Original ArticleCommunication boards in critical care: patients' views☆
Section snippets
Background
Patients receiving mechanical ventilation have reported communication difficulties as their number one problem while intubated (Gries & Fernsler, 1988, Johnson & Sexton, 1990, Rotundi et al., 2002, Stovsky et al., 1988). Patients' inability to communicate results in unrecognized pain, feelings of loss of control, depersonalization, anxiety, fear, distress, and frustration (Criner & Isaac, 1995, Dickerson et al., 2002, Gries & Fernsler, 1988, Hafsteindottir, 1996, Heath, 1989, Johnson & Sexton,
Purposes
The purposes of this study were as follows:
- 1.
To identify patients' perceived level of frustration when attempting to communicate during mechanical ventilation;
- 2.
To determine patients' perceived level of frustration if a communication board had been used; and
- 3.
To describe patients' perceptions of the appropriate content and format of a communication board for patients receiving mechanical ventilation.
This study will extend the body of literature on communication techniques used by patients receiving
Review of the literature
Published case studies and other clinical literature have predominantly described the need to use communication boards and other assistive communication devices for patients receiving mechanical ventilation. These devices range from simple pencils and papers, to alphabet/word/picture boards, to computer keyboards (Adomat & Killingworth, 1994, Belitz, 1983, Happ, 2001, Williams, 1992). Although many authors suggest a picture board for use with patients during mechanical ventilation, they rarely
Design
An exploratory descriptive design involving both qualitative and quantitative analyses was used. Data reported here are part of a larger descriptive study of the communication needs of 29 critically ill patients receiving ventilator support (Patak, Gawlinski, Fung, Doering, & Berg, 2004). The principal investigator spent 20–60 minutes interviewing each patient using a questionnaire consisting of 13 questions. Those questions had been developed based on researchers' 25 years of collective
Analysis
The interviews were all tape-recorded and then transcribed verbatim. Two researchers independently examined each transcription and analyzed each one for statements related to receiving mechanical ventilation. Then the two researchers shared their extracted statements and agreed upon a meaning, or theme, for each of the statements. Each transcript was then transferred verbatim, according to its assigned theme, into a qualitative research computer program (Nudist). Qualitative data were analyzed
Description of subjects
Thirty-two patients met the criteria for inclusion in the study. Two patients were excluded because they were too tired to complete the interview. Another subject was excluded because of a technical problem with recording that prevented a verbatim transcript from being generated. Data for the remaining 29 subjects were analyzed. Most patients were male (65.5%; n = 19). The mean age of the subjects was 55.5 years (SD = 17.3 years). The most common primary diagnosis among the participants was
Discussion
Our findings indicate that some patients receiving mechanical ventilation experience a high level of frustration in communicating their needs and that the use of a communication board might reduce frustration. The majority of subjects thought that a communication board would have significantly decreased the level of frustration they had experienced during mechanical ventilation. Subjects identified a communication board as a tool to increase the speed and efficiency of communicating what they
Conclusion
Our results allow health care practitioners to see the communication needs of patients receiving ventilator support through the eyes of the patients themselves after recovery from intubation and mechanical ventilation. This information offers insights into levels of frustration that patients experience when attempting to communicate during mechanical ventilation. A communication board may be effective in decreasing frustration and in facilitating communication. Patients also described several
Acknowledgement
This project was funded by a research grant from Sigma Theta Tau, Gamma Tau Chapter.
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Institution project completed: University of California-Los Angeles Medical Center and School of Nursing, Rm. 14-176 CHS, 10833 Le Conte, Los Angeles, CA 90095.