Review: Communication with invasive mechanically ventilated patients and the use of alternative devices: integrative review

Throughout my career as an intensive care nurse communication with my patient was a prerequisite of all of the care that was undertaken throughout the day. This dated back to my time working within a rehabilitation hospital, where communicating what was wrong, what the treatment was, when the intervention/rehabilitation was going to happen and what level of cooperative work was required from the patient, was almost a natural reflex.

This was further ingrained through experience and from two standout lectures, given early into my nursing studies and postgraduate training in critical care – that all patients need disclosure, compassion and to be treated with the level of empathy one would give to a relative.

It struck me when reading the reviewed study that I had always presumed that mechanically ventilated patients were communicated to by healthcare professionals throughout their time in intensive care. This presumption was based on the fact that this was what I did. It was based on the fact that this was the example I set when in my educator role, shift lead and managerial role. It was the example set by the majority of critical care nurses I worked with. However, two-way communication for sedated, lightly sedated and awake ventilated patients for all patients was not something that was guaranteed to be the priority that the reviewed study suggests it needs to be.

As outlined in the paper, according to a study investigating patients’ experiences in the intensive care unit (ICU) by Alasad et al. (2015), ‘64% of patients wished they knew more about their health status progress in ICU, reflecting that the majority of IMV patient communication with nurses was brief and directed towards informing them about procedures rather than providing an explanation regarding their health condition’.

The effect good communication has on outcomes is very difficult to quantify, but evidential practice will point to an improvement to some patients’ ‘sense of safety and security, and it might decrease the length of patient stay in the ICU (Sizemore, 2014)’.

Excellent points are made relating to communication and the current post-traumatic stress disorder issues linked with time spent in intensive care, which have been raised through the studies by Ely et al. on delirium in critical care.

Does communication exist when a patient is heavily sedated, other than to let them know what procedure is happening at that given moment?

Does looking after an awake patient who is mechanically ventilated allow for open disclosure relating to their condition, or even for ensuring communication beyond procedure mapping?

Should the high-tech world of intensive care not allow us more time to have the opportunity to communicate in a way that will allow for two-way communication between the team and the patient? Yet ‘ICU nurses reported that IMV patients would be at risk of being ignored, neglected and isolated due to ineffective communication (Khalaila et al., 2011)’.

There appears to be a hesitancy among the nursing profession to embrace the use of alternative and augmented communication tools in critical care for various reasons, most strikingly of all relating to concerns about proper access to education relating to their use.

We are happy to talk to you, but engaging in either high-tech or low-tech aids to allow for two-way communication does not come across strongly here.

Although not outlined here, the accomplishment of competency in communication skills through undergraduate and postgraduate education should be a mandatory assessment at both levels, and such a study relating to this would allow for that discussion to commence.

Biography

Derek Cribbin, National Nurse Lead, Critical Care Programme, Health Service Executive, Honorary Clinical Associate and Fellow of the Faculty of Nursing and Midwifery, Royal College of Surgeons Ireland. With a postgraduate diploma in critical care nursing and a Master’s in healthcare management, Derek has been instrumental over the past year in the roll-out of a national foundation education module in critical care nursing which is available to all critical care nurses in the Republic of Ireland. He is the current chairperson of the Irish Association of Critical Care Nurses.