Communication between rehabilitation staff and people with traumatic brain injury: A systematic review.

This systematic review aimed to synthesize barriers and facilitators in communicative interactions between staff and people with traumatic brain injury (TBI) in the rehabilitation context. Searches captured published evidence up to November 2022 in MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, AMED, and PsycINFO. Eligible studies reported on the communicative interaction between rehabilitation staff and adults with TBI. In total, 31 studies were included in the review; including quantitative, qualitative, and mixed-methods designs. Quality assessment was carried out using standard checklists. Quantitative studies and quantitative components of mixed-method studies were synthesized descriptively according to reported communication barriers and facilitators. Qualitative studies and qualitative components of mixed-method studies were analysed through an inductive thematic meta-synthesis; generating six main themes with four subthemes. Themes were categorized as barriers or facilitators to communicative interaction. Findings demonstrated that cognitive-communication disorders of people with TBI challenge the communicative interaction between rehabilitation staff and people with TBI. However, the extent to which these disorders create a communicative barrier is closely related to staff's communicative approach. While staff holding a collaborative and acknowledging approach and using supportive strategies may facilitate successful communicative interactions, staff using the opposite approach may exacerbate communication barriers.

Meeting the confused patient with confidence: perceived benefits of communication partner training in subacute TBI.

OBJECTIVE: This study aims to explore health professionals' perceived benefits of implementing Communication Partner Training (CPT) using Supported Conversation for Adults with Aphasia (SCA™) in a subacute rehabilitation setting with patients in post-traumatic confusional state (PTCS) after TBI. METHOD: The study was conducted in a clinical setting using a pre-post questionnaire design to explore change. One hundred and four interdisciplinary clinicians attended CPT in the SCA™ method and subsequent implementation support. Participants completed a questionnaire with both quantitative and qualitative questions before and after the training and implementation period. Data were analyzed using descriptive and inferential statistics and qualitative content analysis. RESULTS: Participants' perceived confidence and self-assessed ability to communicate with patients in PTCS significantly increased after CPT (p = 0.006). While participants still experienced communication challenges, they reported using CPT-related tools and strategies in their interactions. Participants found they could apply strategies to improve patients' comprehension of information and to confirm their understanding of patients' communication. However, using strategies to enhance patients' expressive abilities was perceived as more challenging. CONCLUSIONS: Training health professionals in CPT increase their confidence in managing communication with patients in PTCS. Further research is needed to evaluate the efficacy of CPT within a more rigorous research design.

Communicative and Supportive Strategies: A Qualitative Study Investigating Nursing Staff's Communicative Practice With Patients With Aphasia in Stroke Care.

This study aimed to provide detailed descriptions of the influences on the nursing staff's communicative practices with patients with aphasia in the context of usual stroke care interactions, and secondly to explore the nursing staff's use or non-use of supportive techniques, including the SCATM method. A qualitative design was chosen, combining field observations and semi-structured interviews. Inductive and deductive qualitative content analysis was used. The results showed that the nursing staff's interactions with patients with aphasia were influenced by organizational and environmental influences, nurses' roles and functions and supporting patients with aphasia in communication. The role of the nursing staff in caring for the psychosocial well-being of patients is deprioritised in favor of other tasks. If there is no time or culture for prioritizing time for conversing with patients and supporting their psychosocial well-being, communication-partner training like SCATM is likely hindered.

Communication with patients in post-traumatic confusional state: perception of rehabilitation staff.

Objective: People in Post-Traumatic Confusional State (PTCS) present with communication difficulties that are well described in literature. However, limited study has been conducted on the experiences of their communication partners. The current study aimed to understand the experience of rehabilitation staff of their communication with patients in PTCS prior to communication partner training (CPT).Methods: Staff on a subacute inpatient TBI rehabilitation unit were invited to complete a 10-item questionnaire. The questionnaire contained quantitative and open-ended text response formats, analyzed with descriptive statistics and content analysis, respectively.Results: 78 interdisciplinary staff members completed the questionnaire. The majority of staff found communication to be difficult and time-consuming with half not feeling comfortable communicating with patients in PTCS. Confidence in communication was not associated with length of clinical experience. The majority of staff reported utilizing strategies to support communication, largely focused on augmenting activities with supportive objects and ensuring patient's comprehension through modification of verbal language.Conclusions: Staff are aware of the need for creating a structured environment for patients in PTCS and less aware of communication-specific strategies aiming at helping patients' expression, which underlines the need to emphasize these strategies as part of CPT in this type of setting.