TEMPORARILY NONVOCAL TRAUMA PATIENTS AND THEIR GESTURES: A DESCRIPTIVE STUDY (TRAUMA PATIENTS, VENTILATOR DEPENDENT PATIENTS, SPEECHLESS PATIENTS).
Contributors: Rush University, College Of Nursing.
Published: 1992
Number of pages: 112
Subjects: Health Sciences, Nursing.; Health Sciences, Speech Pathology.; Psychology, General.
Description: One major psychosocial problem of mechanically ventilated patients is their inability to speak because of the cuffed endotracheal or tracheostomy tube obstructing the larynx and airflow. The purpose of this descriptive exploratory study was to: (1) identify and code the gestures used by trauma and non-trauma patients; (2) identify whether these gestures can be organized into a categorical scheme; and (3) test the iconicity and transparency of these patient's idiosyncratic gestures for ease of interpretation by two focus groups (ICU nurses and non-ICU nurses). Twenty-three adult ventilator dependent patients (Traumas (T's) n = 13 and Non-Traumas (NT's) n = 10) were videotaped during nurse-patient interactions for thirty minutes. These videotapes were time-coded then scored and coded by the researcher using McNeill's Coding Criteria marking every occurrence of a head, hand and arm gesture. A total of 1628 gestures were identified with the highest percentage of gestures (34%) coded as agreement/disagreement speech acts (yes and no head nods). Deictic (23%) gestures (pointing) were the most common hand and arm gesture identified, while conventional gestures ranked third (19%) and iconic gestures (3.4%). No metaphoric gestures were coded.

Other gestures identified included self-adjusting and self-stroking movements (13.5%), and (7.2%) were identified as no response to verbal stimuli. No significant differences were found between the Ts and NTs regarding the number or types of gestures performed. Thirty-one percent of the total number of gestures were performed by six subjects who were either in a high semi-fowler's position or up in a chair. Those gestures that were most iconic, conventional and deictic were edited for testing. Twenty-six gestures were shown to ICU (n = 25) and Non-ICU (n = 22) nurses to determine the communicative nature of these gestures. Reliability (92% agreement among three expert raters) was calculated on all of the twenty-six gestures. Using the Kuder-Richardson formula, the KR20 =.57, which indicates moderate reliability. No significant difference between the groups was found in their ability to correctly identify the meaning of the gestures t(45) = 0.1776, p $<$.05. The mean gestural test score for the total group of nurses (n = 47) was 61.78%. These findings support the notion that ventilator patients do gesture and some of their gestures are iconic, conventional and easily understood by both ICU and non-ICU nurses.
Notes: Source: Dissertation Abstracts International, Volume: 53-05, Section: B, page: 2243.

Thesis (D.N.SC.)--RUSH UNIVERSITY, COLLEGE OF NURSING, 1992.

School code: 0591.