Intensive care unit (ICU) nurses can facilitate patient communication for critically ill patients who are unable to speak. Most nurses, however, are not trained in communicating with nonspeaking ICU patients and learn how to do so largely by trial and error.

This Robert Wood Johnson Foundation-funded INQRI (Interdisciplinary Nursing Quality Research Initiative) project—SPEACS-2: Improving Patient Communication and Quality Outcomes in the ICU—explored the impact on nursing care quality and patient outcomes of an innovative Web-based instruction package for ICU nurses to facilitate augmentative and alternative communication (AAC). The program uses self-learning modules and other materials to reinforce assessment and decision-making steps in choosing and applying AAC strategies or requesting special language consultation for ICU patients.

Among some of the strategies employed: teach the patients gestures for common messages; use assistive devices such as extra large print communication boards or a hearing amplification device; and communicate with yes–no signals or exaggerated mouthing of words.

Through ICU patient communication case conferences conducted with a speech language pathologist, ICU nurses learn to accommodate their older nonspeaking patients. Weekly interdisciplinary communication rounds with a speech language pathologist help reinforce nurses’ knowledge and skills with real patients and provide a model for proper communication behaviors and strategies in the ICU.