How do ICU nurses communicate with awake patients on ventilators?

Details

Modern light-sedation protocols, together with an increase in patients with COVID-19 hospitalized in intensive care units (ICUs), have increased the number of patients who are awake while mechanically ventilated. Nurses need specific skills to care for this vulnerable group. They also report feeling inadequate and frustrated when trying to communicate with conscious patients on ventilators.

The study explored the strategies nurses use when caring for conscious, intubated ICU patients and the barriers they encounter when trying to communicate. Researchers used a qualitative design, conducting in-depth semi-structured interviews with 14 intensive care nurses working in ICUs at four hospitals in Cyprus. They analyzed the data using thematic analysis.

Nurses used unaided communication, including lip, hand and leg movements, facial expressions, gestures and touch, as well as aided communication using pen and paper, boards, tablets and mobile phones. Participating nurses reported communication barriers mainly related to patient and nurse characteristics and the ICU environment. Pandemic health protocols added obstacles, mostly related to protective health equipment.

The findings point to the difficulties nurses in Cyprus face when communicating with conscious patients during mechanical ventilation. The authors suggest that a lack of nurse training and suitable equipment for augmentative and alternative communication leaves critically ill patients' complex communication needs unaddressed. Further research including patients' views after recovery would bring more clarity. The study adds evidence about a communication crisis created by pandemic protective health protocols. It highlights the need to educate nurses in augmentative and alternative communication for conscious, mechanically ventilated patients during their ICU stay.