SchmidProspectus12-3FINAL

Running Head: COMMUNICATION BOARDS FOR NONSPEAKING PATIENTS 1
CNL Project Prospectus: Communication Boards for Nonspeaking Patients
Jennifer Schmid
University of San Francisco

COMMUNICATION BOARDS FOR NONSPEAKING PATIENTS 2
Abstract
Quality of care decreases in patients with complex communication needs (CCN) but improves when
using augmentative and alternative communication (AAC). CCN patients experience more preventable
adverse events and more frustration communicating with staff. Communication boards can alleviate some of
the frustrations that nonspeaking patients and nurses experience when communicating.
The purpose of this project was to determine if providing nonspeaking patients on a specialized
medical-surgical unit with a simplified communication board would improve nurse-patient communication
and decrease patient and nursing staff frustration. The unit on which this project was conducted houses a
daily average of 2-3 ENT and trauma patients rendered unable to speak because of tracheostomy, injury, or
surgery. Patients and nurses completed surveys and gave input regarding the use of a simple communication
board. The AAC was redesigned based on feedback and then distributed to patients in the test group.
The final results included reduced perception of the amount of time necessary to communicate,
improved perception of patient-nurse understanding, and decreased perception of patient and nurse
frustration. The mean patient frustration ratings for patients were 4.7 and 3.7, respectively, while the mean
for nursing staff was 4 and 2.8, respectively. Patients were more likely to use the communication board with
daily encouragement. Nurses and nursing assistants also needed time to adapt to the board. Providing
patients with a simple AAC may improve patient outcomes and decrease costs related to adverse events and
length of stay. Communication boards may likewise improve nurse satisfaction.

CNL Project Prospectus: Communication Boards for Nonspeaking Patients
Statement of the Problem
When nonspeaking patients on a specialized medical-surgical unit were provided with a
simplified communication board, nurse-patient communication improved, and patient frustration
decreased.
Rationale
Patients may be rendered unable to speak because of intubation, tracheostomy, or injury
due to trauma or surgery. While patients on mechanical ventilators reside in the intensive care
unit (ICU), stable patients with or without tracheostomy are housed on specialized medical-
surgical units at most hospitals. At a large, urban medical center in northern California, there are
no standardized interventions in place, including the use of augmentative and alternative
communication (AAC), when communicating with tracheostomy patients and those who cannot
speak. In addition, approximately 25% of these patients are primarily Spanish-speaking, and this
presents dual challenges for both patients and nursing staff.
Many of the studies on communicating with nonspeaking patients rely on data from
patients who have either been on a ventilator or received a tracheostomy. However, these results
can be generalized to the nonspeaking patient because this population experiences similar levels
of frustration and communication difficulties (Happ et al., 2011). Happ et al. (2011) found that
because nurses initiate most nurse-patient communication interactions with nonspeaking patients,
nurses tend to “control” what information is communicated. In their study, no communication
boards or other forms of AAC were used to facilitate nurse-patient communication, and
consequently, over 40% of patients in this study rated communication as “somewhat difficult” or
“extremely difficult.” In addition, 35% of patients’ communications about pain were considered

unsuccessful by the study’s authors. Likewise, patients with complex communication needs
(CCN) experience three times more preventable adverse events in the acute care setting when
compared to those patients without language barriers or communication difficulties (Bartlett,
Blais, Tamblin, Clermont, & MacGibbon, 2008). Potential adverse events in the screening
criteria included unplanned readmission, hospital-induced injury, adverse drug reaction, and
nosocomial infection. The majority of preventable adverse events were a result of either
medications or “poor clinical judgment” (Bartlett, Blais, Tamblin, Clermont, & MacGibbon,
2008, p. 1561).
A systematic review of the literature (Finke, Light, & Kitko, 2008) found that the quality
of patient care decreases in patients with CCN, while the level of care improves with the use of
AAC. This is because patients are better able to participate in their care when provided with
AAC. The review highlighted four strategies that nurses could use when communication with
CCN patients: 1) ascertain the patient’s preferred mode of communication, 2) pause so that the
patient has time to respond, 3) restate the message that the patient communicated, and 4) use
AAC.
In addition to the physical needs of nonspeaking patients which may go unaddressed,
nonspeaking patients may also experience a complex range of psychosocial issues related to
impaired verbal communication (Foster, 2010; Patak et al., 2006; Rodriguez & Blischak, 2010).
Patients may become anxious, not only from having a compromised airway but also because of
the inability to communicate their needs (Rodriguez & Blischak, 2010). They may also be afraid
and overwhelmed because of the uncertainties of their condition (Rodriguez & Blischak, 2010).
Moreover, nonverbal patients may feel isolated and stop advocating for their needs (Foster,
2010), which may then compromise their safety and physical needs. In a pilot study specifically

addressing the needs of nonspeaking patients with head and neck cancer, patients identified the
most difficulty in communicating with nurses in comparison to other members of the health care
team (Rodriguez & Blischak, 2010). One limitation of this study is that all patient participants
were male.
Several studies described the benefits of using various modes of AAC to encourage
accurate and adequate nurse-patient communication. Communication boards can alleviate some
of the frustrations that patients experience (Hemsley et al., 2001; Patak et al., 2006); preprinted
boards, in particular, were considered most helpful (Patak et al, 2006). One running theme in the
literature is that it can be tiring for patients attempting to communicate without speaking, and
this fatigue is exacerbated by writing, especially when the effects of medications negatively
impact the clarity and readability of one’s handwriting.
Nurses experience their own frustrations and difficulties working with nonspeaking
patients (Hemsley, Balandin, & Worrall, 2012). When nurses perceive time as an “enemy,” they
encounter more problems with complex communication. However, nurses who initially take
enough time to find ways to communicate – including via AAC – have more success meeting the
CCN patient’s basic care needs (Hemsley, Balandin & Worrall, 2012).
In addition to time constraints and heavy loads, some nurses may feel awkward or
uncomfortable or lack the necessary awareness when working with CCN patients, or they may
perceive the nonspeaking patient as having cognitive deficiencies (Finke, Light, & Kitko, 2008;
Hemsley, Balandin & Worrall, 2012). Studies also cited both the lack of training that nurses
receive regarding AAC as well as the lack of access to simple AAC devices to use with patients
who cannot speak (Hemsley et al., 2001; Patak et al., 2006; Rodriguez & Blischak, 2010). Little
perceived multidisciplinary collaboration between nurses and speech-language pathologists may

also impact nurse attempts at communication and the use of AACs in the acute care setting
(Braun-Janzen, Sarchuk, & Murray, 2009).
Root Cause Analysis
See Appendix A for a root cause analysis of the needs assessment for this quality
improvement project.
Project Overview
The primary objectives of the study were as follows:
1. To improve communication between nurses and nonspeaking patients.
2. To decrease patient frustration by providing nonspeaking patients with a simple, pre-
printed communication board.
3. To introduce the role of the Clinical Nurse Leader (CNL) to the multidisciplinary health
care team on a specialized medical-surgical unit.
The primary goals of this project were as follows:
1. To interview five nonspeaking patients, including three with tracheostomy, as a means of
assessing any communication difficulties with staff and to determine which physical and
psychosocial needs they consider a priority to communicate. Patients would also be
shown a sample of a communication board.
2. To speak with 16 staff nurses and five nursing assistants on the unit to assess their
communication difficulties with nonspeaking patients and to determine which physical
and psychosocial needs they consider a priority when working with nonspeaking patients.
Nurses and patients would be shown a sample of a communication board and given an
opportunity to provide input in developing the communication board.

3. To evaluate whether a pre-printed communication board would improve communication
between nurses and five nonspeaking patients, including three with tracheostomy.
4. To evaluate whether a pre-printed communication board would decrease the frustration
experienced by nonspeaking patients when attempting to communicate with health care
staff.
5. To present the results of this project to the healthcare team of a specialized medical-
surgical unit.
6. To publish the results of this project in a peer-reviewed nursing journal.
Clinical Nurse Leadership Roles
This project encompassed several roles of the CNL. As a patient advocate, the CNL
student improved the safety, efficiency, and effectiveness of client-centered care by facilitating
communication. Clients were also better able to participate in their plan of care. Likewise, as a
member of the profession, the CNL student effected change in the health care practice within the
microsystem as well as in health outcomes. As team manager, the CNL student served as a leader
on the interdisciplinary team by designing and implementing the communication board with the
assistance of nurses, nursing assistants, physicians, and speech-language pathologists, thereby
improving the quality of patient care. The CNL student as clinician worked closely with patients
to design an aspect of their care that was not only cost-effective but also beneficial to the patient.
This evidence-based project further incorporated the role of systems analyst/risk
anticipator. As mentioned previously, CCN clients are at higher risk for adverse events in the
hospital setting, therefore a communication board could decrease this risk and improve patient
safety. The CNL student as information manager collected and assessed data as they pertained to
the communication board and evaluated their impact on nursing staff and patients. Ultimately, as

outcomes manager, the CNL student used these data to change practice and achieve more
optimal client outcomes among nonspeaking patients.
Methodology
This CNL project was conducted on a specialized medical-surgical unit at a large urban
teaching hospital in northern California. Among its patient population, this unit housed ear-nose-
throat (ENT) and trauma patients who received either a temporary or permanent tracheostomy as
a result of cancer or traumatic injury such as laryngeal edema. Other patients were rendered
unable to speak due to injury or wiring of the jaw. This quality improvement program took place
in October and November 2012.
Sample
Six nonspeaking patients were surveyed as a control group, and six nonspeaking patients
were surveyed as the test group following creation of the preprinted communication board.
Inclusion criteria included the following:
1. Patients at least 18 years of age, housed on this specialized medical-surgical unit.
2. Temporary or permanent speech impairment defined as the inability to communicate by
speaking. Such impaired verbal communication was the result of trauma, surgery, and/or
disease.
3. Patients were primarily English speaking. There were no Spanish speaking patients
available for the study.
4. Patients were verbally consented before inclusion in the study. See Appendix B for the
text that was read to patients to obtain their consent.
Exclusion criteria included visual impairment, reduced levels of consciousness and
orientation, advanced dementia, and severe cognitive deficits as may be experienced with

traumatic brain injury (TBI), nor were patients with a deflated cuff and/or capped tracheostomy
included in the patient sample.
Patient diagnoses for those in the control group included cancer (mandible and/or
pharynx) (50%), obstructive sleep apnea (OSA) (33%), and jaw deformity (17%), and patients
were rendered unable to speak due to tracheostomy and/or laryngectomy (50%), mandibular and
maxillary osteotomy (MMO) (33%), and tonsillectomy (17%). In those receiving the revised
communication board, there were two cancer patients (33%), two patients with OSA (33%), one
patient with tracheal stenosis (17%), and one with jaw deformity (17%). Their reasons for
impaired verbal communication included two MMO (33%), one laryngectomy (17%), one
tracheostomy (17%), one based on physician orders due to previous tracheostomy and self-
extubation (17%), and one mandibular osteotomy (17%). Three (25%) of the 12 patients were
female, and all were primarily English speaking. The average age of patients in the control group
was 48.7 years (range, 24-86), while the average age of patients in the change group was 56.1
years (range, 38-73).
Eighteen staff nurses and six nursing assistants were surveyed before the creation and
implementation of the revised communication board. This represents 56% of staff nurses (18/32)
and 67% of nursing assistants (6/9). “Float” nurses and nurses working per diem were not
surveyed. Ten nurses (31%) and two nursing assistants (22%) were surveyed after the initiation
of the quality improvement project, when patients had been given the revised communication
board. The average number of years spent working on the unit for control nursing staff was 7.5,
while the average number of years’ experience on the unit for nursing staff in the change group
was 2.95 (range, 0.2-8).
Procedure

In developing this study, a literature search revealed one patient communication
questionnaire which had not yet been validated or evaluated for reliability (Rodriguez &
Blischak, 2010). Attempts to contact the authors for permission to adapt their survey were
unsuccessful. Therefore, a survey based on the findings of Foster (2010), Patak et al. (2006), and
Rodriguez and Blischak (2010) was used to query patients and nurses who would serve as a
control sample before the implementation of the AAC. Contents of the survey included physical
and psychosocial issues as related to patient care, satisfaction with patient-nurse communication,
and patient frustration. Appendix C and Appendix D contain the surveys for control patients and
nurses respectively.
The laminated, 8-1/2x11” communication board given to patients was predetermined by a
query of both staff nurses and nonspeaking patients; these statements were written in English and
Spanish with a large (24 point) font. Please see Appendix E for the initial version of the
communication board shown to patients and nurses during the control survey period, Appendix F
for the revised version of the communication board given to patients during the project, and
Appendix G for the final version designed for unit-wide dissemination. This initial
communication board was based on the aforementioned studies as well as amended per
consultation with a speech-language pathologist who worked with nonspeaking patients on the
unit.
Upon completion of the interviews with the nursing staff and the control group of
patients, the data from the surveys were analyzed. In conjunction with the literature, patients in
the control group felt that communicating both physical and psychosocial needs were important
priorities. While only 67% chose pain as an area of priority, 83% indicated a desire to

communicate frustration and fear. Specifically, patients asked for the 0-10 pain scale to be placed
on the board as well as the ability to show that they were hot or cold and thirsty or hungry.
The revised version of the communication board was printed and laminated. It was then
distributed upon consent to patients in the test group no later than their second day as an in-
patient on the unit. Anonymous patient data collected included the following: unit room number,
gender, age, diagnosis, reason for impaired verbal communication, date of admission, date of
transfer to the unit from ICU (if applicable), date which patient received communication board,
and date surveyed about the use of the communication board. Patients were then assigned a
number between 1-10 in order to facilitate collection of the data to be used for evaluation
purposes.
Evaluation
Approximately 24 hours after receiving the communication board, patients were asked
the following questions:
1. Have you used the communication board?
2. If so, which items did you use?
3. How often have you used it?
a. Never
b. Once
c. Two to four times
d. Five times or more
4. Do you think the nurses and nursing assistants understood your needs?
5. Do you think the communication board reduced the time necessary for the nurses and
nursing assistants to address your needs?

6. Do you get frustrated trying to communicate to the nurses and nursing assistants? On a
scale of 0-10, with 0 being no frustration, and 10 being extreme frustration, where would
you rate your frustration?
7. Do you think the communication board makes it less frustrating to communication with
nurses and nursing assistants?
Answers to questions 4 and 6 were based on a 4-point Likert scale (always, sometimes, rarely,
never). See Appendix H for a copy of the survey.
Within four days after caring for a patient who received the communication board, nurses
and nursing assistants were asked the following questions:
1. Did the patient use the communication board?
2. If no, were you aware that the patient had been given a tool to facilitate communication?
3. If yes, did you find it helpful in communicating with the patient?
4. Which items did you find most helpful?
5. Do you think you understood the patient’s needs?
6. Do you think the communication board has reduced the time necessary for you to address
the patient’s needs?
7. Do you ever get frustrated trying to communicate with nonspeaking patients?
8. On a scale of 0-10, with 0 being no frustration, and 10 being extreme frustration, where
would you rate your frustration?
9. Do you think the communication board makes it less frustrating to communicate with the
nonspeaking patient?

Answers to questions 5 and 7 were based on a 4-point Likert scale (always, sometimes, rarely,
and never), while questions 3, 6, and 9 could be answered, “yes,” “I’m not sure,” and “no.” See
Appendix I for a copy of the survey.
Data were collected in a spreadsheet format and then analyzed for results.
Timeline
October 19-November 1: Patients in the control group and nurses were interviewed
regarding potential content of a communication board. The speech-language pathologist was also
consulted during this time.
November 1-November 4: Survey results were analyzed, and the revised version of the
communication board was created, printed, and laminated.
November 8-November 14: Upon consent, the communication board was distributed to
seven patients in the test group within 24 hours of admission as an in-patient on the unit. Data
regarding six of the seven test group patients was collected, and nurses and nursing assistants
providing direct care to the test group were surveyed about its use and success at improving
nurse-patient communication and decreasing frustration. Analysis of data occurred concurrently
with data collection until the final conclusions could be drawn.
Results
When nonverbal patients were provided with a communication board, the following
results were obtained:
1. Reduced perception of the amount of time necessary to communicate: Four out of
five patients who responded felt that the communication board reduced the time
necessary for the nurse or nursing assistant to address their needs. Likewise, 40% of

nursing staff (4 of 10 respondents) felt that the communication board reduced the time
needed to communicate with nonspeaking patients. Another 40% were not sure.
2. Improved perception of patient-nurse understanding: Both nurses and patients
perceived an improvement in patient-nurse understanding. Nurses had a nearly
statistically significant improvement (p=0.06) in understanding patients’ needs after the
communication board was given (Figure 1).
Figure 1. Nursing staff perception of understanding nonspeaking patients’ needs. This
figure illustrates nursing staff’s answer when asked if they understand nonspeaking
patients’ needs. Responses were based on a Likert scale of “always,” “sometimes,”
“rarely,” and “never.”
3. Decreased patient frustration based on patient perception: The mean and median patient
frustration ratings for patients in the control group were 4.7 and 5, respectively (range, 0-8),
while the mean and median ratings for patients who received the board were 3.7 and 2.5,
respectively (range, 1-8). Due to the small sample size, these results were not statistically
significant (p=0.55) (Figure 2). In addition, 100% of patients (6 of 6) who were given the
board felt that it made communicating with the nursing staff less frustrating.

4. Decreased nursing staff frustration based on nursing staff perception: The mean and
median patient frustration rating for nursing staff in the control group was 4 (range, 1-9),
while the mean and median ratings for nursing staff whose patients received the board
were 2.8 and 2, respectively. Due to the small sample size, these results were not
statistically significant (p=0.16) (Figure 2).
Figure 2. Mean frustration levels before and after implementation of the
communication board based on a 0-10 scale.
The majority of patients (4 of 6, or 67%) reported using the board between two and four
times in a 12- to 24-hour period. One patient used the board only once in but self-reported that he
“should have used it more.” According to patients, “Pain” was the most frequently used aspect of

the communication board (50% of patients), while nurses recalled that “Hungry” was most
frequently used (38% of patients). Two patients asked to take the communication boards with
them upon discharge from the unit, and one patient went home with the board before he could be
surveyed.
Patients were more likely to use the communication board with daily encouragement and
follow-up, even after they were surveyed. The author of this project feels that had she re-
surveyed patients three days after having received the board, frustration would have been further
reduced, as would have the patients’ perceptions of the nursing staff understanding the patients’
needs. This is evidenced by the fact that the first patient in the change group who was surveyed
expressed reduced frustration throughout his hospital stay, despite having rated his initial
frustration upon surveying as an 8 on a 0-10 scale and reporting that nursing staff rarely
understood his needs.
Likewise, it took time for the nurses and nursing assistants to become accustomed to the
communication board. Nursing staff who encouraged patients’ use of the board felt that the
communication board made it less frustrating to communicate with their nonspeaking patients.
On the other hand, nursing staff who did not promote the use of the board were less sure about its
effectiveness.
The results of this CNL project may improve patient outcomes and decrease costs related
to adverse events as demonstrated in the literature. They may also consequently improve nurse
satisfaction. Further study is needed to ascertain the impact of the communication board on
patient satisfaction rates, adverse events, and length of stay.
Limitations

The results of this quality improvement project were based primarily on patient and
nursing staff recall. Due to scheduling, some nursing staff did not complete the survey until 72
hours after having cared for a patient who received the communication board. This was
evidenced by the fact that when queried, patients reported having used different aspects of the
communication board than what the nursing staff recalled. In addition, a nurse’s or nursing
assistant’s years of experience on the unit may have impacted his/her perception of
understanding patients’ needs, frustration in working with nonspeaking patients, and desire to
use the communication board. Also impacting staff perception was limited contact with the
patient, since nurses were queried after a single 8- or 12-hour shift.
The different diagnoses and reasons for impaired verbal communication may have
impacted the patients’ ability and desire to use the communication board, since some patients’
conditions were more acute than others. Likewise, lack of familiarity with the communication
board likely impacted its use among both patients and nursing staff; patients continued to use the
boards after having been surveyed and expressed greater satisfaction with the board as their use
increased. Because of the small sample sizes of the four groups (control patients, patients
receiving the board, control nursing staff, and nursing staff in the change group), one cannot
generalize the results of this project to the unit as a whole.
Recommendations
As mentioned earlier, a final version of the communication board for nonspeaking
patients was created after initial implementation of the revised board. Board changes, based on
continued feedback from patients who were using the revised version, included larger font size
and larger images for patients who were unable to read and/or speak English. In addition,
separate English and Spanish versions were printed so that an entire side of the board remained

blank if the patient chose to communicate by writing, and for this purpose, a dry erase pen was
attached to the board using Velcro.
Consequently, further study is needed to verify the efficacy of this final version.
Continued patient and nursing staff education and encouragement to use the board should be
incorporated into implementation of the board, and patients should be resurveyed after 3-5 days
of using this AAC. Frequent “huddles” with nursing staff as well as a presentation to staff prior
to implementation may also facilitate the participation of nurses and nursing assistants in this
intervention. Ideally, nonspeaking patients should be given the communication board
immediately upon admission to the unit.
Nursing Relevance
This evidence-based quality improvement intervention created an AAC model that is
inexpensive, simple, and easy for both patients and nurses to use. As demonstrated by the large
body of literature indicating the need for more training and greater availability of methods of
AAC for patients and nurses, this project facilitated nurse-patient communication without
requiring lengthy training workshops or complex technical skills. Nurses are under considerable
pressure to complete a set of tasks and interventions within a specific period of time, yet
ineffective communication with nonspeaking patients can not only slow the nurse down but also
increase his/her levels of stress and frustration (Hemsley, Balandin, & Worrall, 2012). This may
then increase the patients’ levels of frustration, which can lead to poorer patient outcomes
(Finke, Light, & Kitko, 2008). Therefore, facilitating communication between patients and
nurses can serve to decrease patients’ frustration and improve patient outcomes.

References
Bartlett, G., Blais, R., Tamblyn, R., Clermont, R.J., & MacGibbon, B. (2008). Impact of patient
communication problems on the risk of preventable adverse events in acute care settings.
Canadian Medical Association Journal, 178(12), 1555-62.
Braun-Janzen, C., Sarchuk, L., & Murray, R.P. (2009). Roles of speech-language pathologists
and nurses in providing communication intervention for nonspeaking adults in acute care:
A regional pilot study. Canadian Journal of Speech Language Pathology and Audiology,
33(1), 5-17.
Finke, E.H., Light, J., & Kitko, L. (2008). A systematic review of the effectiveness of nurse
communication with patients with complex communication needs with a focus on the use
of augmentative and alternative communication. Journal of Clinical Nursing, 17(16),
2102-2115.
Foster, A. (2010). More than nothing: The lived experience of tracheostomy while acutely ill.
Intensive and Critical Care Nursing, 26(1), 33-43.
Happ, M.B., Garrett, K., DiVirgilio Thomas, D., Tate, J., George, E., Houze, M., … & Sereika,
S. (2011). Nurse-patient communication interactions in the intensive care unit. American
Journal of Critical Care, 20(2), e28-e40.
Hemsley, B., Balandin, S., & Worrall, L. (2012). Nursing the patient with complex
communication needs: Time as a barrier and a facilitator to successful communication in
hospital. Journal of Advanced Nursing, 68(1), 116-26.

Hemsley, B., Sigafoos, S., Forbes, R., Taylor, C., Green, V.A., & Parmenter, T. (2001). Nursing
the patient with severe communication impairment. Journal of Advanced Nursing, 35,
827-835.
Patak, L., Gawlinski, A., Fung, N.I., Doering, L., Berg, J., & Henneman, E. (2006).
Communication boards in critical care: patient views. Applied Nursing Research, 19(4),
182-190.
Rodriguez, C.S. & Blischak, D.M. (2010). Communication needs of nonspeaking hospitalized
postoperative patients with head and neck cancer. Applied Nursing Research, 23(2), 110-
115.

Appendix A
Root Cause Analysis

Appendix B
Patient Consent – Control Group
Good morning/afternoon, Mr./Ms. __________, my name is Jennifer Schmid, and I am a
graduate nursing student from the University of San Francisco. I understand that you are
unable to speak because of your injuries. I am working with nonspeaking patients on the
unit to see if a communication tool would be helpful. May I please ask you a few
questions about your stay here on the unit? All of your answers will be recorded
anonymously and will have no negative impact on your care here. My goal is to improve
communication between nursing staff and nonspeaking patients.
Patient Consent – Test Group
Good morning/afternoon, Mr./Ms. __________, my name is Jennifer Schmid, and I am a
graduate nursing student from the University of San Francisco. I understand that you are
unable to speak because of your injuries. I am working with nonspeaking patients on the
unit to see if a communication tool would be helpful. Here is a communication board that
we are considering implementing on the unit. Would you be willing to try it and then
answer a few questions about it tomorrow? All of your answers will be recorded
anonymously and will have no negative impact on your care here. My goal is to improve
communication between nursing staff and nonspeaking patients.

Appendix C
Patient Survey – Control Group
1. Do you think the nurses and nursing assistants understand your needs?
always sometimes rarely never
2. Do you think that communication with the nurses and nursing assistants takes longer than
it should?
3. Do you ever get frustrated trying to communicate with the nurses and nursing assistants?
0 1 2 3 4 5 6 7 8 9 10
5. If you were given a communication board to use, what items would you like to see on it?
a. Pain
b. Suctioning
c. Breathing problems
d. Going to the bathroom
e. Being repositioned
f. My mouth is dry.
g. I want to walk around.
h. I want to talk to my doctor.
i. I don’t know why I am taking this medication.
j. I’m frustrated/lonely/afraid.
k. I can’t sleep.
6. Please take a look at this communication board. Do you think you would use it?
Y N
7. Is there anything missing from this communication board that would make
communicating with your nurse or nursing assistant less frustrating for you?

Appendix D
Nurse/Nursing assistant survey – Control Group
1. Do you think you understand the needs of nonspeaking patient (i.e., with a trach that is
not capped)?
2. Do you think that communication with nonspeaking patients takes longer than it should?
3. Do you ever get frustrated trying to communicate with nonspeaking patients?
0 1 2 3 4 5 6 7 8 9 10
5. If a nonspeaking patient were given a communication board to use, what items would you
like to see on it? Please check all that apply.
Pain Suctioning
Breathing Problems Going to the bathroom
Repositioning My mouth is dry.
Taking a walk I want to talk to my doctor.
I don’t understand what this
medication is for.
I’m frustrated/lonely/afraid.
I can’t sleep.
6. Please take a look at this communication board. Do you think it would improve
communication with a nonspeaking patient?
Yes, definitely Maybe sometimes No, never
7. Is there anything missing from this communication board that would make
communicating with nonspeaking patients less frustrating for you?

Appendix E
Sample Communication Board (English version)
Please note: This image is slightly smaller than the version that patients received.

Appendix F
Revised Communication Board

Appendix G
Final Communication Board

Appendix H
Patient Survey – Test Group
1. Have you used the communication board?
Yes No
2. How often have you used it?
a. Never
b. Once
c. Two (2) to four (4) times
d. Five (5) or more times
3. Which items did you use?
a. Pain
b. Trouble breathing/need suctioning
c. I need to go to the bathroom
d. I’m frustrated/afraid
e. Change position
f. Light on/off
g. Hot
h. Cold
i. Hungry
j. Thirsty
k. Nauseous/full from tube feed
l. Want family
4. Do you think the nurses and nursing assistants understand your needs?
5. Do you think the communication board has reduced the time necessary for the nurses and
nursing assistants to address your needs?
Yes I’m not sure No
6. Do you ever get frustrated trying to communicate with the nurses and nursing assistants?
0 1 2 3 4 5 6 7 8 9 10
8. Do you think the communication board makes it less frustrating to communicate with
nurses and nursing assistants?

Appendix I
Nurse/Nursing assistant survey #2 – Test Group
1. Did the patient use the communication board?
Yes No
2. If no, were you aware that the patient had been given a tool to facilitate communication?
Yes No
3. If yes, did you find it helpful in communicating with the patient?
4. Which items did you find most helpful?
a. Pain
b. Trouble breathing/need suctioning
c. I need to go to the bathroom
d. I’m frustrated/afraid
e. Change position
f. Light on/off
g. Hot
h. Cold
i. Hungry
j. Thirsty
k. Nauseous/full from tube feed
l. Want family
5. Do you think you understood the patient’s needs?
6. Do you think the communication board has reduced the time necessary for you to address
the patient’s needs?
7. Did you ever get frustrated trying to communicate with nonspeaking patients?
0 1 2 3 4 5 6 7 8 9 10
9. Do you think the communication board makes it less frustrating to communicate with the
nonspeaking patient?

SchmidProspectus12-3FINAL

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