Date of Award

Fall 2023

Project Type


College or School




Program or Major

Clinical Nurse Leader

Degree Name

Master of Science

First Advisor

Pamela Kallmerten



Local Problem: Each day, almost half of patients in the hospital’s Intensive Care Unit (ICU) require mechanical ventilation through an endotracheal tube. This intervention is often essential for patient’s survival; however, it greatly obstructs the ability to communicate. The unit nurses’ report trialing pen and paper or whiteboards, but often find patients lack the motor control and strength to produce legible written script. The unit nurses also report relying on eye and hand gestures for communication, which are often found to be ineffective.

Background: With the current evidence and changing practice in the ICU of using less sedation and increasing a patient’s level of alertness while intubated, utilizing alternative communication methods are essential for providing effective patient care. The global aim for this quality improvement project was to improve nurse understanding on the importance of communication, and to improve the use of alternative communication methods. Specifically, the aim of this quality improvement (QI) project was to increase nurse awareness and nurse knowledge of using alternative communication methods with mechanically ventilated patients by 30% in two months.

Methods: Utilizing the Plan-Do-Study-Act (PDSA) framework, this quality improvement project performed a 5P’s assessment, evaluated the baseline communication methods used by the ICU nurses, and gathered nurse feedback to assess baseline knowledge and perception of their communication with mechanically ventilated patients. A pre- and post-education survey was created using a Likert scale and contained five ordinal variables for each Likert item (statement) ranging from strongly disagree to strongly agree. The surveys were delivered via work email using the Qualtrics Survey Platform™ to assess nurse awareness and nurse knowledge of using alternative communication methods with mechanically ventilated patients.

Intervention: An educational PowerPoint™ was provided via work email to all full time RNs in the facility’s ICU. The PowerPoint™ include information on: the introduction to the problem, purpose of the intervention, alternative communication methods, strategies to assist with use of alternative communication methods, and a reference to the resource folder that was placed in each nursing pod. In addition to the email containing the Qualtrics™ survey link and the embedded educational PowerPoint™, a resource folder was created for each pod. In-person sessions were held at change-of-shift huddles and during shifts on three dates to introduce the project and answer any follow up questions.

Results: Total aggregate data was used with a sample size of 11, however 2 of the participants did not complete the post-education survey. Using descriptive statistics, nurse awareness had an overall improvement of 22% and nurse knowledge had an overall improvement of 26%. Statistical significance was unable to be determined due to the small sample size and no inferential statistical analysis being completed.

Conclusion: The specific aim of this quality improvement project to improve both nurse awareness and nurse knowledge of alternative communication methods by 30% was not achieved. However, the results did demonstrate small improvements and the need for continued nurse education in for communicating with non-verbal, mechanically ventilated patients