School of Nursing, University of Pittsburgh, Pennsylvania, USA.
Am J Crit Care. 2011 Mar;20(2):e28-40. doi: 10.4037/ajcc2011433.
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.
To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit.
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.
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).
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.
在危重病期间无法说话会给患者带来困扰，但重症监护病房中的护士-患者沟通并未得到系统研究或测量。
描述重症监护病房中护士与无法说话的危重病患者之间的沟通互动、方法和辅助技术。
对一项更大的护士-患者沟通临床研究中的非干预/常规护理队列进行描述性观察研究，该研究纳入了来自内科和心胸外科重症监护病房的 10 名随机选择的护士（每个病房 5 名）和 30 名意识清醒、有反应但因呼吸道插管而无法说话的危重成人（每个病房 15 名）。对 10 名随机选择的护士（每个病房 5 名）与 30 名意识清醒、有反应但因呼吸道插管而无法说话的危重成人（每个病房 15 名）之间的互动进行录像记录，并对频率、成功率、质量、沟通方法和辅助沟通技术进行评分。患者对沟通的容易程度进行自我评估。
护士发起了大多数（86.2%）的沟通交流。完成沟通交流的平均速率为每分钟 2.62 次。最常见的积极护士行为是与患者进行眼神交流。尽管沟通交流通常（>70%）是成功的，但超过三分之一（37.7%）的关于疼痛的沟通交流是不成功的。患者将 40%的与护士的沟通交流评为有些困难到非常困难。辅助沟通策略并不常见，几乎没有使用辅助沟通材料（例如，书写用品、字母或单词板）。
研究结果突出了重症监护病房中护士与无法说话的患者之间沟通方面需要改进的具体领域，特别是在沟通疼痛以及使用辅助沟通策略和沟通材料方面。
