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

Trotta, Rebecca L.; Hermann, Robin M.; Polomano, Rosemary C.; Happ, Mary Beth

The Journal for Healthcare Quality (JHQ): January 03, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/JHQ.0000000000000163
Original Article: PDF Only

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.

For more information on this article, contact Rebecca L. Trotta at

Dr. R. L. Trotta contributed to conceptualization and conduct of the project, and manuscript preparation. R. C. Polomano contributed to the data analysis and preparation of the manuscript. R. M. Hermann contributed to data collection and analysis, and manuscript review. M. B. Happ contributed to conceptualization of the study and study implementation, manuscript review and editing.

The authors declare no conflicts of interest.

© 2019 National Association for Healthcare Quality
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