title: The experience of communication difficulties in critically ill patients in and beyond intensive care: Findings from a larger phenomenological study.
abstract: Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption (DSI). The aim of the study was to describe the lived experience of people who experienced critical illness in ICU using a hermeneutic phenomenological approach in the DSI context. Twelve participants aged between 20 and 76 years with an ICU stay ranging from 3 to 36 days were recruited from a 16 bed ICU in a large regional referral hospital in New South Wales (NSW), Australia. Participants were intubated, mechanically ventilated and subjected to (DSI) during their critical illness in ICU. In-depth face to face interviews with participants were conducted at two weeks after discharge from ICU and at six to eleven months later. Interviews were audio taped and transcribed. Thematic analysis using van Manen's (1990) method was completed. The overarching theme; 'Being in limbo' and subthemes 'Being disrupted'; 'Being imprisoned' and 'Being trapped' depict the main elements of the experience. This paper discusses communication difficulties in critically ill patients as one of the main findings relating to the theme 'Being trapped'. Participants' reports of communication difficulties in ICU are similar to those reported by patients in other studies where DSI was not used. However, not many studies have reported ongoing communication difficulties after ICU hospitalisation. Recommendations are made for new models of care and support to mitigate critically ill patients' communication concerns in ICU and for further research into the causes and treatment to benefit this group of patients. Most importantly, extra care is recommended not to damage vocal cords during intubation and cuff inflation in the course of mechanical ventilation.
authors.affiliation: University of Newcastle, School of Nursing and Midwifery, Faculty of Health and Medicine, Callaghan Campus, Newcastle, NSW 2308, Australia; Newcastle Private Hospital, Look Out Road, New Lambton, NSW 2305, Australia.
authors.forename: Agness C
authors.initials: AC
authors.lastname: Tembo
authors.affiliation: Professor of Nursing University of Newcastle, School of Nursing and Midwifery, Faculty of Health and Medicine, Callaghan Campus, Newcastle, NSW 2308, Australia.
authors.forename: Isabel
authors.initials: I
authors.lastname: Higgins
authors.affiliation: Professor of Nursing University of New England, Armidale, NSW 2351, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Parker
mesh_terms: D000328:Adult; D000368:Aged; D003144:Communication Barriers; D016638:Critical Illness / Q000451:nursing*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D009723:Nurse-Patient Relations; D055815:Young Adult
keywords: Critical illness; Daily sedation interruption, Communication difficulties; Intensive care; Mechanical ventilation