Background The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. Objectives To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. Methods Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. Results Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). Conclusions Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.
This randomized controlled trial tested an intervention, Sharing Patients' Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N = 58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients' deaths and surrogates' end-oflife decision making to assess surrogates' perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants. Keywordsend-stage renal disease (ESRD); African American; end-of-life care; decision making; representational intervention Randomized Controlled Trial of SPIRIT: An Effective Approach to Preparing African American Dialysis Patients and Families for End-of-LifeAdvances in medicine may extend life but often with decreasing quality and escalating dependence on medical technologies (Blank & Merrick, 2005). End-stage renal disease (ESRD) is an example of a chronic illness wherein a technology, dialysis, significantly extends patients' lives but does not necessarily improve the quality of that prolonged survival. The annual mortality rate in this population is high; of 450,000 patients with ESRD, more than 79,000 died in the United States in 2004 (U.S. Renal Data System, 2007. The Renal Physicians Association and American Society of Nephrology (2000) recommend that clinicians initiate timely and continuous discussions with dialysis patients and theirCorresponding author: Mi-Kyung Song, PhD, University of North Carolina at Chapel Hill, School of Nursing, 4108 Carrington Hall, CB # 7460, Chapel Hill, NC 27599-7460, Phone: 919.843.9496, Fax: 919.843.9900, Email: songm@email.unc.edu. The study was conducted at the University of Pittsburgh. NIH Public Access Author ManuscriptRes Nurs Health. Author manuscript; available in PMC 2009 August 3. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript families to assist them in expressing wishes about options in managing their illness and end of life. However, many such discussions are delayed until near death and are narrowly targeted to completion of advance directives (Cherlin, et al., 2005;Covinsky, et al., 2000) despite the widely documented limitations associated with advance directives (Fagerlin & Schneider, 2004;Perkins, 2007).Several factors contribute to the lack of timely end-of-life discussions. Patients and their families may not foresee that death is approaching. This lack of foresight may be due to patients' vacillating between focusing on the illness (having kidney disease) or on the relative wellness they experience from dialysis. Once acclimated to a life on dialysis, patients and their families may have a pe...
Behavioral observation is a fundamental component of nursing practice and a primary source of clinical research data. The use of video technology in behavioral research offers important advantages to nurse scientists in assessing complex behaviors and relationships between behaviors. The appeal of using this method should be balanced, however, by an informed approach to reliability issues. In this paper, we focus on factors that influence reliability, such as the use of sensitizing sessions to minimize participant reactivity and the importance of training protocols for video coders. In addition, we discuss data quality, the selection and use of observational tools, calculating reliability coefficients, and coding considerations for special populations based on our collective experiences across three different populations and settings.
Objective To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients. Design Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurseepatient dyad for communication frequency, quality and success. Patients self-rated communication ease. Setting Two ICUs in a university-affiliated medical center. Participants 89 intubated patients awake, responsive and unable to speak and 30 ICU nurses. Main results Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p < .01). Conclusions This study provides support for the feasibility, utility and efficacy of a multi-level communication skills training, materials and SLP consultation intervention in the ICU.
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