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Loss of voice in mechanically ventilated tracheostomy patients: The patient experience in ICU
Papers and Poster Abstracts / Australian Critical Care 29 (2016) 110–123
Loss of voice in mechanically ventilated tracheostomy patients: The patient experience in ICU Amy Freeman-Sanderson 1,2,∗ , Leanne Togher 2 , Belinda Kenny 2 , Mark Elkins 1,2 , Paul Phipps 1,2 1 Royal Prince Alfred Hospital, Camperdown, Australia 2 University of Sydney, Sydney, Australia
Introduction: Voicelessness experienced during mechanical ventilation has been described as frustrating and stressful, with an adverse impact on communication. In the presence of a tracheostomy, cuff deflation and use of a speaking valve is an effective intervention for voice restoration. Although other communication methods may be available to patients who receive a tracheostomy as part of their management, an exploration of their experience of communication and its impact on their care may be helpful in understanding the importance of professional input to restore voice in this population. Study objectives: To explore the experience of loss and regain of voice in patients who receive a tracheostomy while in Intensive Care (ICU). Methods: Participants were recruited from a tertiary ICU and had participated in a trial of communication intervention. Six months after tracheostomy decannulation, in-depth interviews were conducted to explore the impact of tracheostomy placement on communication ability and subsequent clinical progression. Data were collected by an independent clinician and analysed using a thematic approach. Results: Seventeen patients completed interviews, generating 105 significant statements. Four themes emerged from participants including: “What is happening to me?” Patients were not aware of the reason for voice loss which exacerbated confusion; “It’s hard communicating without a voice”, non-verbal communication and the ICU environment extremely limited communication success; “A storm of dark emotions”, negative mood was universal with voice loss; and “More than a response. . .it’s participating and recovering”, patients were able to engage more in the care process and had a sense of recovery with the return of voice. Conclusion(s): Loss of voice has a direct impact on patients’ ability to clearly communicate information pertaining to their care and comfort in ICU. Return of voice was associated with improved mood, communication success and increased degree of participation, voice should be considered as early as clinically appropriate. http://dx.doi.org/10.1016/j.aucc.2015.12.013
Barriers or facilitators to patient-centred nursing in the intensive care unit Samantha Jakimowicz ∗ , Lin Perry, Joanne Lewis University of Technology, Sydney, Australia Introduction: Patient-centred nursing in the context of critical care differs from that in other areas of health. The highly pressured intensive care environment reflects demands exerted on critical care nurses to provide patient-centred nursing whilst meeting extremely high clinical and organisational requirements. Identification of barriers or facilitators to provision of patientcentred nursing is vital to instigate change to tackle these pressures. Understanding critical care nurses’ perceptions of this concept will support and enable identification of strategies to ensure effective patient-centred nursing and nurses’ continued engagement to maintain and grow an effective critical care nursing workforce.
115
Study objectives: The aim of this project was to conduct a systematic literature review of critical care nurses’ perceptions of facilitators or barriers to provision of patient-centred nursing in the ICU. Methods: Whittemore and Knafl’s integrative review method was used together with framework analysis to critically analyse, aggregate and synthesise textual data. Twenty-one papers meeting the inclusion criteria were identified from database searches. Results: Barriers to patient-centred nursing in the ICU were prominent in the literature. Elements impacting patient-centrednursing include: conflict and difference of opinion between nurse and physician; physical space; family involvement; feelings of failure due to moral distress; and a complicated physiologically compromised patient. Positive nursing values and colleagues were seen to facilitate nurses’ provision of patient-centred-nursing. Conclusion: Critical care nurses can lead change in practice by engaging in research examining the concept of patient-centred nursing and professional quality of life. This important work will contribute to significant shifts in policy and practice. Development of strategies to meet the pressure of clinical and organisational demands will provide support to improve ICU nurses’ professional quality of life, patient satisfaction and nurse workforce retention. http://dx.doi.org/10.1016/j.aucc.2015.12.014 Restructuring intensive care unit ward round practices using critical ethnography Sarah Jones 1,∗ , Janine Bothe 2 , Kush Deshpande 2 1 2
The St George Hospital, Sydney, Australia St George Hospital, Kogarah, Australia
Introduction: Daily rounds are central to safe management of patients in intensive care unit (ICU). These rounds are routine communication forums where multidisciplinary teams provide the detailed plans for the management of patients. The studies exploring ward round processes and recommendations for improvement are lacking in the intensive care setting. Study objective: To mobilise the ICU ‘community’ as a whole with a focus on improvement in the daily ward round practice. Methods: We used ‘critical ethnography’ method from a theoretical perspective of constructionism and symbolic interactionism. We conducted this study in 4 stages. Stage 1 was ethnographic description (non-participant observation) of the unit’s ward round practice by two trained researchers. Stage 2 was development of a narrative describing the experiences and perspectives of staff around the ward rounds. We provided the narrative to all staff in ICU for their comments and feedback. In stage 3, we conducted focus groups with medical, nursing and allied health staff in our ICU to explore and understand what we had learnt from the first two stages. Stage 4 was an implementation phase. Results: We conducted this study in an ICU of a metropolitan teaching hospital in Sydney, Australia; from June to December 2014. A total of 16 hours of observations were undertaken over an 8 week period followed by 6 focus groups (each with 8–10 participants and lasting 2–2.5 hours). Four major themes emerged and were mapped. These themes were: streamlining the ward round process, eliminating interruptions, prioritising patient-centred care and avoiding nosocomial infections. Based on these findings, an action plan was agreed and is being implemented. Conclusion: Through collaboration and inclusiveness, the ICU multidisciplinary teams can be engaged in the evaluation and restructuring of ward round practices. http://dx.doi.org/10.1016/j.aucc.2015.12.015
Loss of voice in mechanically ventilated tracheostomy patients: The patient experience in ICU Amy Freeman-Sanderson 1,2,∗ , Leanne Togher 2 , Belinda Kenny 2 , Mark Elkins 1,2 , Paul Phipps 1,2 1 Royal Prince Alfred Hospital, Camperdown, Australia 2 University of Sydney, Sydney, Australia
Introduction: Voicelessness experienced during mechanical ventilation has been described as frustrating and stressful, with an adverse impact on communication. In the presence of a tracheostomy, cuff deflation and use of a speaking valve is an effective intervention for voice restoration. Although other communication methods may be available to patients who receive a tracheostomy as part of their management, an exploration of their experience of communication and its impact on their care may be helpful in understanding the importance of professional input to restore voice in this population. Study objectives: To explore the experience of loss and regain of voice in patients who receive a tracheostomy while in Intensive Care (ICU). Methods: Participants were recruited from a tertiary ICU and had participated in a trial of communication intervention. Six months after tracheostomy decannulation, in-depth interviews were conducted to explore the impact of tracheostomy placement on communication ability and subsequent clinical progression. Data were collected by an independent clinician and analysed using a thematic approach. Results: Seventeen patients completed interviews, generating 105 significant statements. Four themes emerged from participants including: “What is happening to me?” Patients were not aware of the reason for voice loss which exacerbated confusion; “It’s hard communicating without a voice”, non-verbal communication and the ICU environment extremely limited communication success; “A storm of dark emotions”, negative mood was universal with voice loss; and “More than a response. . .it’s participating and recovering”, patients were able to engage more in the care process and had a sense of recovery with the return of voice. Conclusion(s): Loss of voice has a direct impact on patients’ ability to clearly communicate information pertaining to their care and comfort in ICU. Return of voice was associated with improved mood, communication success and increased degree of participation, voice should be considered as early as clinically appropriate. http://dx.doi.org/10.1016/j.aucc.2015.12.013
Barriers or facilitators to patient-centred nursing in the intensive care unit Samantha Jakimowicz ∗ , Lin Perry, Joanne Lewis University of Technology, Sydney, Australia Introduction: Patient-centred nursing in the context of critical care differs from that in other areas of health. The highly pressured intensive care environment reflects demands exerted on critical care nurses to provide patient-centred nursing whilst meeting extremely high clinical and organisational requirements. Identification of barriers or facilitators to provision of patientcentred nursing is vital to instigate change to tackle these pressures. Understanding critical care nurses’ perceptions of this concept will support and enable identification of strategies to ensure effective patient-centred nursing and nurses’ continued engagement to maintain and grow an effective critical care nursing workforce.
115
Study objectives: The aim of this project was to conduct a systematic literature review of critical care nurses’ perceptions of facilitators or barriers to provision of patient-centred nursing in the ICU. Methods: Whittemore and Knafl’s integrative review method was used together with framework analysis to critically analyse, aggregate and synthesise textual data. Twenty-one papers meeting the inclusion criteria were identified from database searches. Results: Barriers to patient-centred nursing in the ICU were prominent in the literature. Elements impacting patient-centrednursing include: conflict and difference of opinion between nurse and physician; physical space; family involvement; feelings of failure due to moral distress; and a complicated physiologically compromised patient. Positive nursing values and colleagues were seen to facilitate nurses’ provision of patient-centred-nursing. Conclusion: Critical care nurses can lead change in practice by engaging in research examining the concept of patient-centred nursing and professional quality of life. This important work will contribute to significant shifts in policy and practice. Development of strategies to meet the pressure of clinical and organisational demands will provide support to improve ICU nurses’ professional quality of life, patient satisfaction and nurse workforce retention. http://dx.doi.org/10.1016/j.aucc.2015.12.014 Restructuring intensive care unit ward round practices using critical ethnography Sarah Jones 1,∗ , Janine Bothe 2 , Kush Deshpande 2 1 2
The St George Hospital, Sydney, Australia St George Hospital, Kogarah, Australia
Introduction: Daily rounds are central to safe management of patients in intensive care unit (ICU). These rounds are routine communication forums where multidisciplinary teams provide the detailed plans for the management of patients. The studies exploring ward round processes and recommendations for improvement are lacking in the intensive care setting. Study objective: To mobilise the ICU ‘community’ as a whole with a focus on improvement in the daily ward round practice. Methods: We used ‘critical ethnography’ method from a theoretical perspective of constructionism and symbolic interactionism. We conducted this study in 4 stages. Stage 1 was ethnographic description (non-participant observation) of the unit’s ward round practice by two trained researchers. Stage 2 was development of a narrative describing the experiences and perspectives of staff around the ward rounds. We provided the narrative to all staff in ICU for their comments and feedback. In stage 3, we conducted focus groups with medical, nursing and allied health staff in our ICU to explore and understand what we had learnt from the first two stages. Stage 4 was an implementation phase. Results: We conducted this study in an ICU of a metropolitan teaching hospital in Sydney, Australia; from June to December 2014. A total of 16 hours of observations were undertaken over an 8 week period followed by 6 focus groups (each with 8–10 participants and lasting 2–2.5 hours). Four major themes emerged and were mapped. These themes were: streamlining the ward round process, eliminating interruptions, prioritising patient-centred care and avoiding nosocomial infections. Based on these findings, an action plan was agreed and is being implemented. Conclusion: Through collaboration and inclusiveness, the ICU multidisciplinary teams can be engaged in the evaluation and restructuring of ward round practices. http://dx.doi.org/10.1016/j.aucc.2015.12.015