Effective communication between patients and their health-care providers is an essential part of care but communicating is not always as easy as it sounds.
For example, language differences can interfere with communication, as can cultural backgrounds. A lack of health literacy is another significant stumbling block. If a patient doesn’t understand the basic medical information that’s needed to make informed health-care decisions, this knowledge gap can lead to poor medication adherence, increased mortality, and increased hospital readmissions and trips to the ER.
But what if the patient’s ability to speak is affected during a hospital stay? This is especially common in the intensive care unit of a hospital, where a patient with a critical illness may be on a ventilator, or had a stroke that impacts language. Studies have found that a large percentage of intubated ICU patients rated communicating with nurses as difficult, even when it concerned pain. Indeed, “patients have ranked an inability to speak as one of the most stressful experiences while being ventilated in the ICU,” said Randy Dubin, MA, CCC-SLP, Speech Pathology team leader at the Hospital of the University of Pennsylvania.
Unable to make themselves understood leaves patients with feelings of frustration, stress, anxiety, and hopelessness. “Barriers to verbal communication may lead to a sense of loss of control and extreme vulnerability,” Dubin said, noting that “patients are not sedated as much today and they want to be able to communicate and be part of the health care team.”
A new program in HUP’s intensive care units is helping critical care nurses respond to the communication needs of their patients. An important component of the program, which all ICU nurses complete, is the SPEACS-2 (Study of Patient-Nurse Effectiveness with Assisted Communication Strategies) training, an online program which helps to build nurses' skills in assessing ICU patients who are unable to speak. By following the SPEACS-2 algorithm, nurses can measure the patient’s cognitive, sensory, and motor capabilities. Then, using this information, the nurse determines which communication strategies are best for that patient and creates an individualized communication care plan that is placed in the patient’s room so all health-care providers – and family members – can work with the plan strategies to communicate with the patient.
This initiative also includes communication carts in each of the hospital’s ICUs containing Augmentative and Alternative Communication (AAC) materials and resources to improve communication with non-verbal patients. For example, “low tech” AAC might include communication boards, with pictures of needs, and alphabet boards. “High tech” ACC includes an iPad with translation and communication apps. Bethany Young, MSN, RN, clinical nurse specialist in the Neuroscience ICU, said that iPads may be easier for some patients who find it difficult to hold a notepad and pen. Also, using the iPad “enables families to get more involved,” Dubin said. “They can use their own iPads and download some free apps to help them communicate with a loved one.”
The introduction of training and resources is being carefully studied to determine both the patient and nurse responses, said Mary Walton, MSN, MBE, director of Patient and Family Centered Care at HUP. “Early findings of this initiative indicate improvement in the ease of communication by patient self-report,” she said. Also, thanks to both the SPEACS-2 training and the easy accessibility of the communication carts, nurses are using more of the strategies and tools with nonverbal patients. There is also a very high percentage of Communication Care Plans developed and posted in patients room to assist in relaying patient specific communication tips and strategies.
Giving patients back the ability to communicate goes beyond just discussing medical needs. “Nurses can now help patients convey their feelings, talk about what the patient is interested in,” Walton said. “We want to see the ‘person,’ not just a patient.”
Photo caption: Clare Kohler of the Medical Intensive Care Unit uses an iPad to help communicate with William Sanchez.