| 1. OBJECTIVESWith improvement of medical technology, the success rate of rescuing critically ill patients has improved greatly. As an important means to rescue critically ill patients, mechanical ventilation has been used widely. Patients receiving mechanical ventilation completely depend on breathing machines and need nurses to maintain life led to communication barriers with the outside world becaused of temporary aphonia due to endotracheal intubations. So they may feel psychologically and physically discomfortable and painful. If the patients' demands does not be expressed clearly and can not be transmitted to medical personnel effectively, the problems may easily lead to anxiety, irritability which increasing myocardial oxygen consumption. More over, they could not actively cooperate with examination, treatment or even a variety of mental, psychological barriers will appear. All these may affect patients' rehabilitation if medical personnel can not find them and treat on time. Nowadays many solutions have been used to solve the artificial incubation-induced communicative barriers, such as rattles, touch, preoperative non-verbal communication training, WordPad, map cards and body language, and the video made from body language communication between nurses and awake patients etc. Certain clinical results have been achieved. However, no formulation has been established and problems of communication barriers between awake patients and nurses caused by disunified communicative approaches are still serious. There are lots of limitations in communicative patterns, such as no unified standard, different understanding of the body language by different people, scarce of self-made simple diagram types and vivid cards, necessity of certain cultural knowledge and normal muscle strength for patients to use WordPad and also difficult understanding of blind written words. As a result, exploiting a quick, effective and standard method to solve communicative barrier problems between nurses and awake patients is extremely important. The purpose of current study is to find out major needs categories of awake patients with mechanical ventilation, to make an unified body language image and signals, to investigate a machine combined with direct and vivid anatomy graphics, body language image sign, WordPad together with the integration of language choice and speech sound hint, to provide a standard and unified communicative platform for doctors, nurses, patients and patients'relatives to communicate each other, and then to shorten the time for understanding patients' needs and improve the communicative effectiveness.2. Objects and MethodsBased on the theory and application of body language system, the current study included selection and organization of the subject content, questionnaire design, machinery making procedure and clinical application. A survey with 60 items of discomfortable and psychological needs for awake patients with language communicative barriers due to mechanical ventilation was made. The surveys inclueded a preliminary pre-survey and two rounds of surveys. According to the evaluation of the most-frequent need items by six nursing specialists, twelve items of discomfortable and psychological needs were selected. A body-language system was developed through the design of a set of standard body language image and sign system by professional cartoonists, computer engineers and the author based on the determined items. One hundred and fifity patients with mechanical ventilation were randomized to different communicative patterns groups (included WordPad group, picture cards group and body-language system group). The time for nurses to certify patient's needs volume in three groups were compared in order to evaluate the clinical effects of body-language system.Awake patients with mechanical ventilation from October 2007 to June 2009 in ICU of our hospital were enrolled to the study of clinical evaluation of self-made body-language system. The subgroup-randomized numbers were generated by SPSS13.0 software The patients were randomized into WordPad group(A group), picture cards group (B group) and body-language system group (C group) with 50 cases in each group respectively. The communication among patients and medical personnel were established through the methoed noted in published articles in A group and B group. And the communicative operations were as followed:firstly, nurses in ICU were trained for the operation of body language system; Secondly, according to patient needs and for the convenience, the body language system were installed on patient beds, crane tower and so on. The functions and operation methods of system were explained to the patients and care workers. Patients were informed to touch the displayed pictures on the screen of the system directly, or ask nurses for operating for themselves if they had certain needs, and nurses would choose need volume based on their clinical experiences and patients'responses. Results such as demand contents, frequency, and time to certify the need, failure frequency and time to give up certifying the need generated in each group were recorded by nurses. Nurses who communicated with patients in the current study were those who worked in ICU not less than three years, also familiar with the contents of a variety of demands.Data were analyzed by SPSS13.0. Normality test of measurement data were carried out. If the data were in accordance with normal distribution, they would be presented as mean±SD; the skewed distributive data are presented as median (Interquartile Range). T test was used to compare the normal distribution data according with homogeneity of variance; non-parametric tests (Mann-Whitney U test or Kruskal-Wallis test)were used in the comparison among other data. Categorical data are presented as number, and X2 test or Exact probability test was conducted for comparison among groups. P values<0.05 was considered that the difference had statistical significance.3. Results3.1 Need Items of body language system determinationNeed items in body language system were determined to meet the basic needs of patients with mechanical ventilation. Combined with visual image of the human anatomy graphics, body language image sign, WordPad, integrated language options and voice prompts into a whole, the system could provide a unified and standard communicative platform for clinicians, nurses, patients and their families which different patients may choose appropriate communicative means to improve the communicative efficiency and shorten time to certify patient's demands.3.2 Standardization of the body language system image symbolAccording to the items of discomfort and psychological needs of awake patients with mechanical ventilation and language barrier, a normative body language image symbol system was made by professional cartoonists, computer engineers and the author based on the existing body language, non-verbal materials, visual effects and aesthetic views. 3.3 Design of the body language systemThere were hardware part and software part in the system. The hardware components included micro-processing system and LCD touch screen, supporting software system to accomplish synchronal ouput for figure and language information.①Body language system interface was divided into two layers which were named as main interface and sub-interface. In main interface, there were three means of needs expression (body position, physical discomfort and psychological discomfort) and two communicative means (handwritten input and language input). Whatever you clicked any one from the means of expression, the second interface would be displayed, and when you clicked on the text or characters shown on the screen, the common symptoms of the site description would be displayed accompanied by voice prompts in the system;②Advanced embedded microprocessor technology was used to meet the requirements of the software design, hardware design and configuration.③Colored LCD touch screen with adjustable display speed was used to estasblish document management to browse pictures for individual use;④Network interface were reversed for connecting local area network, downloading image files on-line, etc.;⑤Electronic screen could be installed in the ward corridors or nurses station, so whenever patients sent needs from body language system, nurses could find and solve the problem at once.3.4 Clinical evaluation of the body language system3.4.1 The evaluation of the system by determined requirement orders from awake patients with mechanical ventilationThere were 1906 requirment orders from patients in total which were 635,553 and 718 in group A, group B and group C respectively. The number of requirement orders determinated successfully was 1549 which was 448,482 and 619 in group A, group B and group C respectively, and the certified rate was 81.27% in total which was 70.55%,87.15% and 86.12% in group A, group B and group C respectively. The certified rate had significant difference among three groups (P=0.000), and that in group B was the highest and that in A group was the lowest. There was significant difference between that of either group B and group C(X2=0.243, P=0.662), or group A and group B(X2=47.967, P=0.000), or group A and group C(X2=49.577, P=0.000)3.4.2 Evaluation of the system by the time to determine awake patients' discomfort items who received mechanical ventilationThe time to determine patients'discomfort items had statiscal difference between either two of three groups (P=0.000). That in group C was the shortest (19.61±12.22)s, and then group C(127.35±117.46)s, and that in group A was the longest(143.25±96.74)s. And the time to identify each item of physical needs in group C was also shortest aomong three groups.3.4.3 Evaluation of body language system by the time to determine psychological needs from awake patients with mechanical ventilationThe time to determine psychological needs had significantly difference between either two of three groups (P=0.000), and that in group C was the shortest.3.4.4 Comparison of the time from giving orders to giving up determination among three groupsThe time from giving orders to giving up determination in group A, group B and group C was 421.00 (254.00) s, (458.00±261.00)s and 198.00(87.00)s respectively, and a significant difference was found among three groups (X2=113.649, P=0.000). Among them, that in group C was the shortest, and the difference had statistical significance between that of either group A and group C(Z =-10.448,P=0.000), or group B and group C(Z=-8.391, P=0.000).The time in identifying the volume of the need in A group, B group and B group was 89(99.25)s,124(92.00)s and 17(10.00)s respectively. The time to identify the volume of the need in the gesture-language system was significantly less than the other 2 groups (both P<0.01).4. ConclusionsRequirements due to physical and psychological discomfort should be generated in awake patients with mechanical ventilation. Timely recognition of the contents of patient's demands is extremely important for clinical treatment and rehabilitation. In this study, the self-made body language system has unified operating procedure, vivid pictures easy to distinguish and audio-visual characteristics. The use of the system in understanding patient's needs after sober aphasia due to incubation shows more rapid and effective compared with patterns such as WordPad, map cards and so on. Therefore, the body language system is expected to become an effective option for solving the problem of communicative barriers in temporary aphasia patients. |
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