Heart & Lung 43 (2014) 87
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
Editorial
Improving communication in the ICU
Communication between health care providers, patients and families has been identified as the most important and least accomplished factor in quality of care in the intensive care unit (ICU).1 Yet it is well recognized that effective communication for patients in the ICU improves clinical decision-making, and contributes to patient and family satisfaction as well as their psychological well-being.2,3 Clinical practice guidelines for support of the ICU patient and family outline a number of recommendations including frequent communication and repeated care conferencing to reduce family stress and improve consistency in communication.4 For the ICU patient who is intubated, communication is often impaired. The study by Happ and colleagues5 reports on the results of a quasi-experimental study conducted in two ICU’s with 89 patients to assess the impact of two levels of intervention on communication frequency, quality, success and ease between nurses and intubated ICU patients. Nurses received a 4 h basic communication skills training session along with assistive communication tools including notebooks, writing pens, hand grip writing aids and communication boards. In a second phase, nurses received the basic communication training and a 2 h training session on the use of electronic communication devices provided by a speech language pathologist (SLP), along with training in the development of a communication care plan. Video recorded observations of communication interactions were conducted and analyzed for verbal and nonverbal behaviors and communication acts and exchanges, assessing frequency quality, and ease of communication. The results of the study demonstrated that communication frequency (defined as the mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one of the ICU settings. The percent of successful communication exchanges about pain were greater for the two intervention groups compared to the usual care/control groups in both ICU’s (p 0.03) with more successful sessions about pain and other symptoms occurring in the augmentative and alternative communication devices and SLP intervention group. Other studies have demonstrated the positive results from focused communication efforts for patients in the ICU.6e10 A variety of communication strategies in the ICU have been explored including communication boards and other assistive devices. Mobile communication apps are now also available to aid communication11,12 but require further evaluation and testing for ICU patients. The current study adds to the body of literature on the
0147-9563/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2014.01.008
benefits of communication interventions for ICU patients, especially with respect to the impact of focused nurse training in communication techniques and the use of augmentative and alternative communication devices. Addressing barriers to facilitate better communication in the ICU is a priority area to enhance patient safety as well as promote optimal interaction and patient satisfaction. References 1. Arnold R, Nelson J, Prendergast T, et al. Educational Modules for the Critical Care Communication Course. http://www.capc.org/palliative-care-professional-development/Training/c3-module-ipal-icu.pdf; Accessed 12.01.14. 2. Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5): 469. 3. Scheunemann LP, McDevitt M, Carson S, Hanson LC. Systematic review: controlled trials of interventions to improve communication in intensive care. Chest. 2011;139(3):543e554. 4. Davidson J, Powers K, Hedayat K, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force. Crit Care Med. 2007;35: 605e622. 5. Happ MB, Garret K, Tate A, et al. Effect of a multi-level intervention on nursepatent communication in the intensive care unit: results of the SPEACS trial. Heart Lung. 2014;43:89e98. 6. Patak L, Gawlinski A, Fung NI, Doering L, Berg J. Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation. Heart Lung. 2004;33:323e327. 7. Lilly CM, De Meo DL, Sonna LA, et al. An intensive communication intervention for the critically ill. Am J Med. 2000;109:469. 8. MacAulay F, Etchels M, Brodie JK, et al. The Development of ICU-Talk: An AAC Device for Intensive Care Units. http://staff.computing.dundee.ac.uk/ricketts/ cv/preprints/ISAAC_2002_ICUTalk_preprint.pdf; Accessed 10.01.14. 9. Happ MB, Roesch TK, Garrett K. Electronic voice-output communication aids for temporarily nonspeaking patients in a medical intensive care unit: a feasibility study. Heart Lung. 2004;33(2):92e101. 10. Miglietta MA, Bochicchio G, Scalea TM. Computer-assisted communication for critically ill patients: a pilot study. J Trauma. 2004;57(3):488e493. 11. Leibs A. http://assistivetechnology.about.com/od/AugmentativeCommunication/tp/Top-10-Alternative-And-Augmentative-Communication-Aac-Apps.htm; Accessed 12.01.14. 12. Patient Communication App for iPad. http://www.sccm.org/Education-Center/ Clinical-Resources/Pages/Patient-and-Family.aspx; Accessed 12.01.14.
Ruth M. Kleinpell, PhD, RN, FAAN, FCCM* Rush University Medical Center Rush University College of Nursing, USA * Corresponding author. E-mail address: [email protected]
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
Editorial
Improving communication in the ICU
Communication between health care providers, patients and families has been identified as the most important and least accomplished factor in quality of care in the intensive care unit (ICU).1 Yet it is well recognized that effective communication for patients in the ICU improves clinical decision-making, and contributes to patient and family satisfaction as well as their psychological well-being.2,3 Clinical practice guidelines for support of the ICU patient and family outline a number of recommendations including frequent communication and repeated care conferencing to reduce family stress and improve consistency in communication.4 For the ICU patient who is intubated, communication is often impaired. The study by Happ and colleagues5 reports on the results of a quasi-experimental study conducted in two ICU’s with 89 patients to assess the impact of two levels of intervention on communication frequency, quality, success and ease between nurses and intubated ICU patients. Nurses received a 4 h basic communication skills training session along with assistive communication tools including notebooks, writing pens, hand grip writing aids and communication boards. In a second phase, nurses received the basic communication training and a 2 h training session on the use of electronic communication devices provided by a speech language pathologist (SLP), along with training in the development of a communication care plan. Video recorded observations of communication interactions were conducted and analyzed for verbal and nonverbal behaviors and communication acts and exchanges, assessing frequency quality, and ease of communication. The results of the study demonstrated that communication frequency (defined as the mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one of the ICU settings. The percent of successful communication exchanges about pain were greater for the two intervention groups compared to the usual care/control groups in both ICU’s (p 0.03) with more successful sessions about pain and other symptoms occurring in the augmentative and alternative communication devices and SLP intervention group. Other studies have demonstrated the positive results from focused communication efforts for patients in the ICU.6e10 A variety of communication strategies in the ICU have been explored including communication boards and other assistive devices. Mobile communication apps are now also available to aid communication11,12 but require further evaluation and testing for ICU patients. The current study adds to the body of literature on the
0147-9563/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2014.01.008
benefits of communication interventions for ICU patients, especially with respect to the impact of focused nurse training in communication techniques and the use of augmentative and alternative communication devices. Addressing barriers to facilitate better communication in the ICU is a priority area to enhance patient safety as well as promote optimal interaction and patient satisfaction. References 1. Arnold R, Nelson J, Prendergast T, et al. Educational Modules for the Critical Care Communication Course. http://www.capc.org/palliative-care-professional-development/Training/c3-module-ipal-icu.pdf; Accessed 12.01.14. 2. Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5): 469. 3. Scheunemann LP, McDevitt M, Carson S, Hanson LC. Systematic review: controlled trials of interventions to improve communication in intensive care. Chest. 2011;139(3):543e554. 4. Davidson J, Powers K, Hedayat K, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force. Crit Care Med. 2007;35: 605e622. 5. Happ MB, Garret K, Tate A, et al. Effect of a multi-level intervention on nursepatent communication in the intensive care unit: results of the SPEACS trial. Heart Lung. 2014;43:89e98. 6. Patak L, Gawlinski A, Fung NI, Doering L, Berg J. Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation. Heart Lung. 2004;33:323e327. 7. Lilly CM, De Meo DL, Sonna LA, et al. An intensive communication intervention for the critically ill. Am J Med. 2000;109:469. 8. MacAulay F, Etchels M, Brodie JK, et al. The Development of ICU-Talk: An AAC Device for Intensive Care Units. http://staff.computing.dundee.ac.uk/ricketts/ cv/preprints/ISAAC_2002_ICUTalk_preprint.pdf; Accessed 10.01.14. 9. Happ MB, Roesch TK, Garrett K. Electronic voice-output communication aids for temporarily nonspeaking patients in a medical intensive care unit: a feasibility study. Heart Lung. 2004;33(2):92e101. 10. Miglietta MA, Bochicchio G, Scalea TM. Computer-assisted communication for critically ill patients: a pilot study. J Trauma. 2004;57(3):488e493. 11. Leibs A. http://assistivetechnology.about.com/od/AugmentativeCommunication/tp/Top-10-Alternative-And-Augmentative-Communication-Aac-Apps.htm; Accessed 12.01.14. 12. Patient Communication App for iPad. http://www.sccm.org/Education-Center/ Clinical-Resources/Pages/Patient-and-Family.aspx; Accessed 12.01.14.
Ruth M. Kleinpell, PhD, RN, FAAN, FCCM* Rush University Medical Center Rush University College of Nursing, USA * Corresponding author. E-mail address: [email protected]
