Communication boards in critical care: patients' viewsBackgroundPurposesReview of the literatureMethodDesignSample and settingProcedureInstrumentationSurveyCommunication boardAnalysisResultsDescription of subjectsPatients' level of frustrationPatients' perceived level of frustration if a communication board had been availablePatients' perceptions of the helpfulness of a communication boardPatients' reports on the content of the Vidatak EZ BoardA preprinted communication board is more efficient and faster than writingA preprinted communication board facilitates patients' communication of their emotional needs and conveyance of their individualityA preprinted communication board meets the visual and literal needs of patientsDiscussionConclusionAcknowledgementAppendix AReferencesOriginal ArticleCommunication boards in critical care: patients’ viewsBLance Patak, RN, BSN, CCRNa, Anna Gawlinski, RN, DNScb,*,Ng Irene Fung, RN, MSN, ACNPc, CCRNc, Lynn Doering, RN, DNScd,Jill Berg, RN, PhDd, Elizabeth A. Henneman, RN, PhDeaCardiothoracic Intensive Care Unit, UCLA Medical Center, Los Angeles, CA, USAbNursing Research and Education, UCLA Medical Center, Los Angeles, CA, USAcCardiac Surgery, Kaiser Permanente, Los Angeles, CA, USAdSchool of Nursing, UCLA School of Nursing, Los Angeles, CA, USAeSchool of Nursing, University of Massachusetts, Amherst, MA, USAReceived 14 September 2004; accepted 23 September 2005Abstract Background: Some patients receiving mechanical ventilation experience an intensified need tocommunicate while their ability to do so is compromised as the endotracheal tube prevents speech.Although the use of a communication board to enhance communication with such patients hasbeen suggested, few descriptive or empirical studies have addressed the content and format ofthese devices or of patients’ perspectives on decreasing frustration with communication.Objectives: The objectives of this study were: (1) to identify the perceived level of frustration ofpatients receiving mechanical ventilation while they attempt to communicate; (2) to determinepatients’ perceived level of frustration if a communication board had been used; and (3) to describepatients’ perceptions of the appropriate content and format of a communication board.Methods: Twenty-nine critically ill patients who were extubated within the past 72 hours wereincluded in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interviewconsisting of questions about their perceived level of frustration when communicating with andwithout a communication board and their thoughts about the appropriate content and format of aboard. Transcripts were analyzed by questions for meaning and overall themes.Results: Sixty-two percent (n = 18) of patients reported a high level of frustration in communicatingtheir needs while receiving mechanical ventilation. Patients judged that their perceived level offrustration in communicating their needs would have been significantly lower ( P b .001) if acommunication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20)perceived that a communication board would have been helpful, and they also identified specificcharacteristics and content for a communication board. A communication board may be an effectiveintervention for decreasing patients’ frustration and facilitating communication.Conclusions: Most patients receiving mechanical ventilation experienced a moderate to a high levelof frustration when communicating their needs. In this study, a communication board, if usedpatiently during mechanical ventilation, has been shown to alleviate frustration with communication.Patients have specific ideas about what terms and ideograms are useful for a communication board.Further research is needed to test the effects of a communication board and other methods offacilitating communication on outcomes such as satisfaction and anxiety of patients, adequate andappropriate management of pain, and length of mechanical ventilation time and hospital stay.D 2006 Elsevier Inc. All rights reserved.1. BackgroundPatients receiving mechanical ventilation have reportedcommunication difficulties as their number one problemwhile intubated (Gries & Fernsler, 1988; Johnso n & Sexton,0897-1897/$ – see front matter D 2006 Elsevier Inc. All rights reserved.doi:10.1016/j.apnr.2005.09.006BInstitution project completed: University of California-Los AngelesMedical Center and School of Nursing, Rm. 14-176 CHS, 10833 Le Conte,Los Angeles, CA 90095.4 Corresponding author. Tel.: +1 310 206 1884 (work), +1 310 4709340 (home); fax: +1 310 794 7482.Applied Nursing Research 19 (2006) 182 – 190www.elsevier.com/locate/apnr1990; Rotundi et al., 2002; Stovsky, Rudy, & Dragonette,1988). Patients’ inability to communicate results in unrec-ognized pain, feelings of loss of control, depersonalization,anxiety, fear, distress, and frustration (Criner & Isaac, 1995;Dickerson, Stone, Panchura, & Usiak, 2002; Gries &Fernsler, 1 988; Hafsteindottir, 1996; Heath, 1989; Johnson& Sexton, 1990; Riggio , Singer, Hartman, & Sneider, 1982;Stein-Parbury & McKinley, 2000). Patients may becomeanxious when their needs are not met during periods ofmechanical ventilation because of their inability to verballycommunicate with family and health care providers(Levine, Koester, & Ket, 1987). A cycle of confusionensues, involving misunderstandings between nurses andpatients during attempts to convey messages that aremisinterpreted or misunderstood (Carroll, 2004). Anxietyand frustration build and contribute to the negativeemotions and feelings of d ependency, dehumanization,and futility (Carroll, 2004). Patients have described theirinability to communicate during mechanical ventilation asbfrustrating,Qbscary,Q and bhorribleQ (Fowler, 1997; Happ,Tuite, Dobbin, DiVigilio-Thomas, & Kitutu, 2004). Inter-ventions that health care practitioners can use includeinterpreting a patient’s nonverbal forms of communicationsuch as mout hing, gesticulating, nodding, and writing. Suchnonverbal methods not only require energy but are tiringand emotionally draining for these patients. The use of aboard as an intervention to enhance communication hasbeen proposed by health care practitioners (Adomat &Killingworth, 1994; Belitz, 1983; Happ, 2001; Martensson& Fridlund, 2002; Williams, 1992). Appel-Hardin (1984)described the components of a commun ication board,wherein patients can easily point to letters, words,