Some patients receiving mechanical ventilation experience an increased need to communicate while their ability to do so is compromised as the endotracheal tube limits speech. In such cases, a communication board can be used to address the need. The objective is to reduce perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate. Most of the patients feel that their perceived level of frustration in communicating their needs would be lower if a communication board had been offered. A communication board may be an effective intervention for decreasing patients’ frustration and facilitating communication. Further research is needed to test the impacts of a communication board and other methods of facilitating communication on results such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and period of mechanical ventilation and hospital stay.
Patients receiving mechanical ventilation have reported communication difficulties as their number one problem while intubated (Gries & Fernsler, 1988; Johnson & Sexton, 1990; Rotundi et al., 2002; Stovsky, Rudy, & Dragonette, 1988). Patient’s inability to communicate results in unrecognised pain, anxiety, depersonalization, fear, frustration and distress. (Criner & Isaac, 1995; Dickerson, Stone, Panchura, & Usiak, 2002; Gries & Fernsler, 1988; Hafsteindottir, 1996; Heath, 1989; Johnson & Sexton, 1990; Riggio, Singer, Hartman, & Sneider, 1982; Stein-Parbury & McKinley, 2000). Patients get anxious when their needs are not met during the duration of mechanical ventilation because of their inability to communicate with family and health care providers (Levine, Koester, & Ket, 1987). There is a cycle of confusion involving misinterpretations and misunderstanding between nurses and patients during attempts to convey messages (Carroll, 2004). Anxiety and frustration grows up and contribute to the negative emotions such as feelings of dependency, dehumanisation, and hopelessness (Carroll, 2004). Patients have described their inability to interact during mechanical ventilation as frustrating, (Fowler, 1997; Happ, Tuite, Dobbin, DiVigilio-Thomas, & Kitutu, 2004). Interventions that health care practitioners can use include interpreting a patient’s nonverbal forms of communication such as mouthing, nodding, gesticulating, and writing. Such nonverbal ways on interacting not only require energy but are tiring and emotionally draining for the patients. Health care practitioners recommended the use of a board as an interference to improve communication. (Adomat & Killingworth, 1994; Belitz, 1983; Happ, 2001; Martensson & Fridlund, 2002; Williams, 1992). Appel-Hardin (1984) stated the components of a communication board, wherein patients can quickly point to the letters, words, or pictures. Williams (1992) showed an algorithm for selecting a communication technique, including various types of boards, for use in patients during mechanical ventilation. However, little systematic research has approached whether communication boards have the potential to improve communication in intubated patients. Furthermore, the optimal content for communication card in ICUs is not known. Thus, further research is required to examine patients’ perceptions of the use of communication board and to recognise the content and format patients want on a communication board.
Published case studies and other clinical research have predominantly explained the need to use communication boards and other assistive communication devices for patients undergoing mechanical ventilation. These devices range from simple pencils and papers to words, alphabets, computer keyboards and picture boards (Adomat & Killingworth, 1994; Belitz, 1983; Happ, 2001; Williams, 1992). Although several authors suggest a picture board for practice with patients during mechanical ventilation, they rarely explain what the board consists of, what patients mostly ask for on the board, and whether the board is helping patients or not (Adomat & Killingworth, 1994; Belitz, 1983; Happ, 2001; Martensson & Fridlund, 2002; Stovsky et al., 1988; Williams, 1992).
1. A pre-printed communication board is more efficient and faster than writing
- Positive comments included using the board to increase the efficiency and speed of communication with pre-printed text.
- One patient stated: extremely helpful because it speeds up the process of communication. This is very efficient. You don’t need much time to write it down.
- Other patients’ comments reflected the thoroughness of the board: This has most of the questions I wanted to ask.
2. A pre-printed communication board facilitate patients’ communication of their emotional needs and conveyance of their identity
- Patients also expressed their emotional needs, as well as recognition of their status using the board.
- One patient explained the benefits of the board as follows:
It would create an interface between the patient and the staff that would, in a way, formalise the requirement that they pay attention to what the patient is trying to convey. It would be like a passport. Even if the patient doesn’t use it, could wave it, say ‘I matter. I can be heard. It’s not just about you acting on me. It’s about me being capable of telling you what I want, what I’m doing’. I believe this concept itself is powerful because it would obligate the staff to both stops and listen with a fresh ear, rather than saying, Oh well, they’re intubated. They can’t talk. Let’s just write them off. It could inspire, that is to say, in still hope and empower those who are not as strong-willed as I am.
Communication board may be useful in decreasing frustration and in facilitating communication. Patients also described several advantages of a communication card with pre-printed text:
(1) It enhances the efficiency and speed of communication;
(2) It facilitates the meeting of needs; and
(3) It acts as a vehicle to get recognition of patients’ individuality.
Further research is required to assess the use of pre-printed communication cards and other methods of facilitating communication concerning increasing patients’ satisfaction, lessening patients’ anxiety, and achieving adequate and appropriate pain management. It may also be beneficial to study the experiences of families and nurses in using the card. Other areas of investigation relating to the utilisation of a pre-printed communication board include examining its potential impact on shortening the duration of intubation and mechanical ventilation and on reducing the length of hospital stay by encouraging a more expedient weaning from mechanical ventilation.
- Adomat, R., & Killingworth, A. (1994). Care of the critically ill patient: The impact of stress on the use of touch in intensive therapy units. Journal of Advanced Nursing, 19, 912–922.
- Fried-Oaken, M., Howard, J., & Stewart, S. (1991). Feedback on AAC intervention from adults who are temporarily unable to speak. Augmentative and Alternative Communication, 7, 43–50.
- 4. Patak, L., Gawlinski, A., Fung, I., Doering, L., & Berg, J. (2004). Patients’ reports of frustrations and health care practitioner interventions during mechanical ventilation. Heart and Lung, 33(3), 1– 14.