Knowledge Bank

Introduction/Background: Mechanical ventilation causes the inability to speak due to the inflated cuff of the endotracheal or tracheostomy tube blocking passage of air over the vocal cords. As a result, mechanically ventilated patients in the intensive care unit (ICU) often experience difficulty communicating with others, including family visitors. Most prior research has focused on communication between patients and nurses in the ICU. There is little research regarding the process and topics of communication between mechanically ventilated patients and family. The purpose of this study is to explore the topics that nonvocal, mechanically ventilated patients communicate about in the ICU with their family members and to identify how often patients initiate these topics. Methods: We conducted qualitative, descriptive analysis of transcripts from 14 video-recorded sessions of communication between 5 patient-family dyads during visitation in the ICU. To explore topics of communication between patients and family, we developed a list of 6 topic code categories from the literature and applied them to transcribed patient-visitor communication exchanges. Transcripts were coded for topic and initiator (patient vs. family) by the student investigator with 100% expert review. Coding discrepancies were resolved by discussion. New topic categories and definitions were added, and definitions expanded during analysis, resulting in 13 final topic categories.
Results: In total, there were 334 communication topic exchanges, and 45 (13.5%) were initiated by the patient. The most frequent communication topic category was personalized conversation (21.6%). Personalized conversation includes questions and statements about life outside the ICU, such as family, weather, and societal events. It also includes humor and reminiscing on the past. The least frequent topic was feelings/emotions (1.2%), which may have been influenced by the observation effect. Conclusions: Patient-family communication in the ICU covers a broad range of topics. The most frequent topic was personalized conversation, showing how patients and families attempt to normalize conversation by discussing life outside of the ICU. Patients initiated conversation less often compared to their family visitors when mechanically ventilated. However, using a variety of communication tools, including electronic devices, can support the complex communication between patients and their family members in the ICU.