Tracheostomies are one of the most common procedures that critically ill patients undergo. There are a number of methods that can be undertaken to help patients regain their speech after a tracheostomy. A recently published article entitled the “Restoring Speech to Tracheostomy Patients,” gives an overview of the different types of assessments and interventions that nurses can administer to help these patients regain their ability to speak post surgery.
Critical care nurses work alongside an interdisciplinary team which consists of respiratory therapists, speech pathologists, advanced practice nurses and physicians in order to coordinate care and ensure that a patient-specific communication plan is developed and implemented. This is an essential component in voice restoration for these patients.
Lead author Linda L. Morris, PhD, APN, CCNS, FCCM, is a tracheostomy specialist/consultant and associate professor of clinical anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago. The co-editor/author of the 2010 edition of “Tracheostomies: The Complete Guide,” she also serves on the board of directors for the Global Tracheostomy Collaborative. “Losing the ability to speak after a tracheostomy adds to the stress, fear and frustration of being critically ill,” she said. “Restoring speech to a patient after a tracheostomy allows them to more fully and effectively express their needs and wishes, participate in their plan of care and converse with their loved ones and caregivers.
Regaining verbal speech post tracheostomy requires an adequate air supply reaching and passing through the vocal folds with minimal resistance. The tracheostomy tube itself which is inserted in the process is an important component to the person’s ability to phonate or create sounds through their vocal cords. The type of tube that is chosen depending on diameter or length, can assist with phonation and help avoid complications, leading to easier phonation and speech.
The article discusses these different approaches to assisting in restore phonation in patients that have undergone a tracheostomy, with a specific focus on the considerations related to nursing interventions. The article touches on a variety of methods targeted at a range of patients such as those that are spontaneously breathing, receiving treatment through intermittent mechanical ventilation or are fully dependent on ventilators.
An essential component of successfully helping a patient regain the ability to speak is to determine which option or options are most appropriate, and nurses need to be aware of all the options available, Morris said.