Pain communication in children with autism spectrum disorder: A scoping review.

Children with autism spectrum disorder (ASD) experience social interaction and communication challenges and often display repetitive, restricted patterns of behavior, activities, and interests. The concept of pain is regarded as one of the most complex human stressors due to its subjective and personal nature and the influences of multiple internal and external factors. Due to the complexity of this disorder, it remains concerning how children with ASD communicate their pain and how observers (i.e., parents, carers, and health care practitioners) respond to these children's pain communication. This scoping review aimed to identify how children with ASD communicate or express their pain. Ten studies met the inclusion criteria for further data extraction. Through reflexive thematic analysis, two main themes were identified: verbal and nonverbal responses used by children with ASD to communicate their pain that could influence pain assessment and management strategies. This review highlighted that children with ASD utilized various verbal and nonverbal methods to communicate their pain experiences and that these methods differed compared to children without disabilities. Furthermore, this review emphasizes the importance of holistic pain assessment strategies as well as additional pictorial support for children with ASD. This review recommends that future research should focus on understanding how the inclusion of different stakeholders in pain assessment for children with ASD, can contribute to holistic pain assessment.

Critically ill patients' experiences of nursing care and the effect on their personhood: A retrospective study.

AIM: This study aims to report patients' experiences of nursing care in the critical care unit and the resulting effect of such care on the personhood of patients. DESIGN AND METHOD: The study adopted a qualitative design and aimed to include both descriptive and exploratory information. It involved a single participant group comprising ten previously critically ill patients with whom retrospective, semi-structured interviews were conducted in a natural setting during 2018. Private hospitals in Gauteng, South Africa, were targeted for data collection. RESULTS: The findings of this study were categorised and described according to Kitwood's conceptualisation of person-centred care. Five categories were identified by patients as impacting their personhood and perceived person-centred care. CONCLUSION: Nurses ability to support perceived personhood of patients during person-centred care is integral to the betterment of the patient. Patient's experiences of nursing care can often be affected if they perceive their personhood as not being valued by nurses. This study creates increased awareness of these components to ensure that patient-nurse relationships are established adequately to meet both the patients' and the nurses' needs.

A systematic review of physical activity: benefits and needs for maintenance of quality of life among adults with intellectual disability.

The inactivity of people with intellectual disabilities (PwID) is a major contributor to ill health. Probably because people with intellectual disabilities are not adequately informed about physical activity and intervention programs required to enhance their fitness. This study critically reviewed physical activity: benefits and needs for maintenance of quality of life among adults with intellectual disability. An extensive search of bibliographic databases such as PubMed, PsycINFO, BioMed Central and Medline identified 735 academic papers. The research rigour was evaluated, and the validity of the findings was established. Based on the inclusion criteria, 15 studies were included in the review. Various forms of physical activity were studied as interventions. The results of a critical review indicate that physical activity has a moderate to strong positive impact on weight loss, sedentary behaviour, and disability-related quality of life. Adults with ID may benefit from physical activity as a non-pharmaceutical method of improving their health needs. However, this study's results may only apply to some adults with intellectual disabilities. The sample size needs to be increased in future studies in order to draw generalizable conclusions.

Multimodal communication reported by familiar caregivers to build communication capacity in persons who are minimally conscious.

PURPOSE: Limited clinical and research evidence is available to support healthcare practitioners in the communication assessment and intervention of persons who are minimally conscious. This study placed a specific focus on the multimodal communication strategies familiar caregivers of persons who are minimally conscious observed, as well as the verbal and the nonverbal communication strategies they employed to build communication capacity. This may inform clinical practice as it provides valuable autobiographical information as well as familiar stimuli that may elicit responses from persons in a minimally conscious state. METHOD: A descriptive qualitative design employing in-depth semi-structured interviews with familiar caregivers was utilised to address the purpose of the study. RESULT: Familiar caregivers reported that they used both nonverbal and verbal communication strategies to obtain a response from persons who are minimally conscious. These caregivers also reported that these persons appeared to rely on nonverbal communication strategies to express 36 different communication functions. CONCLUSION: Based on the findings of this study, it is clear that caregivers can be beneficial to persons who are minimally conscious, if they are able to observe and capitalise on naturally occurring multimodal communication strategies and functions. This study emphasises that familiar caregivers respect and value the dignity of persons who are minimally conscious and want to improve their communication capacity, but often lack confidence in their own communication skills.

The Sustainable Development Goals: A framework for addressing participation of persons with complex communication needs in South Africa.

BACKGROUND: Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa. PURPOSE: This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa. RESULT: Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs. CONCLUSION: The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society.

The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach.

BACKGROUND: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. OBJECTIVE: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents' views and health care professionals' expectations and requirements for an mHealth tool. METHODS: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. RESULTS: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non-clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child's voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. CONCLUSIONS: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings.

Nurses' perspectives on alternative communication strategies use in critical care units.

BACKGROUND: Critically ill patients have the right to communicate and participate in their treatment to avoid adverse medical outcomes due to the severity of their illness, their responsiveness, and level of consciousness. This human right has often been neglected by health care professionals, as a result of limited alternative communication support provided to patients who are unable to speak due to, for example, endotracheal intubation. Despite the successful use of alternative communication strategies in critical care units (CCUs) in other countries, limited implementation in South African hospitals has been reported. AIMS AND OBJECTIVES: This study aimed to determine the perspectives of South African nurses working in CCUs on the frequency of use of alternative communication strategies to support patient-centred communication with critically ill adult patients. DESIGN: The study followed a quantitative non-experimental survey research design. METHODS: A total of 210 nurses working in both private and public hospitals completed a survey on their perspectives on the use of alternative communication strategies in CCUs. RESULTS: Nurse participants reported experience working with critically ill and communication-vulnerable patients. Nurse-patient communication mainly involved the use of pen and paper, facial expressions and gestures to obtain information relating to patients' needs and their health history. Limited use of speech-generating communication devices was reported. CONCLUSION: Nurse training on the use and implementation of alternative communication strategies, such as communication boards or electronic speech-generating devices, should be investigated to improve nurses' communication with communication-vulnerable patients in South Africa. RELEVANCE TO CLINICAL PRACTICE: The results are applicable in clinical practice due to patients' need for alternative communication. The nurses mainly used low-tech solutions, which are cheap and easy to access. However, there exists an opportunity to increase the use of available digital solutions.

Being heard - Supporting person-centred communication in paediatric care using augmentative and alternative communication as universal design: A position paper.

Person-centred care, with its central focus on the patient in partnership with healthcare practitioners, is considered to be the contemporary gold standard of care. This type of care implies effective communication from and by both the patient and the healthcare practitioner. This is often problematic in the case of the paediatric population, because of the many communicative challenges that may arise due to the child's developmental level, illness and distress, linguistic competency and disabilities. The principle of universal design put forth in conventions and legislation means that the design of products and services should be usable by all people, to the greatest extent possible. Augmentative and alternative communication encompasses strategies, for example pictures and apps, that are typically used with people with communication disability. In this position paper, we argue for the universal use of augmentative and alternative communication to support person-centred communication and care for children, regardless of age or potential disability. Clinical examples are shared from three different paediatric care settings where pictorial supports were applied universally. Interviews were conducted with children and adolescents (with and without disabilities), parents and healthcare practitioners, and the principles of universal design were used as a framework to demonstrate how person-centred communication is supported in paediatric care.

Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review.

BACKGROUND: Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication). AIM: To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. METHODS & PROCEDURES: The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. MAIN CONTRIBUTION: The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. CONCLUSIONS & IMPLICATIONS: Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication. WHAT IS KNOWN?: Unaided communication has been widely researched. However, a summary is needed of the various unaided communication behaviours and of the different communication functions addressed by these behaviours. What the paper adds… This paper emphasises that unaided communication behaviours range from non-linguistic to linguistic, and they can support unintentional, pre-intentional and intentional communication functions. Clinical implications Even though aided communication is preferred, unaided communication behaviours are generally used in contexts with limited resources, as well as among culturally and linguistically diverse populations. This study advocates the identification of unaided communication behaviours by partners as well as the support and provision of access to communication strategies for persons with severe CVA. Future research should include more untrained communication partners.

Text messaging "Helps Me to Chat": exploring the interactional aspects of text messaging using mobile phones for youth with complex communication needs.

This study explored the interactional aspects of text messaging on mobile phones for youth with complex communication needs. A qualitative case study design was used to investigate aspects such as reasons, place, timing of communication, content and communication partners. Data were gathered from seven youth with complex communication needs (primary participants) and one communication partner for each youth (secondary participants). In addition to using a questionnaire and tests to obtain participant background information, four data collection methods were used: (a) face-to-face interviews with the primary participants via text messaging, (b) researcher observations of these participants interacting via text messaging, (c) an asynchronous text-messaging focus group involving all seven primary participants, and (d) asynchronous interviews with the secondary participants via text messaging. The thematic data analysis highlighted numerous interactional benefits, most notably that text messaging offered the youth with complex communication needs a means of expressing themselves that was easier than face-to-face interactions. It also emphasizes interaction symmetry with a wide range of communication partners including groups, the privacy to interact with others beyond their often-restricted environments (absent presence), and a measure of anonymity and control over interactions. The study concluded that text messaging provides youth with complex communication needs with new communication possibilities.

Evaluating pictorial support in person-centred care for children (PicPecc): a protocol for a crossover design study.

INTRODUCTION: This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5-17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison. METHODS AND ANALYSIS: Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child's perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council's guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals. TRIAL REGISTRATION: ClinicalTrials.gov; NCT04433650.

The Children's Action-Reaction Assessment Tool (CARAT) as an observational technique for assessing symptom management: An initial validation study with children aged 3-7 years undergoing needle procedures.

PURPOSE: For many children, needle procedures are fearful events that are often painful. The first step in symptom management is to assess the child's pain and fear, and the next step is to use coping strategies to provide symptom relief for children who experience or feel pain and fear during procedures. The Children's Action-Reaction Assessment Tool (CARAT) is built on action-reaction strategies. This study aimed to determine the inter-rater reliability of the CARAT when used during needle procedures with 3- to 7-year-old children. DESIGN AND METHODS: We used a quantitative approach in which 21 children were observed by two independent observers during needle procedures to evaluate the inter-rater reliability of the CARAT. Data were analysed with descriptive statistics, and the observation scores were calculated with an intraclass correlation coefficient (ICC) test on SPSS for Windows, version 25. RESULTS: The completed CARAT indicated the use of action-reaction strategies. Neither action nor reaction strategies were frequently used. The parents were seldom involved in the procedure. The inter-rater reliability showed a sufficient correlation between the observers. PRACTICE IMPLICATIONS: This study showed promising results for the inter-rater reliability of the CARAT, which can be used to facilitate care for children. The observational tool can be used to assess the use of action-reaction strategies in conjunction with needle procedures in children aged 3-7 years.

A Systematic Review of Self-Report Instruments for the Measurement of Anxiety in Hospitalized Children with Cancer.

Anxiety has been identified as one of the most severe and long-lasting symptoms experienced by hospitalized children with cancer. Self-reports are especially important for documenting emotional and abstract concepts, such as anxiety. Children may not always be able to communicate their symptoms due to language difficulties, a lack of developmental language skills, or the severity of their illness. Instruments with sufficient psychometric quality and pictorial support may address this communication challenge. The purpose of this review was to systematically search the published literature and identify validated and reliable self-report instruments available for children aged 5-18 years to use in the assessment of their anxiety to ensure they receive appropriate anxiety-relief intervention in hospital. What validated self-report instruments can children with cancer use to self-report anxiety in the hospital setting? Which of these instruments offer pictorial support? Eight instruments were identified, but most of the instruments lacked pictorial support. The Visual Analogue Scale (VAS) and Pediatric Quality of Life (PedsQL™) 3.0 Brain Tumor Module and Cancer Module proved to be useful in hospitalized children with cancer, as they provide pictorial support. It is recommended that faces or symbols be used along with the VAS, as pictures are easily understood by younger children. Future studies could include the adaptation of existing instruments in digital e-health tools.

Patient and nurse content preferences for a communication board to facilitate dialogue in the intensive care unit.

OBJECTIVES: The main aim of this study was to identify patient and nurse content preferences for a communication board to facilitate effective communication (dialogue) in the critical care unit. RESEARCH DESIGN: A qualitative research design focusing on explorative and descriptive components was used to address the aim of the research study. The study employed two participant groups. Semi-structured interviews and focus group discussions were conducted with critically ill patients (N = 10) and critical care nurses (N = 30). SETTING: The study was conducted in four different private hospitals of the same hospital group in Gauteng, South Africa. FINDINGS: Four distinct themes were identified in the research regarding the vocabulary items that participants would like to have included. CONCLUSION: The findings suggest that patients perceive a communication board to be valuable in enhancing communication in the critical care unit; that cultural and linguistic diversity should be considered; and that patients and nurses have varying opinions on topics of priority during communication.

Transformative equality: Court accommodations for South African citizens with severe communication disabilities.

BACKGROUND: Persons with disabilities are generally at greater risk of experiencing violence than their peers without a disability. Within the sphere of disability, individuals with severe communication disabilities are particularly vulnerable and have an increased risk of being a victim of abuse or violence and typically turn to their country's criminal justice system to seek justice. Unfortunately, victims with disabilities are often denied fair and equal treatment before the court. Transformative equality should be pursued when identifying accommodations in court for persons with communication disabilities, as the aim should be to enable such individuals to participate equally in court, without barriers and discrimination. OBJECTIVES: This research aimed to identify court accommodations recommended by legal experts, which could assist individuals with severe communication disabilities in the South African court. METHOD: A qualitative design was used to conduct a discussion with a panel of legal experts. RESULTS: Using Article 13 (Access to Justice) of the Convention on the Rights of Persons with Disabilities (CRPD) as a human rights framework, four themes were identified: equality, accommodations, participation and training of professionals. CONCLUSION: Foreign and national law clearly prohibits discrimination against persons with communication disabilities because of their disability and state that they should be given fair and equal access to the court system. For transformative equality to be achieved, certain rules and laws need to be changed to include specific accommodations for persons with communication disabilities so that they may be enabled to participate effectively in court in the criminal justice system.

Transformative equality: court accommodations for South African citizens with severe communication disabilities

Background: Persons with disabilities are generally at greater risk of experiencing violence than their peers without a disability. Within the sphere of disability, individuals with severe communication disabilities are particularly vulnerable and have an increased risk of being a victim of abuse or violence and typically turn to their country's criminal justice system to seek justice. Unfortunately, victims with disabilities are often denied fair and equal treatment before the court. Transformative equality should be pursued when identifying accommodations in court for persons with communication disabilities, as the aim should be to enable such individuals to participate equally in court, without barriers and discrimination. Objectives: This research aimed to identify court accommodations recommended by legal experts, which could assist individuals with severe communication disabilities in the South African court. Method: A qualitative design was used to conduct a discussion with a panel of legal experts. Results: Using Article 13 (Access to Justice) of the Convention on the Rights of Persons with Disabilities (CRPD) as a human rights framework, four themes were identified: equality, accommodations, participation and training of professionals. Conclusion: Foreign and national law clearly prohibits discrimination against persons with communication disabilities because of their disability and state that they should be given fair and equal access to the court system. For transformative equality to be achieved, certain rules and laws need to be changed to include specific accommodations for persons with communication disabilities so that they may be enabled to participate effectively in court in the criminal justice system

How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge.

BACKGROUND: Pain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff's perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions. OBJECTIVES: This study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers). METHOD: Five focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection. RESULTS: Most treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered. CONCLUSION: A discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children's hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.

Healthcare professionals' use of augmentative and alternative communication in an intensive care unit: A survey study.

INTRODUCTION: Successful communication between staff and patients plays a key role in the well-being of critically ill patients within an intensive care unit. The use of augmentative and alternative communication strategies could contribute to better pain management, medical outcomes and shorter hospital stays for patients in critical care units. OBJECTIVE: To describe healthcare professionals' use of augmentative and alternative communication strategies to communicate with critically ill patients regarding pain in an intensive care unit. RESEARCH METHOD: A quantitative approach was used, and 83 healthcare professionals of different professions responded to a survey consisting of 16 items that focused on their knowledge of and access to augmentative and alternative communication strategies. The results are presented as descriptive and comparative non-parametric statistics. SETTING: The setting of the study was an intensive care unit in a Swedish hospital. RESULTS: All participants had experience of working in intensive care units with patients with communication challenges. Knowledge of augmentative and alternative communication tools differed between the professions, and less experienced healthcare professionals tended to administer sedative drugs more often than more experienced healthcare professionals. CONCLUSION: Healthcare professionals work with vulnerable patients on a daily basis. Their knowledge of communication tools and clinical experience may influence how they communicate and treat pain in patients in intensive care units.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study.

BACKGROUND: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. AIM: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. SETTING: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. METHODS: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. RESULTS: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. CONCLUSIONS: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: a pilot study

Background: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. Aim: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. Setting: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. Methods: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. Results: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. Conclusions: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised