Communication Board Satisfaction among Clients on Echanical Ventilator

 

Mrs. R. Rathi1, Mr. M. Baskaran2

1Clinical Nurse Specialist, Gastroenterology Department, PSG Hospitals, Coimbatore, Tamil Nadu

2Assistant Professor, Mental Health (Psychiatric) Nursing Specialty, PSG College of Nursing, Coimbatore,

Tamil Nadu

*Corresponding Author Email: anishags4@gmail.com

 

ABSTRACT:

Introduction:

Communication difficulties are all too often devastating in health care settings. They can, and often do, create huge barriers between patients and health care staff. In health care settings, communication breakdowns between patient and caregiver can have dire consequences: increased patient pain, misdiagnoses, drug treatment errors, and unnecessary extensions in length of hospital stay, even death.

Objective:

•       Assess the level of satisfaction in communication among clients on mechanical ventilator using communication board and using the routine board.

•       Evaluate the effectiveness of communication board on the level of satisfaction in communication while comparing with clients using routine method.

Design:

Quasi experimental approach, Post test-only design with a comparison group.

Setting:

The study was conducted in PSG Hospitals, Coimbatore.

Participants:

15 samples were selected (experimental group, n=15 and comparison group n=15) total samples were 30.

Intervention:

The communication board consists of the pictures related to physiological needs such as physical needs discomfort, psychological needs  and social needs.

Measurements and tools:

Rating scale was used to assess the level of satisfaction in communication among the clients on mechanical ventilator.

Descriptive and inferential statistics were used to analyze the data.

Findings:

The findings of the study revealed that In the experimental group the mean value was 83.5 ± 5.5 whereas in the comparison group the mean value was 65 ± 3.6 with the ‘t’ value of 14 which was statistically highly significant at p<0.001 level which showed that the communication board was effective among the clients on mechanical ventilator.

Conclusion:

The present study assessed the effectiveness of communication board on the level of satisfaction in communication among the clients on mechanical ventilator. The results suggested that communication board could be used for the patients on mechanical ventilator in order to enhance their satisfaction with communication.

 

KEY WORDS: Communication board, Level of satisfaction, Communication.

 

 

INTRODUCTION:

Communication difficulties are all too often devastating in health care settings. They can, and often do, create huge barriers between patients and health care staff. In health care settings, communication breakdowns between patient and caregiver can have dire consequences: increased patient pain, misdiagnoses, drug treatment errors, and unnecessary extensions in length of hospital stay, even death. A communication aid helps a person to communicate more effectively with those around them. These aids range from simple letter boards to sophisticated pieces of computer equipment.

 

Effective communication of the nurses can modify the patient’s sensory perceptual alteration. Effective communication has a valuable contribution towards the well being of the patient, the family, and it positively affects the outcome of illness.4

 

NEED FOR THE STUDY:

Communication difficulties are all too often devastating in health care settings and it can often create huge barriers between patients and health care staff. In health care settings, communication breakdowns between patient and caregiver can have dire consequences such as increased patient pain, misdiagnoses, drug treatment errors, unnecessary extensions in length of hospital stay and even death. In a six-year (1997-2002) study of the root causes of “sentinel events” in hospitals, the Joint Commission on Accreditation in Health Care Organizations (JCAHO) in fact placed “communication” at the very top of the list of root causes.6

 

The mechanically ventilated patients often find difficult to communicate their basic needs. The common basic needs that the ventilated patients’ wants to communicate are bathing, brushing, and teething, and combing hair, elimination, eating, drinking and sleeping. Other examples include simple requests or statements such as “too hot’, ‘too cold’, ‘ turn me’, ‘up’, down, ‘my arm hurts’, ‘I can’t breathe’ and ‘ moistened my lips’.2

 

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) strongly emphasizes that “The patient has a right and need for effective communication”. It is very important for the nurse to understand and interpret the messages of critically ill patients. Effective communication also helps the patient to select their treatment during the end of their life. Communication between nurses and patients is critical in providing and receiving quality care. The nurse investigator emphasizes the use of communication board as an intervention to enhance the communication of clients on mechanical ventilation thereby it improves the quality of care.

 

REVIEW OF LITERATURE:

Research studies related to communication of the clients on mechanical ventilator

A study conducted on the communication experience of nonvocal ventilated patients in rehabilitation settings. The aim of the study was to understand the reality of being voiceless by using interpersonal theory. The author used an interpretive phenomenological approach and analyzed the data using thematic analysis. Nineteen patients were interviewed and they described their nonvocal experience as ‘Being trapped in a silent world makes them feel frustrated and incomplete.1

 

A study has investigated the patient and staff communication in the ICU. From the 8 participants, two participants reported that the tracheostomy tube as being a barrier to communication. The study revealed a disparity between these groups interception of communication. They concluded that failure in communication results in feelings of frustration and powerlessness.5

 

Research studies related to the effectiveness of communication board on the level of satisfaction in communication among the clients on mechanical ventilator:

A study conducted to assess the effect of communication board in meeting the needs of the intubated patients in Vijaya Heart Foundation, Chennai. The investigator selected 400 intubated patients with 200 subjects in each experimental group and control group through true experimental design. The data was collected by using the observational checklist to assess the ability of intubated patients in meeting their needs such as physiological, psychological and spiritual aspects. A combined numerical and categorical scale was developed to assess the level of satisfaction towards the communication board in meeting their needs. The results showed that the in the experimental group, 192 (96%) of the subjects were able to meet their needs adequately after using the communication board as compared to 7 (3.5%) in control group.3

 

New Jersey University Hospital’s use of communication picture boards to bridge communication barriers between health care professionals and patients. The New Jersey Department of Health and Senior Services (NJDHSS) have distributed more than 2,200 boards to facilities across the state in its efforts to ensure that every patient receives effective medical care. The article strongly advocated the use of communication boards, stating that they should become an integral part of the U.S. Department of Health and Human Services’ “Effective Communication in Hospitals” program. Although communication boards may not be an appropriate tool for diagnosing diseases or requesting consent, they are useful for every day communication purpose.7

 

STATEMENT OF THE PROBLEM:

Effectiveness of communication board on the level of satisfaction in communication among the clients on mechanical ventilator in PSG Hospitals, Coimbatore.

 

OBJECTIVES:

Assess the level of satisfaction in communication among clients on mechanical ventilator using communication board and routine method.

Evaluate the effectiveness of communication board on the level of satisfaction in communication while comparing with clients using routine method.

 

Assumptions:

·         Patients on mechanical ventilator have communication difficulties.

·         Patients on mechanical ventilator are in need of some aid to communicate their needs.

·         Communication board helps to improve the level of satisfaction in communication of client on mechanical ventilator.

 

Hypotheses:

There will be a significant difference between the level of satisfaction in communication between the clients using the communication board and routine method.

 

Operational definition:

Communication Board:

This is a light weighted board with different pictures that helps the client to communicate the physiological needs, psychological needs and social needs while on mechanical ventilator.

 

Level of Satisfaction:

Level of satisfaction is meant in terms of client’s satisfaction in expressing their basic needs and it was classified as highly satisfied, moderately satisfied and unsatisfied in communication.

 

Projected outcome:

The communication will be effective among the clients on mechanical ventilator using the communication board than the clients using routine method.

 

Research Design:

Quasi experimental approach, Post test-only design with a comparison group.

Experimental group:

 

Comparison group:

 

Variables

Independent Variable

Communication Board.

 

Dependant Variable

Level of Satisfaction in Communication.

 

Setting

The study conducted in Medical Intensive care unit, PSG Hospitals, Coimbatore.

 

Population

The study population comprises of clients on mechanical ventilator in the Medical Intensive Care Unit.

 

Samples

Mechanical Ventilator clients

Sample size

Sample size of the study was 15 samples were selected (experimental group, n=15 and comparison group n=15) total samples were 30.

 

Sampling Technique

Purposive sampling technique

 

Intervention:

Communication board and Routine method.

 

Communication Board:

The board consists of the pictures related to physiological needs such as physical needs (pain, orientation, hygiene, suctioning, hunger, thirst, sleep and comfort), discomfort (sick, dizziness, heat and cold, breathing difficulty and vomiting), psychological needs (emotions, recreation, privacy, environment and the prayer and chaplain) and social needs (paper and pencil, meeting the health team members and the family).

 

Development and description of the tool

The tool constructed for this study consists of 2 parts.

Section A:

This section consists of 8 items including the demographic variables such as sample number, sex, age, education, marital status, type of family and occupation.

Section B:

This section consists of 9 items. Patient medical history including the diagnosis, duration of illness, mode of ventilation, duration of ventilation, previous history of hospitalization, diet, medication and sleep pattern.

Section C:

This consists of 20 items to assess the level of satisfaction in communication among the clients on mechanical ventilator and it was categorized under three subheadings such as physiological needs, psychological needs and social needs. The physiological needs had 10 items, the psychological needs had 5 items and the social needs had 5 items.

 

Each statement has five options such as highly satisfied, moderately satisfied, less satisfied, dissatisfied and highly dissatisfied. The maximum score of the questionnaire was 100 and the minimum score was 20.

The Scoring Key:

Highly Satisfied                    : 5

Moderately Satisfied         : 4

Less satisfied                        : 3

Dissatisfied                           : 2

Highly Dissatisfied              : 1         

The total score is                 : 100

 

Score and Interpretation of rating scale to assess the level of satisfaction in communication

Score                     Interpretation

≥80%                      Highly satisfied

61-80%                   Moderately satisfied

≤ 60%                     Unsatisfied

 

RESULTS:

Table 1: Frequency distribution of level of satisfaction in communicating the physiological needs in the experimental group and the comparison group:                     n=30

S.No

Level of satisfaction

Physiological needs

Experimental group

Comparison group

1

Highly satisfied (≥80%)

11

0

2

Moderately satisfied  (60-80%)

4

12

3

Unsatisfied (≤60%)

0

3

 

Table 2: Frequency distribution of level of satisfaction in communicating the psychological needs in the experimental group and the comparison group:                                                n=30

S.

No

Level of satisfaction

Psychological needs

Experimental group

Comparison group

1

Highly satisfied (≥80%)

7

0

2

Moderately satisfied  (60-80%)

8

9

3

Unsatisfied (≤60%)

0

6

 

 

Table 3: Frequency distribution of level of satisfaction in communicating the social needs in the experimental group and the comparison group:                                                n=30

S.No

Level of satisfaction

Social needs

Experimental group

Comparison group

1

Highly satisfied (≥80%)

15

0

2

Moderately satisfied  (60-80%)

0

14

3

Unsatisfied (≤60%)

0

1

 

Figure 1: Comparison of Mean Value on level of satisfaction in communication between the experimental group and the comparison group

 

Table 4: Mean and standard deviation of scores regarding the level of Satisfaction in communication in experimental and comparison group.                                                                n = 30

S. No.

Group

Mean

S.D

df

‘t’ value

P value

Level of significance

1

Experimental Group

83.5

5.5

28

14

3.67

*p<

0.001

2

Comparison Group

65

3.6

*significant

 

·      Demographic variable was no significant relationship between the age, sex, educational status, occupational status and the duration of illness with the level of satisfaction in communication.

 

IMPLICATIONS:

Nursing practice:

Communication board can be used regularly while taking care of the mechanically ventilated clients as it enhances good interpersonal relationship between the nurses and patients, reducing communication errors, improves patients’ comfort and saves time in providing care thereby communication board plays a role in improving the quality of life among clients on mechanical ventilator

 

RECOMMENDATIONS:

Training can be provided to the staff nurses on the utilization of the communication board among mechanically ventilated clients.

 

CONCLUSION:

The present study assessed the effectiveness of communication board on the level of satisfaction in communication among the clients on mechanical ventilator. The results showed that communication board had significantly improved the level of satisfaction in communication than the routine method. So the researcher suggested that communication board could be used for the patients on mechanical ventilator in order to enhance their satisfaction with communication.

 

ACKNOWLEDGEMENT:

The study was conducted in the Medical Intensive Care Unit, PSG Hospitals, Coimbatore after getting the ethical clearance and formal permission from the Medical Director, in charge of MICU and the Nursing Superintendent of PSG hospitals.

 

REFERENCE:

1.        Carroll SM.,. “Silent, slow life world: the communication experience of nonverbal patients”. Qual Health Res, 17(9); 2007: 1165-1177.

2.        Chulay Marianne and Suzanne M.Burn American Association of Critical Care Nursing (2nd edition). Newyork: McGraw Hill.2010.

3.        Fathima. Effectiveness of communication board for intubated patients. Nightingale Nursing Journal. 7:11; 2012:51-54.

4.        Kuruvilla Jaya.  Essentials of critical care Nursing. Newdelhi: Jaypee.2007.

5.        Magnus VS and Turkington. Communication interaction in ICU. 2006

6.        Pressman Harvey and Heather Smith. The Joint Commission Standards for Hospitals. Oakbrook Terrace, IL: The Joint Commission;2008

7.        Thompson L. “Picture boards help patients communicate ailments to nurses”. Gannett Healthcare Group; 2007: 143-148.

 

 

 

 

Received on 29.07.2014          Modified on 30.08.2014

Accepted on 05.09.2014          © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 4(4): Oct.- Dec., 2014; Page 447-451