title: Nurse-patient communication interactions in the intensive care unit.
abstract: BACKGROUND
  The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured.
  
  
  OBJECTIVE
  To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit.
  
  
  METHODS
  Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication.
  
  
  RESULTS
  Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards).
  
  
  CONCLUSIONS
  Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials.
authors.affiliation: School of Nursing, University of Pittsburgh, Pennsylvania, USA. mhapp@pitt.edu
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Happ
authors.forename: Kathryn
authors.initials: K
authors.lastname: Garrett
authors.forename: Dana DiVirgilio
authors.initials: DD
authors.lastname: Thomas
authors.forename: Judith
authors.initials: J
authors.lastname: Tate
authors.forename: Elisabeth
authors.initials: E
authors.lastname: George
authors.forename: Martin
authors.initials: M
authors.lastname: Houze
authors.forename: Jill
authors.initials: J
authors.lastname: Radtke
authors.forename: Susan
authors.initials: S
authors.lastname: Sereika
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003142:Communication; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D014741:Video Recording