Exploring and Enhancing the Communication Process between Nonverbal Patients and Healthcare Professionals in Intensive Care in Saudi Arabia

Abstract

Patients in intensive care units (ICUs) are frequently mechanically ventilated, leaving them nonverbal. This impacts on their ability to communicate their needs and their interactions with healthcare professionals (HCPs), causing negative emotions, and an increased burden of care. Nonverbal communication can be facilitated using augmentative and alternative communication (AAC). In Saudi Arabia, there are many non-Saudi HCPs whose cultures and languages differ from those of the Saudi community, creating challenges in providing, receiving, and explaining information to patients, and thus potentially compromising quality of care. Little is known about AAC use and the communication process between HCPs and patients in the Saudi ICUs. Therefore, this thesis aimed to enhance communication between nonverbal patients and HCPs in Saudi ICUs by exploring the lived experience of communication, and by developing and exploring the acceptability of using a low-tech AAC prototype. Using mixed research and based on a framework for developing complex interventions, this thesis involved three phases, each represented a study. In the first phase, the effectiveness, experience and usability of low-tech AAC within ICUs were explored through a mixed methods systematic review. Findings indicated such strategies can be beneficial to ICU population. In the second phase, a qualitative study explored patients’ and HCPs’ lived experiences of the communication process in Saudi ICUs. Findings revealed a lack of evidence-based communication strategies and challenges to communication with a significant presence of the language barrier. Therefore, the third phase involved designing a low-tech AAC strategy named “ICommUnicare”, adapted to Saudi ICU and exploring its acceptability among HCPs using a qualitative study. Findings indicated ICommUnicare is acceptable to HCPs, but it needs modification and further exploration. This thesis contributed new knowledge about the use of low-tech AAC and shed light on the communication between nonverbal patients and HCPs in the foreign language dominated Saudi ICU.