Effective communication is an important aspect of nursing care to explore patients’ feelings and meet their physical, social, and psychological needs. Clients, who have tracheostomy tubes installed for drainage suction or other medical purposes, always find it difficult to express their needs; nevertheless, these procedures place healthcare professionals in a very challenging situation as well. At my clinical placement, I shadowed the staff nurse for the day to understand the daily routine of work. While working with her and responding to her assigned patients’ calls for help, I came across a female client who had tracheostomy tube inserted for some clinical purposes. She was quite frequent in the use of nurse call bell due to the severity and the nature of illness. I followed the staff nurse to respond to her call for help. Preponderance, the patient asked the nurse to clear the airway by suctioning through the tracheal tube. She was unable to speak clearly because of the inserted tube in her trachea. The patient used sign language or muttered to express her needs. It was late afternoon, when we had a call for help from her, as we immediately responded, the patient was trying to articulate her needs over and over again; unfortunately we could not understand her expressions. We asked her family member if he could comprehend what the patient was requesting, but he was unable to help us. Considering methods of facilitating communication, I took out a note-pad and a pen to offer the patient in anticipation that she might be able to write her need. The patient started lettering on the note-pad with her weak and shaky hands. However, it was not legible for us to figure out her need at that moment. This was not only frustrating for the patient but also for both of us. The patient befalls exhausted and she wrote two characters “OK”.
Patients’ calls for help can be better responded if their needs are understood appropriately by the healthcare staff. Patients can better identify their needs compared to any healthcare team. They are the masters of their own body and should lead the care they want from healthcare team (Parse, 2006). There was an enormous block to communication between us as nurses and the patient, not only because of the tracheostomy but also because of our lack of knowledge regarding communication techniques for patients with tracheostomy. Another factor was not having the required and appropriate tools to communicate. Furthermore, we were creating blocks to communication by acting on our needs to get the work done and move on to other patients (Beital, 1998); while client centered care demands from nurses to focus on patients’ needs with respect, dignity and provide continuous and consistent care.
Several researchers have found the effective communication techniques and tools for patients with tracheostomy, such as communication kit, communicating pictorial symbols, lips reading, good eye contact, note-pad, and a pen (Grossbach, Stranberg, & Chlan, 2011). The authors also suggested that the patients, family members and the healthcare team should also be educated about the effective communication techniques. The communication tools should be easily accessible and readily available to all healthcare team members and the family members to understand patients’ needs so that their needs can be fulfilled appropriately and timely. Depending on the patients’ health status and oxygen saturation, there are certain techniques that involve the partial or full deflation of cuff, capping the tube while patient speaks, installation of one way speech valve, tracheostomy tubes that come with talking device, and fenestrated tracheostomy tubes. Healthcare professionals should consider the use of these devices or techniques to provide continuous and consistent care, while making sure of the contraindications of certain procedures, such as not capping the tube for longer time period (Grossbach et al., 2011).
Reflecting upon the situation encompassed with the patient makes me reflect that nursing like teaching is sacred and is more than just a job. Our patients depend on us for their basic healthcare needs. The client may be soliciting for something that was more important to her? Care does make a difference if it is provided according to patients’ wishes. As nurses, we are obligated to respect patients’ wishes by providing autonomy and timely interventions. It was deficient of knowledge and mismanagement that we were able to use only two techniques to communicate with the patient. Thus, we were incompetent to understand and respond to her needs accordingly because of poor communication skills and techniques. Patients’ needs are important and have significant meanings for them. In future, if I come across such situations I will use all available resources, such as communication kit, pictorial communication symbols, and five physical techniques that have been mentioned earlier, making sure that I can understand patients’ desires and respond to them accordingly. Making Q-cards with common questions on them can be used to help find out patients’ needs. Touch screen devices such as IPAD or touch screen monitors with keypad can also be used to explore patients’ needs with speech impaired or patients with tracheostomy. These devices can easily be used for some frail elderly patients. Furthermore, patients’ and family’s education and personal development are required for nurses to understand their patients scientifically and intuitively, which would ultimately help nurses to respond appropriately and timely (Parse, 2006).
Beitel, J. (1998). Illuminations file: Illuminations newsletter of the international consortium of Parse scholars, 7(3), 3-5. R. Spee, RN, APN, Sunnybrook Health Sciences Centre: Toronto, Ontario
Grossbach, I., Stranberg, S., & Chlan, L. (2011). Promoting effective communication for patients receiving mechanical ventilation. Critical Care Nurse, 31. doi: 10.4037/ccn2010728
Parse, R. R. (2006). Rosemarie Rizzo Parse’s theory of human becoming school of thought. In M. E. Parker (Ed.), Nursing theories and nursing practice (pp. 187-216). Philadelphia, PA: F.A Davis Company
These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: email@example.com