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Nurses Help Tracheostomy Patients Regain Speech

Tracheostomies are among the most common procedures performed in critically ill patients, and various methods are available to help patients with tracheostomies regain the ability to speak, according to an article in the December issue of Critical Care Nurse (CCN). The article, "Restoring Speech to Tracheostomy Patients," provides an overview of nursing assessments and interventions to help patients regain the ability to speak after a tracheostomy.

Critical care nurses work as part of an interdisciplinary team that includes respiratory therapists, speech pathologists, advanced practice nurses and physicians to coordinate care and develop a patient-specific communication plan, which is essential to the goal of voice restoration.

Lead author Linda L. Morris, PhD, APN, CCNS, FCCM, is a tracheostomy specialist/consultant and associate professor of clinical anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago. "Losing the ability to speak after a tracheostomy adds to the stress, fear and frustration of being critically ill," she said. "Restoring speech to a patient after a tracheostomy allows them to more fully and effectively express their needs and wishes, participate in their plan of care and converse with their loved ones and caregivers."

Speaking after a tracheostomy depends on having an adequate supply of air reach the vocal cords with a minimum of resistance, and the tracheostomy tube itself is an important factor related to phonation, or the ability to make sound with one's vocal cords. Changing the type of tube, as well as its diameter or length, can help avoid complications and lead to greater success in phonation.

The article summarizes different approaches to restore phonation in patients with a tracheostomy, including special considerations related to nursing interventions. The methods vary, depending on whether the patient is spontaneously breathing, being treated with intermittent mechanical ventilation or is fully ventilator dependent.

"An essential component of successfully helping a patient regain the ability to speak is to determine which option or options are most appropriate, and nurses need to be aware of all the options available," Morris said.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org/.

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