Improving Nonvocal Critical Care Patients' Ease of Communication Using a Modified SPEACS-2 Program

Objective: To evaluate the feasibility and impact of implementing the "study of patient-nurse effectiveness with assisted communication strategies-2" (SPEACS-2); a program to facilitate communication with nonvocal patients. Study Design: The plan-do-study-act quality improvement methodology guided the implementation of a modified SPEACS-2 program within a pre and posttest design. The Ease of Communication Scale (ECS) measured patients' communication difficulty, and care processes measured the program's success. Study Population: Nurses (N = 385) across 5 intensive care units were trained in SPEACS-2. We assessed 354 nonvocal patients (aged 18-95 years) requiring continued mechanical ventilation after withdrawal of heavy sedation. Patients were evaluated over one 2-week preintervention (n = 163) and two 3-week postintervention periods (n = 128; n = 63). A subsample of intervention patients (n = 204) completed the ECS. Results: Ease of Communication Scale scores improved significantly (p = .027) from baseline (mean 25.86 +/- 12.2, n = 71) to postintervention period 2 (21.22 +/- 12.2, n = 63). Nurses' use of communication techniques and compliance with communication plans of care incrementally increased after training. Conclusions: Implementing SPEACS-2 demonstrated positive changes in patients' ease of communication and feasibility of incorporating evidence-based communication strategies into practice.