Critically ill patients are often unable to speak as a result of respiratory tract intubation for airway management and mechanical ventilation, which can be a traumatic life event that is frightening, reducespatient participation in care and decision-making, and impairs pain and symptom assessment. No large-scale communication intervention studies have been conducted in the intensive care unit (ICU) setting. To date, no studies have tested the effectiveness of teaching nurses to be facilitative communication partners of temporarily nonspeaking patients in ICU settings.
The specific aims of this study are to (1) test the impact of two experimental interventions: (a) basic communication skills training (BCST) for nurses and (b) AAC techniques and education for nurses with individualized speech language pathologist consultation (AAC/SLP), on the ease, quality, frequency, and success of communications between nurses and nonspeaking ICU patients. (2) Compare the effects of BCST and AAC-SLP training with a control (usual care) cohort. This study is a prospective field experiment using a quasi-experimental cohort design conducted in two intensive care units, medical ICU and cardiothoracic ICU. The sample will be equally distributed between units. Three cohorts of 30 patient participants each and their respective nurse caregivers will be enrolled as participants (10 RNs for each cohort; 30 total nurses, and 90 total nurse-patient dyads). Conditions will be implemented in sequential order (control, BCST, AAC-SLP) to prevent contamination from other intervention conditions and to systematically investigate the effect of the intervention components. Trained observers will measure the frequency of nurse facilitative behaviors (quality), number of communication exchanges (frequency), number of successful exchanges, and rate communication ease across 4 observation sessions (2 per day) with each nurse-patient dyad. Primary covariates include severity of illness, level of consciousness, and physical restraint use. Statistical analysis will involve hierarchical generalized linear modeling (HGLM) by outcome groups and planned group comparisons using linear contrasts within the context of the HGLM.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZHD1-RRG-K (02))
Program Officer
Ansel, Beth
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Other Health Professions
Schools of Nursing
United States
Zip Code
Choi, JiYeon; Campbell, Margaret L; Gélinas, Céline et al. (2017) Symptom assessment in non-vocal or cognitively impaired ICU patients: Implications for practice and future research. Heart Lung 46:239-245
Happ, Mary Beth; Garrett, Kathryn L; Tate, Judith A et al. (2014) Effect of a multi-level intervention on nurse-patient communication in the intensive care unit: results of the SPEACS trial. Heart Lung 43:89-98
Nilsen, Marci L; Sereika, Susan M; Hoffman, Leslie A et al. (2014) Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU. Res Gerontol Nurs 7:113-25
Nilsen, Marci Lee; Happ, Mary Beth; Donovan, Heidi et al. (2014) Adaptation of a communication interaction behavior instrument for use in mechanically ventilated, nonvocal older adults. Nurs Res 63:3-13
Tate, Judith A; Sereika, Susan; Divirgilio, Dana et al. (2013) Symptom communication during critical illness: the impact of age, delirium, and delirium presentation. J Gerontol Nurs 39:28-38
Nilsen, Marci Lee; Sereika, Susan; Happ, Mary Beth (2013) Nurse and patient characteristics associated with duration of nurse talk during patient encounters in ICU. Heart Lung 42:5-12
Radtke, Jill V; Tate, Judith A; Happ, Mary Beth (2012) Nurses' perceptions of communication training in the ICU. Intensive Crit Care Nurs 28:16-25
Broyles, Lauren M; Tate, Judith A; Happ, Mary Beth (2012) Use of augmentative and alternative communication strategies by family members in the intensive care unit. Am J Crit Care 21:e21-32
Happ, Mary Beth (2012) Caring to communicate revisited. Crit Care Med 40:1672-3
Tate, Judith A; Happ, Mary Beth (2011) Neurocognitive problems in critically ill older adults: the importance of history. Geriatr Nurs 32:285-7

Showing the most recent 10 out of 17 publications