Nurses can play a major role in the process of helping patients recover the ability to speak after tracheostomy, according to a recent report in the journal Critical Care Nurse. The report, titled “Restoring Speech to Tracheostomy Patients,” was published in the December issue.
Researchers note that although critical care nurses are in an ideal position to guide tracheostomy patients to phonate, they may not know about all the options available. Researchers examined methods of restoring speech in tracheostomy patients. Methods vary depending on whether the patient is spontaneously breathing, is being treated with intermittent mechanical ventilation or is ventilator dependent, according to the report.
Although communication commonly used by tracheostomy patients such as lipreading, writing, hand signals and picture boards may be helpful for expressing basic needs, they do not allow for the reciprocal style of conversation, researchers said. Lipreading, for example, is a specialized skill nurses may have difficulty mastering, the report said. Other gestures, such as coded eye blinking, hand gestures and nodding answers must have collaboration from both patients and nurses and require understanding by other caregivers who work with the patient to create consistency. Still, the authors note such gestures can be time consuming and affect the efficiency of caring for critically ill patients. A communication plan specific to the patient should be at his or her bedside and made available to everyone who interacts with the patient, the report stated.
Being able to create sound with a tracheostomy tube depends on having an adequate supply of air reach the vocal cords with a minimum of resistance, researchers wrote. The diameter, length and type of tracheostomy tube play roles in avoiding complications and in greater phonation success, the report stated. The method could be as simple as changing one or all of these components of the tube, resulting in less airway resistance and preventing respiratory distress and unsuccessful attempts at phonation.
Still, the authors write that prior to starting any attempts at phonation, assessing the patients’ physical and mental condition is crucial and can help decide which approach should be taken. The patient also should be able to communicate verbally and have intact cognitive function, the report states. Success depends on the patient’s ability to follow instructions and let nurses know about any difficulty with breathing or phonation.
An inability to communicate or actively participate in their plan of care can lead to depression among ICU patients, the report said. It also can cause patients to be disengaged from their recovery and to have non-adherence with their therapeutic plan.
“Many different methods can be used to restore phonation in patients who have a tracheostomy, and critical care nurses are the ideal members of the health care team to facilitate a planned and systematic approach to achieving phonation,” the authors concluded. “Coordination of the interdisciplinary team, which includes critical care nurses, respiratory therapists, speech pathologists, advanced practice nurses, and physicians, is essential to the goal of voice restoration. Early involvement of this team can improve clinical outcomes and patient satisfaction by reducing the time needed for phonation.”
To comment, email [email protected]