Communication boards in critical care: patients' views

doi:10.1016/j.apnr.2005.09.006

Applied Nursing Research

Volume 19, Issue 4, November 2006, Pages 182-190

https://doi.org/10.1016/j.apnr.2005.09.006 Get rights and content

Abstract

Background

Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication.

Objectives

The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (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.

Methods

Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes.

Results

Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication.

Conclusions

Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.

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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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.
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Citation Excerpt :
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To investigate the feasibility of embedding a brief inservice into an existing undergraduate nursing course, and to determine the feasibility and relevance of AAC use during their clinical ICU rotation.
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Pre-service nursing students responded favorably to a brief inservice embedded into an existing nursing course. Survey data indicated an increase in the students' knowledge of AAC (z = 4.52, p < .05) and awareness that AAC can improve communication between patients and staff (z = 2.24, p < .05).
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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.

View full text

Original ArticleCommunication boards in critical care: patients' views☆

Abstract

Background

Objectives

Methods

Results

Conclusions

Section snippets

Background

Purposes

Review of the literature

Design

Analysis

Description of subjects

Discussion

Conclusion

Acknowledgement

Intensive and Critical Care Nursing

Intensive Care Nursing

Intensive and Critical Care Nursing

Heart and Lung

Care of the critically ill patient: The impact of stress on the use of touch in intensive therapy units

Journal of Advanced Nursing

Communicating with intubated patients

Critical Care Nurse

Minimizing the psychological complications of patients who require mechanical ventilation

Critical Care Nurse

Nonvocal ventilated patients' perceptions of being understood

Western Journal of Nursing Research

ACC intervention in the intensive care unit: The Children's Hospital Boston model

Augmentative and alternative communication

Psychological issues in the ventilator dependent patient

Respiratory Care

The meaning of communication: Experiences with augmentative communication devices

Rehabilitation Nursing

Impaired verbal communication during short term oral intubation

Nursing Diagnosis

Original Article
Communication boards in critical care: patients' views☆