Nurses Communicating With Critically Ill and Sedated Patients

Nurses and Communication

Nurses play an important role in the care of patients with critical illnesses and patients that are sedated.

Communicating with patients that are critically ill and sedated can be a huge challenge for nurses. This challenge exists because critically ill and sedated patients are sometimes not in a position to make decisions for themselves. For the critically ill, there are added stressors and the patient may be very aware of the likelihood of death. For this reason, nurses must be extremely sensitive to the needs of patients that are critically ill or sedated. The purpose of this paper is to discuss the manner in which nurses communicate with critically ill and sedated patients. Let us begin our discussion with an overview of what the relationship between a nurse and a patient entails.

Nurse-patient Relationships and the Importance of Communication

According to a book entitled, the relationship between a nurse and a patient should be one of care and compassion. The author asserts that the relationship should be pleasant and helpful (Riley 2000). The book goes on to assert there are a set of pre-established rules that define the nurse-client relationship. These rules differentiate between a social relationship and a helping relationship. A social relationship or friendship is developed for the benefit of both parties. However, a helping relationship is established so that a patient can receive the best possible care for their particular health needs (Gabbard-Alley 1995). The book also explains there is a different set of actions that occur in a helping relationship and a friendship. The author argues,

Professional practitioners of nursing bear primary responsibility for the nursing care clients / patients receive (Congress for Nursing Practice, ANA, 1973). Client-nurse relationships are entered for the benefit of the client, but such a relationship is more effective if it is mutually satisfying. Clients are satisfied when their health care needs have been met and they sense that they have been cared for. Nurses feel a sense of accomplishment when their interventions have had a positive influence on their clients' health status and when their conduct has been competent and caring. Client-nurse relationships may be a mutual learning experience, but in general the goals of therapeutic relationships are directed toward the growth of clients (Riley 2000)."

Riley (2000) also asserts that communication is also essential to any type of nurse-patient relationship. The author explains that communication involves the process of receiving and sending messages. Nurses must communicate in a manner that is both assertive and caring. The book explains that communication in the healthcare environment is so essential because it can either aid in the creation of a therapeutic relationship or interrupt the patients' ability to recover.

Engaging in assertive communication means that the nurse is able to communicate in a manner that is clear and precise. It also means that the nurse exudes confidence without appearing to be overbearing or brutish. The book contends that an assertive nurse will be certain not to cause patients or their families any unnecessary anxiety. Assertiveness in communication is essential because it entails "taking an active role, having a positive, caring, nonjudgmental attitude, maintaining your rights without denying the rights of others and communicating your desires in a clear and direct manner without threatening or attacking (Riley 2000)."

Nurses must also communicate in a manner that is caring and responsible. Riley (2000) explains that responsible communication means that nurses are held accountable for what they say to patients and their families. Nurses must be truthful with patients and ensure that the message that is conveyed is medically sound and accurate (Riley 2000). In addition, nurses must show care and sensitivity to their patients.

Communicating with Critically ill and sedated patients

Critical care nurses and those dealing with sedated patients have extremely stressful jobs and must be able to communicate effectively with patients and their families. Critically ill patients are usually described as those patients that are in an intensive care unit or critical care unit at a hospital. Sedate patients are those individuals that have been given drugs to keep them calm.

A book entitled Caring in Crisis: An Oral History of Critical Care Nursing explains,

The critical care nurse lives twenty-four hours a day, seven days a week, in highly stressful, intellectually demanding, and rapidly changing environments, with and for patients with multiple needs. This patient population is sicker and older than before, with more complex health problems requiring a variety of interventions (Freeman et al., 1987). Further, critical care nurses are now at risk of exposure to life-threatening diseases like AIDS, hepatitis, and tuberculosis and injury from toxic products and processes such as x-rays in the environment. The involvement of the nurse with the patient, the patient's family and friends, the physicians, and other health care personnel may exemplify a model of communication and practice that is unique (Zalumas 1995; 22)

Riley (2000) explains that communicating with distressed patients is a particularly daunting task for a nurse. Distress often occurs when an illness worsens or when patients are unsure about their futures (Riley 2000). These two factors usually arise with critically ill patients. Nurses must understand these reactions and communicate effectively.

Indeed, effective communication with a critically ill patient or their family can greatly reduce anxiety and improve the chances of the patient recovering. In fact, the I.L. Janis study of 1958 found that the anxiety level of critically ill patients were decreased when nurses and health care professionals were careful and provided patients with appropriate preoperative communication that permitted the patients to prepare for the dangerous situation mentally (Zalumas 1995). The study found that this type of positive communication increase the patients comfort during postoperative adjustments (Zalumas 1995).

The book also explains that the advent of various technological equipment have created an obstacle for nurses to communicate effectively. The book explains that the various technologies that are present in the critical care unit of a hospital can create an environment that is counterproductive to the development of interpersonal relationships. To compensate for the impact of technology on the well-being of the patient, the book asserts that nurses must make a more of a concerted effort to communicate with patients. The author explains that one of the most effect ways that nurses can communicate in this type of environment is through empathy. The book contends

Because technological environments are fraught with obstacles to interpersonal openness and communication, the effect of nurses' empathy, especially in ICUs, is an important issue. In Brunt's comparison of empathy responses of nurses from four clinical units as varied as rehabilitation and surgical ICU, the surgical nurses perceived that they worked in a more technical unit than the other nurses, but all nurses scored very low on an empathy scale. Brunt notes that her results deviate from those of other investigators, where nurses were found to score average to high in empathy, but recommends that nurses should be taught content on empathy in nursing schools and in continuing education offerings (Zalumas 1995)."

Empathy is important because it allows the critically ill patient with the comfort of knowing that the individual that is taking care of them understands of their situation and their needs. Riley (2000), describes empathy as "the act of communicating to our fellow human beings that we understand how they are feeling and what makes them feel that way (Hogan, 1969). Empathy is the ability to "get inside another's skin" and subjectively feel with a client (Riley 2000)." Empathy is also important to the family of critically ill patients because it lets them know that they have an advocate that as their best interest at heart. Nurses must be certain to comfort critically ill patients and their families through empathetic actions.

Indeed, nurses usually serve as intermediaries between the doctor and the family. The book explains that the nurse often uses information collected by the family to develop a diagnosis of the needs of the patient and the family (Youngner 1986).. The author asserts that once the nurse has assessed these needs the proper actions can be taken. Nurses must find a way to communicate with the patient or family even if they have not asked the nurse to intervene (Youngner 1986). The book explains that there are several tactics that the nurse can use to increase communication of everyone involved. The author explains,

There are many options potentially available to the nurse -- for example, simply sharing the family's communication with others; getting answers from the physician to transmit back to the family; arranging meetings between physician and family; helping the family to ask their questions or raise their concerns with physicians or other caregivers; instituting a plan to enable consistency in the manner in which others interact with the family. Doing nothing is rarely acceptable. Repeated contact with the family, repeated questions and expressions of distress, and the reality of having to participate in care that is inadequate, unsatisfactory, or simply not wanted generate feelings which, in turn, provide the nurse with powerful motivations for advocacy attempts (Youngner 1986)."

Youngner (1986) asserts that critical care nurses must find the balance between meeting the needs of the patient and conforming to the wishes of the family (Youngner 1986).

The nurse must understand that the proper communication is essential to the health and recovery of the patient (Youngner 1986).

Once nurses understand their role, they will be able to care for critically ill patients more effectively.

According to a study published in the journal Health Communications, there are psychological responses that occur when patients are communicating with nurses and other health care professionals. This particular study observed that communication with nurses, family and physicians had an impact on the overall well being of the patient. The journal article reports that The purposes of this study were to examine CCU patients' cardiovascular responses to the process of communication and to examine the effects of communication with individuals of varying roles (i.e., nurse, physician, and family member) on physiological variables. This was part of a larger study of environmental effects on patients. In this study, communication was defined as conversation between patients and their nurses, physicians, and families. Patient cardiovascular responses were defined as HR and blood pressure (BP), which were assessed while patients were talking and listening to others (Baker et al. 1992).

The results of the study were conclusive with other studies that have suggested that there is no change in blood pressure or the heart rate minimum when critical care patients were communicating with nurses, family or doctors. However, the study did find that there was a difference in the maximum heart rate when communicating with these individuals. This confirms previous findings, which suggest that "increased sympathetic stimulation which increases the need for myocardial oxygenation (Baker et al. 1992)."

These findings are important because they illustrate how communication affects critical patients. These findings also allow nurses and others in the healthcare profession to devise ways to meet the needs of patients through effective communication.

An article entitled, "What Patients Remember: a Content Analysis of Critical Incidents in Health Care," explains that caring and effective communication were amongst the things that patients remembered most when faced with a critical care situation. The patients indicated that the communication that they shared with their nurses affected their recovery. The patients specifically noted that the interpersonal relationships that were developed were of particular importance to their recovery. One participant noted that, "the friendly attitude makes you feel relaxed when you are tense. (Ruben 1993)" This again confirms the need for compassionate communication and care giving amongst nurses.