12/5/15

Improving Patient-Nurse
Communication in the ICU
Setting: A Best Practice
Protocol

Description of Nursing Practice

Issue
Current practice of communication with mechanically
ventilated patients who are lightly sedated or conscious
is impaired due to the lack of education and resources
available to ICU nurses.
This is significant because lack of nurse-patient
communication can lead to lengthy hospital stays and
unsatisfactory patient outcomes ultimately resulting in
decreased patient satisfaction.

www.nursing.arizona.edu

PICOT Question

(Otuzojlu & Karahan, 2014)

(Tingsvik, Bexell, Andersson, & Henricson, 2013)

Summary of Current Practice

In the population of non-speaking, intubated

patients with a GCS score of 13 or higher in the
ICU, how does the use of the illustrated
communication strategies and assistive
communication devices compared to current
practice influence the overall patient-nurse
communication after a single 12-hour shift?

Within various ICU settings, there are no

well-established levels of communication
between nurses and their patients.
Examples of current methods include:
Lip reading, gestures, written messages, head
nodding, and the use of alphabet boards
(Otuzojlu & Karahan, 2014)
(Happ et al., 2014)

Negative Impact of Current

Practice
Lip reading Increased risk of aspiration
Excessive movements (nodding, gestures,
writing) increased oxygen demand
fluctuations in hemodynamics & increased
risk for falls and injury

Synopsis of Current Literature

Best Practice: Why is it important?
Improving the communication between nurses and
patients in the ICU will increase satisfaction and create
less traumatic experiences for the patients.

(Otuzojlu & Karahan, 2014)

12/5/15

Synopsis of Current Literature

What is the issue with current practice?
Physiological needs, including toileting, pain
management, feeding, and repositioning are
ineffectively being met with current practice.
For example: 37.7% of communication regarding
pain is unsuccessful between non-speaking ICU
patients and their nurse.

Synopsis of Current Literature

Solution to current practice issue:
In order to evoke change, necessary implementation
strategies include the use of visual diagrams allowing
patient and nurses to point out specific patient needs
and clinical education to teach the use of low-tech
communication devices including spiral notebooks,
white boards, and felt-tip pens.

(Happ, et al., 2011)

(Otuzojlu & Karahan, 2014)

Synopsis of Current Literature

Significance of implemented change:
This change is important because patients view the ICU
environment as unfamiliar and feel that they have no
impact on how it is organized, which leads to dependency,
especially on the nursing staff.
Patients expressed feelings of frustration, lack of
control and self-determination and physical discomfort
during their stay in the ICU.
Being voiceless creates a loss of freedom and
personhood.
(Otuzojlu & Karahan, 2014)

(Happ et al., 2014)

Synopsis of Current Literature

Significance of implemented change:
Under current practice, being absent and inattentive
results in worry, anxiety, fears, and threats to the
patients lives.
Patients feel that they are unable to build trust and
confidence in their nurse, resulting in self-reliance for
their survival.

(Karlsson, Forsberg & Bergbom, 2011)

Summary of Strengths and Limitations

Interventions:
Educating ICU nurses on best practice
Assistive communication devices and
strategies

(Karlsson, Forsberg & Bergbom, 2011)

Educating ICU nurses on best practice

Strengths

Limitations

Training classes left the

nurses feeling less
frustrated when
communicating with nonspeaking patients.
14 out of 15 nurses felt
that the class was
beneficial.

Elevated cost for training

Small sample size was
tested (n=15)
Training was time
consuming for both the
staff and hospital

(Radtke, Tate, & Happ, 2012)

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Assistive Communication Devices and

Strategies
Strengths

Limitations

Testing to narrow sample

size to exclude patients with
vision loss, dementia,
orientation or confusion
disorders or linguistics
problems to prevent skewed
data
Nurses approve simplicity of
comprehension and
application of devices and
strategies

Studies included narrow

patient populations
Change in patient condition
altered the participation in
the study
Patients had difficulty
remembering the
communication material due
to effects of sedation

Evidence Based Nursing

Recommendations
1. ICU nurses should complete education seminar
addressing best practice communication
techniques

This seminar should include teaching the use of illustrated

communication materials and low-tech devices

2. Hospitals should implement the use of

illustrated patient materials and low-tech devices
in every patient room in various ICU settings.

(Otuzojlu & Karahan, 2014)

(Happ et al., 2014)

Overall Application/Implementation to
Nursing Practice
Implementation for Recommendation 1:
Schedule a paid-for, one-hour seminar for currently
employed ICU nurses.
Newly-hired ICU nurses will be required to complete
the paid-for, one-hour seminar as part of their New
Hire Orientation
The seminar will include demonstration of how to
use the illustrative assistive devices as well as
teaching the patients on how to use them.

Overall Application/Implementation to
Nursing Practice
Implementation for Recommendation 2:
The Clinical Nurse Manager on each ICU unit will
purchase supplies with hospital funding including a
diagram, white board, and markers for each patient
room.
Upon admission of a non-speaking patient to the
ICU, the nurse will instruct the patient about the use
of the diagram and white board.

Risk vs. Benefit to Hospital

Detailed Cost Analysis

Average hourly pay
White boards,
for ICU nurses ($31),
markers, number of
how many nurses in
rooms printing and
all ICUs, Cost of
lamination cost,
educator x5, room
guidelines for
reservation, 5 classes
breakroom, 1-10
(Mo-Fr at noon)
scale printing
refreshments,
projector, powerpoint,
printouts for examples

Risk

Benefit

Loss of money due to

lack of implementation of
education
Loss of money due to not
using supplied materials

Hospital gains better

patient satisfaction
Less cost to the hospital
with effective
implementation due to
shorter hospital stay

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Risk vs. Benefit to Patient

Risk
Diagram could become
inaccessible due to
misplacement
Level of patient education
may limit understanding
of material
Dependent upon nurses
willingness to teach and
implement

Benefit
Decrease the chance of
adverse patient events
including:
Risk of aspiration, changing
oxygen levels, and an
increased chance of falls
and injury.

Increased patient-nurse
communication and
satisfaction
Reduction of patient
powerlessness
Improves nurses time
management resulting in
prioritization of patient
needs

Evaluation
At the end of a single 12-hour shift, the
patients will be asked by the nurse to
report their satisfaction at a 5 with the
implemented communication techniques
according to a 1-5 with facial expressions
scale.

Summary
Improving the communication between nurses and
patients in the ICU will increase satisfaction and create
less traumatic experiences for the patients.
Physiological needs, including toileting, pain
management, feeding, and repositioning are ineffectively
being met with current practice.
In order to evoke change, necessary implementation
strategies need to be used.
This change is important because patients view the ICU
environment as unfamiliar and feel that they have no
impact on how it is organized, which leads to
dependency, especially on the nursing staff.