Augmentative and Alternative communication (AAC)

Augmentative and Alternative communication (AAC) Introduction: Communication is one of human basic needs. It is an essential part of life that no one can live without it. It is a process of transferring information, ideas, attitudes, or feelings from an individual to another individual or to a group of individuals. The process includes the exchange of experiences between individuals; under the shared common understandings of media or symbols that contain the information in the messages. Communication can occur with at least 2 persons; each being both message senders and receivers simultaneously through the interchanging of these 2 roles. Sending or receiving messages can both be in verbal and nonverbal forms. The verbal communication is considered the basic form of communication. In verbal communications, an individual needs to use several organs such as larynx, vocal cords, tongue, mouth, lips, teeth, and jaws, in order to produce sounds (Ruben, 1983). One can express ones needs to others with the verbal communications. They require fewer interpretations, given that both parties use the same language. Nonverbal communications, on the other hand, include communications through gesturing, nodding, or shaking ones head, touching, facial expressing, moving lips, writing on paper, using pictures, having eye contacts, and etc. They are used as a complimentary of the verbal communications, or are used when verbal communication is impossible (Peel, 1995; Beis, 1996; Sundee, et al., 1998). The nonverbal communications may occur when persons are in quiet places where no voice is allowed, when both parties are in distant and sound cannot be sent from one to another, or when a person has physical conditions that ability to speak is limited, for example in patients on respirator with endotracheal tubes (Verity, 1996; Happ, Garret, oesch, 2003). Normally, the vocal cord vibrates and produces sound when the air flows through it. When the endotracheal tube is inserted, air will flow through the tube introduction not through the trachea and the vocal cord (Ruben, 1984; Guyton Hall, 2000) obstructing the sound making process (Sitzer, 1993; Hafsteindottir, 1996). Patients with good conscious, who cannot verbally communicate, are affected both physically and emotionally by inability of speaking. Need for Study: Clients with endotracheal tube on Mechanical Ventilation tube experienced pain and discomforts. Several complications that can occur include injuries and irritations of the oral mucosa, throat, trachea, pharynx, and larynx. Psychological effects included anxiety, stress, fear, sleeplessness, and in some clients the feeling of social separations. Clients with good conscious, who cannot verbally communicate, are affected both physically and emotionally by inability of speaking. Communication is important in order to provide effective nursing care that respond to clients needs. Effective communication improves the quality of care. The literature suggests that in many facilities AAC intervention is inadequate and that there is a need for increased education of nurses and other caregivers in the area of communication . Leathart observed 8 nurse-patient interactions in an intensive therapy unit (ITU). Patients were intubated but alert and able to com-municate. Patients communication was mainly comprised of replying to yesà no questions. Seven of 8 nurses reported dificulty communicating with patients in ITUs. Reasons cited were dificulty lip-reading, lack of patient feedback, Hafsteind-ttir (1996) described patient frustration with alternative means of communication. The frustrations stemmed from physical weakness, poor vision, and hand tremors (associated with dificulty writing). None of the patients recalled receiving instructions about communication methods. Over half of ventilated patients who participated in a study by Lohmeier and Hoit (2003) reported that they had no history of speech therapy, and only 5 of the 50 respondents had ever received AAC interventions. Problems or frustrations with speech were reported by 36 participants, suggesting a need for increased communication intervention for this population. Happ et al. (2004) investigated 36 records of patients who received mechanical vVentilation and who died during hospitalization in 8 ICUs during a 12-month period. No uses of picture boards, letter boards, or electrolarynx devices were documented. Their findings indicated that most communication consisted of yes/no responses to caregivers questions about orientation or pain, suggesting that nurses controlled the communicative interactions. Wojnicki-Johansson (2001) asked nurses to evaluate the communication of 22 patients who had been mechanically ventilated in the ICU. Nurses reported functional communication in 19 patients, however, this conflicted with the reports of 13 of the patients, who indicated that nurses had failed to understand their needs during their stay in ICU. Six patients reported that no functional communication was achieved, whereas nurses reported this to be the case for only 2 patients. Eight patients reported that nurses were unable to understand their messages. The author suggested that nurses should critically evaluate their communication skills and frequently verify the content of communication with patients. Fried-Oken et al. (1991) interviewed 5 patients who reported negative emotional responses to the sudden onset of communication difficulties, the most common response being fear. Patients reported that some caregivers and family members did not know how to use their AAC systems and emphasized the need for increased training in this area. Hall (1996) studied communication by observing interactions between nurses and their patients who were on ventilators. Hall concluded nurses seemed more concerned about meeting their need to provide specific information to the patient than to discover what the patient might want. The author questioned whether nurses have the skills and knowledge to respond to and/or assess nonverbal communication and felt that this warranted continued investigation. Statement of the problem: A study to assess the effectiveness of Augmentative and Alternative communication (AAC) towards fulfilling the needs and satisfaction of among the clients with endotracheal tube on Mechanical Ventilation in Govt Rajaji Hospital. Madurai. Objectives of the study: The objectives of this study are to: To assess the level of patients fulfilling needs and satisfaction after administering the aided augmentative and alternative communication. To evaluate the effectiveness of administering the aided augmentative and alternative communication. To associates the level of Satisfaction and selected demographic variable. Hypothesis: 1. There will be no significant association between the level of satisfaction and selected demographic variables 2. There will be a significant difference between the level of communication and patient satisfaction among the endotracheal tube on Mechanical Ventilation patients after administering the augmentative and alternative communication. OPERATIONAL DEFINITION Effectiveness It refers that effectiveness relates to how well a AAC works in practice or what the indent results Augmentative and Alternative Communication (AAC) Augmentative and Alternative Communication (AAC) refers way of communication that provide an alternative method by using devices such as paper and pencil and picture board etc Needs In this study need refers that patient fulfill his physical, physiological, therapeutic, social, psychological, spiritual needs by means of alternative communication. Endotracheal tube on Mechanical Ventilation It is a surgical procedure and after the surgical procedure the patients are having impaired verbal communication. Assumption Delimitation