Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson's disease.

PURPOSE: To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. METHOD: Five dyads consisting of a person with stroke-induced aphasia (n = 4) or Parkinson's disease (PD) (n = 1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. RESULTS: Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. CONCLUSIONS: The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training. IMPLICATIONS FOR REHABILITATION: Communication partner training can improve the communicative environment of people with communication disorders. For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker. An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders. The training also positively affected the perceived functional communication of the persons with communication disorders.

[Caregivers faced with anxiety-depressive disorders in elderly people with severe dementia]. / Soignants et troubles anxio-dépressifs des personnes âgées atteintes de démence sévère.

A survey of 104 caregivers in nursing homes assesses their knowledge of anxiety-depressive disorders in patients with severe dementia with aphasia and their proposed treatment. Despite a lack of training, information and tools to assess these disorders and offer adapted care, this survey highlights in particular caregivers' concern for these issues.

Mentoring the next generation of neuroscience nurses: a pilot study of mentor engagement within an academic-service partnership.

Resulting from a system-wide launch of an academic-service partnership that united a research-intensive School of Nursing and a tertiary healthcare system, neuroscience nurses used a team-based approach in mentoring undergraduate nursing students in neuroscience nursing. They linked their team approach to the Institute of Medicine's Future of Nursing report and American Association of Neuroscience Nurses' (2012) strategic plan to prepare neuroscience nurses for the future. Using case reports containing both the mentors' and students' perspective, we showcase sophomore nursing students' development in neuroscience nursing with focus on their developing skills in competency, leadership, and collaboration. Results from this implementation phase include improved reliability in performing undergraduate neurological assessments; developing competency in collaborating with the health team using a culturally sensitive approach; beginning leadership in managing a patient with seizures; and collaborating with families in patient-family-focused care. Evaluation of the effectiveness of this mentored approach to clinical undergraduate nursing education will focus on confidence building for students and mentors.

[Communication strategies of the nursing team in the aphasia after cerebrovascular accident]. / Estratégias de Comunicação da Equipe de Enfermagem na afasia decorrente de acidente vascular encefálico.

This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.

Communication Strategies Of The Nursing Team In The Aphasia After Cerebrovascular Accident / Estrategias De Comunicación Del Equipo De Enfermería En La Afasia Secundaria A Accidente Cerebrovascular / Estratégias De Comunicação Da Equipe De Enfermagem Na Afasia Decorrente De Acidente Vascular Encefálico

This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.
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Estudio exploratorio de corte transversal, cuantitativo, cuyo objetivo fue identificar estrategias de comunicación utilizadas por el equipo de enfermería en el cuidado de pacientes afásicos después de un accidente cerebrovascular. Se utilizaron las técnicas de entrevistas y de observación participante en 27 sujetos del equipo de enfermería de unidades de neurología de un hospital general. Las estrategias más referidas fueron gestos (100%), comunicación verbal (33,3%), comunicación escrita (29,6%) y los toques (18,5%). Entre las estrategias observadas, los gestos alcanzaron el 40,7 % y el toque estaba presente en todas las situaciones dado su carácter instrumental esencial para cuidar. Los resultados indican un desconocimiento de la comunicación no verbal, proxémica, kinésica o háptica. No se observaron diferencias significativas entre las categorías profesionales en función del tiempo de experiencia con respecto a las estrategias mencionadas por los miembros del personal de enfermería para el cuidado de los pacientes con afasia.
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Estudo exploratório, transversal, de delineamento quantitativo, cujo objetivo foi identificar estratégias de comunicação referidas e usadas pela equipe de enfermagem durante o cuidado de pacientes afásicos após acidente vascular encefálico. Foram utilizadas a técnica de entrevista e a observação participante com 27 sujeitos da equipe de enfermagem de unidades neurológicas de um hospital geral. As estratégias mais referidas foram os gestos (100%), a comunicação verbal (33,3%), a comunicação escrita (29,6 %) e os toques (18,5%). Entre as estratégias observadas, os gestos atingiram 40,7% e o toque esteve presente em todas as situações, dado seu caráter instrumental imprescindível aos cuidados. Os achados indicam desconhecimento da comunicação não verbal, proxêmica, cinésica ou tacêsica. Não foram observadas diferenças significativas entre as categorias profissionais em função do tempo de experiência com respeito às estratégias referidas pelos membros da equipe de enfermagem para cuidar do paciente afásico.
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The impact of stroke aphasia on health and well-being and appropriate nursing interventions: an exploration using the Theory of Human Scale Development.

AIMS AND OBJECTIVES: This paper considers the impact of aphasia on health and well-being and provides suggestions for appropriate nursing interventions. Background. Effective communication is essential to holistic care and positive outcomes for individuals affected by aphasia. When verbal communication is absent, nurses fail to adequately use alternative strategies so that the standard of nurse/patient communication is frequently poor. DESIGN: This is a discursive paper which reviews relevant literature and uses the Theory of Human Scale Development as a framework for discussion. METHOD: The Theory of Human Scale Development is introduced. This theory emphasises that quality of life depends as much upon self-actualisation and relation building as on physical health. The theory is used within the discussion to highlight the significance of communication to quality of life and how its loss has profound psychological and social consequences. RESULTS: Aphasia results in 'loss of self'. The situation is exacerbated by inadequate healthcare communication strategies. Suggestions are offered regarding more appropriate strategies. Efficacy of family input is considered; nursing competence regarding language practice therapies is discussed, and the 'quest approach' is explored. Aphasia has a negative impact on relationships by denying access to support networks, which results in isolation. The individual's predicament is worsened by negative nursing responses. Positive nursing strategies, which alleviate effects of aphasia on individuals' social health, are investigated. Concept analysis and self-awareness exercises as methods of enhancing compassion skills are explored. The social model of disability is discussed to highlight the benefits to individuals of environmental adaptations. The social benefits of aphasia-group affiliation are discussed. CONCLUSION: The paper concludes by emphasising that fundamental human needs involve social and psychological as well as physical aspects. RELEVANCE TO CLINICAL PRACTICE: Nursing interventions must address all needs to provide holistic care in its fullest sense.

Teaching nursing assistant students about aphasia and communication.

Research indicates that communication between patients with communication disorders and their health care providers may be compromised, which leads to adverse outcomes and reduced participation in patients' own health care. Emerging studies demonstrate that effective communication education programs may decrease communication difficulties. This feasibility study of an education program that includes people with aphasia as educators aims to improve nursing assistant students' knowledge of aphasia and awareness of supported communication strategies while also examining the experiences of participants with aphasia. This preliminary study suggests that explicit aphasia and communication training delivered in this format has positive learning outcomes for nursing assistant students and potential psychosocial benefits to participants with aphasia. The format can be modified for a variety of health care audiences and lends itself to implementation by community aphasia groups and centers.

Focus on communication: increasing the opportunity for successful staff-patient interactions.

OBJECTIVES: This study reports on a pilot study examining the feasibility of a Patient-Centred Communication Intervention. Aims of this study include: assessing the implementation of the communication care plans; identifying staff perceptions of the intervention; exploring changes in patients' perceptions of care and psychosocial functioning; and exploring changes in nurses' knowledge of and attitude towards communication with patients. BACKGROUND: More than 50% of stroke survivors have speech and language impairments. Many nurses lack the specialized skills to effectively communicate with patients and therefore have difficulties understanding the patients' needs. DESIGN: A one-group pre- post-test design supplemented with a focus group session with nursing staff was used. The intervention consisted of developing individualized communication plans; attending at a workshop; and implementing a system to support nurses when using the plans. The plans were used over a 2-month period. Focus groups were held with seven nurses. RESULTS: The pilot study demonstrated feasibility. There was an excellent response rate and nurses adhered to the intervention. CONCLUSION: The Patient-Centred Communication Intervention is feasible and has demonstrated potential for a larger-scale study. RELEVANCE TO CLINICAL PRACTICE: Providing tailored approaches to communication-enhancement education may be necessary for changes in practice to occur.

A systematic review of nursing rehabilitation of stroke patients with aphasia.

AIM AND OBJECTIVES: To explore the evidence on rehabilitation of stroke patients with aphasia in relation to nursing care, focusing on the following themes: (1) the identification of aphasia, (2) the effectiveness of speech-language interventions. BACKGROUND: Patients with poststroke aphasia have higher mortality rates and worse functional outcome than patients without aphasia. Nurses are well aware of aphasia and the associated problems for patients with stroke because they have daily contact with them. The challenge is to provide evidence-based care directed at the aphasia. Although rehabilitation stroke guidelines are available, they do not address the caregiving of nurses to patients with aphasia. DESIGN: Systematic review. METHOD: Published studies were reviewed, focusing on identification and treatment of aphasic patients after stroke in terms of the consequences for nursing care. Also, data concerning effective speech-language interventions were extrapolated into nursing practice with respect to the classification of nursing interventions. RESULTS: Intensive speech-language therapy, which was initiated in the acute stage post stroke, showed the best rehabilitation outcomes. Trained persons other than speech-language therapists provided effective speech-language interventions. Speech-language therapy included several types of intervention that met nursing intervention classifications. CONCLUSION: The contribution of nursing to the rehabilitation of patients with aphasia is relevant. The use of screening instruments by nurses can increase early detection of aphasia, a precondition for initiating timely speech-language therapy. Collaboration between speech-language therapists and nurses is of the utmost importance for increasing the intensity and functionality of speech-language exercises, which may enhance the quality of treatment. RELEVANCE TO CLINICAL PRACTICE: The findings of this study can be used to develop nursing rehabilitation guidelines for stroke patients with aphasia. Further research is necessary to explore the feasibility of using such guidelines in clinical nursing practice and to examine the experiences of patients with nursing interventions directed at aphasia.

Professional aphasia care trusting the patient's competence while facing existential issues.

AIMS AND OBJECTIVES: The aim of this study was to complement 'expert' knowledge about speech-language therapy by studying the phenomenon of professional aphasia care from the patient's perspective. BACKGROUND: The methods for assisting patients with aphasia have mainly been based on speech language therapy with methods for training language. However, the effectiveness of mereley training has not been conclusively proven. In this study, it was assumed that patients with impaired use of language require professional caring interventions as a base for training. DESIGN: A phenomenological approach was used to gain understanding of patients' lived experiences of professional aphasia care. METHOD: Data consisted of eight in-depth interviews, four follow-up interviews, two notes from diaries and two biographies. Data were analysed according to a descriptive phenomenological method. RESULTS: The essential meaning of the phenomenon was: trusting the patient's competence while facing existential issues. To enhance understanding, the essential meaning was specified in terms of the following constituents: preventing isolation, straightforwardness, provision of security, recognition of caring needs, encouraging efforts to practise language, equality and supporting maintenance of identity. CONCLUSIONS: This study adds to the knowledge about speech-language therapy that professional aphasia care presupposes a secure base and a carer who recognises and trusts the patient's ability to think and communicate. RELEVANCE TO CLINICAL PRACTICE: Implications for clinical practice are outlined under the following main headings, a secure caring base, encourage a fighting spirit and expressions of feelings, facilitate communication, try to understand the patient's existential situation and enable patients to recognise that their self-image derives from the painful experience of losing the world of symbols. Inside is the same person and carers should make it clear that they are aware of that.

Predictors of life situation among significant others of depressed or aphasic stroke patients.

AIM: The aim of this study was to examine predictors of the life situation of the significant other of depressed or aphasic stroke patients. BACKGROUND: Depression and aphasia are common consequences of stroke, and both may put pressure on the significant other who have to deal not only with a possible physical handicap but also with communication and/or serious psychiatric difficulties. DESIGN: Descriptive, cross-sectional study. METHODS: The participants were significant others of 71 depressed and 77 aphasic stroke patients. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder, and degree of aphasia was diagnosed with the Amsterdam Nijmegen Everyday Language Test. Assessments of the life situation, state of depression and aggression, personality change and need of assistance were made through questionnaires issued to the significant others. RESULTS: Perceived need of assistance was the only common predictor of life situation of the significant other in both groups (p < 0.001). With respect to the aphasic patients, perceived personality change (p < 0.001) and living with the patient (p = 0.004) were factors that had a negative effect on the life situation of the significant other. CONCLUSIONS: This study highlights that the perception of the patient's need of assistance is an important factor in predicting the life situation among spouses of depressed as well as aphasic stroke patients. A comparison of the two groups to explain the life situation of the significant others revealed greater explanatory power for the aphasic group. RELEVANCE TO CLINICAL PRACTICE: Assessments of the spouses' perception as well as of the patients' factual situation may identify those significant others at risk. With this new approach, necessary steps may be taken to alleviate pressure on the significant other.

[Autism and nursing. Facilitated communication: significance of and use to the nursing of persons with autism with severe disabilities of action and communication]. / Die Gestützte Kommunikation: Bedeutung und Anwendung in der Pflege von autistischen Menschen mit schweren Handlungs- und Kommunikationsstörungen.

The following article searches for evidence based nursing measures in case of severe disabilities of action and communication, if criteria of autism can be applied. The effects of the impairments on daily life are described in typical situations. The caregivers of the persons affected must perform a constant and very demanding care, if they want to cope with daily life and strive for a meaningful social existence. The given situation prompted the question how professional caregivers take care of individuals with autism, who are both apraxic and aphasic. The central characteristics of autism are described on the basis of the International Classification of Diseases (ICD), and specific therapeutic interventions are named. But neither autism therapies nor a literature search concerning nursing concepts for apraxic and aphasic persons could answer the above question. Hence, the author investigates the nursing relevance of the pedagogical concept of Facilitated Communication (FC). That widespread but scientifically, controversially discussed method is applied to persons with autism who are apraxic and unable to speak and communicate with gestures or facial expressions. Practical examples of daily life give a first impression of the use of Facilitated Communication. Subsequently the historical development, the target group and central elements of Facilitated Communication, as communication assessment and well-directed physical, verbal and emotional support, are described. The depiction of the concept FC ends with the discussion regarding the validity of the method. If validity of Facilitated Communication is discussed the term apraxia is frequently mentioned. In order to better understand the nature of apraxic disorders and to validate Facilitated Communication more appropriately, this method is brought into relationship with knowledge of medicine and physiotherapy. Basic Stimulation and the concept of Affolter resemble Facilitated Communication. They focus similar target groups and work likewise with physical contact; therefore differences and equivalencies are discussed. Finally, the possible application of Facilitated Communication in nursing is presented in the context of the preceding investigations. The "Action Oriented Care" of Wittneben forms the frame to the exemplary development of a nursing assessment and description of nursing measures for persons with autism and severe disabilities of action and communication. A representation of relevant evaluation criteria permits the nurses to estimate the effectiveness of their care and gives thus reference points, whether the practiced care actually helps the persons who are affected.

Caregiver strain and caregiver burden of primary caregivers of stroke survivors with and without aphasia.

Little is known about how the burden and strain of caring for stroke patients with or without aphasia affects primary caregivers. This article (a) critically examines the literature on the burden and strain of care experienced by caregivers of stroke patients and (b) examines the relationship between aphasia and caregiver burden and strain. Two literature reviews of three databases were conducted. Fourteen articles (12 quantitative articles, 1 mixed-design article, and 1 qualitative article) were found to comply with the study criteria for the first literature search. A second literature search focused on the effects of stroke survivors' aphasia on caregiving; none of the articles retrieved met the inclusion criteria. This article suggests that there is a lack of research in this area and that several key initiatives are needed, including the development of an instrument with psychometric properties appropriate for assessing the burden and strain on caregivers of stroke patients. Implications for future nursing practice and research are highlighted.

The provision of health information to stroke patients within an acute hospital setting: what actually happens and how do patients feel about it?

This preliminary study describes how health information is provided to stroke patients in an acute hospital and describes their perceptions of health information provision. A further aim was to determine if patients with aphasia were disadvantaged in their receipt of information. Seven stroke patients were observed in hospital for an average of 102 minutes each and then interviewed using a semi-structured interview. When communication occurred, only 17.5% of communication time was spent providing information. Patients with aphasia received information for less time and on fewer topics. Implications regarding approaches to information provision for patients with and without aphasia are discussed.