Nurses' perceptions of communication training in the ICU.

OBJECTIVE: To describe the experience and perceptions of nurse study participants regarding a communication intervention (training and communication tools) for use with nonspeaking, critically ill patients. RESEARCH METHODOLOGY/DESIGN: Small focus groups and an individual interview were conducted with six critical care nurses. Transcripts were analysed using qualitative content analysis and constant comparison. SETTING: Two ICUs within a large, metropolitan medical centre in western Pennsylvania, United States of America. MAIN OUTCOME MEASURES: Critical care nurses' evaluations of (1) a basic communication skills training programme (BCST) and (2) augmentative and alternative communication strategies (AAC) introduced during their study participation. RESULTS: Six main categories were identified in the data: (1) communication value/perceived competence; (2) communication intention; (3) benefits of training; (4) barriers to implementation; (5) preferences/utilisation of strategies; and 6) leading-following. Perceived value of and individual competence in communication with nonspeaking patients varied. Nurses prioritised communication about physical needs, but recognised complexity of other intended patient messages. Nurses evaluated the BCST as helpful in reinforcing basic communication strategies and found several new strategies effective. Advanced strategies received mixed reviews. Primary barriers to practise integration included patients' mental status, time constraints, and the small proportion of nurses trained or knowledgeable about best patient communication practices in the ICU. CONCLUSIONS: The results suggest that the communication skills training programme could be valuable in reinforcing basic/intuitive communication strategies, assisting in the acquisition of new skills and ensuring communication supply availability. Practice integration will most likely require unit-wide interdisciplinary dissemination, expert modelling and reinforcement.

Nurse-patient communication interactions in the intensive care unit.

BACKGROUND: The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. OBJECTIVES: To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. METHODS: Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. RESULTS: Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). CONCLUSIONS: Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.

Listening to the voiceless patient: case reports in assisted communication in the intensive care unit.

Communication problems experienced by nonspeaking, critically ill patients in the Intensive Care Unit (ICU) have serious implications for the physical and psychological well-being of patients and the quality of their care. These problems are most profound for those with prolonged critical illnesses who are at the highest risk of dying. Recently, speech language pathologist (SLP) services have been used to provide augmentative and alternative communication (AAC) assistance to this vulnerable group of patients, their caregivers, and medical staff. Here we present three clinical cases that illustrate the application of AAC strategies across different levels of illness severity and communication impairment for nonspeaking patients in the ICU. Both high-tech communication devices with voice output and low-tech options were used for each patient according to their motor and cognitive abilities. To accommodate fluctuations in patient status and communication needs, multiple AAC strategies were integrated into the communication repertoire and tailored for each case. Medical personnel involved in these cases attributed enhanced communication efficiency, improved ventilator weaning trials, and increased patient engagement to the AAC techniques. This approach has the potential to improve symptom communication and to ease suffering for seriously ill ICU patients with speech limitations.

The paradox of breastfeeding-associated morbidity among late preterm infants.

OBJECTIVE: To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population. DATA SOURCES: Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles. STUDY SELECTION: Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks. DATA EXTRACTION: Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants. DATA SYNTHESIS: Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking. CONCLUSIONS: Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.

The Menopause-Specific Quality of Life Questionnaire: psychometric evaluation among breast cancer survivors.

OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Menopause-Specific Quality of Life Questionnaire (MENQOL) in a sample of breast cancer survivors experiencing menopausal symptoms. METHODS: This was a secondary analysis of MENQOL psychometric data from two larger parent studies investigating acupuncture for the relief of menopausal symptoms among breast cancer survivors. Reliability was assessed for each subscale of the MENQOL via (1) internal consistency reliability with Cronbach α and (2) test-retest reliability at multiple follow-up points with intraclass correlation coefficients and r. Convergent and discriminant validities were assessed via correlations of the vasomotor and psychosocial MENQOL subscales with select items in the Kupperman index and daily symptom diary. A principal components analysis was performed to determine construct validity. RESULTS: For each subscale, Cronbach α was 0.70 or greater. All subscale test-retest reliabilities at first follow-up were significant and at least moderately correlated (≥ 0.450; r's and intraclass correlation coefficients). Convergent validity was moderate between the vasomotor and psychosocial subscales and the symptom diary (r ≥ 0.410, P < 0.001) and larger between these domains and the Kupperman index (r ≥ 0.614, P < 0.001). In the same subscales, discriminant validity was supported by low, nonsignificant correlations (r ≤ 0.176, P > 0.05). The principal components analysis revealed a latent structure nearly identical to the prespecified instrument domains, with the exception of the physical domain. CONCLUSIONS: With results comparable with those obtained in previous psychometric work, the MENQOL seems to be a reliable and valid instrument to assess quality of life in postmenopausal breast cancer survivors.