Effectiveness, experience, and usability of low-technology augmentative and alternative communication in intensive care: A mixed-methods systematic review

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE Australian Critical Care Pub Date : 2025-01-01 DOI:10.1016/j.aucc.2024.04.006

Hissah A. Alodan OT, MSc , Anna-Liisa Sutt MSPA, CPSP, PhD , Rebekah Hill RGN, MSc, MA, PhD , Joud Alsadhan OT, MSc , Jane L. Cross Grad Dip Phys, MSc, EdD

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Abstract

Background

Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them nonverbal. Low-technology augmentative and alternative communication (AAC) strategies are simple and effective ways to enhance communication between patients and their communication partners but are underutilised.

Aim

The aim of this study was to systematically review current evidence regarding the effectiveness, experience of use, and usability of low-technology AAC with nonverbal patients and their communication partners in the ICU.

Methods

This review included quantitative, qualitative, and mixed-methods studies of adult ICU patients aged 18 or older who were nonverbal due to mechanical ventilation and their communication partners. Studies using low-technology AAC, such as communication boards and pen and paper, were included. Six databases were searched, and the review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A convergent segregated approach was used for data synthesis.

Results

Thirty-two studies were included. Low-technology AAC improved patient satisfaction, facilitated communication, and met patients' physical and psychological needs. Communication boards with mixed content (e.g., pictures, words, and letters) were preferred but were used less frequently than unaided strategies due to patients' medical status, tool availability, and staff attitudes. Boards should be user-friendly, tailored, include pen/paper, and introduced preoperation to increase patient's comfort when using them postoperatively.

Conclusion

Existing evidence support low-technology AAC's efficacy in meeting patients' needs. Better usability hinges on proper implementation and addressing challenges. Further research is crucial for refining communication-board design, ensuring both user-friendliness and sophistication to cater to ICU patients' diverse needs.

Registration

The review protocol was registered in the International Prospective Register of Systematic Reviews, with registration number CRD42022331566.

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重症监护中低技术辅助和替代性交流的效果、经验和可用性：混合方法系统综述。

背景：重症监护病房（ICU）的患者通常需要通过气管插管或气管切开术进行机械通气，这通常会导致他们无法开口说话。低技术辅助和替代性交流（AAC）策略是加强患者与其交流伙伴之间交流的简单而有效的方法，但却未得到充分利用。目的：本研究旨在系统性地回顾目前有关低技术辅助和替代性交流对重症监护室中不会说话的患者及其交流伙伴的有效性、使用经验和可用性的证据：本综述包括针对因机械通气而无法言语的 18 岁或以上成年重症监护病房患者及其交流伙伴的定量、定性和混合方法研究。其中包括使用低技术 AAC（如交流板和纸笔）的研究。研究人员检索了六个数据库，并根据《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南进行了综述。数据综合采用了聚合分离法：结果：共纳入 32 项研究。低技术含量的辅助交流设备提高了患者的满意度，促进了交流，满足了患者的生理和心理需求。混合内容（如图片、文字和字母）的交流板是首选，但由于患者的医疗状况、工具的可用性和工作人员的态度，使用频率低于无辅助策略。操作板应便于使用、量身定制、包括笔/纸，并在术前引入，以提高患者术后使用时的舒适度：现有证据表明，低技术的 AAC 能够有效满足患者的需求。更好的可用性取决于正确的实施和应对挑战。进一步的研究对于完善交流板的设计至关重要，既要确保用户友好性，又要确保其先进性，以满足重症监护病房患者的不同需求：本综述方案已在国际系统综述前瞻性注册中心注册，注册号为CRD42022331566。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.