Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health & Medical Sciences, University of Copenhagen, Denmark.
Aust Crit Care. 2023 Mar;36(2):215-222. doi: 10.1016/j.aucc.2022.01.006. Epub 2022 Mar 7.
Communication in the intensive care unit is challenged by patients' inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques.
The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges.
This study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel.
Communication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise.
This study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.
由于插管、治疗和疾病，患者无法说话，这给重症监护病房的沟通带来了挑战。研究集中在使用沟通工具或技术、患者与临床医生之间沟通的特点，以及他们对沟通挑战的体验上。然而，很少有研究将患者、家属和临床医生的观点结合起来。我们从不同角度探讨沟通，并调查无法用辅助工具和沟通技巧的无效使用来解释的沟通挑战。
本研究旨在探讨患者、家属和护士之间的沟通，并调查先前未被识别的沟通挑战。
本研究采用案例导向设计，采用多种三角测量法。它在挪威一家大学医院的两个普通重症监护病房进行。对 9 名机械通气患者与家属和医护人员进行沟通时进行了参与者观察。观察后，对 6 名患者、6 名家属和 9 名医护人员进行了单独访谈。
观察时，沟通似乎很简单，但访谈中的信息揭示了另一幅画面。我们展示了参与者在讨论他们的经历时强调的不同内容，揭示了在这种情况下感知到的重要性存在差异。家属在解释患者的迹象方面发挥了重要作用，揭示了一些如果没有护士的参与，否则护士可能不会发现的挑战。
本研究说明了重症监护病房中的沟通挑战在沟通时可能对观察者或所有参与的参与者都不明显。护士需要意识到这些沟通挑战，并认识到患者可能面临一些问题，如果没有患者、家属和护士的广泛参与，甚至可能在患者康复过程的后期阶段，这些问题都无法轻易解决。
