Because the tracheostomy re-directs air away from the vocal cords, communication may be challenging between patients and their healthcare providers.  The following qualitative study was undertaken using a phenomenological approach with patients who were in a rehabilitation environment, had a tracheostomy, and were non-vocal on a ventilator.

The sample size consisted of 19 participants, 10 male and 9 female; average age was 66, with a range of 43-82.  Interviews were conducted with an expert in lip reading.  Several themes emerged, including:

  1. Being trapped in a silent world makes me feel frustrated and incomplete.
  2. Voicelessness is a form of physical restriction; regaining the voice makes me feel whole and free.
  3. Negative emotions were lessened or eliminated when participants could speak, particularly when the tracheostomy tube was removed altogether.
  4. Time passed much more slowly when the voice was missing; boredom contributes to slow-motion existence.
  5. Participants realized they were dependent on others and that they did not always have control over their own care. They were uncertain whether their needs would be met. Regaining the voice enables regaining control.
  6. The non-vocal communication experience was one of futility, where participants would give up when they were not understood.

The researcher concluded that the powerlessness of being non-vocal was ameliorated by developing coping strategies and by consistent and reliable nursing care.  In turn, caregivers can explore options to provide phonation to ventilated patients to improve communication.

 

From:  Carroll, SM (2007). Silent, slow lifeworld: The communication experience of nonvocal ventilated patients. Qualitative Health Research, 17(9):1165-1177.