COMMUNICATION TOOL KIT:

A GUIDE TO COMMUNICATION IN ICU

A Nelms1, N Clayton2, E Oustambasidis3, R Eggers4, S Cowling5, P Maitz6
1 Speech Pathology Department, Royal Prince Alfred Hospital, 2 Speech Pathology Department, Concord Repatriation General Hospital
3 Speech Pathology Department, Liverpool Hospital, 4 Speech Pathology Department, Bankstown Hospital
5 Speech Pathology Department, Campbelltown Hospital, 6 Burns Unit, Concord Repatriation General Hospital

Staff demonstrated an encouraging response to the proposed

development of an appropriate augmentative and alternative
Background PAIN SCALE

communication device specific to the ICU with 83% indicating

Communication is an important tool which we use to relay our
1 2 3 4 5 6 7 8 9 10

that they definitely would use a digital photo board should one
physical and emotional needs as well as share our identity with be available, whereas 14% maybe would and 3% reported they
the world. Communication is adversely affected during illness, would not use the proposed digital photo boards.
particularly when artificial ventilation is required and the ability
to phonate is not possible. Patients report feelings of anger and A number of suggested items/topics that staff would like to see
low mood associated with altered communication which can on the digital photo communication boards were collated.
result in reduced participation in rehabilitation1. Communication
PAIN

Digital photos were subsequently taken and collected of

is particularly important in hospital for the reporting of specific ICU equipment and patient needs. A staff training
symptoms and accurate diagnosis, discussion of treatment package (consisting of a powerpoint presentation and one page
options including withdrawal of treatment, participating in care summary) was also developed and implemented in group and
decision processes, engaging in the health service as well as
FIGURE 1

1:1 sessions at all sites. The training package focused on

for social interaction1. educating staff on multi-modal aspects of communication in
order to facilitate effective and efficient communication
Professionals working in the Intensive Care environment report exchange. The newly made communication boards were
that successful communication is important although time
MEDICATION

launched at the same time as the training sessions.

DRINK MOUTH CARE

consuming and feel that they lack training in this area2.

Specific training targeting education has been shown to be vital The digital photo communication boards contained: an alphabet
in improving communication, and indeed improved board, ICU staff members (specific to each site), a human body
communication has been linked with higher quality health
BREATHING TIRED

diagram, pain scale and basic wants/needs, etc. (see Figures

DIFFICULTY UNCOMFORTABLE

care3,4. Intensive communication sessions between Intensive 1, 2 & 3 for examples from Communication Toolkit).
Care Unit (ICU) staff, patients and families also reportedly
result in a reduction of length of stay and mortality rate for 80 colour digital photo communication boards were developed
WORRIED HAPPY SAD HOT COLD

critically ill patients in ICU5. and implemented across all 5 of the ICUs (Figure 4). 8 group
FIGURE 2

and several individual education sessions were conducted and

a total of approximately 100 multidisciplinary ICU staff
educated. The digital photo communication boards were
Aim
To develop a communication system for patient and staff use, situated at the patient bedside, or attached to the equipment
specific to the ICU environment. trolley in the room.
Family Nurse Doctor Dietitian

47 multidisciplinary ICU staff (15% medical, 57% nursing, 28%

Method allied health) participated in the repeat survey. 92% of
participants reported that they were aware of the digital photo
Speech Pathologist

The Speech Pathology Respiratory and Critical Care Clinical communication boards and 81% reported using them
Social Worker Physiotherapist
Occupational Therapist

Network in Sydney South West Area Health Service audited “frequently” or “sometimes”. 62% indicated that they felt the
FIGURE 3

and reviewed communication practice amongst medical, communication boards improved communication with their
nursing and allied health staff in ICU across 5 Sydney teaching patient. Feedback regarding the content of the digital photo
hospitals. A Communication Toolkit was developed consisting communication boards and suggested modifications were
of digital photo communication boards and a staff training collected. The need for ongoing education on multi-modal
package. The training package was implemented and communication was also highlighted.
communication boards introduced for use in all 5 ICUs. The
effectiveness of the Communication Toolkit was then re-
evaluated via a second ICU multidisciplinary staff survey.
Conclusion
Effective communication between staff and patients is essential
Results in the ICU environment. Digital photo communication boards
together with staff training may improve the success of
119 multidisciplinary ICU staff (23% medical, 41% nursing, communication exchange in the ventilated patient, and
36% allied health) were initially surveyed across 5 Sydney subsequently improve patient care and patient outcomes.
FIGURE 4

teaching hospitals. Results indicated a positive trend in

Modes of com m unication used by ICU staff

identifying that communication is an important target area for

w ith their patients

improvement. Nearly all participants (97%) agreed that

successful communication with their patient improves the
References
1. Magnus SV, Turkington L. Communication interaction in ICU: Patient and staff experiences and perceptions.

quality of patient care. The modes of communication used by

Other
7% Intensive and Critical Care Nursing 2006, 22: 167-180

staff with their ventilated patients are summarised in Graph 1.

Verbal 2. Baker C, Melby V. An investigation into the attitudes and practices of intensive care nurses towards verbal
33% communication with unconscious patients. Journal of Clinical Nursing Volume 1996, 5(3): 185-192
Gesture 3. Treece P. Communication in the Intensive Care Unit about the end of life. Advanced Critical Care 2007, 18(4):
406-414

“Other” modes of communication used by staff included

33%
4. Anthonypillai, F. Cross cultural communication in an intensive therapy unit. Intensive and Critical Care Nursing 1993,

communication boards, alphabet boards, lip reading, eye

9(4): 263-8

blinking and yes/no questions.

5. Lilly CM, Sonna LA, Haley KJ, Massaro AF. Intensive communication: four-year follow-up from a clinical practice
Written study. Critical Care Medicine 2003, 31(5): S394-399
27%
GRAPH 1

AVS 60720