Implementation of a Patient Preference Card (PPC) to Enhance Nurse–Patient Communication in the Intensive Care Unit

Authors

• LaShunda S. Hickerson, University of Texas Health Science Center at HoustonFollow

Author Biographical Info

LaShunda Hickerson, BSN, RN, is a Doctor of Nursing Practice (DNP) student at the University of Texas Health Science Center at Houston School of Nursing, with an expected graduation date of December 15, 2027. She currently practices as a Registered Nurse in the Thoracic Surgical Intensive Care Unit (TSICU) at Baylor St. Luke’s Medical Center in Houston, Texas.

Ms. Hickerson brings over two decades of healthcare experience, with a strong focus in critical care nursing and high-acuity patient management. Her professional interests include improving nurse–patient communication, advancing patient-centered care, and implementing evidence-based strategies to support non-verbal and critically ill patients.

Her DNP project, titled “Implementation of a Patient Preference Card (PPC) to Enhance Nurse–Patient Communication in the Intensive Care Unit,” focuses on improving communication outcomes and patient satisfaction through a structured bedside tool. Her work integrates evidence-based practice, Watson’s Theory of Human Caring, and quality improvement methodologies such as the Plan–Do–Study–Act cycle.

Ms. Hickerson is dedicated to advancing nursing practice through leadership, innovation, and the translation of evidence into clinical care to improve patient outcomes.

Date of Doctor of Nursing Practice Project Completion

Spring 5-1-2026

Faculty Advisor

Dr. Madelene J. Ottosen, Ph.D., MSN, RN

Abstract

Purpose

Nurse-patient communication barriers occur when critically ill patients are sedated, mechanically ventilated, or neurologically impaired. The purpose of this quality improvement project was to implement a structured Patient Preference Card (PPC) to improve nurse–patient communication for non-verbal postoperative patients in an intensive care unit (ICU). The primary aim was to improve nurse-patient communication scores on the Nurse-Patient Communication Scale (NPCS) by at least 20% during a 90-day pilot implementation. A secondary aim was to achieve at least 90% compliance with PPC completion and use across nursing shifts to support consistent communication of patient preferences.

Background

Communication breakdowns frequently occur in intensive care settings when patients are unable to verbally communicate their needs during early postoperative recovery. In these situations, nurses rely on fragmented documentation and variable shift-to-shift handoff communication; result in repeated clarification of patient preferences and reduced continuity of individualized care. Evidence suggests that structured bedside communication tools can improve care coordination by making patient preferences visible to the healthcare team and supporting more consistent patient-centered communication.

Methodology

This quality improvement project used three Plan-Do-Study-Act (PDSA) framework to guide implementation of the Patient Preference Card intervention. Nurses were educated on completing the PPC with patients or family members, and completed cards were displayed at the bedside to support communication during care delivery and nursing handoff. Data were collected using the Nurse–Patient Communication Scale (NPCS), patient and family satisfaction surveys, and bedside verification checklist audits of PPC usage. Descriptive statistics were used to evaluate changes in communication outcomes and implementation fidelity.

Thirty-two nurses completed the pre-intervention survey and thirty completed the post-intervention survey. Mean nurse-patient communication scores increased from 3.1 to 4.4, representing a 41.9% improvement and exceeding the project target. PPC completion compliance increased from 41% during early implementation to 94% by the final improvement cycle. Of the 38 eligible patients or family members, 31 completed the post-intervention satisfaction survey, yielding an 82% response rate. Patient and family satisfaction scores increased from 3.3 to 4.6, and 87% of respondents reported improved communication clarity following implementation of the PPC.

Implications

Implementation of the Patient Preference Card improved nurse–patient communication and enhanced patient-centered communication practices in a critical care environment. The intervention represents a low-cost strategy that can be integrated into existing nursing workflows and sustained within intensive care settings. Expansion of the PPC to additional inpatient units may further improve communication with non-verbal and communication-limited patients. Future quality improvement efforts should evaluate long-term sustainability and explore the impact of structured communication tools on broader care outcomes.

Keywords

Key words: nurse-patient communication, intensive care unit, patient preferences, quality improvement, bedside communication tools

Recommended Citation

LaShunda S. Hickerson, "Implementation of a Patient Preference Card (PPC) to Enhance Nurse–Patient Communication in the Intensive Care Unit" (2026). Doctor of Nursing Practice Final Project Abstract. 193.
https://digitalcommons.library.tmc.edu/dnp_abstract/193