Use of augmentative and alternative communication strategies by family members in the intensive care unit (summary)

family members

Family members are often relied upon to act as spokesmen for critically ill patients, but do not always have the skills needed to support patients' communication.

Little is known about how families are able to use AAC systems and how they feel about these forms of communication.

There has been little investigation into the involvement of families in use of AAC with non-speaking patients in intensive care units (ICUs).

The purpose of this study was to describe family involvement with assistive communication when nurses and patients had different levels of training. The authors looked into which AAC tools families used and how they used them, and the views of families and nurses about the communication of non-speaking patients on ICU.

What did the authors do?
They looked at information gathered in a previous study in which nurses on ICU were given varying amounts of training in the use of AAC systems and provided with communication support materials on the ward.

As part of the study nurses were asked about family involvement in AAC strategies. Family members' comments about communication were also noted.

The authors reviewed observation notes from the previous study and noted any family involvement with AAC strategies and which family members were involved. The tools and devices used were identified and themes around what nurses and family members said about communication were identified.

What did they find?
Families of 44% of the patients in the study were found to have used AAC, most often this was spouses or adult children.

Five main themes were identified including families being unprepared and unaware and their perception of communication effectiveness.

Families tended to be more positive in their view of AAC when the nurses they were working with had had some communication training.

The study was not initially established to look at family use of AAC and only looked at a limited number of observed episodes so might not represent the full extent of involvement. Alternatively because the observation took place in a unit where various communication resources were available they might have been used more frequently than in typical ICUs.

Despite difficulties in communication with family members use of AAC strategies is limited, this might contribute to increasing stress for patients and family members. Interventions to improve knowledge and ability to use AAC strategies might be beneficial.

Things you may want to look into:

Nurses' perceptions of communication training in the ICU

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014