ABSTRACT
BACKGROUND: Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication. OBJECTIVES: The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board. METHODS: Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes. RESULTS: Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication. CONCLUSIONS: Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.
Subject(s)
Attitude to Health , Communication Aids for Disabled/psychology , Critical Care/psychology , Critical Illness/psychology , Inpatients/psychology , Respiration, Artificial/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Communication Aids for Disabled/adverse effects , Communication Aids for Disabled/standards , Critical Care/methods , Critical Illness/nursing , Equipment Design/standards , Female , Frustration , Health Services Needs and Demand , Helping Behavior , Humans , Male , Middle Aged , Nurse's Role/psychology , Nurse-Patient Relations , Nursing Methodology Research , Pain Measurement/instrumentation , Pain Measurement/nursing , Pain Measurement/psychology , Qualitative Research , Respiration, Artificial/adverse effects , Respiration, Artificial/nursing , Surveys and QuestionnairesSubject(s)
Communication Aids for Disabled/psychology , Compulsive Behavior/psychology , Depressive Disorder/psychology , Social Behavior , Adult , Behavior Therapy , Combined Modality Therapy , Communication Aids for Disabled/adverse effects , Compulsive Behavior/therapy , Depressive Disorder/therapy , Female , Humans , Interpersonal Relations , Male , Trazodone/therapeutic use , Treatment OutcomeABSTRACT
The use of speech recognition systems as a replacement for other types of transcription systems is increasing rapidly, partly because many people are unable to use conventional keyboards as a result of upper-extremity repetitive strain injury (RSI). However, the frequent or continuous use of such systems can cause muscle tension dysphonia in some patients. The scientific literature suggests that there is an association between upper-extremity RSI and muscle tension dysphonia. We present a retrospective case series of five patients with workplace upper-extremity RSI who developed muscle tension dysphonia soon after they began using discrete computerized speech recognition software. The diagnosis of dysphonia was based on laryngovideostroboscopy, acoustic analyses, and voice load testing. All patients had normal voice when using everyday speech, but speaking into the computer resulted in the rapid onset of aperiodicity, strain, and a decrease in fundamental frequency. In three of the five patients, laryngovideostroboscopy showed posterior glottic overapproximation, but no other abnormalities. Treatment was centered on voice therapy and avoidance of long periods of using computerized speech recognition systems. The condition of three of the five patients improved with therapy. We conclude that computer speech recognition programs can lead to the onset of muscle tension dysphonia in some patients. These patients can be successfully treated with voice therapy.
