Implementation of supported conversation for communication between nursing staff and in-hospital patients with aphasia

Background: Patients admitted with aphasia due to stroke may find it difficult to access information and participate in decision-making concerning their own treatment, care, and rehabilitation. An increased understanding of the importance of communicative access has prompted speech-language therapists to direct intervention at contextual factors, including communication partner training.Aims: An implementation project is described in which supported conversation for adults with aphasia (SCA) was adapted for use at a large hospital stroke unit. The project aims were (1) to develop a procedural guideline for interdisciplinary staff to communicate with in-patients with aphasia, (2) to develop an interdisciplinary training course and educate all staff members, and (3) to make available a set of shared communication tools. The present study reports the outcome of the training programme for nursing staff.Methods & Procedures: A stepwise adaptation and implementation procedure is described which led to the development of the guideline, tools, and training programme. A mixed-methods design was used to measure changes pre- and post-training for nursing staff, including assessment of quantitative and qualitative outcomes. All nurses and nursing assistants received a questionnaire before and after their participation in an SCA workshop, and seven members from the nursing staff also participated in individual semi-structured interviews about their experiences with the SCA method.Outcomes & Results: Questionnaires from 31 nursing staff members showed that they rated their understanding of aphasia higher after the workshop and they perceived communication to be less frustrating for the patient. Changes were also noted in the types of strategies they used. In the interviews, the nurses described feeling more confident about their ability to communicate with patients, more certain about establishing understanding with patients, and more willing to initiate conversations about complex topics. Difficulties with using tools and techniques were attributed to shortage of time, picture tools being too complex, and patient symptoms.Conclusions: Implementation was considered successful based on the nursing staff's evaluations. Contributing factors may have been staff's involvement in adaptation, leadership support, and a working culture on the stroke unit characterised by readiness to adapt to guidelines. To ensure that the majority of staff members will actually apply tools and techniques, continued monitoring of the implementation process will be necessary as well as education of new staff and re-evaluation of procedures.