are challenged to meet patients’ communication needs—especially
intensive care patients who have artificial airways and can’t communicate verbally.
These patients may experience high levels of anxiety, frustration, anger, fear, and helplessness.
Although many studies support the need and desire
for nurses to communicate effectively with patients,
few have addressed specifically how to communicate
with nonverbal patients. In our surgical trauma intensive
care unit at University Hospital in San Antonio,
Texas, we realized nurses were markedly dissatisfied
with their ability to communicate with patients effectively.
What’s more, they sensed that patients with artificial
airways were extremely frustrated with their own
inability to express their needs or ask questions.
To explore this problem, we performed a needs
assessment by distributing a short staff survey. Analysis
of survey results revealed three major problems:
- no standardized approach to communication
- lack of formal training
- inadequate communication tools.
Results also showed most nurses had never received
formal training on communicating with nonverbal patients.
Most reported they learned to communicate by
watching others—or from “figuring it out” on their
own. Nurses also expressed dissatisfaction with the
lack of communication tools available at the hospital.
Turning the tide
We set out to develop a program aimed at improving
staff communication with mechanically ventilated patients.
In doing so, we realized variation would exist in
communication devices chosen by nurses, based on
their variable training and experience. So we decided
to use a communication algorithm to standardize the
approach to selecting communication tools. This algorithm
guides nurses through assessment of the patient’s
level of consciousness, cognitive level, language ability,
fine motor skills, and gross motor skills. It also helps
them evaluate the effectiveness of communication and
provides an opportunity for a speech consult. (See Selecting
alternative communication methods by clicking the PDF icon above.)
To rectify staff nurses’ lack of formal training, we
offered a 90-minute communication class to meet
their learning needs. The class discussed the pros and
cons of various communication techniques and tools,
addressed nurses’ and patients’ perceptions of effective
communication, and explored current techniques
for overcoming communication barriers.
As part of our program, new communication devices
were investigated and implemented to augment
patients’ communication needs. They included an
electronic communication board and a bilingual dryerase
Ongoing evaluation of our communication program
includes interviewing patients after extubation
and asking them to share with staff their experiences
of being on a ventilator and unable to communicate.
This information has helped close the communication
gap between nurses and intubated patients.
Our communication program has been successful.
In fact, after it was presented to the hospital’s quality
committee, senior leaders requested it be implemented
Vital and mandated
Effective patient communication isn’t just vital to meeting
patients’ needs. It’s mandated by the Joint Commission.
Communication training, an algorithm to guide staff in
selecting the appropriate communication method, and
adequate communication tools are essential for achieving
effective nurse-patient communication.
Visit References for a complete list of selected references.
Charles Reed and Ileana Fonseca are patient care coordinators at University
Hospital in San Antonio, Texas. Carol Reineck is chair of the Department of Health
Restoration and Care Systems Management and an associate professor at the
University of Texas Health Science Center School of Nursing in San Antonio.