الفهرس 
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Abstract
Effective communication is important in patient care and might decrease the time that a patient stays in the ICU and might contribute positively to their recovery.
Critically ill patients in the intensive care unit (ICU) often experience pain, anxiety, fear, dyspnea, and other forms of distress related to ICU interventions and mechanical ventilation.
When a patient is intubated, communication is often accomplished through facial expressions, gestures, and/or writing , however, these simple modes of communication are not always effective.
Communication board one of the methods that help patients point to a picture which express their complain
The aim of this study was to evaluate the effect of nonverbal communication versus traditional methods towards expressing complains for patients on mechanical ventilation through:
• Teaching patients nonverbal communication prior to be ventilated .
• Evaluate the nonverbal communication as a way as patient use to express his complains.
• Compare between study group using nonverbal communication and control group using traditional methods in identifying their complains.
Quasi experimental design was utilized to fulfill the aim of this study on a purposive sample of 80patients in both sexes newly admitted and meet inclusion criteria and randomly divided into two equal groups: control group receive information about traditional methods for nonverbal communication and study group receive teaching about communication board pre-ventilation. The study was carried out at open heart, I.C.U. at Ain Shams University Hospitals through 3 days/wk in morning and afternoon shifts from December 2015 to July 2016.
To fulfill the aim of this study the following research hypotheses were formulated:
• The level of patient’s awareness about nonverbal communication increased significantly after application of nonverbal communication.
• The level of patient’s pain intensity significantly decreased as a study group more than control group.
• The level of patient’s anxiety significantly decreased as a study group more than control group.
• The level of patient’s satisfaction significantly increased as a study group more than control group.
The following tools were utilized for data collection:
1. Patient characteristics tool (Appendix I): used to assess patient demographic data such as: age, sex, level of education, and type of operation.
2.Anxiety Hamilton scale (Appendix II): It used to assess the level of anxiety in both group ( study and control ) pre/post connected to mechanical ventilation
3. Pain analogue scale (Appendix III): It used to assess level of pain in both group ( study and control ) during connected to mechanical ventilation.
4. Communication tool (Appendix IV): It divided into
A: communication board :used to assess the level of patient awareness pre connected to mechanical ventilation and patient expression post connected to mechanical ventilation in study group , it’s divided into 2 sections pain (site, severity, and description of pain) and breathing (need oxygen ,dypnea, need suction , need coughing, need mechanical ventilation) by using pictures and letters .
B. Traditional methods : used to assess communication with control group including gestures , mouthing words , arm movements and writing .
5. Interviewing patient’s satisfaction questionnaire (IPSQ) :
( Appendix V): This tool used to assess the level of patient satisfaction in both group (study & control).
The result reveled that:
• Age of studied patient ( study & control ) from 30 -45 years old.
• The majority of studied patient was males .
• The majority of type of operation among studied patient ( study & control) was CABG .
• There was highly statistical significant difference between study and control group in anxiety level pre intervention. ( increased anxiety level in both groups).
• There was highly statistical significance difference increased level of anxiety in control group than study group during ventilation.
• There was not statistical significant difference increased level of pain in control group than study group.
• There was statistical significance difference increased level of study group awareness pre intervention than patient expression post intervention.
• Statistical highly significance decreased level of patient expression post intervention with control group than awareness pre intervention .
• No statistical significance in increased level of patient satisfaction in study group more than control group.
The study recommended that:
1. Replication of the study on a larger probability sample selected from different geographical areas in Egypt is recommended to obtain more generalizable data.
2. Further studies should be provide communication board with more pictures that show all things patients need or feel it.
3. Further studies should be assess effect of communication board on physiological parameters.