Who is talking to the ventilated and sedated patient?

Abstract

The Society of Critical Care Medicine estimates that 5.7 million people are annually admitted to the Intensive Care Unit (ICU); 20-30% require mechanical ventilation and some level of sedation. The literature strongly supports that sedated patients benefit emotionally and physiologically from verbal communication. Although nurses provide 92% of bedside patient care in the ICU and report that verbal communication with the patient is important, research suggests nurses struggle to communicate with ventilated, sedated patients.  I conducted a literature review to explore the potential gap between nurses’ perceptions and practice regarding the phenomenon of speaking to sedated patients in the ICU.  Baker and Meley (1996) found that 4 out of 5 critical care nurses considered verbal communication with sedated patients ‘very important’. However, observation of these nurses’ patient care over 4 hour periods revealed that verbal communication only accounted for 5% of that time.  Elliot and Wright (1999) found that a majority of verbal communication consisted of explaining procedural tasks and interventions.  Later findings of Alshraideh and Ahmad (2004) show that the lack of consistent verbal communication continues among nurses.  Mona and Sahar’s (2015) quasi-experimental study demonstrated a correlation between using a structured communication message and a decrease in length of mechanical ventilation as well as the length of stay in the ICU.  The literature supports a persistent gap between nurses' beliefs about the need for communication with the sedated patient and nurses’ demonstrated clinical practice. Further investigation into the identified barriers and facilitators of talking to sedated patients is warranted.