Determinants of communication Failure in intubated critically ill patients: a qualitative phenomenological study from the perspective of critical care nurses.

Abstract

[eng] To explore what factors determine communication with awake intubated critically illpatients from the point of view of critical care nursing professionals. Background: Impaired commu-nication frequently affects mechanically ventilated patients with artificial airways in the intensivecare unit. Consequences of communication breaches comprise emotional and ethical aspects as wellas clinical safety, affecting both patients and their conversation partners. Identification of determiningfactors in communication with awake intubated patients is needed to design effective action strategies.Design: A qualitative phenomenological approach was used. Methods: Semi-structured interviewswere used as the data collection method. A total of 11 participants from three intensive care unitsof three Majorcan public hospitals, selected by purposive sampling, were interviewed. Findings:Three major themes regarding the communication determinants of the awake intubated critically illpatients were identified from the interviewees’ statements: factors related to the patient (physical andcognitive functionality to communicate, their relational and communicative style and their personalcircumstances), to the context (family presence, ICU characteristics, workload, availability/adequacyof communication aids, features of the messages and communication situations) and, finally, those re-lated to the professionals themselves (professional experience and person-centredness). Conclusions:The present study reveals determinants that influence communication with the awake intubatedpatient, as there are attitudes and professional beliefs. Relevance to clinical practice: The discovery ofrelations between different kinds of determinants (of patient, context or professionals) provides amulti-factor perspective on the communicative problem which should be considered in the design ofnew approaches to improve communicative effectiveness. This study is reported according to theCOREQ checklist