Mary Beth Happ

Background: Communication with mechanically ventilated patients in intensive care is complex. Decades of research demonstrate that communication barriers are commonly experienced and one of the most challenging experiences during an intensive care stay. Support for the health care providers in these situations could be a model for communication, guiding the interaction. Aim: The aim of this study was to examine critical care nurses' (CCNs') perspectives of the clinical relevance and applicability of a communication model for mechanically ventilated patients. Study Design: Qualitative, explorative design in accordance with Im & Meleis' phases of development of situation‐specific theories. We conducted six focus group interviews with CCNs from Denmark, Norway and the United States, two in each country, lasting between 58 and 90 min. The interviews were analysed by a content analytic approach with both inductive and deductive phases. Findings: Twenty‐nine CCNs participated in the focus group interviews. The main category was identified during the analysis, which was: ‘Relationship‐building as a starting point for meaningful communication’. The main category was further described by three subcategories: (1) Patients' abilities and challenges in communication while being mechanically ventilated. (2) Nurses' competencies and strategies for effective communication with mechanically ventilated patients and (3) Tools and resources in practice. Conclusions: The nurses' perspectives yielded a deeper understanding of how clinical practice both corresponds to and departs from a theoretical lens. Given that the interviews with nurses revealed the relational component as a critical starting point of communication, the model should highlight this specific element more explicitly. To understand the complexity occurring in the daily practice of an ICU, a situation‐specific theory will be useful for providing examples of good practice. Relevance to Clinical Practice: Communication in an ICU setting requires the establishment of a relationship to find effective ways to communicate. Integrating clinical perspectives can refine and adapt the preliminary model to the real communication encounters and improve care.

RATIONALE: The value of effective clinician-patient communication for patient safety and comfort is well-established, yet most ICU clinicians have little training and few resources to guide them in communication assessment and application of patient-centered communication strategies. The Study of Patient- Nurse Effectiveness with Assisted Communication Strategies (SPEACS-2) algorithm is an evidence-based method to guide clinicians through assessment and communication strategies selection tailored to patient function. OBJECTIVE: To describe the process of design, usability, and acceptability testing of the interactive Patient Communication Support Guide (PCSG) based on the SPEACS-2 algorithm and training program to assist clinicians in communicating more effectively with ICU patients. METHODS: We used an iterative, user-centered design to create the PCSG on the QualtricsXM platform and field-tested it for usability and acceptability with ICU nurses. Nurse participants received 1-hr training and orientation to the PCSG, augmentative and alternative communication (AAC) tools, and the study protocol. Nurses were instructed to use the PCSG with at least 5 patients over a 2-week testing period and to complete the 10-item System Usability Scale (SUS). Scores above 68/100 points are considered above average. Nurses provided qualitative feedback and repeated the field-testing following a washout period for tool refinement. RESULTS: We recruited 10 nurses evenly distributed in 2 ICUs in two different community hospitals, one with Magnet status, in Southern Ohio. One unit was a mixed medical-surgical unit, and the other was a neurocritical care unit. Participating nurses’ ICU experience ranged from less than 1 to 9 years; all were BSN-prepared. SUS scores show improved usability scores after PCSG refinement; however, the likelihood to recommend the PCSG (acceptability) decreased slightly. Overall, the qualitative feedback was positive; several nurses indicated that they changed their practice because of the PCSG and used the AAC tools frequently. Nurses felt that they quickly learned how to choose the correct AAC tool for their patient and that the PCSG was quick and simple, recommending integration in the electronic health record. CONCLUSIONS: Best practices in user-centered design resulted in a Patient Communication Support Guide that is usable and acceptable to ICU nurses.

African American caregivers of older adults living with Alzheimer’s disease or a related dementia are at high risk for physical, spiritual, and psychosocial challenges. Peer mentorship, a relationship-centered person-to-person approach may reduce healthcare decision-making burden among African American caregivers through cultural tailoring by promoting oral traditions, personal contact, and storytelling. The purpose of this Stage 1 intervention study is to use a stakeholder-informed approach in further developing and pilot testing the co-created Peer Support for Caregivers of African Americans Living with Alzheimer’s Disease and Related Dementias (Pair2Care), a culturally sensitive caregiver peer support program. Pair2Care feasibility and acceptability will be evaluated in current (n=15) and trained former (n=15) African American Alzheimer’s and related dementia caregivers. Pair2Care will be deemed feasible and acceptable by evaluating eligibility criteria, recruitment and retention data, protocol adherence, satisfaction, and feedback on program appropriateness for broader dissemination. Preliminary intervention outcomes of caregiver anxiety, depression, quality-of-life, social support, self-efficacy for surrogate decision-making, and intent to use palliative care or hospice services will be assessed to evaluate intervention effectiveness. At 6 months as compared to baseline, current caregivers will report less anxiety and depression, improved quality-of-life, social support, and self-efficacy for surrogate decision-making, as well as intent to use palliative care or hospice services as part of healthcare and advance care planning decision- making. Pair2Care poses an innovative strategy with the potential to address advance care planning and healthcare decision-making, a significant health disparity problem and thereby promote health equity.

Mechanically ventilated patients experience many adverse symptoms, such as anxiety, thirst, and dyspnea. However, these common symptoms are not included in practice guideline recommendations for routine assessment of mechanically ventilated patients. An American Thoracic Society-sponsored workshop with researchers and clinicians with expertise in critical care and symptom management was convened for a discussion of symptom assessment in mechanically ventilated patients. Members included nurses, physicians, a respiratory therapist, a speech–language pathologist, a critical care pharmacist, and a former intensive care unit patient. This report summarizes existing evidence and consensus among workshop participants regarding 1) symptoms that should be considered for routine assessment of adult patients receiving mechanical ventilation; 2) key symptom assessment principles; 3) strategies that support symptom assessment in nonvocal patients; and 4) areas for future clinical practice development and research. Systematic patient-centered assessment of multiple symptoms has great potential to minimize patient distress and improve the patient experience. A culture shift is necessary to promote ongoing holistic symptom assessment with valid and reliable instruments. This report represents our workgroup consensus on symptom assessment for mechanically ventilated patients. Future work should address how holistic, patient-centered symptom assessment can be embedded into clinical practice.

Aims: The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients.Design: The Im & Meleis approach for concept analysis guided the study.Search Methods: A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998–2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references.Review Methods: After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed.Results: We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units.Conclusion: Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves.Impact: A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further.Patient or Public Contribution: No patient or public contribution, as this is a concept analysis of previous research.

Background: Chaplain-led communication-board-guided spiritual care may reduce anxiety and stress during an intensive care unit (ICU) admission for nonvocal mechanically ventilated patients, but clinical pastoral education does not teach the assistive communication skills needed to provide communication-board-guided spiritual care. Objective: To evaluate a four-hour chaplain-led seminar to educate chaplains about ICU patients' psychoemotional distress, and train them in assistive communication skills for providing chaplain-led communication-board-guided spiritual care. Design: A survey immediately before and after the seminar, and one-year follow-up about use of communication-board-guided spiritual care. Subjects/Setting: Sixty-two chaplains from four U.S. medical centers. Measurements: Multiple-choice and 10-point integer scale questions about ICU patients' mental health and communication-board-guided spiritual care best practices. Results: Chaplain awareness of ICU sedation practices, signs of delirium, and depression, anxiety, and post-traumatic stress disorder in ICU survivors increased significantly (all p < 0.001). Knowledge about using tagged yes/no questions to communicate with nonvocal patients increased from 38% to 87%, p < 0.001. Self-reported skill and comfort in providing communication-board-guided spiritual care increased from a median (interquartile range) score of 4 (2–6) to 7 (5–8) and 6 (4–8) to 8 (6–9), respectively (both p < 0.001). One year later, 31% of chaplains reported providing communication-board-guided spiritual care in the ICU. Conclusions: A single chaplain-led seminar taught chaplains about ICU patients' psychoemotional distress, trained chaplains in assistive communication skills with nonvocal patients, and led to the use of communication-board-guided spiritual care in the ICU for up to one year later.