“Living in a foreign country”: experiences of staff–patient communication in inpatient stroke settings for people with post-stroke aphasia and those supporting them

Abstract

Purpose: Staff-patient communication in in-patient stroke settings is viewed as challenging for stroke survivors with aphasia and those supporting them. This study sought to explore these experiences from the perspectives of stroke survivors, their carers and healthcare professionals. Methods: A qualitative study where stroke survivors with aphasia, carers and healthcare professionals were interviewed (audio recorded) one-to-one or via focus group. Stroke survivors were at least 6 months post-stroke and had a self-reported mild to moderate level of post-stroke aphasia. Transcripts for each group were analysed separately using inductive thematic analysis; followed by an integrative analysis. Results: Six stroke survivors with aphasia, ten carers, and six healthcare professionals were recruited. Three overarching themes were identified: 'being in a foreign country', 'finding a voice', and 'you're just a number'. A dynamic model of communication is proposed offering a framework for understanding the relationships between 'the context', 'the people' and 'the interactions'. Conclusions: Communication was viewed as important but challenging by all three groups. To maximise staff-patient interactions in the future, attention needs to be paid to: the psychosocial needs of stroke survivors and their carers, ongoing staff training and support for the healthcare professionals supporting them, and the provision of an aphasia-friendly and a communicatively stimulating ward environment.

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

“…Our consultation with experienced researchers took place in March 2018. References were updated prior to submission for publication; accordingly two papers [18,33] which were published online during or before April 2019 have been updated after being assigned to a specific volume/issue of the journal.…”

“…People came into healthcare in a vulnerable position, reporting a range of complex emotions such as feeling isolated [12], being in shock, "terrified, even horror-stricken," and "small and helpless" [21,p.2507], as they realised the impact of the stroke. Depression was not uncommon [22,33]. The presence of a strong relationship, one in which the person felt understood and supported, and where they felt they could trust the clinician [12,18], could provide safety and security that could alleviate this emotional distress: "When a patient realises that the carer really wants to know and understand, he/she finds it easier for feel safe" [21,p.2508].…”

‘The Lynchpin of the Acute Stroke Service’—An envisioning of the scope and role of the advanced nurse practitioner in stroke care in a qualitative study

“…Healthcare professionals experience challenge in communicating with stroke survivors with speech and cognitive impairments (Clancy et al, 2020), and therefore, the training needs of the ANPs in this regard will need to be addressed. More generally, the research that has investigated the nature of the discourse between…”

“…If the ANP uses approaches that actively involve, support and empower the person and family unit as anticipated, there is potential for agreement about priorities in care and partnership approaches towards improved management of comorbidities. Healthcare professionals experience challenge in communicating with stroke survivors with speech and cognitive impairments (Clancy et al, 2020), and therefore, the training needs of the ANPs in this regard will need to be addressed. More generally, the research that has investigated the nature of the discourse between ANPs and people and their families demonstrates mixed findings (Jenkins et al, 2018; Siouta et al, 2019).…”

Augmentative and Alternative Communication Intervention for in-patient Individuals With Post-stroke Aphasia: Study Protocol of a Parallel-group, Pragmatic Randomized Controlled Trial

“…However, PWA often complain that communication in hospital settings is challenging due to reduced comprehension and expression abilities. Meanwhile, caregivers and healthcare professionals also reported di culties when communicating with PWA [30]. Therefore, when PWA work with speechlanguage pathologists (SLPs), SLPs help PWA identify communication needs and introduce different communication strategies to maximize their communication skills within desired life roles [29].…”