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

Abstract

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.