An App for Intubated Cancer Patients: Giving Voice to the Voiceless

An App for Intubated Cancer Patients: Giving Voice to the Voiceless
An App for Intubated Cancer Patients: Giving Voice to the Voiceless

Being able to communicate with another person is an essential human quality. A patient lying alone in a hospital room, intubated and in pain after surgery, should be able to tell a nurse that her incision hurts. Or that she's frightened of being so ill and helpless. Or that she simply has to use the toilet. But more than half of the approximately 790,000 patients who are intubated in this country every year find conveying these basic concepts impossible — despite being awake and alert.1 Now, the new tablet-based communication app, Speak for Myself™, will ease these patients' fears.

In an effort to empower the voiceless patient, Rebecca Koszalinski, RN, PhD, developed Speak for Myself while pursuing her doctoral degree under the guidance of Ruth Tappen, EdD, RN, FAAN — the Christine E. Lynn eminent scholar and professor at the Christine E. Lynn College of Nursing at Florida Atlantic University. Dr Koszalinski is now an assistant professor herself in the College of Nursing at the University of Tennessee, Knoxville.

According to the developers: “Speak for Myself is designed to provide a means for communication when the communication dysfunction is due to loss of or impairment of the physical structures needed to produce speech. This includes head and neck cancers as well as intubation or tracheostomy to support respiration” (RM Tappen, oral communication, September 9, 2016).

How It Works

When installed on a tablet-based computer, the application enables a patient to communicate pain when he or she touches an onscreen body graphic to indicate where it hurts, and an analog pain scale to indicate how badly it hurts. When the patient touches the “Speak” button and then touches the onscreen body graphic in a particular place, the app's voice speaks, “It hurts here.”

And the app goes far beyond helping patients express pain. Speak for Myself lets patients request all types of needs, such as to use the bedpan or toilet or to be repositioned. It allows patients to express difficulty with breathing and the need for suctioning. Most compassionately, the application allows patients to express end of life wishes.

The program runs on any tablet computer using any operating system, and it can translate more than 100 languages. The tablet is readily available and can stay with the patient, eliminating time-consuming searches for patients' writing boards. The device saves time in other ways as well. It uses familiar text messaging methodology, so the patient can actually express emotions — for example, texting that she is anxious or lonely. A user can begin typing a word and, by using predictive text, the application completes that word, or the patient can continue typing to override the predicted word. Certain words are shortcuts so users do not have to type entire phrases and sentences. The patient can also customize a menu by touching the “Recent” tab and choosing from a list of all words and phrases that he or she has entered, similar to creating a music playlist. This feature individualizes the application for each patient, eliminating unnecessary words and phrases.

Research Study

Speak for Myself was evaluated in a study of 20 patients — 6 women and 14 men — ranging in age from 45 to 91 years. Ten participants had endotracheal tubes for ventilator support, and 8 had tracheostomies. Their diagnoses were tongue metastasis, atrial fibrillation, arteriosclerotic heart disease, cardiogenic shock, endocarditis, neck abscess, renal failure, and status post-seizure activity. These patients used the device for an average of 9 hours a day, and 2 patients kept it by their bedside overnight. When asked, the participants said they felt less frustrated, more in control, less frightened, and more empowered when using the app — especially because the medical staff or relatives who had tried to translate or speak for them did not always correctly interpret their needs.

In one instance, a study participant kept expressing pain coming from his nasogastric tube, and when staff evaluated him, they found that his tube had twisted and was causing the pain. Correcting the placement resolved his pain. As another study participant commented, “I think [Speak for Myself] was outstanding. Wish I could have had it 3 weeks ago!”1

Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.

Reference

1. Koszalinski RS, Tappen RM, Hickman C, et al. Communication needs of critical care patients who are voiceless. Comput Inform Nurs. 2016;34(8):339-344. 

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