More than half of mechanically ventilated ICU patients have the ability to communicate

Contact: Meggie Biss, 614-292-2247, biss.11@osu.edu

A new study authored by a College of Nursing professor reveals that more than half of mechanically ventilated patients in intensive care units (ICU) could benefit from assistive communication tools.

The article, “The number of mechanically ventilated ICU patients meeting communication criteria,” appears in the January/February 2015 issue of Heart & Lung and is authored by Mary Beth Happ, PhD, RN, FGSA, FAAN, distinguished professor and director of the college’s Center of Excellence in Critical and Complex Care, along with her colleagues from the University of Pittsburgh.

The study found that 53.9 percent of the 2,671 mechanically ventilated (respirator) patients screened met basic communication criteria and could potentially benefit from the use of assistive communication tools and speech language consultation. According to the study, eligible patients were awake, alert and responsive to verbal communication from clinicians for at least one 12-hour shift while receiving mechanical ventilation for two or more days. Patients who did not meet basic communication criteria were younger, had shorter lengths of stay and lower costs, and were more likely to die during the hospitalization.

“Our findings challenge the commonly held assumption of many clinicians and researchers that these patients are unable to communicate or participate in their care,” explained Dr. Happ. “Establishing lines of communication is the first step in a patient being able to make his or her needs known, have accurate symptom assessment and management, and contributes to an overall better patient experience. We know from interviews with patients who remember their critical care experience that the inability to communicate is anxiety producing and, in some cases, terrifying.”

While the study indicates that many patients do have the ability to communicate, that doesn’t mean that communication is being properly facilitated, says Dr. Happ. “We need to change the culture of care teams in the ICU to better address communication support needs,” she said. “We often don’t have the necessary tools at the bedside, and it does require a certain skill level on the part of the clinician to be able to assist patients without both parties becoming very frustrated.”

Dr. Happ’s research focuses on patient-provider communication in acute and critical care and has been funded by the National Institutes of Health and the Robert Wood Johnson Foundation (RWJF). This particular study received funding by RWJF through the Interdisciplinary Nursing Quality Research Initiative (INQRI). Dr. Happ’s co-authors for the new study are Judith A. Tate, PhD, RN, The Ohio State University College of Nursing; Jennifer B. Seaman, BSN; Marci L. Nilsen, PhD, RN; Andrea Sciulli, BA; Melissa Saul, MS; and Amber E. Barnato, MD, MPH, MS (co-principal investigator); all of the University of Pittsburgh. The study was conducted over a two year period while Dr. Happ was at Pittsburgh.

The study notes that “as critical care clinical practice moves toward less sedation, promoting wakefulness and early mobilization during mechanical ventilation, the proportion of awake and potentially communicative patients is likely to increase, therefore increasing the need for communication support.”

“We’ve known that this is a problem for over 30 years, but it’s an area that has been largely ignored because it’s a need that crosses disciplines. It becomes an issue of ‘who’s responsible?’” explains Dr. Happ. She says the next steps for identifying a solution are to design implementation programs for care teams that can fully address communication needs for mechanically ventilated patients while also measuring patient care outcomes related to this practice change.

Currently the College of Nursing offers an online Continuing Education program which addresses appropriate strategies and low-tech assistive communication tools to facilitate communication among non-vocal patients. To learn more about the program, visit go.osu.edu/speacs2.