title: Implementing augmentative and alternative communication in critical care settings: Perspectives of healthcare professionals.
abstract: OBJECTIVE
  To describe the perspectives of healthcare professionals caring for intubated patients on implementing augmentative and alternative communication (AAC) in critical care settings.
  
  
  BACKGROUND
  Patients in critical care settings subjected to endotracheal intubation suffer from a temporary functional speech disorder and can also experience anxiety, stress and delirium, leading to longer and more complicated hospitalisation and rehabilitation. Little is known about the use of AAC in critical care settings.
  
  
  METHODS
  The design was informed by interpretive descriptive methodology along with the theoretical framework symbolic interactionism, which guided the study of healthcare professionals (n = 48) in five different intensive care units. Data were generated through participant observations and 10 focus group interviews.
  
  
  RESULTS
  The findings represent an understanding of the healthcare professionals' perspectives on implementing AAC in critical care settings and revealed three themes. Caring Ontology was the foundation of the healthcare professionals' profession. Cultural Belief represented the actual premise in the interactions during the healthcare professionals' work, saving lives in a biomedical setting whilst appearing competent and efficient, leading to Triggered Conduct and giving low priority to psychosocial issues like communication.
  
  
  CONCLUSIONS
  Lack of the ability to communicate puts patients at greater risk of receiving poorer treatment, which supports the pressuring need to implement and use AAC in critical care. It is documented that culture in biomedical paradigms can have consequences that are the opposite of the staffs' ideals. The findings may guide staff in implementing AAC strategies in their communication with patients and at the same time preserve their caring ontology and professional pride.
  
  
  CONCLUSIONS
  Improving communication strategies may improve patient safety and make a difference in patient outcomes. Increased knowledge of and familiarity with AAC strategies may provide healthcare professionals with an enhanced feeling of competence.
authors.affiliation: Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Aarhus, Denmark.|DEFACTUM, Aarhus, Central Denmark Region, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Handberg
authors.affiliation: Technology in Practice, MarselisborgCenter, Danish Centre for Rehabilitation - Research and Development, Aarhus, Denmark.
authors.forename: Anna Katarina
authors.initials: AK
authors.lastname: Voss
mesh_terms: D000328:Adult; D001007:Anxiety / Q000517:prevention & control; D001291:Attitude of Health Personnel; D003143:Communication Devices for People with Disabilities; D003144:Communication Barriers; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000517:prevention & control; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000523:psychology; D008297:Male; D036301:Qualitative Research; D013064:Speech Disorders / Q000628:therapy*; D013315:Stress, Psychological / Q000517:prevention & control
keywords: alternative and augmentative communication (AAC); communication; communication aids; healthcare professionals; intensive care units (ICU); interpretive description; nursing care; rehabilitation; speech impairment; symbolic interactionism