Question 28

College comments

Syllabus topic/section: 2.2.1 Communication and collaboration in Intensive Care: Topic - Communication with patients as part of care in the ICU.

Discussion: 

This is an essential topic. Good candidates could demonstrate the ability to have an in-depth discussion of consequences of long-term ICU care including relevant aspects of patient centred care, issues with decision making, dealing with negative emotions, sentinel events/adverse events and quality of life, as related to communication.

Specific strategies to improve marks could include a comprehensive outline of both nonverbal (e.g., writing, mouthing, gestures, switches and many more) and verbal methods of communication, with an emphasis on verbal techniques specific to patients with a tracheostomy (cuff inflated, ventilated; cuff deflated, not ventilated).

Interpretation

• Consequences of ineffective communicaton with invasively ventilated patients:
  • Patient effects: Depression, anxiety, frustration, poor understanding of their care, poor cooperation, loneliness, and disengagement
  • Staff psychological effects: Frustration with the process of communication, leading to avoidance and the reliance on sedation, decreased satisfaction with their work, and burnout
  • Effect on care: unmet patient needs, unrecognised distress, missed symptoms, increased sedation
• Methods of two-way communication with invasively ventilated patients:
  • Gesture
    • clickers, buzzers, lights, bells (to get attention)
    • eye tracking apps, joystick or console controllers, foot pedals
  • Written
    • ​​​​​​​Communication boards with words, letters or symbols
    • Writing implements, ranging from pen and paper to whiteboards
    • Electronic methods (iPad, mouse/keyboard, eye tracking apps)
• Additional methods afforded by the presence of a tracheostomy:
  • Nonvocal​​​: ​​​​​​​Mouthing words, tongue clicks
  • Vocal: speech permitted by various methods:
    • ​​​​​​​"Leak speech" using PEEP
    • Above the cuff gas flow
    • Cuff down, with or without speaking valve