ACQ Vol 12 No 3 2010

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:

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 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 for the ICU patient Communication in ICU

Table 1. Barriers to effective communication Barrier

% of patients

No or poor knowledge of discharge plan

31 28 28 20 15 15

Hearing impairment

Poor understanding of rehabilitation

Vision impairment

Needed an interpreter Lonely/isolated/bored

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

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ACQ uiring knowledge in speech, language and hearing