Augmentative and alternative communication in intensive care units in New Zealand : experiences of healthcare professionals : a thesis presented in partial fulfilment of the requirements for the degree of Master of Speech Language Therapy at Massey University, Albany, New Zealand
Research shows that communication between patients and healthcare professionals
(HCPs) in the Intensive Care Unit (ICU) is often fraught with difficulty. Communication
problems increase the risk of adverse events and psychological distress. Augmentative
and alternative communication (AAC) tools are useful for enabling communication with
patients in the ICU. To date, all of the research about communication and AAC use in
the ICU has been completed outside of New Zealand.
Five nurses and three speech and language therapists (SLTs) working in ICUs in five
District Health Boards (DHBs) were interviewed to explore their experiences
communicating with patients who were conscious but unable to speak. Seven key
findings emerged: 1) Nurses reported experiencing communication breakdown with
patients; 2) HCPs reported that communication attempts were limited for patients; 3)
HCPs reported using unaided and low-tech AAC tools and strategies. High-tech AAC
tools were relatively uncommon; 4) Alternative access options were rarely used; 5) The
greatest barriers to effective communication were time and workload (including
prioritization of dysphagia management) and patients’ limb weakness, cognitive deficits
and sedation; 6) In three DHBs, ICU staff regularly referred patients to SLT and in two
they did not; 7) Training in AAC for both professions was limited, and nurses wanted
more information about options for communicating with their patients.
The interviews showed that New Zealand nurses’ perceptions about communicating with
patients were similar to reports from international studies. AAC tools and SLT services
should be provided in ICUs across the country. Additionally, AAC training is needed for
nurses and SLTs.