Abstract
OBJECTIVE: To describe the experience and perceptions of nurse study participants regarding a communication intervention (training and communication tools) for use with nonspeaking, critically ill patients. RESEARCH METHODOLOGY/DESIGN: Small focus groups and an individual interview were conducted with six critical care nurses. Transcripts were analysed using qualitative content analysis and constant comparison. SETTING: Two ICUs within a large, metropolitan medical centre in western Pennsylvania, United States of America. MAIN OUTCOME MEASURES: Critical care nurses' evaluations of (1) a basic communication skills training programme (BCST) and (2) augmentative and alternative communication strategies (AAC) introduced during their study participation. RESULTS: Six main categories were identified in the data: (1) communication value/perceived competence; (2) communication intention; (3) benefits of training; (4) barriers to implementation; (5) preferences/utilisation of strategies; and 6) leading-following. Perceived value of and individual competence in communication with nonspeaking patients varied. Nurses prioritised communication about physical needs, but recognised complexity of other intended patient messages. Nurses evaluated the BCST as helpful in reinforcing basic communication strategies and found several new strategies effective. Advanced strategies received mixed reviews. Primary barriers to practise integration included patients' mental status, time constraints, and the small proportion of nurses trained or knowledgeable about best patient communication practices in the ICU. CONCLUSIONS: The results suggest that the communication skills training programme could be valuable in reinforcing basic/intuitive communication strategies, assisting in the acquisition of new skills and ensuring communication supply availability. Practice integration will most likely require unit-wide interdisciplinary dissemination, expert modelling and reinforcement.