - frustration. Four key interventions were identified and an integration of these may be key to designing and implementing future ICU communication packages. IMPACT Nurse-patient communication is characterized by an unequal power relationship with one joint experience - frustration. Four key interventions should be integrated when designing and implementing communication packages in the ICU. Findings are transferable to ICU practices where patients are conscious and experience communication difficulties.
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Affiliation(s)
- Anna Holm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Viftrup
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark.,University of Bergen, Bergen, Norway
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12
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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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13
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Anguera MT, Portell M, Chacón-Moscoso S, Sanduvete-Chaves S. Indirect Observation in Everyday Contexts: Concepts and Methodological Guidelines within a Mixed Methods Framework. Front Psychol 2018; 9:13. [PMID: 29441028 PMCID: PMC5797623 DOI: 10.3389/fpsyg.2018.00013] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/04/2018] [Indexed: 01/25/2023] Open
Abstract
Indirect observation is a recent concept in systematic observation. It largely involves analyzing textual material generated either indirectly from transcriptions of audio recordings of verbal behavior in natural settings (e.g., conversation, group discussions) or directly from narratives (e.g., letters of complaint, tweets, forum posts). It may also feature seemingly unobtrusive objects that can provide relevant insights into daily routines. All these materials constitute an extremely rich source of information for studying everyday life, and they are continuously growing with the burgeoning of new technologies for data recording, dissemination, and storage. Narratives are an excellent vehicle for studying everyday life, and quantitization is proposed as a means of integrating qualitative and quantitative elements. However, this analysis requires a structured system that enables researchers to analyze varying forms and sources of information objectively. In this paper, we present a methodological framework detailing the steps and decisions required to quantitatively analyze a set of data that was originally qualitative. We provide guidelines on study dimensions, text segmentation criteria, ad hoc observation instruments, data quality controls, and coding and preparation of text for quantitative analysis. The quality control stage is essential to ensure that the code matrices generated from the qualitative data are reliable. We provide examples of how an indirect observation study can produce data for quantitative analysis and also describe the different software tools available for the various stages of the process. The proposed method is framed within a specific mixed methods approach that involves collecting qualitative data and subsequently transforming these into matrices of codes (not frequencies) for quantitative analysis to detect underlying structures and behavioral patterns. The data collection and quality control procedures fully meet the requirement of flexibility and provide new perspectives on data integration in the study of biopsychosocial aspects in everyday contexts.
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Affiliation(s)
- M. Teresa Anguera
- Faculty of Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Mariona Portell
- Faculty of Psychology, Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador Chacón-Moscoso
- Facultad de Psicología, Universidad de Sevilla, Seville, Spain
- Departamento de Psicología, Universidad Autónoma de Chile, Santiago, Chile
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Nakarada-Kordic I, Patterson N, Wrapson J, Reay SD. A Systematic Review of Patient and Caregiver Experiences with a Tracheostomy. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 11:175-191. [DOI: 10.1007/s40271-017-0277-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Holm A, Dreyer P. Nurse-patient communication within the context of non-sedated mechanical ventilation: A hermeneutic-phenomenological study. Nurs Crit Care 2017; 23:88-94. [PMID: 28593721 DOI: 10.1111/nicc.12297] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/03/2017] [Accepted: 04/09/2017] [Indexed: 12/25/2022]
Abstract
AIMS AND OBJECTIVES To explore non-sedated mechanically ventilated patients' communication with nurses in the intensive care unit. BACKGROUND Mechanically ventilated patients are temporarily voiceless, making interpersonal communication complex. Both nurses and patients find communication challenging and may experience negative emotions when communication fails. In Nordic countries, sedation protocols have changed to light/non-sedation, resulting in more patients being conscious and more clinical practitioners experiencing communication difficulties. DESIGN The study was qualitative with a phenomenological-hermeneutic approach. Data were collected at two intensive care units in Denmark from January to April 2015. METHODS Data collection consisted of interviews with patients, focus group interviews with nurses and field observations concerning nurse-patient communication. Data were analysed as one collective body of data using Ricoeur's theory of interpretation. FINDINGS The main theme showed that communication is a movement between the two opposite feelings of comprehension and frustration. Sub-themes showed (1) the dynamics of power change when the patient is voiceless; (2) consciousness and voicelessness make caring difficult; and (3) the process of interpreting and structuring communication is situational. CONCLUSION These findings are important in nursing care and provide perspectives on the shift from communication towards comprehension and, thus, away from frustration. A non-sedation protocol is a major change in clinical practice in relation to communication. It requires a new way of thinking where communication becomes an integrated part of care, and the nurse has to be constantly alert and adjust his or her communication strategies to the patient's changing needs and communication ability. RELEVANCE TO CLINICAL PRACTICE Some nursing interventions may optimize communication: (1) systematic assessment of patients' communication; (2) education of nurses in Augmentative and Alternative Communication; (3) using communication tools when possible; and (4) securing time, continuity, empathy and patience in nursing care.
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Affiliation(s)
- A Holm
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, 8000 Aarhus C, Denmark
| | - P Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, 8000 Aarhus C, Denmark.,Institute of Public Health, Section of Nursing, University of Aarhus, 8000 Aarhus C, Denmark
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Hwang JJ, Donnelly TT, Ewashen C, McKiel E, Raffin S, Kinch J. Sociocultural Influences on Arab Women's Participation in Breast Cancer Screening in Qatar. QUALITATIVE HEALTH RESEARCH 2017; 27:714-726. [PMID: 26631675 DOI: 10.1177/1049732315619373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Breast cancer, the most common cancer among Arab women in Qatar, significantly affects the morbidity and mortality of Arab women largely because of low participation rates in breast cancer screening. We used a critical ethnographic approach to uncover and describe factors that influence Arab women's breast cancer screening practices. We conducted semistructured interviews with 15 health care practitioners in Qatar. Through thematic analysis of the data, we found three major factors influencing breast cancer screening practices: (a) beliefs, attitudes, and practices regarding women's bodies, health, and illness; (b) religious beliefs and a culturally sensitive health care structure; and (c) culturally specific gender relations and roles. Arab women's health practices cannot be understood in isolation from the sociocultural environment. The problem of low rates of breast cancer screening practices and supportive interventions must be addressed within the context and not be limited to the individual.
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Affiliation(s)
| | | | | | | | | | - Janice Kinch
- 1 University of Calgary, Calgary, Alberta, Canada
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17
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Koszalinski RS, Tappen RM, Hickman C, Melhuish T. Communication Needs of Critical Care Patients Who Are Voiceless. Comput Inform Nurs 2017; 34:339-44. [PMID: 27315366 DOI: 10.1097/cin.0000000000000266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Voice is crucial for communication in all healthcare settings. Evidence-based care highlights the need for clear communication. Clear communication methods must be applied when caring for special populations in order to assess pain effectively. Communication efforts also should be offered to patients who are in end-of-life care and would like to make independent decisions. A computer communication application was offered to patients in intensive care/critical care units in three hospitals in South Florida. Inclusion criteria included the age of 18 years or older, Richmond Agitation Sedation Scale between -1 and +1, ability to read and write English, and willingness to use the computer application. Exclusion criteria included inability to read and write English, agitation as defined by the Richmond Agitation Sedation Scale, and any patient on infection isolation protocol. Four qualitative themes were revealed, which directly relate to two published evidence-based guidelines. These are the End of Life Care and Decision Making Evidence-Based Care Guidelines and the Pain Assessment in Special Populations Guidelines. This knowledge is important for developing effective patient-healthcare provider communication.
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Affiliation(s)
- Rebecca S Koszalinski
- Author Affiliations: College of Nursing, University of Tennessee Knoxville (Dr Koszalinski); Florida Atlantic University, Boca Raton (Dr Tappen); Boca Raton Regional Hospital, Florida (Ms Hickman); and CVICU, CCU, and NSICU, Holy Cross Hospital, Fort Lauderdale, Florida (Ms Melhuish).The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article
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18
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Rodriguez CS, Rowe M, Thomas L, Shuster J, Koeppel B, Cairns P. Enhancing the Communication of Suddenly Speechless Critical Care Patients. Am J Crit Care 2016; 25:e40-7. [PMID: 27134237 DOI: 10.4037/ajcc2016217] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sudden speechlessness is common in critically ill patients who are intubated or have had surgery for head and neck cancer. Sudden inability to speak poses challenges for hospitalized patients because strategies to facilitate communication are often limited and unreliable. OBJECTIVE To determine the impact of a technology-based communication intervention on patients' perception of communication difficulty, satisfaction with communication methods, and frustration with communication. METHODS A quasi-experimental, 4-cohort (control and intervention) repeated-measures design was used. Data were collected daily for up to 10 days. Patients in adult critical care units were followed up as they were transferred to other units within the institutions selected for the study. The impact of a technology-based communication system (intervention) was compared with usual care (control). Patients' communication outcomes pertinent to communication with nursing staff that were evaluated included perception of communication ease, satisfaction with methods used for communication, and frustration with communication. RESULTS Compared with participants in the control group, participants in the intervention group reported lower mean frustration levels (-2.68; SE, 0.17; 95% CI, -3.02 to -2.34; P < .001) and higher mean satisfaction levels (0.59; SE, 0.16; 95% CI, 0.27 to 0.91; P < .001) with use of the communication intervention. Participants in the intervention group reported a consistent increase in perception of communication ease during the hospital stay. CONCLUSIONS The results facilitated evaluation of a bedside technology-based communication intervention tailored to the needs of suddenly speechless critically ill patients.
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Affiliation(s)
- Carmen S. Rodriguez
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Meredeth Rowe
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Loris Thomas
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Jonathan Shuster
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Brent Koeppel
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
| | - Paula Cairns
- Carmen S. Rodriguez and Loris Thomas are assistant professors, Meredeth Rowe is a professor and nurse scientist, and Paula Cairns is a nurse researcher, University of South Florida, College of Nursing, Tampa, Florida. Jonathan Shuster is a professor, Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida, and Brent Koeppel is a principal and founder of Chameleon Adaptiveware, LLC, Natick, Massachusetts
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