JCPSLP Vol 18 no 2 July 2016

National Disability Insurance Scheme

Communication partner training for nurses A pilot study of an online learning program Kathryn McKinley and Robyn O’Halloran

Communication partner training improves the communication skills of conversation partners of people with aphasia. Health care providers who work nightshifts or on weekends may not be able to access this training. This study investigated if an online education program was associated with improved nursing knowledge of communication strategies and improved perceived knowledge and confidence when communicating with patients with aphasia. This mixed method study found that an online education program significantly increased nurses’ perceived knowledge about aphasia, knowledge of communication strategies, and perceived confidence communicating with patients with aphasia. Further research is needed to determine the effects of this training on interactions with patients. E ffective health care communication between patients and health care providers is a central tenet of patient-centred care (Bensing, Verhaak, van Dulmen, & Visser, 2000), and has been linked directly and indirectly to a range of positive health outcomes such as improved pain control, increased functional ability, and emotional well-being (Street, Makoul, Arora, & Epstein, 2009). Yet many patients with communication disabilities and their health care providers are unable to communicate effectively. Approximately half of all patients observed communicating with health care providers in acute stroke units were unable to communicate their typical health care needs (O’Halloran, Worrall, & Hickson, 2012). When asked, patients with communication disabilities describe a range of communication difficulties such as “difficulty remembering what to say, not being understood, feeling the doctor did not believe them, being rushed, and not following what the doctor said” (Murphy, 2006, p. 55). The inability to effectively communicate puts patients with communication disabilities at risk of a range of poor health outcomes including misdiagnosis (Hines, 2000), preventable adverse events (Hemsley, Werninck, & Worrall, 2013), inadequate pain relief and even death (Mencap, 2007). Being unable to communicate effectively may be due in part to the nature and severity of a person’s communication

impairment(s), as well as the number and type of barriers to communication in the health care environment. A 2012 meta-synthesis identified a range of environmental factors that influence health care communication. These related to the individual health care provider, such as the provider’s knowledge and attitude, and hospital processes, such as opportunities for communicating (O’Halloran, Grohn, & Worrall, 2012). The lack of knowledge and skills of the communication partner has also been cited as a communication barrier specifically for people with aphasia (Parr, Byng, Gilpin, & Ireland, 1997). An observational study by Hersh, Godecke, Armstrong, Ciccone, and Bernhardt (2014) suggests that the lack of knowledge and skills of the communication partner continues to be barrier for patients with aphasia in hospital. In their study, three inpatients, two of whom had aphasia, were videorecorded continuously for 7.5 hours. The two patients with aphasia had few opportunities to engage in conversation with nursing staff and the nurses employed very few conversation strategies to support communication with them. Communication partner training (CPT) is a proven intervention that focuses on enhancing the knowledge and skills of the communication partner in order to support the person with aphasia to participate in conversation more successfully (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010). CPT has also been extended to support communication with people with a range of different communication disabilities. Simmons-Mackie (2014) describes four levels of CPT training. The aim of level 1 training is to raise the awareness of communication partners about aphasia, how aphasia can impact on communication, and how communication support can help the person with aphasia communicate. Level 2 training aims to build awareness plus provide communication partners with strategies to facilitate communication in a specific activity, such as teaching a doctor how to use strategies to facilitate taking a medical history. Level 3 training builds on level 2 training and aims to develop the person’s skills in facilitating communication across a variety of situations using a range of different supports and resources. Finally, level 4 training is directed towards teaching the communication partner how to train others. CPT is needed at all levels and while CPT may be necessary for health care providers, it may not be sufficient in the hospital setting to ensure communicative access for people with aphasia (see Simmons-Mackie, Kagan, O’Neill Christie, Huijbregts, McEwen, & Willems, 2007). However, level 1 training that aims to raise awareness

KEYWORDS APHASIA

COMMUNICA- TION PARTNER

TRAINING HOSPITAL NURSES ONLINE

THIS ARTICLE HAS BEEN PEER- REVIEWED

Kathryn McKinley (top)

and Robyn O’Halloran

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JCPSLP Volume 18, Number 2 2016

www.speechpathologyaustralia.org.au