Unable to communicate: tracheostomy patients' experience in mechanical ventilation in the Intensive Care Unit

Many studies have highlighted the inability to communicate as one of the main sources of psychological stress that tracheotomy patients experience during mechanical ventilation. Few studies describe communicative difficulty... [ view full abstract ]

Many studies have highlighted the inability to communicate as one of the main sources of psychological stress that tracheotomy patients experience during mechanical ventilation.
Few studies describe communicative difficulty in tracheostomy and endotracheal intubated patients, who are easily subject to emotional distress.

The aim of the study is to examine tracheostomy patient's experience in communication with nurses nurse and understanding patient's sources of discomfort and comfort.

The framework is phenomenological. A sample of 10-15 patients will be enrolled from the ICU of the San Martino Hospital of Genoa (Italy).

Data will be collected through:
- semi-structured interviews for patients
- participant observation
- on site interviews with nurses

Preliminary results showed an association between physical restrains and not being able to speak, or move part of your body to communicate, including verbal communication. Some ethical implications emerged from preliminary results: participants did not understand the reasons for having physical restraints and described this as the most terrible experience of their life, as if they were ‘imprisoned’.

Participants reported different types of discomforts including physical restrains, not being able to speak, nightmares, wanting to live while hearing people say that you will probably die, and the way you feel your own body. Several sources of comfort were described, including selected medical interventions, knowing that somebody listens and understands you, moving your arms and being able to speak.

This research will have implications for clinical practice and nursing education. Understanding patients’ experience in the ICU, what they feel and what they are going through, and their vulnerability is ethically important. It will provide major insight in what could be the sources of comfort / discomfort experienced by tracheotomy patients and what strategies and actions could be put in place to improve communication and the ethical value of the freedom to communicate.