Safety issues and harms of communication vulnerability for adult patients in critical care: A qualitative descriptive study

BACKGROUND: Patients, family members, and healthcare providers value and prioritise patient safety in critical care settings. Communication difficulties experienced by patients during critical illness increases their vulnerability to harms and preventable adverse events. Despite their importance, safety issues and harms related to communication vulnerability in adult critical care settings have not yet been described or systematically characterised. OBJECTIVES: The objective of this study was to identify, describe, and understand safety issues and harms related to communication vulnerability as experienced or observed by patients, family members, and healthcare providers in adult ICU settings. METHODS: We used a qualitative descriptive methodology including semistructured interviews which were audio-recorded and transcribed verbatim. Paired content analysis was conducted using an inductive approach. FINDINGS: Between January and April 2024, 22 participants were interviewed including 11 professionally diverse healthcare providers, seven family members, and four patients from a community academic hospital in Toronto, Canada. Participants identified and described actual and potential physical, psychological, social, and self-determination harms related to their understanding of communication vulnerability during critical illness. Physical harms included respiratory distress and failure, unmet care (e.g., treatment of pain), falls, equipment failures, medication errors, and pressure injuries. Psychological harms included emotional distress (e.g., frustration and anxiety). Social harms included isolation and disrespect (e.g., being mislabelled as "difficult"). Self-determination harms were loss of agency and care without consent. CONCLUSIONS: Communication difficulties experienced during critical illness contribute to safety issues and harms across multiple physical, psychological, and social domains. Findings contribute to a growing body of evidence characterising the experiences and perceptions of patient safety in the adult intensive care unit. Findings have multiprofessional clinical implications in critical care settings particularly in relation to patient communication assessment and treatment and the creation of communication accessible and safe critical care settings.