This isn’t a new problem, but it does continue to be a difficult to solve clinical issue that needs a more comprehensive approach, says researcher Laura Istanboulian.
A new study from Laura Istanboulian, assistant professor at the Lawrence Bloomberg Faculty of Nursing, has identified contributing factors to challenges to patient communication in the ICU, and found that many of the reported barriers are structural, socio-relational, and environmental in nature.
“The way patients experience communication in the ICU has long been reported to be frustrating and dehumanizing for the patient, impacting their ability to report symptoms and be part of decision making,” says Istanboulian. “This isn’t a new problem, but it does continue to be a difficult to solve clinical issue that needs a more comprehensive approach.”
The study published in Intensive Critical Care Nursing, interviewed a group of 22 participants which included healthcare providers, family members, and patient survivors from a community academic hospital in Toronto, Canada.
The participants reported, structural and environmental factors like lighting and noise levels, a lack of accessibility to communication tools, infection control and family visiting protocols, as well as a lack of communication skills in staff as contributing barriers to patient communication.
During her PhD, Istanboulian had developed a bundled intervention toolkit to help facilitate communication among patients in the ICU. In implementing the toolkit, it was clear that health care providers want to see communication improved, but “creating interventions alone is not getting to the root of the problem,” she says.
Istanboulian points out that there are many structural problems with patient communication – right down to how it is labelled, either as a difficulty, a challenge, or impairment.
“There is no global term for this issue, but we started thinking about communication in ICU as a vulnerability, because patient communication challenges make them vulnerable to specific harms and avoidable safety incidents,” says Istanboulian.
Not being able to communicate can pose significant health risks for patients and lead to frequent or prolonged medical interventions that can impact someone’s quality of life. In this study, participants also reported the impact of not being able to communicate.
“If a patient can’t indicate that that they need to be suctioned, or their vent settings need to be changed, or they need to be repositioned, it can lead to agitation, unconsciousness or the patient pulling off their tubing to try and get a health care providers attention,” says Istanboulian.
In this study she and her colleagues decided to use a critical disability approach as a different way of framing and understanding the problem of communication vulnerability in the ICU.
“We felt this was a good framework to use when thinking about communication in ICU, because instead of focusing only on the individual patient level, it forces us to focus on the social and organizational responsibility to optimize communication vulnerability.” “This approach really allowed us to broaden the way we define communication vulnerability and identify many more opportunities to address it in the ICU setting”.
Istanboulian and her team are about to publish a report of the harms of communication vulnerability described by patients, family, and healthcare provides. Looking towards the next phase of this research, Istanboulian aims to work towards estimating the frequency at which these harms occur in the ICU.
“There is no current, ICU specific research that states people with communication issues are more likely to have a safety issue in their care,” says Istanboulian. “There is a massive gap in the evidence that we are looking to address in the future.”