Communication in the Hospital after Traumatic Spinal Cord Injury

Abstract

The purpose of this focused ethnographic study was to examine the communication culture of a trauma intensive care unit (TICU) during the early hospitalization of patients with traumatic spinal cord injury (SCI). The study examined interactions among patients, family members, and healthcare providers. The study design was motivated by three primary orienting questions: 1) What characterized the communication culture of the Trauma ICU during interactions with patients following acute spinal cord injury? 2) How did healthcare providers shape the possibilities, limits, and uptake of patient participation within clinical interactions? 3) How did patients and families respond to, expose the limits of, and expand the communicative possibilities available within these interactions? My research demonstrates how provider-defined tasks, fixing, forward flow, specialized roles, and professional hierarchies organized what became relevant within clinical interactions. When patients could not speak, providers continued assessments and bedside care through mouthing, gestures, facial expressions, writing, and yes/no responses rather than routinely reconfiguring respiratory support around restoring phonation. Lack of voice intensified the constraints on patient participation, but across modalities, providers often narrowed patients’ contributions into forms that could be readily used within the task underway, reformulating communication into recognizable answers or agreement and selecting the meanings most relevant to their work. Patients with SCI, on the other hand, brought their histories, relationships, humor, communities, and futures into encounters organized primarily around clinical tasks. Taken together, this research shows that communication in the Trauma ICU was highly functional for accomplishing clinical work but less reliably organized around helping patients understand, interpret, and live through acute SCI. Expanding communicative possibility therefore requires not only more skilled individual providers, but changes in the practices, responsibilities, and outcomes through which the unit defines its work.