COMMUNICATION BARRIERS BETWEEN PATIENTS AND NURSES

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CHAPTER 4 ANALYSIS AND INTERPRETATION OF PHASE 1 AND PHASE 2 RESULTS

 INTRODUCTION

In this chapter, quantitative data results for phase 1 are presented according to the phases. For phase 1, quantitative data for the following sections are discussed including data analysis on audit of previously admitted ventilated patients’ files and data analysis on the survey of the nurses-working in the two referral hospital ICUs. Also in this chapter the findings from qualitative analysis for phase 2 on nurses and nurse manager’s interviews are discussed. The study aimed at answering the following question:

• Is there any existing policies about communicating with ventilated patients in two referral hospitals in Botswana?
• Is there any in-service training on communication skills offered for the ICU nurses?
• How do nurses assess ventilated patients for communication ability?
• Which communication strategies and methods do nurses use when communicating with ventilated patients?
• What information do nurses give to ventilated patients?
• What existing knowledge and skills do nurses have regarding communicating with ventilated patients in Botswana?
• What are nurses’ perceptions of communication with ventilated patients?
• What needs and barriers do they experience when communicating with ventilated patients?
• What are nurses’ experiences and perceptions about communication training?

The section that follows presents data analysis for audit of previously admitted ventilated patients’ files.

PHASE 1: QUANTITATIVE ANALYSIS

The qualitative phase included audit for the patients’ files in which data were collected using an audit guide developed for this study (Annexure K). The details of the audit guide are discussed in section 4.2.1 below.

Data analysis for audit of the patients’ files

Data were analysed for availability of information from the patient’s files.

General availability of information on the audit guide

The records of previously admitted ventilated patients in intensive care units in both referral hospitals were analysed to determine the documentation of the nurse-patient interactions. There were 159 patients’ files, which were studied by the researcher and the research assistants from the two study hospitals. Data were organised into demographics; availability of the patient’s communication ability assessed by the nurses, availability of information on communication strategies/methods used by the nurses to assist with communication; availability of information on assisted communication devices used by the nurses; availability of information by the nurses to the patients that included information regarding availability of explanation of treatment by the nurses to the patient; availability on information on orientating the patient; availability of information the nurses assessed the patient on barriers to participate in communication and availability of information on nurses collaboration with other health care team members. Some of these had an item referred to as “other (specify).”

Demographic data of participants

Demographic data of the participants included: date and time of admission in the ICU, date and time of intubation and extubation, if tracheostomy was performed, date and time of tracheostomy insertion, and date and time of patient’s discharged from the ICU. Table 4.1 indicates that overall percentages.
A total of 159 files of patients who were treated in ICU were audited. Most (60.4%; n=96) of the patients were males and 39.6% (n=63) of the patients were females. The average age was 35 years old (age range of 2−92 years). The overall mortality rate in the ICU was 5.7%. Sixty-two percent of the files showed that the patients were discharged from the ICU to the general wards. However, it was found that some of the patients’ files indicated those who were readmitted in the ICU and these files were not reassessed for more information because they were already included in the sample. Most (62.3%; n=99) of the patients’ diagnosis operative and only 37.7% (n=60) were non operative. Of these patients, many (42.7%; n=68) of the patients’’ diagnosis was trauma related, 12.6% (n=20) of the patients’ diagnosis was cardiovascular related, 25.8% (n=41) respiratory and other diagnosis composed of 18.9% (n=30) table 4.1.

Assessment for use of sedation and analgesic

The files were also studied for the type of sedatives and analgesic used. The files revealed that the majority of patients (94.3%; n=150) were given midazolam as a sedative especially during the first 12−24 hours of admission in the ICU, 45.2%, (n=72) of patient were given fentanyl as a sedative drug. Ninety-nine patients (62.3%) were given morphine sulfate, which is narcotic analgesic and 36.5% (n=58) were given paracetamol orally. However, these patients were not assessed for sedation level. All patients’ files (N=159; 100%) revealed that the patients were assessed for level of consciousness using Glasgow Coma Scale (GCS). The researcher followed the inclusion criteria of GCS of above 10/15 without failure to study the files for nurse-patient communication with these patients.

Nurses’ assessment for patients’ ability to communicate

Assessment of the patients’ communication ability also could help in minimising the nurses’ frustration in case the patient fails to use the method that the nurse has selected for the patient (Happ 2001:247).
Table 4.4 reveals that the assessment of patients’ ability to communicate was well recorded in many (91.8%; n=146) of the patients’ files. However, the information on assessment for patient’s use of gestures/symbols was recorded in 45.9% (n=73) of files. The least recorded findings on the nurses’ assessment was the patients’ preferred language and lip reading with only 3.1% (n=5) for each. The information on nurses’ assessment for the patient’s hearing was insufficiently recorded (90.6%; n=144) and patient’s vision was not recorded in 61% (n=79) of the files. The information on patient’s literacy, that is, ability to write and patient’s ability to use pictures were not recorded in 100%; (n=159) of patients’ files. The ability for the patient to use lip reading was recorded in only 3.1% (n=5) of the patients’ file, ability to mouth words in only 6.3 (n=10) of the files, use of gestures or symbols in many file (45.9%; n=73) of the file and the use of Yes/No in 22% (n=35) of the patients’ files.

CHAPTER 1 ORIENTATION OF THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND
1.3 STATEMENT OF THE RESEARCH PROBLEM
1.4 STUDY SIGNIFICANCE
1.5 PURPOSE OF THE STUDY
1.6 RESEARCH OBJECTIVES
1.7 RESEARCH QUESTIONS
1.8 CONCEPTUAL FRAMEWORK
1.9 DEFINITION OF KEY CONCEPTS
1.10 RESEARCH DESIGN AND METHODS
1.11 POPULATION AND SAMPLE17
1.12 DATA COLLECTION PROCEDURES
1.13 PILOT TESTING
1.14 DATA ANALYSIS
1.15 ESTABLISHING RIGOR FOR QUALITATIVE STUDIES
1.16 ETHICAL CONSIDERATIONS
1.17 METHODOLOGICAL AND THEORETICAL LIMITATIONS
1.18 ORGANISATION OF THE CHAPTERS
1.19 CONCLUSION.
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 COMMUNICATION DURING MECHANICAL VENTILATION.
2.3 COMMUNICATION BARRIERS BETWEEN PATIENTS AND NURSES
2.4 THE NATURE OF NURSE-PATIENT INTERACTION IN THE ICU..
2.5 STRATEGIES TO FACILITATE NURSE-PATIENT INTERACTIONS IN THE ICU
2.6 CONCEPTUAL FRAMEWORK FOR THE STUDY
2.7 CONCLUSION.
CHAPTER 3 RESEARCH DESIGN AND METHODS
3.1 INTRODUCTION
3.2 JUSTIFICATION FOR RESEARCH METHODOLOGY UNDERPINNING THIS STUDY
3.3 JUSTIFICATION OF THE RESEARCH DESIGN
3.4 JUSTIFICATION FOR DATA COLLECTION METHODS
3.5 JUSTIFICATION FOR DATA ANALYSIS
3.6 RESEARCH METHODS.
3.7 DATA ANALYSIS
3.8 ETHICAL CONSIDERATIONS
3.9 RIGOUR AND TRUSTWORTHINESS
3.10 STUDY METHODOLOGICAL AND THEORETICAL LIMITATIONS
3.11 CONCLUSION
CHAPTER 4 ANALYSIS AND INTERPRETATION OF PHASE 1 AND PHASE 2 RESULTS
4.1 INTRODUCTION
4.2 PHASE 1: QUANTITATIVE ANALYSIS
4.3 Data analysis and interpretation of the review of the system
4.4 PHASE 1: DATA ANALYSIS AND INTERPRETATION OF THE NURSES’ SURVEY (QUANTITATIVE)
4.5 PHASE 2: QUALITATIVE ANALYSIS AND PRESENTATION OF NURSES AND NURSE
LEADERS’ INTERVIEWS
4.6 ANALYSIS AND INTERPRETATION OF FINDINGS OF THE ICU NURSE MANAGERS’
INTERVIEWS
4.7 CONCLUSION
CHAPTER 5 INTERVENTION
5.1 INTRODUCTION
5.2 DESCRIPTION OF INTERVENTION
5.3 PREPARATION FOR COMMUNICATION SKILLS WORKSHOPS
5.4 NURSES’ RESPONSE OF THE SEMINARS
5.5 LEAVING THE FIELD
5.6 CONCLUSION
CHAPTER 6 DISCUSSION OF FINDINGS
6.1 INTRODUCTION
6.2 MAJOR FINDINGS OF THE STUDY
6.3 IMPROVED NURSES’ ATTITUDES AFTER COMMUNICATION TRAINING.
6.4 CONCLUSION
CHAPTER 7 CONCLUSIONS AND RECOMMENDATIONS
7.1 INTRODUCTION
7.2 RECOMMENDATIONS
7.4 LIMITATIONS OF THE STUDY
7.5 CONTRIBUTION OF THE STUDY
7.6 CONCLUSION
REFERENCES
GET THE COMPLETE PROJECT
NURSES’ COMMUNICATION WITH MECHANICALLY VENTILATED PATIENTS IN THE INTENSIVE CARE UNITS