Use of electronic communication aids by temporarily nonvocal patients in the ICU

Purpose: To examine the enactment and progression of assistive and augmentative communication (AAC) device use by nonvocal intensive care unit (ICU) patients during nurse-patient communication over two days. \ud Background: Patient-nurse communication in the ICU is a complex process. Endotracheal intubation or tracheostomy renders patients temporarily unable to speak. ICU nurses occupy a crucial role in facilitating patient communication. The Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS) presented basic communication skills training and training in electronic communication devices to nurses in two ICUs to improve communication with nonvocal patients. \ud Methods: We used a descriptive multiple case study design and applied microanalytic communication coding with descriptive analysis using primarily qualitative techniques. A subset of patients (n = 9) who were physically (i.e., upper motor) and cognitively intact (RASS = 0, CAM-ICU negative for delirium), throughout all study observations was extracted from the SPEACS sample. The patients were > 21 years old, intubated, scored 13 on the Glasgow Coma Scale, and received a communication plan and electronic AAC device matched to patient ability and preference from a speech language pathologist. For two days directly after the plan was developed, the nurse-patient dyad was videotaped four times (twice daily) during routine care. The full-length videos (3:25-19:38 minutes) were coded for patient use of natural, low tech AAC, and high tech AAC communication modality; nurse facilitative behaviors/strategies; and patient communication topic. \ud Results/Conclusion: Five patients used the high tech AAC device during observation; 4 patients did not. The Lightwriter device was most common (n=4) and most popular among the high tech AAC users. Nurse facilitative behaviors were observed with 7 dyads; positioning the high tech device appropriately was the most common facilitative behavior for patients who used high tech AAC. The most common topics were comfort care/needs, patient’s condition, and greetings/small talk. These were also common topics during high tech AAC communication. All patients used multiple communication modalities and used natural communication modalities most frequently. Although the pattern of AAC use over time differed among the patients, communication rates dropped in most (8/9) cases during session 4. This information regarding how patients use AAC devices may help nurses to better predict their patients’ communication needs and to facilitate effective communication.\u