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January 12, 2018
CRITICALLY ILL
Nurse Scientist Describes ‘Giving Voice To the Voiceless’

When Dr. Mary Beth Happ began her research on improving communication with impaired patients, she couldn’t have known that she would one day find herself using the techniques identified in her research to communicate with a critically ill loved one. However, when a brain tumor limited her own husband’s ability to communicate during his last weeks of life, Happ’s professional and personal lives came together.

Happ discussed this intersection, as well as the research career that led to it, at the third of 2017’s NINR Director’s Lectures in her talk, “Giving Voice to the Voiceless: Improving Communication with Critically Ill Patients.”

Dr. Mary Beth Happ (l) with NINR director Dr. Patricia Grady at a recent NINR Director’s Lecture
Dr. Mary Beth Happ (l) with NINR director Dr. Patricia Grady at a recent NINR Director’s Lecture

Happ’s early research identified the problem of voicelessness in critically ill older adults. These patients were intubated or had preexisting communication disabilities such as poor vision or hearing, which made it difficult for them to express their symptoms and care needs, as well as important end-of-life messages and treatment preferences. According to Happ, nurses for these patients expressed frustration and admitted to avoiding patients for whom communication was most difficult. Thirty years of observational research indicated that there was a need for more tools and training for learning how to best communicate with these patients, leading Happ and her research team to build and test solutions to this problem.

Two such solutions were the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS) and SPEACS-2. Both interventions helped intensive care unit nurses become better trained to work with patients who had communication disabilities and improved the success of communication about pain and other symptoms.

Happ also tested an electronic tablet communication application developed by Dr. Lance Patak, a pediatric anesthesiologist who previously practiced as a critical-care nurse, in a population of mechanically ventilated patients to ensure that the application was easy to use and appropriate for critically ill patients.

Noting that there are still barriers to making tools such as these available in the clinical setting, Happ advocated for broader training in these techniques and for increasing their reach to patients with communication difficulties outside of the ICU.

In her own experience during her husband’s last weeks of life, Happ found making use of the communication tools and techniques she’d studied over the course of her career to be a profound and validating experience. “It kept us connected and reassured him that I was still there and trying.”

Happ is a nursing distinguished professor of critical care research and associate dean of research and innovation at Ohio State University College of Nursing. She is an NIH-funded researcher in the areas of critical care and aging.

The NINR Director’s Lecture Series is designed to bring the nation’s top nurse scientists to NIH to share their work and interests with a trans-disciplinary audience. Happ’s lecture is available on NINR’s YouTube channel at https://www.youtube.com/watch?v=TUG4mDcAXgU.

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