Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation

doi:10.1016/j.hrtlng.2004.02.002

Heart & Lung

Volume 33, Issue 5, September–October 2004, Pages 308-320

https://doi.org/10.1016/j.hrtlng.2004.02.002 Get rights and content

Abstract

Background

The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients’ perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients’ perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient.

Objectives

Methods

A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes.

Results

It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r = .109, P = .573) or between the diagnosis and the level of frustration (P = .932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P = .084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and “absent” from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner.

Conclusions

Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient’s experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.

Introduction

Mechanically ventilated patients experience many barriers to communicating their needs.1 Patients have reported that their inability to communicate results in unrecognized pain, feelings of loss of control and depersonalization, anxiety, fear, distress, and frustration.2, 3, 4, 5, 6, 7, 8 According to Levine et al,9 the lack of ability to communicate with care providers and family during periods of mechanical ventilation results in high-risk situations and increases patient anxiety and frustration because life-threatening needs may not be met. Patients receiving mechanical ventilation have reported communication difficulties as their number 1 problem while being intubated.5, 8, 10

Health care practitioner interventions often include interpreting patients’ nonverbal forms of communication such as mouthing, gesticulating, nodding, and writing. Such nonverbal methods require excess energy and are fatiguing and emotionally draining for these patients. Previous literature supports health care practitioner interventions in facilitating communication in mechanically ventilated patients. However, limited research exists on the patient’s perception of the helpfulness of these interventions.2, 11, 12 Furthermore, previous research studies have not yet reported the actual level of frustration experienced by mechanically ventilated patients. Therefore, research is needed to investigate these areas.

This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient. This study will add to the body of knowledge regarding communication in mechanically ventilated patients by reporting the actual level of frustration these patients experience and exploring their perception of the methods used by the heath care practitioner during communication.

Section snippets

Review of literature

In the last 20 years, research studies related to mechanical ventilation have focused on the experiences of the patient and his or her communication with the health care practitioner. First, the experiences of patients who required mechanical ventilation were explored in 3 qualitative studies (Table 1). Jablonski13 interviewed 12 participants who were intubated and mechanically ventilated 2 to 108 months after their intensive care unit (ICU) experience. All were initially orally or nasally

Design

The research method was an exploratory descriptive design with both qualitative and quantitative analysis. Data from this report are part of a larger descriptive study that explores the communication needs of 29 mechanically ventilated, critically ill patients. Subjects who signed the informed consent participated in an audiotaped interview session lasting 20 to 60 minutes. The principal investigator interviewed patients using a questionnaire consisting of 13 questions (Appendix A). The

Analysis

Quantitative data were analyzed by using the Statistical Package for the Social Sciences 10.0 (SPSS Inc, Chicago, Ill). Descriptive and frequency analyses were performed on all demographic data. All interviews were tape-recorded and then transcribed verbatim. Each transcription was examined separately by 2 researchers and individually analyzed for statements that related to the experience of being mechanically ventilated. Together, the 2 researchers shared their extracted statements and agreed

Description of subjects

Two of the 32 subjects were excluded from the study because of fatigue and inability to complete the interview. One additional subject was excluded because of a technical problem with recording the interview, and so verbatim audiotaped content of the interview was not possible. Data analysis was completed for 29 subjects. The majority of the participants were male (65.5%, n = 19). The mean age of the participants was 55 years (SD, 17.27 years). The most common primary diagnoses of the

Discussion

Mechanically ventilated patients are unable to vocalize feelings, verify perceptions, and cope with fears, anxiety, and stress through verbal communication.11 Heath7 reported that mechanically ventilated patients are desperate in making themselves understood and that nurses dismiss patients’ communication efforts. Previous studies have suggested interventions that alleviate patients’ legitimate fears and preserve their identity and dignity. These interventions included talking, explaining,

Conclusion

The results of this study permit health care practitioners to see the communication needs of mechanically ventilated patients through the eyes of the patient. Patients report being frustrated in their attempts to make their needs known and further acknowledge the role of the critical care nurse in bridging the communication gap. This information offers insight into the actual level of frustration patients experience when attempting to communicate while being mechanically ventilated. Patients

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Issues in respiratory nursingPatients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation

Abstract

Background

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Review of literature

Design

Analysis

Description of subjects

Discussion

Conclusion

Intensive Crit Care Nurs

Intensive Crit Care Nurs

Intensive Crit Care Nurs

Heart Lung

Communicating with mechanically ventilated patientsstate of the science

AACN Clin Issues

Patients’ experiences of being in an intensive care unita select literature review

Am J Crit Care

Psychological issues in the ventilator-dependent patient

Respir Care

Distress during mechanical ventilationpatients’ perceptions

Crit Care Nurse

Psychological issues in the care of critically ill respirator patientsdifferential perceptions of patients, relatives, and staff

Psychol Rep

Patient perceptions of the mechanical ventilation experience

Focus Crit Care

Issues in respiratory nursing
Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation