Advertisement

The Power of Communication

  • Jackie McRaeEmail author
  • Aeron Ginnelly
  • Helen Newman
  • Gemma Clunie
  • Mari Viviers
Chapter
  • 50 Downloads

Abstract

Whilst the goal of intensive care is to maintain life and ideally restore a person’s health through complex management of multiple bodily systems, an unintended consequence of these interventions is a loss of awareness and control of their unfamiliar environment. Our ability to speak enables us to manipulate and modify the information we receive, to help the process of adaptation. With technological advancements, many more people are surviving ICU although many report distorted memories and traumatic experiences often through the lack of being able to speak to the people around them, to verify their thoughts and allay their fears and anxieties. Facilitating communication is an important role for all healthcare staff, and the skill and expertise of speech and language therapists (SLT) can help to maximise opportunities for effective communication through either verbal or non-verbal means. In turn, this improves the quality of the experience of intensive care and aids psychological and emotional recovery alongside physical improvement. This chapter shares the importance of communication, the impact of communication impairment on the patient and those around them, and provides a range of methods to support communication.

Keywords

Communication Speech Aphonia Critical care Tracheostomy 

References

  1. 1.
    van Dijk TA. Discourse and context: a sociocognitive approach. Cambridge: Cambridge University Press; 2008.CrossRefGoogle Scholar
  2. 2.
    Radtke JV, Baumann BM, Garrett KL, Happ MB. Listening to the voiceless patient: case reports in assisted communication in the intensive care unit. J Palliat Med. 2011;14(6):791–5.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Happ MB. Interpretation of nonvocal behavior and the meaning of voicelessness in critical care. Soc Sci Med. 2000;50(9):1247–55.PubMedCrossRefGoogle Scholar
  4. 4.
    Pang PSK, Suen LKP. Stressors in the ICU: a comparison of patients’ and nurses’ perceptions. J Clin Nurs. 2008;17(20):2681–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Khalaila R, Zbidat W, Anwar K, Bayya A, Linton DM, Sviri S. Communication difficulties and psychoemotional distress in patients receiving mechanical ventilation. Am J Crit Care. 2011;20(6):470–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002;30(4):746–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Bergbom-Engberg I, Haljamae H. Assessment of patients’ experience of discomforts during respirator therapy. Crit Care Med. 1989;17(10):1068–72.PubMedCrossRefGoogle Scholar
  8. 8.
    Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012;308(19):1985–92.PubMedCrossRefGoogle Scholar
  10. 10.
    UK National Tracheostomy Safety Project. National Tracheostomy Safety Manual; 2013.Google Scholar
  11. 11.
    Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016;150(5):1129–40.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Brookshire RH, McNeil MR. Introduction to neurogenic communication disorders. 8th ed. St Louis, MO: Mosby; 2015. ix, 500-ix, p.Google Scholar
  13. 13.
    Ward EC, van As-Brooks CJ. Head and neck cancer: treatment, rehabilitation, and outcomes. 2nd ed. San Diego, CA: Plural Publishing; 2014. 640 p.Google Scholar
  14. 14.
    Mohamed EE, El-Maghraby RA. Voice changes in patients with chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberculosis. 2014;63(3):561–7.CrossRefGoogle Scholar
  15. 15.
    Rosenthal LH, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope. 2007;117(10):1864–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Karlsson V, Lindahl B, Bergbom I. Patients’ statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study. Nurs Inq. 2012;19(3):247–58.PubMedCrossRefGoogle Scholar
  17. 17.
    Happ MB, Sereika SM, Houze MP, Seaman JB, Tate JA, Nilsen ML, et al. Quality of care and resource use among mechanically ventilated patients before and after an intervention to assist nurse-nonvocal patient communication. Heart Lung. 2015;44(5):408–15.e2.PubMedCrossRefGoogle Scholar
  18. 18.
    Carroll SM. Silent, slow lifeworld: the communication experience of nonvocal ventilated patients. Qual Health Res. 2007;17(9):1165–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Laerkner E, Egerod I, Olesen F, Hansen HP. A sense of agency: an ethnographic exploration of being awake during mechanical ventilation in the intensive care unit. Int J Nurs Stud. 2017;75:1–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Alasad J, Ahmad M. Communication with critically ill patients. J Adv Nurs. 2005;50(4):356–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: a mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs. 2018;46:10–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Morris LL, Bedon AM, McIntosh E, Whitmer A. Restoring speech to tracheostomy patients. Crit Care Nurse. 2015;35(6):13–28.PubMedCrossRefGoogle Scholar
  23. 23.
    Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Quality of life improves with return of voice in tracheostomy patients in intensive care: an observational study. J Crit Care. 2016;33:186–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Magnus VS, Turkington L. Communication interaction in ICU—patient and staff experiences and perceptions. Intensive Crit Care Nurs. 2006;22(3):167–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Todres L, Galvin KT, Holloway I. The humanization of healthcare: a value framework for qualitative research. Int J Qual Stud Health Well Being. 2009;4(2):68–77.CrossRefGoogle Scholar
  26. 26.
    Happ MB, Garrett K, Thomas DD, Tate J, George E, Houze M, et al. Nurse-patient communication interactions in the intensive care unit. Am J Crit Care. 2011;20(2):e28–40.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    ten Hoorn S, Elbers PW, Girbes AR, Tuinman PR. Communicating with conscious and mechanically ventilated critically ill patients: a systematic review. Crit Care. 2016;20(1):333.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Menzel LK. Factors related to the emotional responses of intubated patients to being unable to speak. Heart Lung. 1998;27(4):245–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Happ MB. The power and importance of accommodation for communication impairment in the intensive care unit. Ann Am Thorac Soc. 2016;13(8):1215–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Happ MB, Garrett KL, Tate JA, Divirgilio D, Houze MP, Demirci JR, et al. Effect of a multi-level intervention on nurse–patient communication in the intensive care unit: results of the SPEACS trial. Heart Lung. 2014;43(2):89–98.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Radtke JV, Tate JA, Happ MB. Nurses’ perceptions of communication training in the ICU. Intensive Crit Care Nurs. 2012;28(1):16–25.PubMedCrossRefGoogle Scholar
  32. 32.
    Tate JA, Sereika S, Divirgilio D, Nilsen M, Demerci J, Campbell G, et al. Symptom communication during critical illness: the impact of age, delirium, and delirium presentation. J Gerontol Nurs. 2013;39(8):28–38.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Broyles LM, Tate JA, Happ MB. Use of augmentative and alternative communication strategies by family members in the intensive care unit. Am J Crit Care. 2012;21(2):e21–32.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Intensive Care Society. Intensive Care Society review of best practice for analgesia and sedation in the critical care. 2014. https://www.ics.ac.uk/ICS/GuidelinesStandards/ICS_Guidelines/ICS/GuidelinesAndStandards/ICSGuidelines.
  35. 35.
    Faculty of Intensive Care Medicine, Intensive Care Society. Guidelines for the Provision of Intensive Care Services (GPICS) Edition 2. 2019. https://www.ficm.ac.uk/sites/default/files/gpics-v2.pdf.
  36. 36.
    Jesus LMTD, Simões JFFL, Voegeli D. Comunicação verbal com pacientes inconscientes. Acta Paulista de Enfermagem. 2013;26(5):506–13.CrossRefGoogle Scholar
  37. 37.
    Patak L, Gawlinski A, Fung NI, Doering L, Berg J, Henneman EA. Communication boards in critical care: patients’ views. Appl Nurs Res. 2006;19(4):182–90.PubMedCrossRefGoogle Scholar
  38. 38.
    Otuzoglu M, Karahan A. Determining the effectiveness of illustrated communication material for communication with intubated patients at an intensive care unit. Int J Nurs Pract. 2014;20(5):490–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Kagohara DM, Van Der Meer L, Ramdoss S, O’Reilly MF, Lancioni GE, Davis TN, et al. Using iPods® and iPads® in teaching programs for individuals with developmental disabilities: a systematic review. Res Dev Disabil. 2013;34(1):147–56.PubMedCrossRefGoogle Scholar
  40. 40.
    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):92–101.PubMedCrossRefGoogle Scholar
  41. 41.
    Maringelli F, Brienza N, Scorrano F, Grasso F, Gregoretti C. Gaze-controlled, computer-assisted communication in Intensive Care Unit: “speaking through the eyes”. Minerva Anestesiol. 2013;79(2):165–75.PubMedGoogle Scholar
  42. 42.
    Sutt AL, Fraser JF. Patients want to be heard-loud and clear! Crit Care. 2017;21(1):6.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Donzelli J, Brady S, Wesling M, Theisen M. Secretions, occlusion status, and swallowing in patients with a tracheotomy tube: a descriptive study. Ear Nose Throat J. 2006;85(12):831–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Prigent H, Orlikowski D, Blumen MB, Leroux K, Legrand L, Lejaille M, et al. Characteristics of tracheostomy phonation valves. Eur Respir J. 2006;27(5):992–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Sutt AL, Caruana LR, Dunster KR, Cornwell PL, Anstey CM, Fraser JF. Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation—do they facilitate lung recruitment? Crit Care. 2016;20:91.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Sutt AL, Cornwell P, Mullany D, Kinneally T, Fraser JF. The use of tracheostomy speaking valves in mechanically ventilated patients results in improved communication and does not prolong ventilation time in cardiothoracic intensive care unit patients. J Crit Care. 2015;30(3):491–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Return of voice for ventilated tracheostomy patients in ICU: a randomized controlled trial of early-targeted intervention. Crit Care Med. 2016;44(6):1075–81.PubMedCrossRefGoogle Scholar
  48. 48.
    Sutt AL, Fraser JF. Speaking valves as part of standard care with tracheostomized mechanically ventilated patients in intensive care unit. J Crit Care. 2015;30(5):1119–20.PubMedCrossRefGoogle Scholar
  49. 49.
    Heimer J, Eggert S, Fliss B, Meixner E. Fatal bilateral pneumothorax and generalized emphysema following contraindicated speaking-valve application. Forensic Sci Med Pathol. 2019;15(2):239–42.PubMedCrossRefGoogle Scholar
  50. 50.
    Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29(5):1033–56.PubMedCrossRefGoogle Scholar
  51. 51.
    McGrath B, Lynch J, Wilson M, Nicholson L, Wallace S. Above cuff vocalisation: a novel technique for communication in the ventilator-dependent tracheostomy patient. J Intensive Care Soc. 2015;17(1):19–26.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Jackie McRae
    • 1
    Email author
  • Aeron Ginnelly
    • 2
  • Helen Newman
    • 3
  • Gemma Clunie
    • 4
  • Mari Viviers
    • 5
  1. 1.St George’s University Hospitals NHS Foundation TrustLondonUK
  2. 2.Critical Care and NeurosciencesRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
  3. 3.Critical Care, Respiratory and SurgeryBarnet Hospital, Royal Free London NHS Foundation TrustLondonUK
  4. 4.Airways/ENT, Charing Cross HospitalLondonUK
  5. 5.Evelina London Children’s Hospital, St Thomas’ HospitalLondonUK

Personalised recommendations