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Copy of AAC in Hospital Acute Care with a Focus on the Intensive Care Unit (ICU)

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Tina Valentine

on 9 August 2014

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Transcript of Copy of AAC in Hospital Acute Care with a Focus on the Intensive Care Unit (ICU)

AAC in Hospital Acute Care with a Focus on the Intensive Care Unit (ICU)

Kayla Hatfield

Patients in the ICU may require care for brief or extended periods of time
Patients may be unable to speak or communicate effectively due to mechanical ventilation, respiratory compromise, neuromuscular weakness, and/or cognitive deficits
Patients report feelings of frustration, panic, anxiety, and dehumunization when they are unable to speak
(Radtke, et. al., 2010 )
Intensive Care Unit (ICU)
Allows the patients to participate in the asssessment of pain and other symptoms
Communicating with nurses and family members helps lighten the highly stressful situation
Patients with access to communication receive less sedation and are transitioned faster
Patients feel more in control
Bottom line: "The patient has a right and need for effective communication."
(Pressman & Newman, 2009)
Why does an ICU patient need to communicate?
An SLP should be called on to help determine what tools may or may not work for a patient
SLPs services have been used to provide AAC assistance to these patients, their caregivers, and medical staff
Nurses can become familiar with and use AAC strategies
Caregivers and family members can give suggestions on making communication with the patient more effective and efficient
(Pressman & Newman, 2009)
Who can help?
Lack of access to communication tools such as AAC
Communicative interactions between nurses and patients tend to be task-focused and nurse-controlled
Nurses have a lack of AAC knowledge and training
Nurses find it difficult to communicate with someone who cannot "speak" back
Patients feel anxiety, fear, frustration, unrecognized pain, and overall loss of control
(Pressman & Newman, 2009)
(Finke et. al., 2008)
Barriers
Using AAC strategies will assist nurses and patients in bettering communicating with each other when speech is not an option
Addresses communication needs of patients by enabling them to communicate their wants, needs and feelings to the medical staff and family members
Patients are enabled to participate more fully in their care
(Pressman & Newman, 2009)
Why AAC?
High Tech Devices:
Speech generating devices: Patients with pre-planned surgeries may record messages in these communication devices
iPad
Keyboard-based systems for patients who are literate

These devices are usually underused in healthcare settings because of lack of knowledge and/or access to the devices.
(Costello et. al., 2009)




What are the options?
Low-tech devices
Picture communication boards
Switches such as BIGmack

No-tech strategies
White boards with felt tip pens
Gestural communication
Alphabet boards
Partner assisted scanning

(Costello et. al.,2010 )
(Radtke et. al., 2010)


More Options
Model was introduced at Children's Hospital in Boston
Allows patients to participate in selection of AAC strategies when they have good information-processing abilities
May facilitate mastery and competence with AAC strategies prior to patient being unable to speak
Patients are able to be more active participants in their own care
Includes providing introduction to AAC strategies, selecting vocabulary, "voice banking" messages, teaching family and staff techniques, and conducting discharge interviews
(Costello, 2000)
Preoperative Model
AAC is not currently part of routine practice in the ICU, but providing communication devices and materials and SLP consultation offers additional communication support and enhances communication outcomes. (Radtke et. al., 2010)
A preoperative model of AAC intervention that adresses the anticipated communication needs of patients who will be temporarily unable to speak appears to be an appropriate and beneficial clinical strategy. (Costello, 2000)
Hospitals around the world are increasingly recognizing and addressing patients' needs for communication access and have begun to implement communication screenings and assessments at admission and throughout the hospital stay. New standards for all American hospitals mandate efforts to improve patient communication. (Costello et. al., 2010)
What the research says
Systematic research is needed to investigate the extent to which the benefits of the preoperative models are actually related to short and long-term outcomes.
Additional research should also focus on issues of pain management and ICU recovery time.
Focus on effective training to equip nurses with the appropriate skills to communicate effectively with the range of patients they may encounter in the ICU
(Finke et. al.,2008)
(Costello, 2000)
Future Implications
Blackstone, S. W. (2007, February). AAC In the ICU. Augementative Communication News. Retrieved February 15, 2012, from http://www.augcominc.com/newsletters/index.cfm/newsletter_1.pdf

Pressman, H., & Newman, E. (2009, August 24). Communication Access Within Healthcare Environments. In Patient Provider Communication. Retrieved February 15, 2012, from http://www.patientprovidercommunication.org/index.cfm/article_3.htm
Costello, J. M. (2000, September). AAC Intervention in the Intensive Care Unit: The Children's Hospital Boston Model. AAC Augmentative and Alternative Communication, 16, 137-151. Retrieved from Ebsco.
Etchels, M., MacAulay, F., Judson, A., Ashraf, S., Ricketts, I., Walter, A., Aim, N., Warden, Gordon, B., Brodie, J., & Shearer, A. (2003).ICU-Talk: The development of computerized communication aid for patients in ICU. Care of the Critically Ill, 19, 4-9.
Costello, J. M., Patak, L., & Pritchard, J. (2010, October). Communication vulnerable patients in the pediatric ICU: Enhancing care through augmentative and alternative communication. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 289-298. Retrieved from Ebsco.
Finke, E. H., Light, J., & Kitko, L. (2008, January). 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. Journal of Clinical Nursing, 2102-2114. Retrieved from Ebsco.
Radtke, J. V., Baumann, B. M., Garrett, K. L., & Happ, M. B. (2010, November 19). Listening to the Voiceless Patient: Case Reports in Assisted Communication in the Intensive Care Unit. Journal of Pallative Medicine, 14(6), 791-794. Retrieved from Ebsco.



References
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