FFICM Patient Communication Skills 2 — Questions and Answers
Question 1: A mechanically ventilated patient with a tracheostomy is attempting to communicate distress. Which augmentative and alternative communication (AAC) strategy should be trialed first?
- Immediately sedate the patient to reduce agitation
- Offer a simple yes/no head-nod system before progressing to letter boards (Correct answer)
- Wait until the patient is extubated before attempting communication
- Ask family members to interpret all patient needs
Correct answer: Offer a simple yes/no head-nod system before progressing to letter boards
A hierarchical AAC approach starting with simple yes/no signals minimizes patient frustration and is the recommended first step in ICU communication.
Question 2: When disclosing a poor prognosis to a patient's family in the ICU, which communication framework is most evidence-based?
- SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Summary) (Correct answer)
- SBAR (Situation, Background, Assessment, Recommendation)
- ISBAR (Introduction, Situation, Background, Assessment, Recommendation)
- PDSA (Plan, Do, Study, Act)
Correct answer: SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Summary)
The SPIKES protocol is specifically designed for delivering bad news and is widely validated in critical care settings.
Question 3: A patient who is alert but intubated becomes increasingly agitated. After ruling out medical causes, the most appropriate initial communication intervention is:
- Increase sedation to RASS -3
- Establish a reliable yes/no signaling method and assess for pain and anxiety (Correct answer)
- Restrain the patient to prevent self-extubation
- Defer all communication to the next family visit
Correct answer: Establish a reliable yes/no signaling method and assess for pain and anxiety
Establishing a reliable communication channel addresses the root cause of agitation in alert intubated patients before escalating sedation.
Question 4: During a family meeting about withdrawing life-sustaining treatment, a family member says 'He would have wanted everything done.' The best clinician response uses which technique?
- Immediately explain the futility of continued treatment
- Reflect the emotion and explore what 'everything' means to the family (Correct answer)
- Defer the discussion to the hospital ethics committee without further exploration
- Document the request and proceed with full escalation of care
Correct answer: Reflect the emotion and explore what 'everything' means to the family
Reflective listening and clarifying the meaning of 'everything' helps uncover the patient's values and facilitates shared decision-making.
Question 5: Which element of the NURSE mnemonic is being used when a clinician says, 'I can only imagine how frightening this uncertainty must be for you'?
- Normalizing
- Understanding
- Respecting
- Empathizing (Correct answer)
Correct answer: Empathizing
The statement directly acknowledges and validates the family member's emotional experience, which is the core of the Empathizing element.
Question 6: An ICU patient from a non-English-speaking background requires an interpreter for a goals-of-care discussion. The patient's bilingual adult child offers to interpret. The best approach is:
- Accept the offer as it is most convenient and culturally sensitive
- Use a professional medical interpreter to ensure accuracy and avoid burdening the child (Correct answer)
- Use a telephone translation service only if no family member is available
- Proceed in English with written materials provided in the patient's language
Correct answer: Use a professional medical interpreter to ensure accuracy and avoid burdening the child
Professional interpreters reduce errors, avoid placing emotional burden on family members, and maintain confidentiality and neutrality in complex discussions.
Question 7: After a prolonged ICU stay ending in patient death, which communication action best supports the bereaved family?
- Send a condolence letter only if the family specifically requests follow-up
- Offer a bereavement follow-up meeting or call within 30–90 days to answer questions and provide support (Correct answer)
- Avoid contact to respect the family's grief process
- Document the death in the medical record and close the case
Correct answer: Offer a bereavement follow-up meeting or call within 30–90 days to answer questions and provide support
Proactive bereavement follow-up reduces complicated grief and PTSD symptoms in ICU family members, and is recommended by international guidelines.
FFICM Patient Communication Skills 2
A mechanically ventilated patient with a tracheostomy is attempting to communicate distress.
Which augmentative and alternative communication (AAC) strategy should be trialed first?