During the COVID-19 pandemic, the number of patients placed on mechanical ventilators reached unprecedented levels. Life on a ventilator is physically and emotionally taxing, often leading to complications such as Post-ICU Syndrome (PICS). Despite the many barriers to communication in these circumstances, connection is still possible. In fact, research published in 2015 revealed that more than half of ICU patients on ventilators can communicate in some form. To explore how nurses can make that communication meaningful, DailyNurse spoke with study co-author Mary Beth Happ, PhD, RN, FAAN, FGSA, an expert in patient-provider communication.
​​What to Expect When a Patient is on a Ventilator
Patients are unable to vocalize during mechanical ventilation due to the breathing tube. Also, ventilated patients may be sedated or have fluctuating consciousness; their ability to comprehend or attend to communications may also fluctuate. Patients often have other pre-existing communication impairments – many will be hard of hearing and approximately 80% will be glasses wearers, however, most will not have glasses or hearing aids readily available at the bedside. Writing may be impaired due to swollen hands/fingers, muscle weakness, or lack of coordination.
Assessing the Patient’s Communication Abilities
Assume that all mechanically ventilated patients need support for understanding your message to them. I suggest beginning with your assessment of cognitive (following commands, attention/inattention, consistent yes/no signal) and language abilities (reading, writing, limited English proficiency), sensory deficits (such as hearing and vision), and the patient’s upper motor strength and coordination (holding a marker or pen, pointing, activating touchscreen on an electronic tablet).
Tips for Communicating with a Patient on a Ventilator
- Get the patient’s attention by touch and maintain eye contact
- Have glasses and hearing aids or amplifiers, large print if needed,
- Have notebook and marker available to write key words or phrases that emphasize or reinforce your message,
- Use picture boards in addition to your words to explain medical procedures,
- Use pointing and gestures as you speak
- Speak slowly, over enunciate, and in short sentences or phrases
- Pause 10 seconds to wait for the patient’s response before going on
- Consult with your hospital’s speech-language pathologists. SPLs are skilled in assessment of communication-impaired patients and can recommend low tech and electronic augmentative communication tools.
Helpful Online Resources
Use picture word-phrase boards or tablet applications designed for patient communication that are matched to the patient’s abilities and preferences. The SPEACS-2 training program and website has these assessment and tool selection guides available https://go.osu.edu/speacs2.
Download tools curated by speech-language pathologists for communicating with mechanically ventilated, COVID-19 patients: https://www.patientprovidercommunication.org/covid-19-tools/supporting-communication-with-patients-who-have-covid-19/
Listen to this American Thoracic Society podcast: https://www.thoracic.org/about/ats-podcasts/tips-for-communicating-with-your-covid-19-patients-on-mechanical-ventilation.php
Dr. Mary Beth Happ, PhD, RN, FAAN, FGSA is a specialist in patient-provider communication and has conducted extensive research on the issues associated with communicating with patients on ventilators.
Dr. Happ is the Nursing Distinguished Professor of Critical Care Research and Associate Dean for Research and Innovation at The Ohio State University College of Nursing. She and her team developed the SPEACS-2 online training program to reduce misinterpretation of patient messages and facilitate ICU liberation for mechanically ventilated patients.
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