Aphasia disrupts usual care: the stroke team’s perceptions of delivering healthcare to patients with aphasia

Carragher, Marcella; Steel, Gillian; O’Halloran, Robyn; Torabi, Torab; Johnson, Hilary; Taylor, Nicholas F.; Rose, Miranda

doi:10.1080/09638288.2020.1722264

Cited by 58 publications

(58 citation statements)

References 38 publications

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“…Communication and relationships are demonstrably important when working with people with communication impairments in supporting them to engage and to develop a strong self-identity post-stroke. However, these interpersonal aspects of care are not always prioritised in clinical practice [11,65,66] and indeed, clinicians report many challenges in communicating with this population which can lead to them restricting their interactions [15]. That is not to say that clinicians do not value them or consider important, rather, that they are "rendered invisible and devalued" [55,p.2] in biomedical care models and in health systems which are focus on technical aspects of care, patient throughput, and readily measurable outcomes, arguably at the expense of relational models of care that value meaningful engagement with patients [9,55].…”

Section: Discussionmentioning

confidence: 99%

“…Communication is recognised as a leading form of "care" that nurses "left undone" in times of acuity and busyness [66]. Staff report a lack of knowledge, skill and time which impacts on their communication [15]. This reflects that clinicians' ways of working are strongly influenced by the contexts they work in.…”

Section: Discussionmentioning

confidence: 99%

“…Our description of relationship-enhancing communicative practices will support clinicians to critically reflect on their own communication, identifying which elements are most evident their own practice. We urge clinicians to also reflect on the circumstances which may facilitate, or hinder this approach to communication, recognising that the context of care and workplace structures and pressures influence how people work [15]. It has been suggested that clinicians' communicative practices are influenced by values, knowledge and skills [11,20,71].…”

Section: Discussionmentioning

confidence: 99%

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Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke

Bright

Reeves

2020

Disability and Rehabilitation

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Purpose: Communication between patients and clinicians influences the development of therapeutic relationships. Communication is disrupted when the patient has communication impairments after stroke. However, how these communication disruptions influence therapeutic relationships is not well-understood. This qualitative metasynthesis explores the perspectives of people with communication impairment to understand how interpersonal communication influences therapeutic relationships. Material and methods: Four databases were searched for qualitative studies which discussed how communication influenced therapeutic relationships from the perspectives of people with aphasia, dysarthria or apraxia of speech. Additional papers were identified through citation searching and subject experts. Nineteen eligible papers were included and analysed using thematic analysis. Results: Four themes were constructed from the analysis: (1) Relationships provide the foundation for rehabilitation; (2) Different relational possibilities arise from "reading" the clinician; (3) Creating therapeutic relationships through validating interactions and connections; and (4) Creating therapeutic disconnections through invalidating, exclusionary interactions. Conclusions: A therapeutic relationship develops, at least in part, in response to the clinician's communication and how this is received and experienced by the patient. Understanding the characteristics of relationship-fostering communication and knowing how communication influences relationships can help clinicians critically reflect on their communication and better develop therapeutic relationships with people with communication impairment. ä IMPLICATIONS FOR REHABILITATIONPractitioner-patient communication can facilitate therapeutic relationships or create therapeutic disconnections. Communication patterns that are commonly evident when a patient has communication impairments can impede therapeutic relationships. Clinicians need to attend to how their communication is received and how it influences people's sense of self. Communication partner training should address the existential and relational needs of people with communication impairment after stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke

Bright

Reeves

2020

Disability and Rehabilitation

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“…2018, Carragher et al . 2020). In contrast, speech and language therapists (SLTs), who are trained to assess, diagnose and treat communication disorders, are ideally placed to lead or support capacity assessments for people with communication disabilities (Zuscak et al .…”

Section: Introductionmentioning

confidence: 99%

“…For individuals with communication disabilities, this includes making adjustments to the way that information about decisions is provided and to the way that mental capacity is assessed, to ensure that these processes are more accessible. Professionals without expertise in working with people with communication disabilities find it difficult to accurately identify and support communication needs (Cameron et al 2018, Carragher et al 2020. In contrast, speech and language therapists (SLTs), who are trained to assess, diagnose and treat communication disorders, are ideally placed to lead or support capacity assessments for people with communication disabilities (Zuscak et al 2016, Volkmer 2016.…”

Section: Introductionmentioning

confidence: 99%

Giving voice to people with communication disabilities during mental capacity assessments

Jayes

Palmer

Enderby

2020

Intl J Lang & Comm Disor

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Background: Healthcare professionals without specialist training in communication disorders may not know how to identify and support patients with communication disabilities during mental capacity assessments. To meet this need, a novel communication screening tool was developed and tested as part of a mental capacity assessment support toolkit. Aims: To provide an initial evaluation of the communication screening tool's usability, interrater reliability and criterion validity. Methods & Procedures: A prototype communication screening tool was developed iteratively using co-production and user-centred design principles. A mixed-methods case series design was used to explore how multidisciplinary healthcare professionals used the tool to test patients in acute hospital and intermediate care settings. Usability data were collected in an electronic survey and from a documentary analysis. Screening test outcomes obtained by pairs of professionals were compared to measure the tool's interrater reliability. Outcomes obtained by professionals were compared with the outcomes of a speech and language therapist's communication assessment to measure criterion validity. Quantitative data were analysed using frequency counts and inferential statistics. Qualitative data were analysed using framework analysis. Outcomes & Results: A total of 21 professionals, including physicians, nurses, occupational therapists, physiotherapists, and speech and language therapists, and 17 patients with diagnoses of stroke or cognitive impairment took part. Professionals reported they found the tool easy to use, useful and that its use increased their understanding of communication support methods and the speech and language therapist role in relation to mental capacity assessment. However, not all used it consistently or accurately. Professionals reported they chose not to use the tool when they perceived patients' communication to be intact. Four of eight patients with a diagnosis of dementia or memory impairment, who professionals elected not to screen, were found to have significant communication needs. Screening outcome data for nine patients suggest the tool's interrater reliability is currently moderate, whilst its criterion validity is poor. Conclusions & Implications: This study highlights that non-speech and language therapist health professionals have difficulty identifying and screening for communication difficulties. This confirms existing evidence that people with communication disabilities may not receive the decision-making support they require during mental capacity assessments when speech and language therapists are not involved. Greater understanding of health professionals' thought processes regarding communication is required to further develop this unique communication screening tool so that it can effectively enable healthcare professionals to identify and use communicative adaptations to support decision-making.

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Nurses' experiences of communicating with patients with aphasia

Hur

Kang

2021

Nursing Open

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Approximately 180,000 cases of aphasia occur every year in the United States, with the estimated prevalence of approximately one in 250 people (National Institute on Deafness & Other Communication Disorders, 2015). Stroke is the main cause of aphasia; approximately 35%-40% of stroke patients are diagnosed with aphasia (Dickey et al., 2010). Stroke is one of the three major causes of death in South Korea (Statistics Korea, 2018). Its mortality rate has decreased significantly owing to the advancement of medical science. The number of stroke survivors have increased in Korea since the death rate has decreased by approximately 11.8% over the past decade (Statistics Korea, 2018). Reportedly, aphasia occurs in 28.8% of patients hospitalized with stroke in Korea (Chang et al., 2017).Patients with aphasia have difficulty communicating because of damage in the speech center of the cerebrum (Saldert et al., 2013). Approximately 13% of patients admitted to the hospital with stroke have difficulty in complaining of pain on their

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Aphasia disrupts usual care: the stroke team’s perceptions of delivering healthcare to patients with aphasia

Cited by 58 publications

References 38 publications

Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke

Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke

Giving voice to people with communication disabilities during mental capacity assessments

Nurses' experiences of communicating with patients with aphasia

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