SPEACS-2: Intensive Care Unit ‘‘Communication Rounds’’ with Speech Language Pathology (summary)



Intensive Care Unit (ICU) nurses are extremely important in supporting the communication of critically ill patients who are unable to speak, but they usually have very limited training in how best to do this, and insufficient access to speech and language therapists (SLTs). The authors looked at the impact of a web-based training package for nurses on care quality and clinical outcomes for older patients on ICU.

The paper describes weekly communication case conferences held by an SLT in a hospital and describes the SPEACS-2 communication skills training program that was available to the nurses.

What did the authors do?

The SPEACS-2 training program is made up of 6 self-learning modules available on-line. The modules cover choosing and applying AAC strategies and requesting SLT input with ICU patients. This package was made available to all nurses on the ICU. In addition some nurses on each unit were given additional training to enable them to act as peer mentors and champions for the program. During the 3 month training period teaching posters highlighting communication strategies were displayed in the units and communication support materials were provided on the wards.

The paper uses 3 case-studies to demonstrate various strategies and techniques that were helpful to the patients, their families and nursing staff and the way in which SLTs leading 'communication rounds' on the ward was beneficial.

What did they find?

The use of 'case conferences' and bedside modelling of different communication support strategies in ICU can help nurses to identify adaptations needed to communication materials for individual patients.

A need is identified for transition planning about communication as patients move from ICU to other settings, and for involving families in the use of AAC.

A number of possible barriers to successful implementation of communication rounds, including SLT time, willingness of nurses to act as Communication Resource Nurses and the demands on ICU staff making attendance at communication rounds difficult, are identified.

The availability of a 'Communication Care Plan' at the bedside was helpful in disseminating information.


Although the paper states it is to 'explore the impact of an innovative, web-based instructional package' its' focus is primarily on the SLT input, there is limited information given about the specific skills targeted in the training package.


The training was found to have positive effects on nurses' awareness of the role of the SLT beyond swallowing. Direct observation of recommended techniques was found to increase motivation to complete the on-line training later.

Further investigation is needed to find out whether the strategies recommended are implemented by the nurses and which are used most often but in general the use of shared communication case conferences was found to be of benefit to all concerned.

Things you may want to look into:

Nurses' perceptions of communication training in the ICU

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