Communication is an essential component of effective care in the hospital setting, especially in the ICU where patients can experience altered communication abilities due to their critical illness. Patient outcomes are influenced by patients' abilities to communicate effectively and participate in their care.
The importance of communication and its impact on patient outcomes is recognized by several entities, including The Joint Commission, American Association of Critical-Care Nurses (AACN), Society of Critical Care Medicine (SCCM) and NIH.1-3
Recent recommendations from the American College of Chest Physicians and the AACN focus on the importance of skilled communication as an essential element of providing care for acute and critically ill patients.4SCCM's clinical practice guidelines for patient-centered care in the ICU also advocate for effective communication to enhance care for patients in the ICU.5
Patients in the ICU can experience altered communication abilities due to their critical illness (e.g., extreme weakness, fatigue, immobilization, deconditioning) and various treatments (e.g. intubation, tracheostomy). Barriers to verbal communication, such as endotracheal intubation and mechanical ventilation, can prevent speech, making communication difficult.
The administration of sedative medications also may limit the ability of the patient to understand information.6In addition, patients may experience communication difficulties and disabilities, including linguistic, cultural, behavioral and physical barriers (e.g., the patient wears glasses or uses hearing aids or the patient does not speak/understand English).
Ensuring adequate communication for patients in the ICU is an important priority area for nursing care as communication difficulties and disabilities experienced by patients may increase their risk for adverse events or medical errors.7,8
Patients in the ICU who are unable to communicate verbally may use nonverbal communication techniques to relate their needs, such as mouthing words, writing or using gestures. However, these techniques, which can be subjectively interpreted by communication partners, may lead to misinterpretation of patient intent, further contributing to patient frustration and distress.9-13Still, patients report employing communication aids such as prefabricated patient communication boards can reduce their frustration with the inability to verbally communicate.14
Tools & Strategies
Several tools and strategies can be used to enhance communication in the ICU for patients with altered communication abilities. Many patients may be candidates for augmentative communication tools like alphabet or communication boards and other readily available resources, such as pen and paper, which should be available at the bedside.
An augmentative communication consultation with speech-language pathology services may yield more patient-specific tools and strategies. Further, strategies such as the use of qualified healthcare interpreters, communication skills training and family care conferences are critical toward addressing the complex needs of a patient who cannot effectively communicate in the healthcare setting.
Patients who are hearing-impaired and rely on hearing aids or are vision-impaired and need glasses should have access to these devices as soon as the procedure or test that restricted access is complete. This simple solution can often be overlooked or dismissed, secondary to the presumption that a patient is not ready or has her needs met adequately by a family member.
All devices essential for communication should be documented in the patient's plan of care. To optimize both nurse and patient efforts in overcoming communication impairments, such tools should be evidence-based when available.
Readily available resources to aid in communication should not only be present in the ICU, but also a mainstay of the patient's daily plan of care. In addition, healthcare practitioners should be trained to value the importance of using such devices identified in the patient's plan for care.
Adopting patient communication assessment and interventions as routine care for patients in the ICU can be formally incorporated using an ICU Daily Goals worksheet. This worksheet incorporates patient communication into the plan of care and allows for the daily assessment and evaluation of effectiveness of communication aids, resources and interventions, as well as the need to request a referral to a communication specialist when point-of-care resources fail to achieve stated goals.15-18