Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

Abstract

ObjectivesTo explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.DesignA qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward.SettingA metropolitan Australian private hospital.ParticipantsFocus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted.ResultsThe key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients’ functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients.ConclusionsBarriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.

A Qualitative Study Exploring Rehabilitant and Informal Caregiver Perspectives of a Challenging Rehabilitation Environment for Geriatric Rehabilitation

“…Literature has shown that a lack of communication has a negative effect on the rehabilitation process, as the personal needs of rehabilitants are unclear to the professionals ( 25 ). Good communication is complex and there can be multiple barriers and facilitators related to organization, staff, and rehabilitant factors ( 26 ). Barriers can, for example, relate to mixed wards, the power imbalance between staff and rehabilitants, staff perception of time pressures, personality, lack of knowledge and skills regarding communication, or a rehabilitant's functional and medical status.…”

“…Barriers can, for example, relate to mixed wards, the power imbalance between staff and rehabilitants, staff perception of time pressures, personality, lack of knowledge and skills regarding communication, or a rehabilitant's functional and medical status. Examples of facilitators are shared rooms, staff knowledge and utilization of communication strategies, and the personality of staff ( 26 ) This emphasizes the complexity and importance of communication, so rehabilitants know what to expect in a CRE and what they can do themselves. Therefore, when implementing a CRE, attention must be paid to all these aspects of communication.…”

Communicative and Supportive Strategies: A Qualitative Study Investigating Nursing Staff’s Communicative Practice With Patients With Aphasia in Stroke Care

“…The inability to participate fully in communication is a severe challenge for PWA and HCPs and their ability to inform and involve patients. Being the second most frequent communication partner, only exceeded by family, the nursing staff play a vital role in the communicative rehabilitation post-stroke (D’Souza et al, 2021).…”