Effectiveness of Communication board on the Communication Pattern and level of Satisfaction among Mechanically Ventilated Patients.

Sasmita Das¹, Binu xavier², Farzana Begum³

¹Associate Dean, SUM Nursing College, Siksha O Anusandhan University, Bhubaneswar.

²Lecturer, SUM Nursing College, Siksha O Anusandhan University, Bhubaneswar.

³M.Sc Nursing Student, SUM Nursing College, Siksha O Anusandhan University, Bhubaneswar.

*Corresponding author Email: das.sasmita2@gmail.com

ABSTRACT:

An experimental one group pre test and post test design was carried out to assess the communication pattern and level of satisfaction among mechanically ventilated patients. Sixty numbers of mechanically ventilated and conscious patients were selected in a multispecialty Hospital by non probability purposive sampling technique. The technique used for data collection were interview Performa for demographic data and self structured rating scale to assess communication pattern and level of satisfaction. The result shows that, mean post test score of satisfaction level is 36.9, which is higher than mean pre test score of satisfaction level 31.4. The stander deviation of post test 2.51 is less than stander deviation of pre test 2.55 which indicates that the group is more homogenous in post test and marked improvement in satisfaction level in post test than pre test.

Mean post test score of communication pattern is 134.4, which is higher than mean pre test score of communication pattern 78.85. The stander deviation of post test 6.69 is less than stander deviation of pre test 7.2 which indicates that the group was more homogenous in post test and has a marked improvement in communication pattern in post test than pre test.

There is significant positive relationship between communication pattern and level of satisfaction of the patients with mechanical ventilator. The calculated r value is 0.25 (before using communication board) and 0.29 (after using communication board) indicate high significant relationship between communication pattern and level of satisfaction of the patients with mechanical ventilator. The investigator observed that all patients admitted on mechanical ventilator had poor communication pattern and thus frustrated.

KEY WORDS:

INTRODUCTION:

Critically ill patients often have their usual means of communication interrupted or limited, either mechanically by endotracheal intubation or by the effect of drugs, at a time when the need for the information and expression of anxieties is great. Deficiency in communication ranks as one of the most negative experiences in the studies of perception of intubated patients. Patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs.

In this study, a communication board, if used patiently during mechanical ventilation, frustration with communication may be alleviated .The study will gauge patients' opinion on communication Board, a light, flexible communication board that will be prepared so that the patient can easily inform the caregiver of all of his or her conceivable needs. This study will describe the communication pattern and level of satisfaction experienced by the mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patients. This study will add to the body of knowledge regarding communication in mechanically ventilated patients by reporting the effectiveness of communication board on communication pattern and level of satisfaction.

BACK GROUND OF THE STUDY:

Berrouschot J.et.al (2000) have suggested that neurological, particularly cerebrovascular, patients requiring mechanical ventilation have a very bad prognosis and questioned the usefulness of such ventilation. Rabinstein AA.et.al (2004) indicated that a considerable part of these even long-term ventilated patients can have a good outcome.

John Durham Peters (1999) made a systematic review of the literature to assess the difficulties and stresses of mechanically ventilated patients in the intensive care unit (ICU) when trying to communicate with doctors and nurses. The study revealed that critical care nurses rarely receive training in effective communication with non-verbal patients, and most are unfamiliar with augmentative communication methods.

Katja Laksoo, (2011) conducted a study to assess the patient satisfaction in hospital among post operative patients However, many patients complained that they were not treated with respect by caregivers, did not receive adequate pain medication after surgery, and did not understand the instructions they received for home care once they left the hospital. The author claimed that poor communication was a major source of medical errors, encouraging doctors and nurses to listen more carefully to their patients.

S. Ali and Z. Kabir, (2007) conducted a study to assess the patient experiences of communication problem during ventilator treatment. A descriptive approach was used and samples are consecutive patients treated in ICCU and structured questionnaire methods are used to collect data. The result suggest that the need for detailed examination of patients potential for effective communication, evaluation of the communication skills of the nurses and further investigations of devices that can help facilitate communication between nurses and patients during ventilator.

OBJECTIVES OF THE STUDY:

1. To assess the communication pattern among the patients with mechanical ventilator before and after use of communication board.

2. To assess the level of satisfaction among the patients with mechanical ventilator before and after use of communication board.

3. To compare the

a) communication pattern before and after use of communication board

b) level of satisfaction before and after use of communication board

4. To Correlate the communication pattern with the level of satisfaction before and after use of communication board among the patients with mechanical ventilator

METHODOLOGY:

Research design

Evaluative approach and pre experimental one group pre test and post test design were adopted to achieve stated objectives.

Population

In this study population includes conscious patients with mechanical ventilator support.

Setting for the study

The present study was conducted in ICU, SUM Hospital, Kalinga Nagar, Bhubaneswar, Orissa

Samples and Sampling

Sample size for the present study was consists of 60 ICU patients those are on mechanical ventilator and conscious and non probability purposive sampling technique is used to collect the data.

Inclusive criteria

Ø The adult hospitalized patients of age group>18yrs on mechanical ventilator on conscious

Ø The patient who are present at the time of visit

Ø The patient who are willing to participate in the study

Ø The patient who speak Oriya, Hindi and English

Exclusion criteria

Ø The adult hospitalized patients of age group<18yrs on mechanical ventilator

Ø The patient who are not willing to participate in the study

Ø The patient who doesn’t speak Oriya, Hindi and English

Setting of the study

Study was conducted at SUM Hospital of Bhubaneswar.

Description of data collection instruments

SECTION-A (Socio-Demographic data)

This section compromises of 9 items on socio-demographic profile that includes: age, sex, marital status, type of family, educational status, occupation, monthly income, area of resident, and duration of ventilatory support.

SECTION-B (Self-Structured rating scale to assess communication pattern)

Ø Deals with self structured questionnaire to assess the communication pattern of patients on ventilator that contains rating scale, each having 3 options.

Ø Responses which occurred always scored 3, responses which occurred sometime scored 2, and responses which occurred never scored 1.

SECTION-C (Self-Structured rating scale to assess level of satisfaction)

Ø Deals with self structured questionnaire to assess the level of satisfaction of patients on ventilator that contains rating scale, each having 3 options.

Ø Responses which occurred never scored 3, responses which occurred sometime scored 2, and responses which occurred often scored 1.

Data analysis and interpretation

Section-A-Description of patients on mechanical ventilator according to socio -demographic variables by using frequency (f) and percentage (%)

TABLE-1: Description of patients on mechanical ventilator according to socio demographic variables

Sl. No.	Sample	Characteristics	Frequency (f)	Percentage (%)
1	Age	21-30	18	30
		31-40	18	30
		41-50	15	25
		>50	09	15
2	Gender	Male	37	62
		female	23	38
3	Marital status	married	51	85
		un-married	09	15
		divorce	00	00
		widow	00	00
4	Educational status	Illiterate	00	00
		Primary/high school	19	32
		Under graduate	26	43
		Graduate and above	15	25
5	Family type	Nuclear	22	36
		Joint	31	52
		extended	07	12
6	Occupation	Business	22	36
		Govt. sector	10	17
		Private sector	13	22
		other	15	25
7	Monthly income	< 5,000	03	05
		5,000-10,000	21	35
		10,000-15,000	14	23
		>15,000	22	37
8	Residential status	Rural	22	37
		Urban	38	63
		slum	00	00
9	Duration of ventilatory support (days)	<4	17	28
		4-7	16	27
		>7	27	45

Table- 2 mean, median and standard deviation of pre test and post test communication pattern of patients with mechanical ventilator

Criteria	Total score	Mean	Median	Standard deviation
Pre test	4731	78.85	79	7.16
Post test	8064	134.4	134	6.68

Distribution of data according to age shows that 30%(18 out of 60) of patients are between age group 21 to 30 yrs, 30%(18 out of 60) of patients are between age group 31 to 40 yrs, 25%(15 out of 60) of patients are between age group 41 to 50 yrs, 15%(09 out of 60) of patients are above 50 yrs.

Distribution of data according to gender shows that 62 %( 37 out of 60) of patients are male and 38 %( 23 out of 60) of patients are female

Distribution of data according to marital status shows that 85 %( 51 out of 60) of patients are married, 15 %( 09 out of 60) of patients are unmarried and 0% (00 out of 60) patients are divorce and widows

Distribution of data according to educational status shows that 00 %( 00 out of 60) of patients are illiterate, 32 %( 19 out of 60) of patients are Primary/high school passed, 43 %( 26 out of 60) of patients are Under graduate and 25% (15 out of 60) patients are Graduate and above Distribution of data according to duration of ventilatory support shows that 28 %( 17 out of 60) of patients are less than 4 days on mechanical ventilator, 27 %( 16 out of 60) of patients are 4 to 7 days on mechanical ventilator and 45% (27 out of 60) patients are more than 7 days on ventilatory support

Section-B

Findings related to evaluation of the effectiveness of communication board in terms of communication pattern

This section describes the findings related to evaluation of the communication board in terms of improvement in communication pattern. The pre test and post test communication pattern score obtained through a structured questionnaire were described and analyzed using both descriptive and inferential statistics.

Table-3 N=60

Type of test	Total mean	Mean score percentage	S.D.	variance	z- value
Pre test	78.85	50.5	7.16	51.26	31.2(p=<0.0001)
Post test	134.4	86.1	6.68	44.74	31.2(p=<0.0001)

Z (59) at 0.05 significant level=2.0

Table- 4. Analysis of overall communication pattern score as per criterion

Communication pattern	score	Pre test		Post test
Communication pattern	score	frequency	percentage	frequency	percentage
Good	104-156	0	0	60	100
Average	52-104	60	100	0	0
Poor	52	0	0	0	0
total		60	100	60	100

Table-.2 reveals that mean post test score of communication pattern is 134.4, which is higher than mean pre test score of communication pattern 78.85. The stander deviation of post test 6.689143 is less than stander deviation of pre test 7.161159 which indicates that the group was more homogenous in post test. It inferred that there is a marked improvement in communication pattern in post test than pre test.

Frequency polygon on pre test and post test communication pattern score of patients with mechanical ventilator

Figure.1. Line diagram showing the pre test and post test communication pattern score.

Fig-1 shows that in pre test all the patients on mechanical ventilator having score between 53-104, which is between 105-156 in post test.

Z- Test effectiveness of communication board on communication pattern of patients with mechanical ventilator

Table-.3 reveals that mean post test communication pattern score 134.4 is higher than their mean pre test communication pattern score 78.85 with a mean score percentage of post test communication pattern 86.1 is higher than their mean score percentage of pre test communication pattern score 50.5. The variance of post test communication pattern score 44.7446 is less than the variance of pre test communication pattern score 51.2656. The calculated ‘z’ value at degree of freedom (d.f.) 59 is 31.2 which is higher than the tabulated z (59) at 0.05 level of significance (2.0). It indicates that communication board is effective in improving communication pattern of patients with mechanical ventilator

Analysis of overall communication pattern score as per criterion

Table 4. depicts that the pre use of communication board the communication pattern of the mechanically ventilated patients is average but it is good after using communication board.

Section-C

Findings related to evaluation of the effectiveness of communication board in terms of satisfaction level reveals that mean post test score of satisfaction level is 36.9, which is higher than mean pre test score of satisfaction level 31.4. The stander deviation of post test 2.51 is less than stander deviation of pre test 2.55 which indicates that the group is more homogenous in post test. It inferred that there is a marked improvement in satisfaction level in post test than pre test.

Section-D

Co-relation between communication pattern and level of satisfaction of the patients with mechanical ventilator.

The findings suggest that there is significant positive relationship between communication pattern and level of satisfaction of the patients with mechanical ventilator. The calculated r value is 0.25 (before using communication board) and 0.29 (after using communication board) indicate high significant relationship between communication pattern and level of satisfaction of the patients with mechanical ventilator

CONCLUSION:

The present study findings described that by using a communication board, the communication pattern and level of satisfaction can be improved. The findings conclude that the communication board developed by the researcher was found to be helpful in enhancing communication pattern and level of satisfaction of the patients with mechanical ventilator.

ACKNOWLEDGEMENT:

The author is very much thankful to all the patients for their cooperation and support who participated in this research study.

FUNDING:

This research was supported by self funding of the authors.

CONFLICTING INTEREST:

The authors declared that there is no conflict of interest in this article.

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Received on 11.11.2014 Modified on 18.11.2013

Int. J. Nur. Edu. and Research 3(1): Jan.-March, 2015; Page 40-44

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