Research Study

Case Study


Providing and empowering the patient with:

• Their voice to express needs, questions, and feelings
• A communication tool can help decrease patient frustration and anxiety related to the inability to verbally speak.

Joint Commission

• Patient-centered communication standard
• The hospital communicates effectively with patients when providing care, treatment, and services (Standard PC.02.01.21). Under this standard, hospitals will identify and address oral and written communication needs—including cognitive, speech, hearing, and vision issues; preferred language; and health literacy—throughout the “course of care.”
• They focus on all patients having their communication needs met. In particular, standards support communication for the most vulnerable patients: those who have no voice; have hearing, vision, or cognitive impairment; speak a language other than English; have limited literacy or knowledge about health care; or have sexual identity, cultural, or religious differences.


• The aim of this study is to evaluate the feasibility of a newly designed augmentative and alternative communication application/device for use in hospitalized patients with barriers to verbal communication.

Study design/methodology

• Exploratory, descriptive design
• Data collection measures include: 1) observations from videotapes of healthcare provider and patient interactions; 2) the Ease of Communication Survey completed by participants prior to and after final use of the device that has been used in other research investigations; 3) a survey distributed to both healthcare providers and patients/families crafted from a review of the literature following their experiences with the device; and 4) data download from the iPad.

Inclusion Criteria

1) Hospitalized adult patients with impaired verbal communication being cared for in trauma intensive care unit and trauma step-down unit; in-patient rehabilitation; neuroscience unit; and surgical oncology; and
2) healthcare providers (nurses, physicians, respiratory therapists, physical therapists, etc.) interacting with these patients 20 patients; 10-20 family members; <100 health care providers. Informed consent for patients and information sheet for team members and families
Feasibility: a feasibility study tries out pieces of the study; feasibility studies can determine if the design, instruments, and analyses are practical and important; it does not focus on the effectiveness or efficacy

The sample or population

• 41 subjects enrolled
• In 12 subjects, the app was not used at all or very limited use
• 29 subjects [9 from surgical oncology, 8 trauma stepdown, 7 trauma ICU (& neuroICU), 5 Rehab]
• 13 females, 16 males
• Age range 17-80; mean age 54 years
• 6 patients -17years and 20’s; 7 –30’s-50’s; 16 –60 years or older
• Two patients on 9LP used the device twice
• A variety of diagnoses; most with tracheostomies; only one with aphasia
• What is the ‘right’ patient at the ‘right’ time to successfully use the Arthur App?

Data Collection Instruments

• Ease of Use tool (valid and reliability)
8 questions:
1) one question, in general
2) three questions about visitors, nurses, and physicians
3) three questions about needs, care, and condition, and
4) one question about thoughts

• Response choices-not hard at all…to extremely hard (5 choices)
• Issues: too many questions for most patients; too many choices (it is either hard or it is not)
• Actions: simply asked the first question –In general, how hard has it been for you to communicate without being able to speak?
• Issue: easy to determine difficulty before using the Arthur App, but patient was often discharged or transferred before the ‘post’ survey could be addressed (very little post data)
• Videos
• Patient was often not using the app when the investigators rounded so there was limited opportunity to ‘take a video.’ 4 videos available; original 8 questions to be used to evaluate the videos were not applicable due to limited footage so a general observation of the videos was made by one of the investigators who had ‘new eyes’ since she did not round much on the patients
• Patient who had more cognitive ability and arm mobility was able to easily use the Arthur App
• Correct position of the app is important in adoption/use (custom for each patient)
• Patient appeared relaxed/relieved/grateful (at ease) that he/she had a way to communicate with healthcare team and family.

Electronic Survey of Staff Nurses

Survey Monkey
• Patients enjoyed using the app.
• Patients either used the Arthur App a lot or frequently.
• The most used icons included: pain, feelings, suction, help, thank you, bathroom, and typing questions.
• Sometimes they used the app when interacting with patients.
• For patients who did not use the app, the reasons identified were due to patient preference and/or not cognitively able to use the app.

• ”Can’t wait for it to be LIVE!”
• "Patients seem to love it and it’s not messy like a dry erase board making it clear to communicate."

Commonly Used Dynamic Icons for Communication

• Needs
• ‘Pain’, using pain scale, and Needs used 174 times
• ‘I need to poop’ used 102 times
• ’I need to be suctioned’ used 68 times
• ’I need a drink’ used 32 times
• ’Hard to breathe’ used 30 times (communicate a feeling/experience)
• ‘I need to pee’ used 24 times
• ‘Pet therapy’ used 15 times
• ‘I need my lips or mouth wet’ used 13 times
• ’I need food’ used 12 times

Other resources to explore

Case Study

Research Study

Asses the practicality of a new communication tool for hospital patients who face challenges in speaking.