Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial.
OBJECTIVE
To test the impact of two levels of intervention on communication frequency, quality, success, and ease between nurses and intubated intensive care unit (ICU) patients.


METHODS
Quasi-experimental, 3-phase sequential cohort study: (1) usual care, (2) basic communication skills training (BCST) for nurses, (3) additional training in augmentative and alternative communication devices and speech language pathologist consultation (AAC + SLP). Trained observers rated four 3-min video-recordings for each nurse-patient dyad for communication frequency, quality and success. Patients self-rated communication ease.


METHODS
Two ICUs in a university-affiliated medical center.


METHODS
89 intubated patients awake, responsive and unable to speak and 30 ICU nurses.


RESULTS
Communication frequency (mean number of communication acts within a communication exchange) and positive nurse communication behaviors increased significantly in one ICU only. Percentage of successful communication exchanges about pain were greater for the two intervention groups than the usual care/control group across both ICUs (p = .03) with more successful sessions about pain and other symptoms in the AAC + SLP group (p = .07). Patients in the AAC + SLP intervention group used significantly more AAC methods (p = .002) and rated communication at high difficulty less often (p < .01).


CONCLUSIONS
This study provides support for the feasibility, utility and efficacy of a multi-level communication skills training, materials and SLP consultation intervention in the ICU.
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; University of Pittsburgh Department of Critical Care Medicine, Pittsburgh, PA, USA; The Ohio State University College of Nursing. Electronic address: happ.3@osu.edu.
Mary Beth
MB
Happ
Alternative Communication, LLC.
Kathryn L
KL
Garrett
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Judith A
JA
Tate
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Dana
D
DiVirgilio
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Martin P
MP
Houze
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine/Children's Hospital of Pittsburgh General Academic Pediatrics, USA.
Jill R
JR
Demirci
University of Pittsburgh Medical Center, Department of Nursing, USA.
Elisabeth
E
George
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Susan M
SM
Sereika
D000328:Adult; D000368:Aged; D003142:Communication; D064648:Critical Care Nursing; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007442:Intubation, Intratracheal; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D057566:Self Report
Augmentative and alternative communication; Communication; Critical care; Mechanical ventilation; Nurse–patient communication; Patient–provider communication