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Kuruppu NR, Chaboyer W, Abayadeera A, Ranse K. Augmentative and alternative communication tools for mechanically ventilated patients in intensive care units: A scoping review. Aust Crit Care 2023; 36:1095-1109. [PMID: 36774294 DOI: 10.1016/j.aucc.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/13/2022] [Accepted: 12/20/2022] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES The aim of this scoping review was to understand the extent and type of evidence on augmentative and alternative communication tools used with mechanically ventilated patients in the intensive care unit. REVIEW METHOD USED This scoping review was conducted using Arksey and O'Malley's methodological framework, followed by PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework to provide a structured approach to analysis of reviews. DATA SOURCES In December 2021, six electronic databases-CENTRAL, CINAHL, Embase, Medline (Ebscohost), PyscINFO, and Web of Science-were searched. Searches were supplemented with hand searching of reference lists of included studies. REVIEW METHODS Studies were selected according to inclusion and exclusion criteria. Full-text review was completed by two independent authors, with any disagreement resolved by consensus or with consultation with a third reviewer. A table was developed to extract key information from the eligible studies. The Mixed Methods Appraisal Tool and Supporting the Use of Research Evidence checklist were used to quality appraise the selected primary research and reviews, respectively. RESULTS Twenty-three studies (19 primary studies and four reviews) were included in the review. Findings highlighted five main patterns: (i) Co-designing of the augmentative and alternative communication tools; (ii) Patients' and healthcare professionals' training needs on augmentative and alternative communication tools; (iii) Implementation of validated communication assessment algorithms; (iv) Amalgamate several communication methods/approaches; (v) Technical competency required for high-technology augmentative and alternative communication tools. CONCLUSION Both low- and high-technology augmentative and alternative communication tools are widely used for mechanically ventilated patients in intensive care units, but there is a need for systematically assessing the communication needs and implementing communication interventions to promote meaningful patient-centred clinical outcomes.
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Affiliation(s)
- Nipuna R Kuruppu
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Nawala, Nugegoda, Sri Lanka.
| | - Wendy Chaboyer
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Anuja Abayadeera
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Colombo, Sri Lanka; National Hospital of Sri Lanka, Sri Lanka
| | - Kristen Ranse
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Queensland, Australia
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2
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Istanboulian L, Rose L, Yunusova Y, Dale C. Mixed-method acceptability evaluation of a co-designed bundled intervention to support communication for patients with an advanced airway in the intensive care unit during a pandemic. Nurs Crit Care 2023; 28:1069-1077. [PMID: 35878874 DOI: 10.1111/nicc.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although bundled communication interventions are recommended to address communication barriers for patients with an advanced airway in the intensive care unit (ICU) such interventions have not been evaluated in pandemic conditions. AIM To evaluate the acceptability, appropriateness, and feasibility of a co-designed bundled intervention to support communication with adult patients with an advanced airway in ICU in pandemic conditions. STUDY DESIGN Prospective, convergent mixed method design in a single centre medical-surgical ICU in Toronto, Canada between September 2021-March 2022. After the use of the co-designed bundled communication intervention quantitative data were collected from health care providers using validated acceptability, appropriateness, and feasibility measures and analysed using descriptive statistics. Qualitative data were collected from providers, patients and families using semi-structured interviews and analysed using content analysis applying the theoretical framework of acceptability. Joint table analysis enabled the integration of the two data sets. RESULTS A total of 64 (41.3%) HCPs responded to the survey: 54 (84.4%) rated the intervention acceptable; 55 (85.9%) appropriate; and 49 (76.6%) feasible for use in this context. Qualitative data (23 interviews: 13 healthcare providers, 6 families and 4 patients) and the joint table analysis extended the understanding that intervention acceptability was related to positive affective attitudes and reduced communication frustration. Appropriateness and feasibility were promoted through intervention alignment with values, ability to personalize tools, and ease of access. Recommendations to improve the acceptability included adaptation for immobilized and/or restrained patients, additional education, and integration into existing workflows. CONCLUSIONS This mixed method evaluation of a co-designed bundled intervention to support patient communication in the ICU during pandemic conditions demonstrated high rated and described acceptability, appropriateness, and feasibility by participants. RELEVANCE TO CLINICAL PRACTICE A co-designed communication intervention demonstrating stakeholder acceptability, appropriateness, and feasibility can be implemented into clinical practice in pandemic and other infection prevention and control contexts.
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Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Prolonged-Ventilation Weaning Centre for Excellence and Long-Term Ventilation, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Harvitz Brain Sciences Program, Sunnybrook Research Institute Wellness Way, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Kelly S, Garner J, Treadway V, Sadera G. Knowledge mobilization in critical care and the evolving communication role of nurses. Nurs Crit Care 2023; 28:913-922. [PMID: 35794068 DOI: 10.1111/nicc.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The importance of appropriate communication skills within a health care setting rests upon the need for effective information sharing. When successful, this provides a supportive working environment for staff and has a positive impact on patient care and outcomes. AIMS The purpose of this study was to explore how knowledge/evidence is acquired, shared, and applied in the Critical Care (CC) environment for staff and patients/family members. STUDY DESIGN A qualitative approach was used, consisting of semi-structured interviews and focus groups. Data analysis was conducted using an iterative thematic approach. RESULTS Data collected prior to the COVID-19 pandemic from United Kingdom (UK) critical care workers (N = 46), patients, and family members (N = 21) identified four communication roles performed by the nursing staff: team member; diplomat; translator and friend. CONCLUSIONS It was evident that without suitable training and support, the stresses and demands placed upon the nurses could lead to disenfranchisement and burnout. RELEVANCE TO CLINICAL PRACTICE These findings are relevant and timely given the impact of the pandemic, highlighting the need for accessible and alternate communication strategies to support nurses by reducing stress, moral distress and increasing psychological safety. Improved communication can provide tailored information for staff and patients/family improving the CC experience for all.
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Affiliation(s)
- Sioban Kelly
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Jayne Garner
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Victoria Treadway
- Library and Knowledge Service, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
- NHS England, Leeds, UK
| | - Girendra Sadera
- Department of Critical Care and Anaesthesia, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Momennasab M, Mohammadi F, DehghanRad F, Jaberi A. Evaluation of the effectiveness of a training programme for nurses regarding augmentative and alternative communication with intubated patients using Kirkpatrick's model: A pilot study. Nurs Open 2022; 10:2895-2903. [PMID: 36577744 PMCID: PMC10077406 DOI: 10.1002/nop2.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 10/19/2022] [Accepted: 11/20/2022] [Indexed: 12/30/2022] Open
Abstract
AIM Communicating with conscious intubated patients who are unable to communicate verbally is one of the challenges faced by intensive care unit (ICU) nurses. The present study was conducted to evaluate the effectiveness of a training programme for nurses regarding augmentative and alternative communication (AAC) with intubated patients using Kirkpatrick's model. DESIGN This study had a one-group, before-after, quasi-experimental design. METHODS Totally, 45 nurses working in ICUs participated in a blended training programme using AAC strategies to communicate with intubated patients. Their contribution was evaluated based on Kirkpatrick's model at four levels. The study data were collected using the "satisfaction and ease questionnaire," "observation checklist" and "communication knowledge test." Then, the data were analysed using the SPSS 22 software and p < 0.05 was considered statistically significant. RESULTS Most participants were satisfied with the implementation of the programme. The nurses' mean score of communication knowledge increased after the intervention (p < 0.05). The results of evaluation of the third and fourth levels of Kirkpatrick's model also showed an increase in the success of communication, use of AAC, and satisfaction with and ease of communication (p < 0.001). IMPLICATION Short-term and long-term effects of the blended training programme about AAC were investigated using Kirkpatrick's model. The results indicated the positive effect of the programme on the quality of the nurses' communication with intubated patients, their understanding of the patients' messages and meeting the patients' needs at a more desirable level. Thus, nurses and other staff are recommended to use this simple method of communication with patients to provide better services. In addition, further quantitative and qualitative studies are suggested to assess these communication strategies in other patients with impaired consciousness.
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Affiliation(s)
- Marzieh Momennasab
- Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mohammadi
- Student Research Committee, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh DehghanRad
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Murray S, Hopf SC. Attitudes toward the use of low-tech AAC in acute settings: a systematized review. Augment Altern Commun 2022; 38:184-195. [PMID: 36128661 DOI: 10.1080/07434618.2022.2122870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The purpose of this systematized review was to investigate how attitudes toward low-tech AAC might be impacting its use in acute care settings. A comprehensive and systematic search of databases identified 23 articles for inclusion. Thematic analysis using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework facilitated a narrative synthesis of findings. Results suggest that in acute care settings (a) adult patients, families, nursing staff, medical team, and allied health professionals all have opportunities to use but do not regularly engage with AAC; (b) individuals reject low-tech AAC devices for a variety of reasons, including that they are not useful, necessary, suitable, or appropriate in settings such as intensive care units; (c) negative attitudes toward AAC are linked to a lack of initial training and ongoing support, perceived impersonal content, limited functionality, and a lack of consistent availability; and (d) positive attitudes toward low-tech AAC are more prevalent when training and support are offered, low-tech AAC effectiveness is demonstrated, and organizational, financial, and procedural commitments are provided. Limitations of the research are highlighted and future research opportunities are identified.
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Affiliation(s)
- Shaeron Murray
- Independent Rehabilitation Services, Carnegie, Australia.,Charles Sturt University, Albury, Australia
| | - Suzanne C Hopf
- Speech Pathology Department, School of Community Health, Charles Sturt University, Albury, Australia
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7
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Brock KL, Koul R, Corwin M, Schlosser RW. Attitudes Toward and Perceived Communicative Competence of Individuals with Aphasia Using Speech-Generating Devices. Augment Altern Commun 2022; 38:15-28. [PMID: 35296192 DOI: 10.1080/07434618.2022.2028009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The purpose of this study was to investigate the effects of interface display and respondent group on listener attitudes toward and perceived communicative competence of persons with aphasia. The Attitudes Toward Nonspeaking Persons scale and the Communicative Competence Scale was used to measure listener attitudes and communicative competence, respectively. A 2 × 3 mixed factorial design was used. Interface display videos served as the within-subjects variable (i.e., grid and scene displays), and the respondent group served as the between-subjects variable. A total of 113 respondents (i.e., undergraduate lower-division students, undergraduate upper-division students, and family caregivers of individuals with aphasia) watched an individual with aphasia using a grid display in one video and a scene display in another video. The respondents completed the two scales. Significant main effects (p < .05) were found for interface display and respondent group. The use of scene displays had a more favorable impact on competence ratings than the use of grid displays. Family caregiver ratings were significantly (p < .05) more favorable than ratings from other groups. The Communicative Competence Scale was found to be a reliable measure of perceived communicative competence. Scene displays have the potential to enhance the perceived communicative competence of this population.
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Affiliation(s)
- Kris L Brock
- Department of Communication Sciences and Disorders, Idaho State University Health Sciences, Meridian, ID, USA
| | - Rajinder Koul
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, USA.,Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Melinda Corwin
- Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ralf W Schlosser
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa.,Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.,Center for Communication Enhancement, Boston Children's Hospital, Waltham, MA, USA
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Qianlan Y, Tianya H, Wei L, Jia G, Chunyan N, Wei Z, Bin L, Huifen L, Wei D, Guanghui D, Yan J. The psychological outcomes of COVID-19 affected the pandemic-after risk perceptions of nurse clinicians: a latent profile analysis. Glob Ment Health (Camb) 2022; 9:123-32. [PMID: 36606238 DOI: 10.1017/gmh.2022.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/03/2021] [Accepted: 02/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Risk perception among nurses after the COVID-19 pandemic is a crucial factor affecting their attitudes and willingness to work in clinics. Those with poor psychological status could perceive risks sensitively as fears or threats that are discouraging. This article aimed to determine whether psychological outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia, following the COVID-19 pandemic were differentially related to the risk perceptions of nurses working in clinics and increased perceived risk. METHOD The participants were 668 nurse clinicians from five local hospitals. Risk perceptions and psychological outcomes were measured by adapted questionnaires via the Internet. Latent profile analysis (LPA) identified subgroups of individuals who showed similar profiles regarding the perceived risks in nursing. Multinomial regression and probit regression were used to examine the extent to which sociodemographic and psychological outcomes predicted class membership. RESULTS LPA revealed four classes: groups with low-, mild-, moderate-, and high-level risk perceptions. Membership of the high-level risk perception class was predicted by the severity of psychological outcomes. Anxiety significantly accounted for a moderate increase in risk perceptions, while the symptoms of insomnia, depression, and PTSD accelerated the increase to the high level of risk perception class. CONCLUSIONS By classifying groups of nurse clinicians sharing similar profiles regarding risk perceptions and then exploring associated predictors, this study shows the psychological outcomes after COVID-19 significantly impacted pandemic-associated risk perceptions and suggests intervening in nurses' psychological outcomes while simultaneously focusing on work-related worries is important following the outbreak of COVID-19.
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Abstract
AIM This study explored nurses' experiences of communicating with patients with aphasia. DESIGN A naturalistic paradigm approach was adopted to describe the phenomenon of interest. METHODS Participants were neurological nurses employed in various neurological departments and recruited using purposive sampling. Group interviews were conducted for 1 hr and 30 min using semi-structured open-ended questions. The Consolidated Criteria for Reporting Qualitative Research checklist was followed. RESULTS Four generic categories were derived: "Conversations with the aphasic patients are frustrating, which leads to impatience among nurses, and they eventually dismiss the patients," "Feeling responsible for communicating with aphasic patients but also experiencing guilt for not being able to give adequate care in practice," "Concerns about communication methods with aphasic patients" and "Desire to learn ways to communicate with aphasic patients." Appropriate education and support should be given to nurses to facilitate communication with aphasic patients to ensure that they are not excluded from medical benefits because of communication difficulties.
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Affiliation(s)
- Yujin Hur
- Frances Payne Bolton School of NursingCase Western Reserve UniversityClevelandOhioUSA
| | - Younhee Kang
- College of NursingEwha Womans UniversitySeoulKorea
- Graduate Program in System Health Science and EngineeringEwha Womans UniversitySeoulKorea
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11
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Karlsen MMW, Mathisen C, Heyn LG. Advancing communication skills in intensive care: Caring for relatives of critically ill patients. Patient Educ Couns 2021; 104:2851-2856. [PMID: 34426038 DOI: 10.1016/j.pec.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/16/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to explore critical care nursing students' experiences with simulation-based communication skills training focusing on relatives. METHODS Two complex scenarios were developed using professional actors in the role as relatives. A survey was conducted with critical care nursing students from 2017 to 2020. We performed descriptive and correlational analysis of the quantitative data and thematic analysis of the open-ended questions. RESULTS The total learning outcome was 4.10 (SD = 0.79, N = 98) on a Likert scale from 1 to 5. The learning outcome with the use of a professional actor was 4.65 (SD = 0.6, N = 118), and the experience of realism was 4.16 (SD = 0.85, N = 67). The students rated the debriefing as 4.38 (SD = 0.73, N = 118), and they experienced more positive emotions than negative during the simulation. CONCLUSION High learning outcomes were reported. The use of professional actors with fine-tuned improvisational skills enhanced the sense of realism in the scenarios. However, the impact of emotions on learning outcomes should be further investigated. PRACTICE IMPLICATIONS By obtaining advanced communication skills focusing on relatives during their nursing education, critical care nursing students can improve the care they give.
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Affiliation(s)
| | - Cathrine Mathisen
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway; University of South-Eastern Norway, Post Office box 25, 3603 Kongsberg, Norway.
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12
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Abstract
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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13
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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14
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Bohlin V, Nolbris MJ, Wigert H. Child health care nurses' experiences of language barriers during home visits. Public Health Nurs 2021; 39:146-152. [PMID: 34558103 DOI: 10.1111/phn.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of the study was to explore the communication tools that child healthcare nurses can use during home visits to families when language barriers exist. DESIGN Qualitative study using data collected from focus group sessions. SAMPLE Six semi-structured focus group interviews with twenty nurses in child healthcare services. MEASUREMENTS The results were analyzed with a thematic content analysis. RESULTS The analysis resulted in two themes: Using pictures as support in the conversation, with subthemes Not using pictures as support, Wanting to know how to use pictures as support, Pictures as support for invitations, Different types of pictures as support, and Alternative means of communication with the subthemes Possibilities of using an interpreter, Obstacles to using an interpreter, Mixed communication. CONCLUSION If language barriers are present during home visits, decision-making nurses in Child Health Care (CHC) put families in an unequal position when communicating with them. These results point to a need for more education, guidelines and support regarding alternative and augmentative communication (AAC) tools and structures to assist in overcoming language barriers.
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Affiliation(s)
- Veronica Bohlin
- Child Health Care unit, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Margaretha Jenholt Nolbris
- Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden and Department of Pediatrics The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Al‐Shamaly HS. Patterns of communicating care and caring in the intensive care unit. Nurs Open 2021; 9:277-298. [PMID: 34536338 PMCID: PMC8685886 DOI: 10.1002/nop2.1061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 11/11/2022] Open
Abstract
Aim To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU). Design A focused ethnography. Methods This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information ‐ over
six months (April‐September, 2014). The data were analysed thematically. Findings This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients’ psychological and emotional needs, and nurses’ caring behaviours are crucial. These findings need further consideration from all stakeholders.
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Istanboulian L, Rose L, Yunusova Y, Dale CM. Protocol for a mixed method acceptability evaluation of a codesigned bundled COmmunication intervention for use in the adult ICU during the COVID-19 PandEmic: the COPE study. BMJ Open 2021; 11:e050347. [PMID: 34518267 PMCID: PMC8438574 DOI: 10.1136/bmjopen-2021-050347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Patients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required. METHODS AND ANALYSIS This three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20-25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8-10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60-65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic. ETHICS AND DISSEMINATION The study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.
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Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Centre for Excellence in Weaning, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Critical Care and Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Al-Yahyai Rn Bsn ANS, Arulappan Rn Rm Bsc N Msc N PhD N DNSc J, Matua GA, Al-Ghafri Rn Bsn SM, Al-Sarakhi Rn Bsn SH, Al-Rahbi Rn Bsn KKS, Jayapal SK. Communicating to Non-Speaking Critically Ill Patients: Augmentative and Alternative Communication Technique as an Essential Strategy. SAGE Open Nurs 2021; 7:23779608211015234. [PMID: 34159256 PMCID: PMC8186114 DOI: 10.1177/23779608211015234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Communication with hospitalized patients is crucial to improve the quality and safety of health care. Methods The study assessed the communication methods used by nurses while communicating to non-speaking critically ill patients. The participants included staff nurses working in ICU, CICU, HD units of neuro- surgical, orthopedic, medical and oncology wards. Purposive sampling technique was used to recruit a total number of 194 nurses. The communication methods used were assessed by a questionnaire comprised of a list of 21 strategies used to communicate with non-speaking patients. Results The most commonly used strategies were reading the patient’s mouthing words, encouraging the patient by telling them that they are doing well and nurses helping them to get better, assessing the patients for their communication ability, “thumps up” to indicate “yes”, “shake head” indicating “no”, use OK, or point to body parts, speaking slowly and waiting for the patient’s response, spending time to listen patiently to what the patient say and touching the non-speaking critically ill patient when the nurse speaks with the patient. Conclusion The study reported that the nurses used variety of communication strategies while communicating to non- speaking critically ill patients. However very few nurses used Augmentative and alternative communication strategies to communicate to non-speaking critically ill patients. The study recommends the importance of establishing Augmentative and Alternative Communication strategies in the hospitals.
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Affiliation(s)
| | | | - Gerald Amandu Matua
- Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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21
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Arimon MP, Llobet MP, Roldán-Merino J, Moreno-Arroyo C, Blanco MÁH, Lluch-Canut T. A Communicative Intervention to Improve the Psychoemotional State of Critical Care Patients Transported by Ambulance. Am J Crit Care 2021; 30:45-54. [PMID: 33385200 DOI: 10.4037/ajcc2021619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Communication is key to understanding the emotional state of critical care patients. OBJECTIVE To analyze the effectiveness of the communicative intervention known as CONECTEM, which incorporates basic communication skills and augmentative alternative communication, in improving pain, anxiety, and posttraumatic stress disorder symptoms in critical care patients transported by ambulance. METHODS This study had a quasi-experimental design with intervention and control groups. It was carried out at 4 emergency medical centers in northern Spain. One of the centers served as the intervention unit, with the other 3 serving as control units. The nurses at the intervention center underwent training in CONECTEM. Pretest and posttest measurements were obtained using a visual analog scale to measure pain, the short-version State-Trait Anxiety Inventory to measure anxiety, and the Impact of Event Scale to measure posttraumatic stress disorder symptoms. RESULTS In the comparative pretest-posttest analysis of the groups, significant differences were found in favor of the intervention group (Pillai multivariate, F2,110 = 57.973, P < .001). The intervention was associated with improvements in pain (mean visual analog scale score, 3.3 pretest vs 1.1 posttest; P < .001) and posttraumatic stress disorder symptoms (mean Impact of Event Scale score, 17.8 pretest vs 11.2 posttest; P < .001). Moreover, the percentage of patients whose anxiety improved was higher in the intervention group than in the control group (62% vs 4%, P < .001). CONCLUSION The communicative intervention CONECTEM was effective in improving psychoemotional state among critical care patients during medical transport.
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Affiliation(s)
- Marta Prats Arimon
- Marta Prats Arimon is an associate professor, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; a collaborating professor, School of Nursing, Faculty of Medicine and Health Sciences, University Ramon Llull, Barcelona, Spain; and a registered nurse, Emergency Department, Hospital Transfronterer de Cerdanya, Puigcerdà (Girona), Spain
| | - Montserrat Puig Llobet
- Montserrat Puig Llobet is a professor and director of the Mental and Public Health Department and director of the master’s program in nursing interventions in complex chronic patients, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona and a researcher in the CARINGCF Research Group, Tarragona, Spain and the GIRISAME Research Group, Madrid, Spain
| | - Juan Roldán-Merino
- Juan Roldán-Merino is a professor, Campus Docent, Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona; a researcher in the GIESS Research Group and the GEIMAC Research Group, Barcelona, Spain; and coordinator of the GIRISAME Research Group and the REICESMA Research Group, Madrid, Spain
| | - Carmen Moreno-Arroyo
- Carmen Moreno-Arroyo is a professor in the Department of Fundamental and Medical-Surgical Nursing and a director of the master’s program in critical care nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona
| | - Miguel Ángel Hidalgo Blanco
- Miguel Ángel Hidalgo Blanco is a professor in the Department of Fundamental and Medical-Surgical Nursing and a director of the master’s program in critical care nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona
| | - Teresa Lluch-Canut
- Teresa Lluch-Canut is a professor of psychosocial and mental health, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona; and a researcher in the GEIMAC Research Group, Barcelona, Spain
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ju XX, Yang J, Liu XX. A systematic review on voiceless patients' willingness to adopt high-technology augmentative and alternative communication in intensive care units. Intensive Crit Care Nurs 2020; 63:102948. [PMID: 33168384 DOI: 10.1016/j.iccn.2020.102948] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To systematically evaluate the acceptability of high-technology augmentative and alternative communication (high-tech AAC) among ICU patients who are voiceless guided by the technology acceptance model (TAM). METHODS We searched the Cochrane Library, EMBASE, PubMed, CINAHL, PsycINFO, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database and Wanfang Database from database inception to September 2019. Studies that examined conscious nonverbal ICU patients with high-tech AAC intervention were included. Two reviewers independently collected and evaluated all the studies. The methodological quality was assessed by using the Joanna Briggs Institute critical appraisal tool. RESULTS Eighteen studies with a total of 914 patients met the inclusion criteria, and the quality of the studies varied from low to moderate. Based on the TAM, ICU voiceless patients perceived that high-tech AAC was useful, was easy to use, decreased communication difficulties, reduced negative emotions, and improved symptom identification and management. Patients maintained a positive attitude and were willing to continue to use high-tech AAC. CONCLUSIONS Although the existing evidence is limited, voiceless patients regard high-tech AAC devices as a useful, reliable, and acceptable alternative communication choice in the ICU. Multicenter, large-sample, and high-quality studies are highly recommended in the future.
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Affiliation(s)
- Xin-Xing Ju
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China.
| | - Jie Yang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China.
| | - Xiao-Xin Liu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
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Abstract
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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Affiliation(s)
- JiYeon Choi
- Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea
| | - Judith A Tate
- Center of Healthy Aging, Self-Management and Complex Care, Undergraduate Nursing Honors Program, The Ohio State University College of Nursing, 386 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
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Al-Kalaldeh M, Amro N, Qtait M, Alwawi A. Barriers to effective nurse-patient communication in the emergency department. Emerg Nurse 2020; 28:29-35. [PMID: 32285654 DOI: 10.7748/en.2020.e1969] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND It has been identified that ineffective nurse-patient communication in the emergency department can lead to frustration, mistrust and inadequate pain management. Therefore, it is important to recognise the potential barriers to effective communication, including nurse and patient-related factors. AIM To identify what emergency nurses perceive as barriers to nurse-patient communication, and if there is any difference in the perception of communication barriers between nurses' demographic subgroups. METHOD A total of 199 emergency nurses were recruited using convenience sampling, from nine hospitals in the West Bank, Palestine. These nurses completed a 27-item questionnaire that encompassed six domains of barriers that may affect nurse-patient communication: demographic, knowledge-related, environmental, social, economic and psychological factors. RESULTS Of the six domains covered by the questionnaire, environmental factors scored the highest, meaning that emergency nurses perceived these to be the most significant barriers to effective nurse-patient communication. This was followed by knowledge-related and psychological factors. Knowledge-related factors were perceived to be a greater communication barrier by male nurses more than female nurses, and by younger nurses more than older nurses. CONCLUSION To enhance nurse-patient communication, it is important to establish a comfortable working environment and to provide ongoing training for nurses to develop their communication skills.
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Affiliation(s)
| | - Nawaf Amro
- Al-Zaytoonah University of Jordan, Amman, Jordan
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26
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Bayog KMS, Bello DMC, Benabaye JMP, Benegas TME, Benito ALM, Berioso MA, Parial LLB, Macindo JRB. A conjoint analysis of the communication preferences of registered nurses towards mechanically ventilated patients. Int J Nurs Pract 2020; 26:e12809. [DOI: 10.1111/ijn.12809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | - John Rey B. Macindo
- Faculty of Management and Development StudiesUniversity of the Philippines Open University Los Baños Laguna Philippines
- Nursing Service Division, AMOSUP Seamen's Hospital, Intramuros Manila Philippines
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Istanboulian L, Rose L, Gorospe F, Yunusova Y, Dale CM. Barriers to and facilitators for the use of augmentative and alternative communication and voice restorative strategies for adults with an advanced airway in the intensive care unit: A scoping review. J Crit Care 2020; 57:168-76. [PMID: 32163752 DOI: 10.1016/j.jcrc.2020.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To identify barriers and facilitators for the use of augmentative and alternative communication (AAC) and voice restorative strategies for adult patients with an advanced airway in the intensive care unit (ICU). MATERIALS AND METHODS Scoping review searching five databases between 1990 and 2019. We screened 13, 167 citations and included all study types reporting barriers and/or facilitators to using communication strategies in an ICU setting. Two authors independently extracted and coded reported barriers and facilitators to the Theoretical Domains Framework (TDF) domains. RESULTS Of the 44 studies meeting inclusion criteria 18 (44%) used qualitative, 18 (44%) used quantitative, and 8 (18%) used mixed methods. In total, 39 unique barriers and 46 unique facilitators were identified and coded to the domains of the TDF. Barriers were most frequently coded to the Skills, Environmental Context and Resources, and Emotion domains. Facilitators were most frequently coded to Reinforcement, Environmental Context and Resources, and Social and Professional Roles/Identity domains. Thematic synthesis produced four potentially modifiable factors: context, emotional support, training, and decisional algorithms. CONCLUSIONS Identified barriers (skills, environment, resources, emotions) and facilitators (reinforcement, resources, roles) to ICU communication strategy use in the literature may be modified through formal training and role support.
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Simmons A, McCarthy J, Koszalinski R, Hedrick M, Reilly K, Hamby E. Knowledge and experiences with augmentative and alternative communication by paediatric nurses: a pilot study. Disabil Rehabil Assist Technol 2019; 16:567-579. [PMID: 31691622 DOI: 10.1080/17483107.2019.1685015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The current mixed methods research study was designed to describe the experience and opinions of paediatric acute care nurses at a single paediatric medical centre regarding augmentative and alternative communication (AAC). This research serves as the beginning of a line of research to determine needs that can be met through later education and training on AAC with paediatric acute care nurses. METHODS Mixed methods were used to gather survey and interview data from nurses at a single paediatric hospital to investigate their knowledge of AAC, perceived relevance of AAC for their patient populations, and preferences for training programmes. RESULTS Quantitative survey and qualitative interview data indicated a need for AAC education for these paediatric nurses. Nurses demonstrated limited knowledge and experience with AAC but communicated both a desire and perceived need to know more to effectively care for their patients. CONCLUSION Nurses reported limited AAC knowledge but expressed a desire for support to use AAC with their patients. AAC education and cross-sector collaboration with healthcare workers such as speech-language pathologists (SLPs) and acute care paediatric nurses are indicated to support effective communication when interacting with patients with complex communication needs (CCN).Implications for rehabilitationImproved background knowledge to develop and implement future nurse education on AAC.Foundation for cross-sector collaboration (e.g., nurses and SLPs) on AAC implementation in paediatric acute care settings.
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Affiliation(s)
- Amanda Simmons
- Audiology and Speech Pathology Department, University of Tennessee Health Science Centre, Knoxville, TN, USA
| | - Jillian McCarthy
- Audiology and Speech Pathology Department, University of Tennessee Health Science Centre, Knoxville, TN, USA
| | | | - Mark Hedrick
- Audiology and Speech Pathology Department, University of Tennessee Health Science Centre, Knoxville, TN, USA
| | - Kevin Reilly
- Audiology and Speech Pathology Department, University of Tennessee Health Science Centre, Knoxville, TN, USA
| | - Ellen Hamby
- Audiology and Speech Pathology Department, University of Tennessee Health Science Centre, Knoxville, TN, USA
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Jansson S, Martin TRS, Johnson E, Nilsson S. Healthcare professionals’ use of augmentative and alternative communication in an intensive care unit: A survey study. Intensive Crit Care Nurs 2019; 54:64-70. [DOI: 10.1016/j.iccn.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/10/2023]
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30
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Gropp M, Johnson E, Bornman J, Koul R. Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study. Health SA 2019; 24:1162. [PMID: 31934427 PMCID: PMC6917450 DOI: 10.4102/hsag.v24i0.1162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 02/27/2019] [Indexed: 01/10/2023] Open
Abstract
Background Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. Aim This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. Setting A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. Methods A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. Results Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses’ perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. Conclusions Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised.
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Affiliation(s)
- Martelize Gropp
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Rajinder Koul
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa.,Department of Communication Sciences and Disorders, Moody College of Communication, The University of Texas at Austin, Austin, United States
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Noguchi A, Inoue T, Yokota I. 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] [What about the content of this article? (0)] [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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Abstract
BACKGROUND Communication with patients has always been a major concern in nursing care. Invasive mechanically ventilated (IMV) patients suffer from a communication barrier due to the presence of the endotracheal tube (ETT), which makes them unable to communicate through speech. AIM The purpose of this review is to examine available evidence regarding existing knowledge, skills, perceptions and barriers to IMV patient communication in order to guide the development of strategies that enhance effective communication with these patients. METHODS A review of the published literature was conducted between January 2010 and December 2016. RESULTS The literature support clear and concise communication in all areas of care, especially when patients suddenly become speechless. Invasive mechanically ventilated patients want to be heard, have control over their treatment and contribute to decisions concerning their health. CONCLUSION There is a need for the establishment of an effective nurse -patient communication strategy, which may include determining the mode of communication used by the patient, waiting and giving time to allow a patient to participate in the communication, confirming the message that was communicated with a patient himself/ herself, and the use of assistive and augmented communication to support comprehension when needed.
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Affiliation(s)
- Aziza Salem
- Senior Education Coordinator, King Hussein Cancer Center,
The University of Jordan, Jordan
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Mendes AP. Impact of critical illness news on the family: hermeneutic phenomenological study. Rev Bras Enferm 2018; 71:170-177. [PMID: 29324960 DOI: 10.1590/0034-7167-2016-0163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 01/20/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Understand the impact of critical-illness news on the experience of family members at an Intensive Care Unit. METHOD Phenomenological approach according to Van Manen's method. Open interviews were held with 21 family members. From analysis and interpretation of the data, three essential themes were identified: the unexpected; the pronouncement of death; and the impact on self-caring within the family. The study complied with the ethical principles inherent to research involving humans. RESULTS The unexpected news and death of the sick person influence the well-being and self-care of family members, affecting their ability for analysis and decision making. It was observed that the family experiences the news with suffering, mainly due to the anticipation arising from the events. FINAL CONSIDERATIONS The humanity of nurses was revealed in response to the needs of the family. In view of the requirements for information, it was verified that the information transmitted allowed them to become aware of themselves, to become empowered in their daily lives and to alleviate the emotional burden experienced.
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Affiliation(s)
- Anabela Pereira Mendes
- Escola Superior de Enfermagem de Lisboa, Unit for Research and Development in Nursing. Lisbon, Portugal.,Universidade Católica Portuguesa, Institute of Health Sciences, PhD in Nursing. Lisbon, Portugal
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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36
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Dithole KS, Thupayagale-Tshweneagae G, Akpor OA, Moleki MM. Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients. BMC Nurs 2017; 16:74. [PMID: 29270079 PMCID: PMC5732530 DOI: 10.1186/s12912-017-0268-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/24/2017] [Indexed: 02/03/2023] Open
Abstract
Background Patients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses’ experience of a communication skills training intervention. Methods A convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis. Results Six themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses. Conclusion The findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training.
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Affiliation(s)
- K S Dithole
- School of Nursing, University of Botswana, Gaborone, Botswana
| | | | - Oluwaseyi A Akpor
- Department of Health Studies, University of South Africa, Pretoria, South Africa.,Department of Nursing, College of Medicine and Health Sciences, Afe Babalola University, KM 8.5 Afe Babalola Way, Ado-Ekiti, Ekiti State PMB 5454 Nigeria
| | - Mary M Moleki
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zamoscik K, Godbold R, Freeman P. Intensive care nurses' experiences and perceptions of delirium and delirium care. Intensive Crit Care Nurs 2017; 40:94-100. [PMID: 28259522 DOI: 10.1016/j.iccn.2017.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/17/2016] [Accepted: 01/01/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore nurses' experiences and perceptions of delirium, managing delirious patients, and screening for delirium, five years after introduction of the Confusion Assessment Method for Intensive Care into standard practice. RESEARCH DESIGN AND SETTING Twelve nurses from a medical-surgical intensive care unit in a large teaching hospital attended two focus group sessions. The collected qualitative data was thematically analysed using Braun and Clarke's framework (2006). FINDINGS The analysis identified seven themes: (1) Delirium as a Secondary Matter (2) Unpleasant Nature of Delirium (3) Scepticism About Delirium Assessment (4) Distrust in Delirium Management (5) Value of Communication (6) Non-pharmacological Therapy (7) Need for Reviewed Delirium Policy. CONCLUSION Nurses described perceiving delirium as a low priority matter and linked it to work culture within the intensive care specialty. Simultaneously, they expressed their readiness to challenge this culture and to promote the notion of providing high-quality delirium care. Nurses discussed their frustrations related to lack of confidence in assessing delirium, as well as lack of effective therapies in managing this group of patients. They declared their appreciation for non-pharmacological interventions in treatment of delirium, suggested improvements to current delirium approach and proposed introducing psychological support for nurses dealing with delirious patients.
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Affiliation(s)
- Katarzyna Zamoscik
- Cambridge University Hospitals, Addenbrooke's Hospital, Intensive Care Unit, Hills Road, Cambridge, CB2 OQQ Cambridgeshire, UK.
| | - Rosemary Godbold
- University of Hertfordshire, Department of Adult Nursing and Primary Care, School of Health and Social Work, Room 2F287 (Wright Building), College Lane, Hatfield, AL10 9AB Hertfordshire, UK.
| | - Pauline Freeman
- University of Hertfordshire, Department of Adult Nursing and Primary Care, School of Health and Social Work, Room 2F279 (Wright Building), College Lane, Hatfield, AL10 9AB Hertfordshire, UK.
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Happ MB, Sereika SM, Houze MP, Seaman JB, Tate JA, Nilsen ML, van Panhuis J, Scuilli A, Baumann BM, George E, Angus DC, Barnato AE. Quality of care and resource use among mechanically ventilated patients before and after an intervention to assist nurse-nonvocal patient communication. Heart Lung 2016; 44:408-415.e2. [PMID: 26354859 DOI: 10.1016/j.hrtlng.2015.07.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/01/2015] [Accepted: 07/04/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS). BACKGROUND SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown. METHODS Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated ≥2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009-2011 with blinded retrospective medical record abstraction. MAIN RESULTS 323/383 (84%) nurses completed training; their communication knowledge (p < .001) and satisfaction and comfort (p < .001) increased. ICU days with physical restraint use (p = .44), heavy sedation (p = .73), pain score documentation (p = .97), presence of ICU-acquired pressure ulcers (p = .78), coma-free days (p = .76), ventilator-free days (p = .83), ICU length of stay (p = .77), hospital length of stay (p = .22), and median costs (p = .07) did not change. CONCLUSIONS SPEACS improved ICU nurses' knowledge, satisfaction and comfort in communicating with nonvocal MV patients but did not impact patient care quality or resource use.
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Affiliation(s)
- Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH, USA; The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | - Susan M Sereika
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Martin P Houze
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jennifer B Seaman
- The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Marci L Nilsen
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jennifer van Panhuis
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea Scuilli
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Derek C Angus
- The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amber E Barnato
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Sharpe B, Hemsley B. Improving nurse–patient communication with patients with communication impairments: hospital nurses' views on the feasibility of using mobile communication technologies. Appl Nurs Res 2016; 30:228-36. [DOI: 10.1016/j.apnr.2015.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 11/23/2022]
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Dithole K, Sibanda S, Moleki MM, Thupayagale-Tshweneagae G. Exploring Communication Challenges Between Nurses and Mechanically Ventilated Patients in the Intensive Care Unit: A Structured Review. Worldviews Evid Based Nurs 2016; 13:197-206. [DOI: 10.1111/wvn.12146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Kefalotse Dithole
- Clinical Nurse Specialist, Department of Health Studies; University of South Africa; Pretoria South Africa
| | - Sambulelwe Sibanda
- Research Fellow, Department of Health Studies; University of South Africa; Pretoria South Africa
| | - Mary M. Moleki
- Professor of Nursing Studies, Department of Health Studies; University of South Africa; Pretoria South Africa
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Abstract
AIMS AND OBJECTIVES This study aimed to identify the approaches used by nurses to address the sensory requirements of patients to respond to the concerns and needs in this area. BACKGROUND Preventing sensory problems is very important for intensive care nurses as these problems may cause various additional health problems in intensive care patients; however, no study has evaluated the approaches used by nurses in this respect. DESIGN The study was conducted as a descriptive study in all internal medicine intensive care units at hospitals located within the borders of the metropolitan municipality in the capital city of Turkey. METHOD Data were collected using case forms that were developed through expert opinions to identify the approaches of nurses for the sensory requirements of patients. The study was conducted with 95 nurses who agreed to be involved in the study of the 107 internal medicine intensive care nurses in the research population. RESULTS Most of the nurses (86.3%) who took part in this study indicated that intensive care patients had sensory requirements, but 80% clarified that their priority was to maintain life support and to meet their physiological needs. Almost all of the nurses were able to accurately identify the specific sensory problems of the six different ones in cases that were assigned to them. However, this ratio decreased when identifying the proper approach for the given sensory requirement. CONCLUSIONS Nurses were able to identify sensory requirements of patients, but they do need support in deciding the appropriate management approach. This study may fill the gap in the literature regarding the approaches of nurses towards sensory requirements and to provide contribution for future research. RELEVANCE TO CLINICAL PRACTICE To help intensive care patients with sensory problems, nurses should routinely assess patients' psychology and should do appropriate interventions.
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Affiliation(s)
| | - Duygu Hiçdurmaz
- Psychiatric Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey
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Tajvar A, Saraji GN, Ghanbarnejad A, Omidi L, Hosseini SSS, Abadi ASS. Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013. Electron Physician 2015; 7:1108-13. [PMID: 26388976 PMCID: PMC4574696 DOI: 10.14661/2015.1108-1113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/23/2015] [Indexed: 11/07/2022] Open
Abstract
Background: Many nurses have reported experiencing high levels of occupational stress in their work environment. Stress, as an outcome of stressful workplaces and tasks, affects nursing behavior in hospital wards. The objectives of this research were to determine the prevalence of occupational stress and mental health problems in nurses in the intensive care unit (ICU) at Shahid Mohammadi Hospital in Bandar Abbas in 2013 and to determine the relationship between occupational stress and mental health. Methods: This cross-sectional study was conducted in 2013 on all of the nurses working in ICU at Shahid Mohammadi Hospital located in Bandar Abbas, Iran. Seventy-two nurses were selected as the population for this study, and all of them were female. Two questionnaires were used in this study, i.e., General Health Questionnaire-28 (GHQ-28) for assessing mental health and an occupational stress test for assessing job stress. Furthermore, the relationship between occupational stress and mental health was examined. One-way analysis of variance (ANOVA), independent samples t-test, and Pearson’s product-moment correlation test were used to analyze the data. Results: High and moderate levels of occupational stress were experienced by 83.9% and 10.7% of ICU nurses, respectively. The prevalence of mental disorders, somatic symptoms, anxiety, social dysfunction, and depression were 58.9, 60.7, 62.5, 71.4, and 10.7%, respectively. The findings of the independent samples t-test showed that somatic symptoms had significant relationships with age and working experience (p = 0.01). According to the independent samples t-test, there were no significant differences between somatic symptoms and working different shifts (p > 0.05). Conclusions: There was a high prevalence of occupational stress among ICU nurses. There was a significant relationship between occupational stress and mental health. Future interventions are needed to codify a comprehensive health program in this field to reduce occupational stress and enhance nurses’ levels of mental health.
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Affiliation(s)
- Abdolhamid Tajvar
- Lecturer of Occupational Health Engineering, Center for Social Determinants in Health Promotion, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Gebraeil Nasl Saraji
- Professor of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Ghanbarnejad
- M.Sc. of Biostatistics, Center for Social Determinants in Health Promotion, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Leila Omidi
- Ph.D. Candidate of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Salehi Sahl Abadi
- Ph.D. Candidate of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
We used a qualitative focus group design to explore the experiences and challenges of nurses who work with hospitalized patients experiencing the sudden inability to verbalize their needs, also known as sudden speechlessness. In response to open-ended questions in facilitated focus groups, 18 nurses discussed issues around the care and communication needs of suddenly speechless (SS) patients. Nurses identified multiple, commonly occurring communication challenges when caring for SS patients. They believed these challenges led to poorer recognition of patient needs, with the potential for compromised patient care. Nurses described how the lack of reliable strategies to facilitate communication sometimes resulted in negative patient outcomes, including unmet psychosocial needs and the potential that informed consent and educational issues were being inadequately addressed for the SS patients. Even experienced nurses indicated ongoing problems in communicating with SS patients, despite using a multitude of strategies, leaving many to deal with issues of frustration and role conflict.
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Guttormson JL, Bremer KL, Jones RM. "Not being able to talk was horrid": A descriptive, correlational study of communication during mechanical ventilation. Intensive Crit Care Nurs 2015; 31:179-86. [PMID: 25579081 DOI: 10.1016/j.iccn.2014.10.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 10/20/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the patient experience of communication during mechanical ventilation. RESEARCH METHODOLOGY This descriptive study is a secondary analysis of data collected to study the relationship between sedation and the MV patients' recall of the ICU. Interviews, conducted after extubation, included the Intensive Care Experience Questionnaire. Data were analysed with Spearman correlation coefficients (rs) and content analysis. SETTING Participants were recruited from a medical-surgical intensive care unit in the Midwest United States. RESULTS Participants (n = 31) with a mean age of 65 ± 11.9 were on the ventilator a median of 5 days. Inability to communicate needs was associated with helplessness (rs = .43). While perceived lack of information received was associated with not feeling in control (rs = 41) and helplessness (rs = 41). Ineffective communication impacted negatively on satisfaction with care. Participants expressed frustration with failed communication and a lack of information received. They believed receipt of information helped them cope and desired a better system of communication during mechanical ventilation. CONCLUSION Communication effectiveness impacts patients' sense of safety and well-being during mechanical ventilation. Greater emphasis needs to be placed on the development and integration of communication strategies into critical care nursing practice.
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Affiliation(s)
- Jill L Guttormson
- Marquette University College of Nursing, P.O. Box 1881, Milwaukee, WI 53210, USA.
| | | | - Rachel M Jones
- Marquette University College of Nursing, 25 N. Franklin St. #2, Madison, WI 53703, USA
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Happ MB, Seaman JB, Nilsen ML, Sciulli A, Tate JA, Saul M, Barnato AE. The number of mechanically ventilated ICU patients meeting communication criteria. Heart Lung 2015; 44:45-9. [PMID: 25261939 DOI: 10.1016/j.hrtlng.2014.08.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/29/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES (1) Estimate the proportion of mechanically ventilated (MV) intensive care unit (ICU) patients meeting basic communication criteria who could potentially be served by assistive communication tools and speech-language consultation. (2) Compare characteristics of patients who met communication criteria with those who did not. DESIGN Observational cohort study in which computerized billing and medical records were screened over a 2-year period. SETTING Six specialty ICUs across two hospitals in an academic health system. PARTICIPANTS Eligible patients were awake, alert, and responsive to verbal communication from clinicians for at least one 12-h nursing shift while receiving MV ≥ 2 consecutive days. MAIN RESULTS Of the 2671 MV patients screened, 1440 (53.9%) met basic communication criteria. The Neurological ICU had the lowest proportion of MV patients meeting communication criteria (40.82%); Trauma ICU had the highest proportion (69.97%). MV patients who did not meet basic communication criteria (n = 1231) were younger, had shorter lengths of stay and lower costs, and were more likely to die during the hospitalization. CONCLUSIONS We estimate that half of MV patients in the ICU could potentially be served by assistive communication tools and speech-language consultation.
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Shafipour V, Mohammad E, Ahmadi F. Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study. Glob J Health Sci 2014; 6:234-44. [PMID: 25363126 PMCID: PMC4825530 DOI: 10.5539/gjhs.v6n6p234] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/18/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. OBJECTIVES The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. DESIGN AND METHODS This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. RESULTS Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). CONCLUSION Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.
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Borhani F, Hosseini SH, Abbaszadeh A. Commitment to care: a qualitative study of intensive care nurses' perspectives of end-of-life care in an Islamic context. Int Nurs Rev 2013; 61:140-7. [PMID: 24382147 DOI: 10.1111/inr.12079] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, end-of-life care is a significant issue and a topic of debate in intensive care settings but understanding of nurses' perspectives about this within an Islamic context is surprisingly lacking. AIM The purpose of this study was to explore intensive care nurses' perspectives of the end-of-life care in South-east of Iran. METHODS A descriptive qualitative research approach was used to engage 12 intensive care nurses from three intensive care units of teaching hospitals affiliated to Kerman University of Medical Science in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. RESULTS Four major categories emerged from analysis of the interviews: commitment to care, awareness of dying patients, caring relationships, and dealing with barriers and ethical issues. The first category was emphasized and appeared dominant in all interviews. LIMITATION Because of specific socio-cultural and environmental factors, the findings of this study may not be applicable in other contexts, but enhance our knowledge about the topic in an Islamic context. CONCLUSIONS This study emphasizes the importance of looking at the end-of-life care for critical terminally ill patients within the context of spiritual milieu associated with commitment to a compassionate care until the last moment of their life. Intensive nurses, faced with various barriers and ethical issues, instead were focused on physical and spiritual care and believed that it should fulfil their role in the challenging process. IMPLICATIONS FOR NURSING AND HEALTH POLICY These findings indicate that there is a need for policies that help increase the quality of life of dying patients. It is imperative that nursing managers and policy makers in Iran consider these findings to improve end-of-life care in intensive setting. More training programmes, further education and research on the topic, should be implemented.
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Affiliation(s)
- F Borhani
- School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman
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Gill FJ, Leslie GD, Grech C, Latour JM. Health consumers' experiences in Australian critical care units: postgraduate nurse education implications. Nurs Crit Care 2013; 18:93-102. [PMID: 23419185 DOI: 10.1111/j.1478-5153.2012.00543.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. BACKGROUND There is an inconsistency in the expected standard of practice to 'qualify' Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. METHOD Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care. FINDINGS Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio-emotional support of patients and family were identified as important for the critical care nurse role. The level of socio-emotional support provided by nurses was reported to be inconsistent. Components of socio-emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy. CONCLUSION Health consumers' views emphasize that socio-emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.
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Affiliation(s)
- Fenella J Gill
- Princess Margaret Hospital for Children, Child & Adolescent Health Services, Perth, WA, Australia.
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