TY - JOUR

T1 - Unidentified communication challenges in the intensive care unit

T2 - A qualitative study using multiple triangulations

AU - Nyhagen, Ragnhild

AU - Egerod, Ingrid

AU - Rustøen, Tone

AU - Lerdal, Anners

AU - Kirkevold, Marit

N1 - Publisher Copyright: © 2022 Australian College of Critical Care Nurses Ltd

PY - 2023

Y1 - 2023

N2 - Background: 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. Objectives: The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges. Methods: 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. Findings: 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. Conclusions: 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.

AB - Background: 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. Objectives: The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges. Methods: 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. Findings: 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. Conclusions: 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.

KW - Communication

KW - Critical care

KW - Family

KW - Intensive care units

KW - Interviews

KW - Nursing

KW - Participant observation

KW - Qualitative research

KW - Triangulation

U2 - 10.1016/j.aucc.2022.01.006

DO - 10.1016/j.aucc.2022.01.006

M3 - Journal article

C2 - 35272909

AN - SCOPUS:85125935621

VL - 36

SP - 215

EP - 222

JO - Australian Critical Care

JF - Australian Critical Care

SN - 1036-7314

IS - 2

ER -