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Barriers to and facilitators for supporting patient communication in the adult ICU during the COVID-19 pandemic: A qualitative study

Research output: Contribution to journalArticlepeer-review

Laura Istanboulian, Louise Rose, Yana Yunusova, Craig Dale

Original languageEnglish
Pages (from-to)2548-2560
Number of pages13
JournalJournal of Advanced Nursing
Volume78
Issue number8
Early online date9 Mar 2022
DOIs
Accepted/In press22 Feb 2022
E-pub ahead of print9 Mar 2022
PublishedAug 2022

Bibliographical note

Funding Information: Funding informationThis study is supported by the Canadian Nurses Foundation, the Bertha Rosenstadt Health Research Fund, the Bluma Appel and Jeannie Butler Graduate Award in Nursing, the Mary Kathleen King Graduate Awards, the Staples Family Graduate Student Award in Nursing and the Michael Garron Hospital TD Community Health Fund Solutions for COVID‐19 Research Grant.

King's Authors

Abstract

Aim
To explore barriers to and facilitators for supporting communication with and for patients treated with invasive mechanical ventilation in the intensive care unit during the COVID-19 pandemic.

Design
A qualitative descriptive study reported according to the Consolidated Criteria for Reporting Qualitative Research.

Methods
Adult intensive care unit patients treated with an advanced airway for mechanical ventilation, their family members and healthcare providers (nurses, intensivists and allied health) were recruited for interviews between January and April 2021. Interviews were audio-recorded, transcribed verbatim and analysed using content analysis methods. Reported communication barriers and facilitators were mapped to the theoretical framework of acceptability to identify potentially modifiable clinical and institutional practices.

Results
We recruited 29 participants (20 healthcare providers, four patients and five family member). Provider communication barriers included isolation procedures, lack of personal protective equipment and inadequate communication tools/training, which reduced perceived communication frequency and effectiveness. Patients and families reported infrequent proactive provision of communication tools, which contributed to a crisis of unmet needs. Reported facilitators included adequate access to personal protective equipment to mitigate the risk of patient proximity and communication tools/training to improve communication effectiveness. Authentic unit leadership helped to assuage pandemic work stressors and encourage humanistic care. Our analysis indicates low acceptability of existing communication practices during the COVID-19 pandemic and the importance of leadership to reduce the burden of communication through provision of key necessary resources.

Conclusion
COVID-19 conditions have precipitated a communication crisis in the ICU. The results of this study have practice and policy implications and will be used to co-design a communication intervention for use during and beyond the COVID-19 pandemic.

Impact
The study contributes a better understanding of resources necessary to support patient communication. Results apply beyond the pandemic to routine use of infection prevention and control precautions in the intensive care unit.

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