The Patient Communication Support Guide (PCSG): development and pilot field testing of a digital clinical guide for patient communication in the intensive care unit

RATIONALE: The value of effective clinician-patient communication for patient safety and comfort is well-established, yet most intensive care unit (ICU) clinicians have little training and few resources to guide them in communication assessment and application of patient-centered communication strategies. The Study of Patient-Nurse Effectiveness with Assisted Communication Strategies algorithm is an evidence-based method to guide clinicians through assessment and communication strategies selection tailored to patient function. OBJECTIVE: To describe the process of design, usability, and acceptability testing of the interactive Patient Communication Support Guide (PCSG) based on the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies algorithm and training program to assist clinicians in communicating more effectively with ICU patients. METHODS: We used an iterative, user-centered design to create the PCSG on the QualtricsXM platform and field tested it for usability and acceptability with ICU nurses. Nurse participants received a 1-hour training and orientation to the PCSG, augmentative and alternative communication (AAC) tools, and the study protocol. Nurses were instructed to use the PCSG with at least 5 patients over a 2-week testing period and to complete the 10-item System Usability Scale. Scores above 68/100 points were considered above average. Nurses provided qualitative feedback and repeated the field testing following a washout period for tool refinement. RESULTS: We recruited 10 nurses evenly distributed in 2 ICUs in 2 different community hospitals, 1 with Magnet status, in Southern Ohio. One unit was a mixed medical-surgical unit, and the other was a neurocritical care unit. Participating nurses' ICU experience ranged from less than 1 to 9 years; all were BSN-prepared. System Usability Scale scores show improved usability scores after PCSG refinement; however, the likelihood to recommend the PCSG (acceptability) decreased slightly. Overall, the qualitative feedback was positive; several nurses indicated that they changed their practice because of the PCSG and used the AAC tools frequently. Nurses felt that they quickly learned how to choose the correct AAC tool for their patient and that the PCSG was quick and simple, recommending integration in the electronic health record. CONCLUSIONS: Best practices in user-centered design resulted in a PCSG that is usable and acceptable to ICU nurses.