Critical care nurses’ experiences of communication- vulnerable patients in the intensive care unit and the influence on rendering compassionate care

Main Article Content

A Kuyler
T Heyns
E Jonhston

Abstract





Background. Interventions administered to critically ill patients, including mechanical ventilation, sedation or other treatments may hinder communication between patients and nurses. These communication challenges may affect critical care nurses’ ability to provide compassionate, person-centred care.


Objective. To identify nurses’ experiences with patients who are communication-vulnerable in the intensive care unit and how they affect nurses’ ability to offer compassionate care.


Method. This qualitative explorative descriptive study involved nurses who worked in intensive care units from four private hospitals in Gauteng, South Africa. Focus groups were conducted with 30 critical care nurses in groups of two to six participants each. Thematic analysis was used to identify themes.


Results. Five main themes were identified based on nurses’ reports of their experiences with critically ill patients who experience communication difficulties and their impact on rendering compassionate care. Themes were deductively identified based on the social purposes of communication categories. Participants indicated that communication-vulnerable patients influence their ability to provide compassionate care. Generally, the physical, emotional, social and communication difficulties of assisting communication-vulnerable patients caused nurses to feel frustrated and negative towards their work environment, which added to their work stress and sometimes resulted in compassion fatigue.


Conclusion. The study shows that various factors could impact the nurses’ ability to provide compassionate care and that they require support to provide person-centred care. These factors can include the physical environment, the patient’s alertness and awareness and institutional barriers. To support nurses in providing compassionate care, communication partner training may be warranted.





Article Details

How to Cite
Critical care nurses’ experiences of communication- vulnerable patients in the intensive care unit and the influence on rendering compassionate care. (2024). Southern African Journal of Critical Care, 40(1). https://doi.org/10.7196/SAJCC.2024.v40i1.750
Section
Research Articles

How to Cite

Critical care nurses’ experiences of communication- vulnerable patients in the intensive care unit and the influence on rendering compassionate care. (2024). Southern African Journal of Critical Care, 40(1). https://doi.org/10.7196/SAJCC.2024.v40i1.750

References

Henderson, A., Jones, J. Developing and maintaining compassionate care in nursing. Nurs Standard 2017;32(4):60-69. https://doi.org/10.7748/ns.2017.e10895

Zamanzadeh V, Valizadeh L, Rahmani A, van der Cingel M, Ghafourifard M. Factors facilitating nurses to deliver compassionate care: A qualitative study. Scand J Caring Sci 2018;32(1):92-97. https://doi.org/10.1111/scs.12434

Muntlin Athlin Å, Brovall M, Wengström Y, Conroy T, Kitson AL. Descriptions of fundamental care needs in cancer care: An exploratory study. J Clin Nurs 2018;27(11-12):2322-2332. https:// doi.org/10.1111/jocn.14251

Jones J, Winch S, Strube P, Mitchell M, Henderson A. Delivering compassionate care in intensive care units: nurses’ perceptions of enablers and barriers. J Adv Nurs 2016;72(12):3137-3146. https://doi.org/10.1111/jan.13064

Beukelman DR, Light J. Augmentative and alternative communication-Supporting children and adults with complex communication needs. 5th ed. Baltimore: Brookes Publishing; 2020.

Bayog KMS, Bello DMC, Benabaye JMP, et al. A conjoint analysis of the communication preferences of registered nurses towards mechanically ventilated patients. Int J Nurs Pract 2019;e12809:1-12. https://doi.org/10.1111/ijn.12809

BoströmE,AliL,ForsA,EkmanI,AnderssonAE.Registerednurses’experiencesofcommunication with patients when practising person-centred care over the phone: A qualitative interview study. BMC Nurs 2020;19(1):1-9. https://doi.org/10.1186/s12912-020-00448-4

Dithole KS, Sibanda S, Moleki MM, Thupayagale-Tshweneagae G. Nurses’ communication with patients who are mechanically ventilated in intensive care: The Botswana experience. Int Nurs Rev 2016;63:415-421. https://doi.org/10.1111/inr.12262

Blackstone SW. Issues and challenges in advancing effective patient-provider communication. In: Blackstone SW, Beukelman DR, M. YK, editors. Patient-provider communication: Roles for speech=language pathologists and other healthcare professionals. San Diego: Plural Publishing; 2015.

Brooke J, Ojo O. Elements of a sustainable, competent, and empathetic workforce to support patients with dementia during an acute hospital stay: A comprehensive literature review. Int J Health Plann Manage 2018;33(1):e10-25. https://doi.org/10.1002/hpm.2448

Andersen E, Havaei F. Measuring relational care in nursing homes: Psychometric evaluation of the relational care scale. J Nurs Meas 2015;23(1):82-95. https://doi.org/10.1891/1061-3749.23.1.82

Buckley L, Berta W, Cleverley K, Medeiros C, Widger K. What is known about paediatric nurse burnout: A scoping review. Hum Resour Health 2020;18(1):1-23. https://doi.org/10.1186/s12960- 020-0451-8

Romagnoli KM, Handler SM, Ligons FM, Hochheiser H. Home-care nurses’ perceptions of unmet information needs and communication difficulties of geriatric patients in the immediate post-hospital discharge period. BMJ Qual Satefy 2014;22(4):324-332. https://doi.org/10.1136/ bmjqs-2012-001207

Dewar B, Mackay R. Appreciating and developing compassionate care in an acute hospital setting caring for older people. Int J Older People Nurs 2010;5(4): 299-308. https://doi.org/10.1111/j.1748- 3743.2010.00251.x

Gropp M, Johnson E, Bornman J, Koul R. Nurses’ perspectives about communication with patients in an intensive care setting using a communication board: A pilot study. Heal SA Gesondheid 2019;24:1-9. https://doi.org/10.4102/hsag.v24i0.1162

Kuyler A, Johnson E. Patient and nurse content preferences for a communication board in the intensive care unit. Intensive Crit Care Nurs 2021 Apr 1;63:103005. https://doi.org/10.1016/j. iccn.2020.103005

Stewart DW, Shamdasani PN. Focus groups: Theory & Practice. 3rd ed. LA: SAGE Publications Inc.; 2014.

Harper M, Cole P. Member checking: Can benefits be gained similar to group therapy? Qual Rep 2012;17(2):1-8.

Jewitt C. An introduction using video research. 2012.

Clarke V, Braun V. Teaching thematic analysis: Overcoming challenges and developing strategies

to effective learning 2012. http://eprints.uwe.ac.uk/21155/3/Teaching thematic analysis Research

Repository version.pdf. (accessed 1 January 2023).

Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness

Criteria. Int J Qual Methods 2017;16(1):1-13. https://doi.org/10.1177/1609406917733847

Birt L, Scott S, Cavers D, Campbell C, Walter F. Member Checking: A Tool to Enhance Trustworthiness or Merely a Nod to Validation? Qual Health Res 2016;26(13):1802-1811.

https://doi.org/10.1177/1049732316654870

Candela AG. Exploring the Function of Member Checking. 2019;24(3):619-628 https://doi.

org/10.46743/2160-3715/2019.3726

Zimmermann E, Alfes CM. Simulating the role of the parent-Promoting family-centered nursing care. Nurs Educ Perspect 2019;14(2):121-122. https://doi.org/10.1097/01.NEP.0000000000000339 25. Kwame A, Petrucka PM. Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: A scoping review. Int J Africa Nurs Sci 2020;12:100198. https://doi.

org/10.1016/j.ijans.2020.100198

Wiklund G. L, Wagner L. The butterfly effect of caring - clinical nursing teachers’ understanding of self-compassion as a source to compassionate care. Scand J Caring Sci 2013;27(1):175-183. https://doi.org/10.1111/j.1471-6712.2012.01033.x

Cossette S, Cote JK, Pepin J, Ricard N, D’Aoust LX. A dimensional structure of nurse-patient interactions from a caring perspective: Refinement of the caring nurse-patient interaction scale (CNPI-Short Scale). J Adv Nurs 2006;55(2):198-214.

Fleischer S, Berg A, Zimmermann M, Wüste K, Behrens J. Nurse-patient interaction and communication: A systematic literature review. J Public Health (Bangkok) 2009;17(5):339-353.

Karlsen MMW, Ølnes MA, Heyn LG. Communication with patients in intensive care units: A scoping review. Nurs Crit Care 2019;24(3):115-131. https://doi.org/10.1111/nicc.12377

Leung CCH, Pun J, Lock G, et al. Exploring the scope of communication content of mechanically ventilated patients. J Crit Care 2018;44(2018):136-141. https://doi.org/10.1016/j.jcrc.2017.10.044 31. Mobasheri MH. Communication aid requirements for ICU patients with transient speech loss.

Augment Altern Commun 2016;32(4):261-271. https://doi.org/10.1080/07434618.2016.1235610 32. Falk AC, Schandl A, Frank C. Barriers in achieving patient participation in the intensive care unit.

Intensive Crit Care Nurs 2019;51:15-19. https://doi.org/10.1016/j.iccn.2018.11.008

Giacino JT, Katz DI, Schiff ND, et al. Practice guideline update recommendations summary: Disorders of consciousness: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and Neurology. 2018;91(10):450-460. https://doi.org/10.1212/

WNL.0000000000005926

Pundole A, Crawford S. The assessment of language and the emergence from disorders of consciousness. Neuropsychol Rehabil 2018;28(8):1285-1294. https://doi.org/10.1080/09602011 .2017.1307766

Tomaiuolo F, Cecchetti L, Gibson RM, et al. Progression from vegetative to minimally conscious state is associated with changes in brain neural response to passive tasks: A longitudinal single- case functional MRI study. J Int Neuropsychol Soc 2016;22(6):620-630. https://doi.org/10.1017/ S1355617716000485

Holm A, Dreyer P. Nurse-patient communication within the context of non-sedated mechanical ventilation: A hermeneutic-phenomenological study. Nurs Crit Care 2018;23(2):88-94. https:// doi.org/10.1111/nicc.12297

Létourneau D, Goudreau J, Cara C. Humanistic caring, a nursing competency: modelling a metamorphosis from students to accomplished nurses. Scand J Caring Sci 2021 Mar;35(1):196- 207. https://doi.org/10.1111/scs.12834

Aupia A, Lee TT, Liu CY, Wu SFV, Mills ME. Caring behavior perceived by nurses, patients and nursing students in Indonesia. J Prof Nurs 2018;34(4):314-319. https://doi.org/10.1016/j. profnurs.2017.11.013

Walivaara B-M. Caring relationships in home-based nursing care: Registered nurses’ experiences. Open Nurs J 2013;7:57-63. https://doi.org/10.2174/1874434620130516003

Garon M. Speaking up, being heard-Registered nurses’ perceptions of workplace communication. J Nurs Manag 2011;20:361-371. https://doi.org/10.1111/j.1365-2834.2011.01296.x

Radtke JV, Tate JA, Happ MB. Nurses’ perceptions of communication training in the ICU. Intensive Crit Care Nurs 2012;28(1):16-25. https://doi.org/10.1016/j.iccn.2011.11.005