Importance of verbal communication with critically ill patients in intensive care unit
Communication is the process of exchanging information between one or many persons. Nurses use this process constantly to communicate with colleagues, patients and patients’ relatives. However, difficulties arise with critically ill patients hospitalized in intensive care unit. The presence of endotracheal tubes and sedation constitute a barrier to effective interaction. This often leads to limited communication, as patients are unable to express clearly their needs. Poor communication commonly complicates nursing care and makes both patients and nurses nervous and unsatisfied. (Ku, Li, Cheng, Ma, 2012).
It has long been known that the use of verbal communication in the care of critically ill patients is of paramount importance (Baker and Meley, 1996). It is demonstrated that these patients can hear, understand and react emotionally to what was being said. Nurses are interacting with a human who needs care and respect and the best approach to achieve this goal is effective communication. However, when providing care for such individuals, verbal communication can be easily omitted or underestimated by nurses (Hemesley, as cited in Alasad and Ahmed, 2004). Inadequate nurse–patient communication leads to high levels of stress and anxiety (Alasad and Ahmed, 2004). Verbal communication helps patient preserve their self-identity and self-esteem, which in turn will enhance their well being and optimism (Dyer, as cited in Elliot and wright, 1999).
While working in intensive care unit, I have noticed that there was an absence of verbal communication with critically ill patient among nurses who ignore the importance of this process, its effects on the patient’s psychology and its implication on the patient’s recovery from the illness.
The purpose of this essay is to explore the importance of verbal communication when caring for unconscious or sedated patients by analyzing the current situation, its consequences on the patient’s health and find the appropriate recommendation to improve practice.
Julia (2012) defines communication as a reciprocal process that involves sending and receiving messages between two or more individuals. This process is divided into two major forms; verbal communication that uses words that can be spoken or written, and nonverbal communication that consists of conveying meaning using a non-word form of messages. This process constitutes an important part of the care provided by nurses to critically ill patients (Elliot and wright, 1999).
Robertson and Al-Haddad (2013) describes critical illness as a process that threatens the patient’s life and which in the absence of medical intervention could end in death or significant morbidity. This process could require life support procedures or machines to maintain organs function until the patient recovers. Therefore patients’ ability to communicate and express in the usual way would be affected since they are unable to convey clearly their needs, feelings, wishes and thoughts to others (Ashworth, cited in Alasad and Ahmed, 2004). Nurses in critical care units are generally aware that communicating with those patients is of a vital importance to a good nursing practice. However, evidences showed that communication in critical care settings was not practiced regularly and effectively (Alasad and Ahmed, 2004).
In 1999, Elliot and Wright published the results of their study where they observed critical care nurses over episodes of four hours per day. They showed that nurses communicate with their patient for an average of three minutes and 30 seconds. Nevertheless, many factors affecting this amount were found: time of communication increases when more investigations, physical care, and medical interventions are needed. Other factors are the level of activity in the unit, the requirements of neighboring patients, the presence of a student or a patient’s relative, and lastly, personality disparities between nurses.
The same study explored the differences in verbal communication used, and described seven categories: the first one is mostly short-term informative about care interventions and the explanation of procedures to the patient. However, Noble (as cited in Elliot and Wright, 1999) found that there was an excess of use of medical terminology during these procedures, which may increase the patient anxiety due to his inability to understand it.
The second type is orientational information about time, place and rationale for equipment. In addition to the patient’s reassurance about alarms, noises or any other treatment and tasks preformed on them.
Another type is the recognition of the discomfort generated to the patient by different procedures. Nurses would usually apologize to the patient while performing them and would provide some details about the expected duration and pain.
The study also revealed a less frequent type of verbal communication used when nurses tried to assess the patient’s consciousness and responsiveness at the beginning of their shift. Whereas other nurses attempted to distract their patient by singing, making jokes, or simply recognizing their presence when a discussion with colleagues occurred at the bedside.
Another study conducted in Jordanian intensive care units by Alasad and Ahmed (2004) clarifies some aspects of this communication as seen by the participant nurses and the investigators. The main findings of this study are as follow:
Communication is imperative but it is easily omitted: nurses agreed that communication with critically ill patients is an important part of care and good practice. Nonetheless, it was often neglected and could be easily forgotten among different other patient’s needs. It is also perceived as discouraging and challenging since it is generally a one-way communication where patients are not giving any response back.
Not enjoyable and frustrating: since patients are not able to speak properly, nurses find difficulties to provide appropriate care, as they cannot define what their patient wants to be done for them. This situation, in turn, forces them to rely on speculating and guessing, and this makes them feel even more frustrated. A nurse participating in this study declared that this frustration is increased when patient are “talking rubbish”, or requesting something that they have just asked two minutes ago or something considered by nurses as unimportant.
Many sorts of popularity: the patient’s popularity is mainly defined by his interaction and ability to communicate. The study revealed that the nurses generally seemed to favor to look after patients who were unconscious. This is due to the fact that those patients were seen as less demanding, as they were unable to express their needs and were not irritable or agitated. Looking after sedated patients is mentally less stressing. Whilst nurses were not obliged to understand what their patients asked for or what they were trying to say, they would merely guess their needs and act without being interrupted. They would implement care activities in which patients have no say.
These studies and others show that verbal communication is far from being practiced in its appropriate way (Jesus, Simões, and Voegeli, 2013). Therefore, some recommendations need to be implemented in order to tackle this problem. Nurses should be taught about the vital importance of communication for the patient’s recovery. Furthermore, the standardization of verbal messages, and a detailed knowledge about the patient’s needs is compulsory to provide a highly personalized care. Additionally, it is necessary to involve the family in this process since they can focus on the personal and emotional aspect of communication, unlike nurses who focus on professional and technical interventions. Finally, additional investigations are needed whilst the number of available literature is limited and mostly outdated.
This essay tried to cover different aspects of verbal communication between nurses and unconscious patients. It is demonstrated that these patients can hear, understand and react emotionally to what is being said. While intensive care nurses agrees about the vital importance of this type of communication, they would spend only 5% of their time in communication focusing mostly on informing the patient about the immediate procedures and reassuring him about noises. However, many factors influence the amount of communication, for instance the quantity of care provided to the patient, the level of their responsiveness, the presence of relatives and family, and lastly the workload of the unit. Finally, many measures were suggested to deal with this problem such as raising awareness among nurses about this issue, involving relatives, and also conducting further investigations about this theme.
References
Ku, J. H., Li, S. L., Cheng, W. J., & Ma, J. C. (2012). Enhancing the Communication Satisfaction Between ICU Nurses and Intubated Patients. Tzu Chi Nursing Journal, 11(4), 95-108.
Baker, C., & Meley, V. (1996). An investigation into the attitudes and practices of intensive care nurses towards verbal communication with unconscious patients. Journal of Clinical Nursing, 5(3), 185-192.
Elliott, R., & Wright, L. (1999). Verbal communication: what do critical care nurses say to their unconscious or sedated patients?. Journal of Advanced Nursing, 29(6), 1412-1420.
Alasad, J., & Ahmad, M. (2005). Communication with critically ill patients.Journal of advanced nursing, 50(4), 356-362.
Riley J. (2012), Communication in nursing, 7th edition, Elsevier Health Sciences.
Elliott, D., Aitken, L., & Chaboyer, W. (2011). ACCCN’s critical care nursing. Elsevier Australia.
Robertson, L. C., & Al-Haddad, M. (2013). Recognizing the critically ill patient. Anaesthesia & Intensive Care Medicine, 14(1), 11-14.
Jesus, L. M. T. D., Simões, J. F. F. L., & Voegeli, D. (2013). Verbal communication with unconscious patients. Acta Paulista de Enfermagem, 26(5), 506-513.