I. C. U. I Hear U? The patient experience of being voiceless in the ICU

Gabrielle Salisbury-baker1

1St George Hospital, South Eastern Sydney Local Health District, Kogarah, Australia

Background: Patients requiring prolonged mechanical ventilation and tracheostomy within the ICU setting regularly experience a period of voicelessness. The psychosocial effects of voicelessness are well documented, with high levels of frustration, anxiety, and depression reported.

Method: A quality improvement project was initiated within an urban, tertiary level hospital to explore the consumer experience of being voiceless in the ICU. Secondary aims were to determine staff communication-training needs, and to guide development of a communication tool that meets the needs of our consumers. A survey or semi-structured interview was completed with ICU staff, and patients who experienced a period of voiceless following intubation and/or tracheostomy.

Results: 15 patients and 32 ICU staff from medical, nursing, and allied health backgrounds completed this survey. 87% of patients indicated communication was inadequate, and 80% did not feel included in care decisions. All emotions described by patients were negative, with common themes of isolation, frustration and fear reported. 66% of ICU staff “frequently” experience difficulty communicating with voiceless patients. Staff reported that patients most want to communicate care needs (e.g. toilet, water, pain), whereas patients most wanted to request information on medical status and management (e.g. “how is my treatment going?”).

Discussion: Voicelessness is a distressing and isolating experience for ICU patients. ICU staff should prioritise the facilitation of successful communication for voiceless patients, and be aware of their need for information on their medical status and management. Results of this survey reveal a discrepancy between what ICU staff and patients feel is important to communicate. For this reason, consumer engagement is essential when developing services and resources that meet the needs of its service users. As a communication tool that encompassed our consumers’ preferences was unable to be located, this tool has been developed for use within our facility.


Gabrielle is a senior speech pathologist working in the areas of intensive care and trauma at St George Hospital. She has a special interest in tracheostomy, traumatic brain injury, and alternative and augmentative communication within the critical care setting.

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