| Abstract |
Background
Communication is the process of exchanging information between two or more members
and involves the exchange of thoughts, messages, feelings through speech, image, writing and
behavior and It is distinguished into verbal and non-verbal communication.
Communication between patient and nursing staff is a key factor in the quality of health care
provided. Patients admitted to the Intensive Care Unit (ICU) often suffer from serious diseases and
are intubated in mechanical ventilation, with inability to speak and communicate. Studies have
shown that patients who are unable to communicate their needs show high rates of frustration,
psychological burden and post-traumatic stress. On the contrary, the degree of patient satisfaction
depends to a large extent on communication.
The challenge is to find and utilize in daily clinical practice the application of the appropriate
communication tool for the seriously ill.
Studies show that the use of an alternative means of communication, in case the patient is
in mechanical support of the breath, facilitates communication and helps to reduce his levels of
stress and anxiety (2), in order to achieve the best possible outcome.
Objective
The main objective of the study is the systematic review of available data through research
that has been carried out so far and concerns the use of alternative media in intubated and / or
mechanically ventilated patients, who can communicate.
The possibilities, perceptions and obstacles in communication with alternative methods and
modern means will be studied, in order to suggest applicable ways and tactics for more effective
communication with these patients. A secondary goal is a pilot study of the number of patients in
the ICU of the University Hospital of Heraklion (PAGNI) Crete to study and measure their satisfaction
in communication that can provide an illustrated laminated table of needs and desires and the use
of the same illustrated table. Methods
This is a retrospective review of published studies, articles and systematic reviews from 2003
to date, with data searched by search engines, PubMed, GoogleScholar and Medline. The pilot study
included ICU PAGNI patients intubated (July-December 2020) as long as they were able to
communicate, not necessarily to speak. Demographic, clinical and laboratory data, cause of
admission, severity of disease, medication, delirium (CAM-ICU) and final outcome were recorded.
In the patients who were finally included, methods of oral communication (verbal) and nods were
applied as well as non-verbal communication with an illustrated laminated table of needs and
desires as well as with the same illustrated table in electronic form in the form of a tablet.
Satisfaction was assessed directly with questions and answers on the LIKERT scale (Not at all-A little-
Moderate-Very-Very Much).
Results
The retrospective review identified 38 articles, 7 of which met the criteria. These studies
highlighted alternative modes of communication such as communication cards, standard illustrated
tables, interactive devices with computers, and "Eye-tracking" technology with eye-tracking
techniques. Despite the small number of patients participating in all studies, greater patient
satisfaction, reduction of stress and pain, positive response from nursing staff and opportunities for
training and learning systems emerged.
The pilot study involved 14 ICU patients (10 men, 4 women) of whom 8 patients were
diagnosed with COVID-19. 78.6% expressed the wish "I want", 50% "asked for water", 14% "wanted
the pipe to come out" and 14% asked "where am I". Patients' satisfaction with the use of the tool
was very good in questions / needs "I want" and moderate or a little in issues "I feel", "I speak", "I
am hungry" (p = 0.011). The degree of satisfaction between Covid-19 and non-Covid-19 patients did
not differ (p = 0.307) and showed high rates of high satisfaction "Very" with the use of the tool (75%)
compared to the non-use of the tool (60% ).
Conclusion
Understanding and meeting the needs of intubated ICU patients leads to greater patient
satisfaction resulting in reduced stress, better outcome and high quality health care. The ways of
communication can be simple conventional and alternative with the use of technology. The
individualization of the patient's needs will also determine the adapted use of the means of
communication. The specialized training of the nurse that provides direct care to the patient and the patient
himself contributes significantly to the full utilization of alternative media for the holistic and
effective provision of high quality health care.
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