The experience of communication difficulties in critically ill patients in and beyond intensive care: Findings from a larger phenomenological study
Introduction
Studies that have examined the impact of technology and ventilation for patients have demonstrated the distressing nature of being ventilated, either through an endotracheal tube (ETT) or tracheostomy. Mechanically ventilated critically ill patients’ distress is associated partly with the inability to speak and communicate effectively with staff and family. In addition, communication difficulties are related to feelings of powerlessness and vulnerability resulting in frustration, anxiety and possibly delirium (Happ, 2001). Compounding factors have been linked to nurses’ busyness and inability to lip read and patients’ personality and inability to write (Happ, 2001).
Findings from previous research on communication difficulties in mechanically ventilated patients have led to the introduction of various communication assistive devices. However, their use and effectiveness remains to be established. Furthermore, the quest to improve patient experience and ICU outcomes have resulted in technological advancement and innovation in ICU practices such as new ventilators and daily sedation interruption (DSI). Reports that a more wakeful patient will be able to communicate and participate in decision making of their care (Mirski et al., 2010, Wunsch and Kress, 2009) have been cited. However, perceptions of patients about communication under such conditions have not been documented.
Section snippets
Background
Various phenomena have been associated with communication difficulties in mechanically ventilated critically ill patients. Granberg et al.’s (1999) seminal work found that many critically ill patients fail to communicate due to demanding nurses’ workload. The authors conducted a hermeneutic phenomenological study in Sweden which comprised nineteen participants who had been mechanically ventilated in ICU. The authors interviewed participants at one week and at eight weeks after discharge from
Aim of the study
The aim of the study reported here was to describe the lived experience of critical illness in ICU in the context of DSI and how it impacts the participants’ continued existence beyond ICU and hospitalisation. Some findings from the larger study have already been published before (Tembo et al., 2012, Tembo et al., 2013).
Research question
The research question was “what was it like to be critically ill in ICU?”
Research design
This study used a qualitative design guided by hermeneutic phenomenology as the research methodology (Tembo et al., 2012, Tembo et al., 2013).
Ethical considerations
Ethical approval was sought and granted in December, 2007 by the Research Ethics Committee where the study was undertaken. Potential participants were given both written and verbal information about the study (Tembo, 2012, Tembo et al., 2012, Tembo et al., 2013).
Setting
The study was conducted in a 16 bed ICU unit, which provides critical care for infants and
Findings
The overarching theme of the larger study was ‘Being in Limbo’ of which one of the major themes was ‘Being Imprisoned’. The major theme of ‘Being imprisoned’ was characterised by sub themes of ‘Being Voiceless’, ‘Being trapped’ and Waiting for the familiar and reliable voice (Tembo, 2012, Tembo et al., 2012, Tembo et al., 2013). The subthemes described in this paper are described in preceding publications (Tembo, 2012, Tembo et al., 2012, Tembo et al., 2013).
Discussion
Despite the use of DSI, people continue to experience communication difficulties and the devastating impact it has on them as they struggle to make themselves heard and understood (Almerud-Österberg, 2010, Almerud et al., 2007, Zeilani and Seymour, 2010). Most importantly, this study adds to the literature that communication difficulties continue long after ICU hospitalisation for some patients. This aspect of communication difficulties has not been extensively explored. This means that there
Conclusion
Communication difficulties continue to affect patients up to eleven months after ICU hospitalisation. This leaves the people with a loss of identity and feelings of being in limbo, not knowing when their voice will come back. This calls for further qualitative research into the experience of communication difficulties after ICU hospitalisation.
The main aim of this study was to explore and understand the experience of communication difficulties during critical illness and ICU hospitalisation and
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