JCPSLP Vol 17 No 1 2015_lores

Diversity in practice

Social conversations for hospital patients with acquired communication disabilities Kathryn McKinley, Renee Heard, Sally Brinkmann, Julia Shulsinger, and Robyn O’Halloran

This paper describes the implementation of a supported conversation training program for volunteers at a tertiary hospital in Melbourne. The objective of the program was to provide increased opportunities for patients with acquired communication disorders as a result of a stroke to engage in social conversation with trained volunteers. Later, the program was extended to include inpatients with other communication-related disorders. The program was highly valued by patients, their families, volunteers, and hospital staff. Future directions include a formal evaluation of the program and rollout of the program across different health care services within the organisation. T he National Stroke Foundation estimates that 67% of people admitted into hospital with stroke have a communication disorder such as aphasia, dyspraxia of speech, or dysarthria (National Stroke Foundation, 2010). O’Halloran and colleagues (2009) also found that the number of people with communication disorders in hospital stroke units is very high. Of 69 consecutive patients admitted into acute hospital stroke units, 79% had a mild or greater hearing loss, 47% had a mild or greater cognitive communicative disorder, 44% had a mild or greater language disorder, and 26% had a mild or greater speech disorder. Of all the patients assessed, 88% had at least one kind of communication disorder and 69% had two or more communication disorders. The consequences of having a communication disorder in hospital have also been explored. The majority of this research has focused on the consequences of having a communication disorder on health-care delivery. Sixty- four percent of the stroke patients identified as having a communication disorder by O’Halloran and colleagues (2009) had difficulty communicating with their health-care providers about their everyday health-care needs. As a result of their communication disorder, these patients did not always understand what was happening, could not ask questions about their care, and/or were unable to call for help when they needed it (O’Halloran, Worrall, & Hickson, 2012). When patients with communication disorders and their health care providers are unable to communicate successfully, the patients often experience distressing

adverse events (Hemsley, Werninck, & Worrall, 2013) and are more likely to be judged as unable to participate in decision-making about their health care (Carling-Rowland, Black, McDonald, & Kagan, 2014). Another less obvious consequence of having a communication disorder in hospital is that there may be fewer opportunities to engage in social conversation (Hersh, Godecke, Armstrong, Ciccone, & Bernhardt, 2014). Social conversation provides people with an opportunity to describe their experiences, express personal attitudes and opinions, and feel known by another. Engaging in successful social conversations is fundamental to a person’s psychological well-being (Kagan & Gailey, 1993). People with aphasia have identified social companionship, positive interactions with others, and a feeling of connectedness as integral to living successfully with aphasia (Brown, Worrall, Davidson, & Howe, 2012). Experiences of successful social interaction may also afford those patients with a newly acquired communication disorder such as aphasia with opportunities to experience themselves as competent communicators. Such opportunities might offer a contrast to other medically oriented interactions that occur in the hospital setting where they may experience themselves as incompetent communicators (Hersh et al., 2014; Shadden, 2005). The skills required to support a person with an acquired communication disorder such as aphasia to engage successfully in conversation can be learned (Kagan, Black, Duchan, Simmons-Mackie, & Square, 2001; Parr & Byng, 1998). Based on a systematic review of the literature, Simmons-Mackie and colleagues (2010) concluded that communication partner training is effective in improving a communication partner’s ability to engage in conversations and probably effective in enhancing the ability of the person with aphasia to engage in conversations. Family and friends may need time to adjust to the changes that have occurred and the time and opportunity to learn how best to communicate with their loved one. Volunteers who have received communication partner training may provide immediate opportunities for inpatients with newly acquired and chronic communication disorders to engage in rewarding social conversation. St Vincent’s Hospital Melbourne delivers a variety of programs with the help of volunteers. In one program named “Angel Volunteers”, trained volunteers provide companionship to patients identified as being at risk of falling. The volunteers engage them in a range of diversional activities such as conversation and reading. Ways to expand the role of the Angel Volunteers were discussed by the first author who had visited Connect (www.ukconnect.

KEYWORDS HOSPITAL STROKE SUPPORTED CONVERSATION PARTNER TRAINING VOLUNTEERS THIS ARTICLE HAS BEEN PEER- REVIEWED

Kathryn McKinley (top), Renee Heard (centre) and Sally Brinkmann

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JCPSLP Volume 17, Number 1 2015

www.speechpathologyaustralia.org.au