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ACQ
Volume 12, Number 3 2010
ACQ
uiring knowledge in speech, language and hearing
recreational activity group. The news group has an added
bonus of assisting some patients with orientation.
7. Improved access to interpreters for CALD patients
was achieved by routinely booking interpreters for
multidisciplinary assessments. Through the screening
process, patients who need an interpreter can be quickly
identified.
8. Finally, an independent project was commenced,
that provided patients with a “key contact person”.
This project provides patients with knowledge of their
discharge plan.
This quality project changed the practice of the speech
pathology department in aged care. Although most of
the initiatives which resulted from the project took time
and energy to introduce and sustain, these initiatives are
now standard practice. By minimising and preventing
communication barriers, the patients on these wards have
increased opportunities to participate in their healthcare.
Project 3: Communication access
for the ICU patient
Communication in ICU
Waking from sedation, intubated or tracheostomised in the
intensive care unit (ICU) and discovering that you are unable
to communicate is both frustrating and stressful (Costello,
2000). Some patients improve quickly and are weaned from
ventilation and extubated soon after sedation is ceased.
Others, however, may suffer long periods during which they
are unable to speak and cannot contribute to important
discussions about their treatment or end of life plans (Happ,
2000). Verbal communication can be facilitated in patients
with stable ventilatory needs and a tracheostomy tube
through leak speech or speaking valves; however, this is not
an option for intubated patients, those with complex
ventilation requirements or poor airway protection. Research
indicates that this period is not only difficult for the patient
but also challenging for ICU staff and an extra source of
anxiety for family members (Costello, 2000).
AAC in ICU
It is not common practice to provide AAC devices to all
ventilator-dependent patients who cannot speak (Garrett,
Happ, Costello, & Fried-Oken, 2007). A few devices are
available for this population; however, most require a degree
of mental acuity and training, not often present in the typical
patient in intensive care. Whiteboards are used but are
frequently unsuitable as drowsy, weak patients are unable to
form legible graphemes (Garrett, et al., 2007).
Project aim
The aim of this project was to provide a cost-effective,
durable, generic, cleanable, self-explanatory communication
device for intubated and non-verbal tracheotomised ICU
patients. The device needed to be suitable for patients of all
ages, literacy levels and for whom English was a second
language. It also needed to be used without individual
speech pathology education, as services are not available
during out of business hours.
Method
A survey of 22 ICU nurses was conducted to gain insight
into their experiences of communicating with non-verbal
patients and to help develop the communication device.
Development of the communication board involved
discussion regarding ideal size, weight, material, modality
as hearing and vision impairment, and culturally and
linguistically diverse (CALD) background. Several themes
also repeatedly emerged from conversations that took
place during the interviews. Seven barriers to effective
communication were identified and are listed in table 1:
Table 1. Barriers to effective communication
Barrier
% of patients
No or poor knowledge of discharge plan
31
Hearing impairment
28
Poor understanding of rehabilitation
28
Vision impairment
20
Needed an interpreter
15
Lonely/isolated/bored
15
Significant disorientation to time and place
8
N = 39
As well as addressing the needs of the individual patients
who were interviewed, several initiatives have been carried
out to reduce these barriers to communication for patients
in these wards at Heidelberg Repatriation Hospital. These
include:
1. All patients admitted to the aged care rehabilitation wards
are now screened by speech pathologists or a trained
allied health assistant (AHA) to determine if the patient:
•
needs an interpreter,
•
has a hearing or vision impairment,
•
is oriented,
•
is aware of the reason for admission to rehabilitation.
Additionally, the interview enables the interviewer to
assess the patient’s suitability to attend an orientation
session and group activities. Most screenings take
only a few minutes and are usually completed on the
day of admission or the day after, allowing issues to be
addressed early in the patient’s admission.
2. Orientation boards were placed on the bathroom door in
each room, allowing all patients the opportunity to read
the information several times a day.
3. Hearing impairment was addressed by:
•
posting “hearing impairment” alert signs above
patients’ beds, with the patient’s consent, with extra
symbols for patients who wear aids,
•
purchase of hearing amplifiers to be used by patients
with significant hearing impairment and no aids,
•
referral to the AHA for all patients with aids for a
“Hearing aid management plan”. This is filed in the
patient’s history and contains information about types
of aids the patient wears, their provider in case of
breakdown, and the level of assistance required to
manage the aids, and
•
offering one-on-one education with the AHA to all
patients who lack skills in managing aids.
4. Appropriate “vision impairment” alert signs are posted
above a patient’s bed when a significant visual impairment
is present and the patient gives permission.
5. A weekly information session about rehabilitation for
new patients and carers was introduced to address
the problem of poor understanding of the rehabilitation
process.
6. To address patients’ feelings of loneliness and isolation,
two weekly groups were introduced to encourage
socialisation. Volunteers were recruited to assist the
AHA to run a “news and current affairs” group and a