Communicating with Mechanically Ventilated Patients Who Are Awake. A Qualitative Study on the Experience of Critical Care Nurses in Cyprus during the COVID-19 Pandemic.

Abstract

Background: Modern protocols for light sedation in combination with the increased turnover of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients. Methods: The purpose of this study was to explore nurses’ experiences taking care of conscious, intubated patients in the intensive care unit. The research questions aimed to identify i. the strategies that nurses use for communicating with patients, and ii. the barriers in communication between nurses and patients. This study employed a qualitative design. Data were collected using semi-structured interviews with 14 intensive care nurses working at ICUs in four different hospitals of Cyprus. The data were analyzed by applying thematic analysis.Results: We identified several strategies of unaided (movements -lips, hands, legs- facial expressions, gestures, touching) and aided forms of communication (pen and paper, boards, tablets, mobiles) used by nurses to communicate with patients. Additionally, barriers in communication were reported by participating nurses mainly pertaining to patients’, nurses’ characteristics and the ICU environment. The health protocols imposed by the pandemic added more barriers in the communication between nurses and patients mostly related to the use of protective health equipment.Conclusions: The results of this study, combined with those of others in different countries, point to the difficulties nurses face when trying to communicate with conscious patients during mechanical ventilation. It appears that the complex communication needs of this group of patients are not being met mainly due to the lack of nurses’ training and of appropriate equipment to facilitate alternative and augmentative communication. Our study is amongst the first to add that the protective health protocols due to the pandemic imposed further communication barriers. Undoubtedly, the recognition of such an important issue creates an urgent need to educate nurses in alternative ways of communication with mechanically ventilated, conscious patients during their ICU stay.