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An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders

Chu, Charlene H., PhD, RN, GNC(c)1,2; Sorin-Peters, Riva, PhD, Reg CASLPO, SLP(c), CCC-SLP3; Sidani, Souraya, PhD, RN4; De La Huerta, Bronwen, MHSc, SLP(C), Reg. CASLPO5; McGilton, Katherine S., PhD, RN1,2

doi: 10.1097/rnj.0000000000000041
FEATURES

Purpose The aim of the study was to evaluate change in nurses’ knowledge, attitudes, and behaviors after an Interprofessional (IP) Communication Training Program designed to improve nurses’ ability to communicate with stroke rehabilitation inpatients with communication disorders.

Design/Methods A quasi-experimental longitudinal study was conducted to evaluate an IP Communication Training Program consisting of a full-day and booster workshop and speech language pathologist support for nurses. The Communication Impairment Questionnaire and the Providers Interactional Comfort Survey were collected prior to and 3 months and 1 year postintervention. Focus groups assessing program acceptability were conducted.

Results Forty-six nurses participated. The Communication Impairment Questionnaire significantly improved postintervention (p = .001), but not at 1 year follow-up (3.76, p = .123). The Providers Interactional Comfort Survey significantly improved postintervention (p = .001) and remained significant 1 year later (8.84, p = .03). Focus groups indicated high acceptability and reported that the education increased their confidence and reduced their frustration.

Conclusion Nurses’ attitudes toward and knowledge about communication strategies improved, which enhances their ability to care for stroke patients with communication disorders.

Clinical Relevance Interdisciplinary workshops and speech language pathologist support appear beneficial to nurses working with patients with communication disorders.

1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

2 Toronto Rehabilitation Institute–University Health Network, Toronto, Ontario, Canada.

3 Revive Speech Therapy, Toronto, Ontario, Canada.

4 Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada.

5 Providence Healthcare, Toronto, Ontario, Canada.

Correspondence: Charlene H. Chu, PhD, RN, GNC(c), Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Suite 130, 155 College Street, Toronto, ON M5T 1P8, Canada. E-mail: Charlene.Chu@mail.utoronto.ca

Cite this article as: Chu, C. H., Sorin-Peters, R., Sidani, S., De La Huerta, B., & McGilton, K. S. (2018). An interprofessional communication training program to improve nurses’ ability to communicate with stroke patients with communication disorders. Rehabilitation Nursing, 43(6), E25–E34. doi: 10.1097/rnj.0000000000000041

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Introduction

One third of all stroke survivors have a communication disorder that impairs their ability to produce or understand language (Lazar, Speizer, Festa, Krakauer, & Marshall, 2008). According to the National Institute for Health and Care Excellence Guideline for Rehabilitation After Stroke and the Canadian Stroke Best Practice Recommendations, healthcare professionals must be provided with the appropriate education and training to enable them to communicate effectively and aid the rehabilitation of patients with communication disorders after stroke (Dworzynski et al., 2013 ; Hebert et al., 2016 ; Lindsay, Gubitz, Bayley, & Phillips, 2013).

Regulated nurses (registered nurses [RNs] and registered practical nurses [RPNs]) have the most interaction with patients and their families during their day-to-day patient care responsibilities (Hersh, Godecke, Armstrong, Ciccone, & Bernhardt, 2014); however, evidence suggests that nursing staff have insufficient knowledge regarding basic communication problems and are poorly prepared to initiate effective communication with patients (Chang, Lin, Yeh, & Lin, 2010 ; Horton, Lane, & Shiggins, 2015). In addition, nurses lack support and resources on the unit due to competing healthcare demands and staff shortages and thereby are unable to give priority to patients’ communication needs (Hemsley & Balandin, 2014 ; Hersh et al., 2014). Enhancing nursing staff’s communication skills with patients who have communication disorders has been identified as a crucial care priority (Ravert, Williams, & Fosbinder, 1997) and best practice (Dworzynski et al., 2013) to improve patients’ quality of life (QOL) poststroke (Clarke, 2014). Yet, currently more guidance is needed in the provision of effective rehabilitation services, including communication to patients with communication disorders, to maximize their QOL after stroke (Dworzynski et al., 2013).

Consequences of ineffective communication between patients with communication disorders and direct care providers, including nurses, include being unable to effectively communicate their wishes and needs, more likely to experience frustration and agitation (Roth et al., 2002), and are at a higher risk of depression (Cameron et al., 2008). Communication impasses between the patient and healthcare providers compromise the patients’ ability to actively participate in care-related decisions (Cameron et al., 2008), which is associated with poor patient outcomes, such as an increased potential for error in diagnosis and treatment (Jensen et al., 2015), lower quality of care, and reduced patient satisfaction with care (Hemsley & Balandin, 2014). Within this context, nurses report high levels of stress (Chang et al., 2010), frustration (Jensen et al., 2015), and burnout, which directly contributes to staff turnover (Barry, Kemper, & Brannon, 2008).

There is minimal literature related to nursing staff and patient communication in the rehabilitation phase of stroke recovery (Clarke, 2014). Of note, a systematic review examining effective methods to improve staff communication skills indicated that the majority of education for staff has focused on general linguistic strategies without specific individualized communication and behavioral management strategies such as using a person-centered approach to relate to the patient (McGilton et al., 2009). This limitation is a significant knowledge gap because patients with ineffective communication can become agitated, and the approach used by staff can either exacerbate or lessen patients’ behavioral symptoms (Burgio, Stevens, Burgio, Paul, & Gerstle, 2002). To address these limitations, an intervention entitled “Interprofessional (IP) Communication Training Program” was developed to enhance nursing staff interactions with patients who have communication disorders in a complex continuing care setting (McGilton et al., 2012). We conducted a pilot study and our results showed an increase in patient QOL and a decrease in agitation when nursing staff received communication training from an speech language pathologist (SLP; McGilton et al., 2011). Given the promising results from our one-group pretest–posttest pilot study, the goal was to replicate this IP Communication Training Program with a control group of nurses in a clinical setting with a high proportion of patients with communication disorders. The purpose of this study is twofold:

  1. to evaluate the components of an IP Communication Training Program designed to educate and support nurses’ communication skills with patients with communication disorders and
  2. to determine the extent to which the IP Communication Training Program improved nursing staff attitudes, knowledge, and use of strategies related to care of patients with communication disorders secondary to stroke at baseline, 3 months, and 1 year following the implementation of the program in two rehabilitation units.
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Design and Methods

Study Design

A quasi-experimental pre–post measurement design was used to examine the effects of the IP Communication Training Program to improve nursing staff outcomes. The IP Communication Training Program is part of a larger study entitled “Patient-Centered Communication Intervention” aimed at improving patients’ QOL after stroke and satisfaction with care while reducing depression and agitation related to communication disorders by means of training nursing staff in communication strategies. The Patient-Centered Communication Intervention consisted of (a) a workshop and booster workshop for nursing staff focused on communication and behavioral management strategies, (b) a comprehensive patient assessment and the development of individualized patient communication care plans, and (c) an SLP staff support system to assist nursing staff in implementing the care plans in their daily practice (McGilton et al., 2011). This present study exclusively focuses on describing the intervention components targeted at nursing staff and the effects of the IP Communication Training Program components on nursing staff outcomes.

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Setting and Participants

The study was conducted on two inpatient stroke rehabilitation units in Ontario, Canada. Nurses were eligible to participate if they were full-time, part-time, or casual RPNs or RNs on the rehabilitation units. Patients were eligible if they (a) were admitted with a stroke-related moderate to severe communication disorder as determined by the SLP, (b) English speaking, and (c) could provide informed consent themselves or had a Power of Attorney of who could provide consent on their behalf. No patients were excluded due to severity of their communication disorder. Patient demographics and outcomes are reported elsewhere (McGilton et al., 2017).

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IP Communication Training Program

The components of the IP Communication Training Program consisted of (a) a full-day workshop for nursing staff taught by an SLP and an academic nurse, (b) the implementation of an SLP staff support system on the unit who was responsible to continually mentor and support nurses, and (c) a booster workshop delivered approximately 8 months after the original workshop. Taken as a whole, IP Communication Training Program provided evidence-based training and then provided staff the resources (Flottorp et al., 2013) in the form of ongoing mentorship with additional SLP support on the unit to improve the likelihood of uptake into daily interactions between nurses and patients with communication disorders. The integration of these components represents an innovative approach to communication training for nurses and is described in greater detail elsewhere (Sorin-Peters et al., 2010).

The components of the program were provided to all nursing staff on the two rehabilitation units regardless of their enrollment status in the study; however, more extensive and in-depth follow-up was provided to nurse participants.

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IP Communication Training Workshop

The PI (K. M.) and SLP (R. S. P.) held a full-day 8-hour educational workshops to increase nurses’ awareness of person and context-specific approaches to communication, educate nurses in the use of relational and supportive conversation strategies when working with patients with communication disorders (Kagan, 1998), and review behavioral management strategies that could be implemented into the nurses’ practice (Kagan, 1998 ; Sorin-Peters, 2004 ; Sorin-Peters, McGilton, & Rochon, 2010).

The Aphasia Framework for Outcome Measurement (Kagan, 2004) was used as the conceptual framework for the workshop content, because it identifies four domains that contribute to the QOL of patients with aphasia/communication disorders (participation in life, the communication environment, severity of communication disorders, and personal characteristics; Kagan, 2004). The workshop content included information about common communication disorders after stroke (e.g., dysarthria, apraxia, aphasia), the characteristics of each communication disorder, general communication strategies to use when working with these patients, assessment and identification of patients’ communication deficits, and application of the relevant communication and behavioral strategies to correspond to patients’ needs (Sorin-Peters et al., 2010). With respect to behavioral management, nursing staff learned about the REAP model of care that identified four pillars of person-centered care: Relating well, Environmental manipulation, Abilities-focused care, and Personhood (McGilton, 2004). Each pillar is associated with behavioral management strategies that have been used in other research studies (McGilton, 2004). The workshop applied adult learning principles (Knowles, Holton, & Swanson, 2014 ; Sorin-Peters et al., 2010) by means of demonstration, video clips, guided activities, and role-play so nurses could immediately see and use the strategies to understand the relevancy in their own practice. The manual from our pilot study was used, and further details with respect to the workshop can be found published elsewhere (McGilton et al., 2011 ; Sorin-Peters et al., 2010).

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IP Communication Training Booster Workshop

A half-day booster workshop was provided approximately 8 months after the full-day workshop to remind all nursing staff of the workshop content. The same information as the original workshop was presented in a condensed version. The timing of the booster workshop was based on when the facility managers were able to schedule coverage for staff to attend the workshop.

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SLP Staff Support System on the Unit

After the initial full-day workshops, the SLP staff support system was implemented to increase the likelihood that the best practices taught in the workshop were translated into daily nursing practice and to reinforce the staff’s successful use of specific communication strategies tailored to the patients’ remaining abilities. The PI recruited a SLP employed by the facility to provide ongoing support via coaching and mentorship for the nurses on the units. The SLP staff support duties included answering nurses’ questions regarding patient communication strategies, demonstration with the nurse at the point of care was offered to nurses, and problem-solving challenging communication–behavioral situations (Sorin-Peters et al., 2010).

The SLP staff support approached each nurse participant at least once a week and was available Monday to Friday 9 a.m. to 5 p.m. on an “as needed basis” to provide help for nurses who required assistance communicating with patients. The SLP documented in detail which nurses they spoke to, the kind of coaching and mentoring that was provided (e.g., demonstration of strategies, clarification), and duration (in minutes) of each nurse interaction.

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Data Collection Procedures

The research assistant (RA) distributed the baseline survey to collect demographic data from nurses such as age, gender, education level, and job status (full time, part time, casual). Figure 1 depicts when the main nurse outcome data were collected throughout the study relative to the implementation of the intervention components. To evaluate the changes in nursing staff attitudes and knowledge, outcome surveys were completed three times: (a) prior to the IP Communication Training Workshop, (b) approximately 3 months after the workshop and SLP staff support implementation, and (c) 1 year follow-up after the booster workshop.

Figure 1

Figure 1

The workshop content was evaluated with a feedback questionnaire filled out by nurses immediately after the workshop. Focus groups with participating nurses and SLPs were conducted after the intervention was discontinued to determine acceptability of the intervention and its components. This study was conducted between March 2011 and March 2014.

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Nurse Outcome Measures

The Communication Impairment Questionnaire (CIQ) measured nurses’ attitudes toward communicating with patients with communication disorders and the degree to which a person-centered approach was used in relating to patients with communication disorders (Généreux et al., 2004). The CIQ scale demonstrated internal consistency reliability (Cronbach’s alpha = .73) and sensitivity to change following communication interventions Généreux et al., 2004; McGilton, Guruge, Librado, Bloch, & Boscart, 2008).

An adapted version of the Providers Interactional Comfort Survey (PICS) was used to evaluate nursing staff knowledge, competence, comfort, and scope of practice toward working with patients with communication disorders (Bowles, Mackintosh, & Torn, 2001). The PICS has acceptable reliability with a Cronbach’s alpha of .81 and has shown sensitivity to a communication intervention (McGilton et al., 2008).

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Workshop Evaluation

After each session, participants were asked to complete a 20-item questionnaire to evaluate the workshop. The effectiveness of the workshop was rated on a 4-point Likert scale (1 = poor, 4 = excellent), with respect to the four principles from the Aphasia Framework for Outcome Measurement framework (Kagan, 2004). Participants were encouraged to provide feedback about the workshop content and critically appraise the presented content (Kirkpatrick & Kirkpatrick, 2007).

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Treatment Fidelity

Nurse–patient dyads were paired and observed at baseline, before the workshop and the implementation of the SLP staff support system, and then 3 months and 1 year after these components were delivered to assess treatment fidelity, the extent to which the nurses applied the linguistic and behavioral strategies into their daily practice (Sidani & Braden, 2011). Furthermore, the nurse–patient dyads provided a specific point of reference for the SLP staff support to provide nurses with bedside mentorship. The SLP identified specific strategies effective for each patient the nurse was paired with and provided support to the nurse throughout the patient’s admission until discharge to enhance the likelihood of knowledge transfer. In this way, participating nurses were continuously paired with patients with communication disorders by means of their patient assignment. Patient participants were identified and approached for consent by a facility SLP who received the patient’s referral on an ongoing basis.

Treatment fidelity was assessed by a trained RA, who is an RN, to complete a standardized checklist that recorded the type and number of verbal and nonverbal communication and behavioral strategies used by the nurse during each observation. The RA was acclimatized to the units in order to be as innocuous as possible. Higher checklist scores indicated a higher number of strategies used by the nurse. The SLP would continue to provide support in a similar manner for each nurse–patient dyad. The SLP support staff system was implemented for approximately 1 year.

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Focus Groups

Focus groups were conducted 3 months after the intervention ended. The aim of the focus groups were to understand how the nurses and SLPs perceived the components of the IP Communication Training Program, determine aspects that were most and least helpful to the nurses with respect to working with patients with communication disorders in their fast paced clinical setting. Two focus groups used a convenience sample of nursing staff (two with RNs and RPNs), and one focus group included all the SLPs with four to five participants in each group. Each focus group was audiotaped and transcribed, and supplemental notes were provided by two note takers who were present during each focus group.

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Data Analysis

All the data were entered into Excel and double-checked for errors by two RAs. The file was exported into Stata for analysis. Descriptive statistics were calculated to describe the demographic characteristics of the nursing staff and the survey responses. A repeated-measures hierarchical regression tested significance of changes in CIQ and PICS scores and the variables of job category and gender were controlled. Hierarchical regression was also used to account for missing values at each measurement period. An α ≤ .05 was applied for all statistical tests to accept a 5% chance of Type I error.

Descriptive analysis of responses to the Likert-scale items from the workshop evaluation questionnaires was completed. Treatment fidelity was assessed by determining the mean frequency of Strategies Utilized (SU) by nurses during the nurse–patient dyad observations pre- and postintervention. Higher SU scores indicated that more strategies were used by nurses.

The focus groups were analyzed using content analysis. The transcripts were closely read, and themes were selected and discussed by the researchers. Smaller themes were collapsed to create broader themes. The documentation from the SLP staff support was read and coded by two RAs; the minutes of each activity were tabulated and described.

This study was conducted in accordance with the Tri-Council Policy Statement, Ethical Conduct for Research Involving Humans. Ethics approval for the study was obtained and was renewed yearly.

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Results

Nurse and Patient Recruitment Rates

A total of 46 nurses participated in the study. No nurses withdrew from the study, and nurses were generally enthusiastic about participating in the study as indicated by the 100% retention rate. The recruitment rate of patients in the control and intervention periods were 56.5% and 90%, respectively, for a total of 62 patients.

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Participant Characteristics

Table 1 describes the demographics of the nurse participants. Overall, most were female (n = 40, 87%); the mean age of the nursing staff enrolled into the study was 45.9 (SD = 9.2); RPNs (76%) worked full time (69.6%) and had worked at the facility for 11.4 years (SD = 7.4 years). Patients had a mean age of 68, 42% female, with the majority of strokes being classified as left hemorrhagic strokes (47%). Patient demographics are reported elsewhere (McGilton et al., 2017).

Table 1

Table 1

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Evaluation of the IP Communication Training Program Components

Workshop Evaluation Forms

All participating nursing staff filled out an evaluation form. The mean scores for all of the items ranged from 3.6 to 3.8 out of 4 meaning “excellent” in each area of evaluation (Table 2). One participant commented that the volume of a video used to demonstrate communication techniques was too low. Three other participants provided positive comments in the comment section (e.g., “this was great and very informative”).

Table 2

Table 2

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Focus Group Results 1 Year Postintervention

Regulated nurses regarded the training program as “valuable” and “acceptable.” The workshop was highly acceptable, and the scenarios presented were “great for learning.” These results corroborate the workshop evaluation feedback. Nurses reported that the booster workshop was a “wonderful refresher” on how to communicate with patients with communication disorders, and it was perceived by nurses that their patients seemed more confident when the nurses appeared to be knowledgeable in communication strategies. From their perspective, the nurses expressed that the communication training program helped increase patients’ QOL because they felt more prepared to communicate with patients with communication disorders, thereby mitigating patients’ frustrations. Nurses found the SLP staff support system to be incredibly helpful with respect to communicating more effectively during patient care because they were able to use the appropriate communication strategies for their patient. Nurses felt more comfortable and less frustrated when communicating with patients with communication disorders, which made communication with their patients less stressful. On the whole, the nurses viewed the components of the IP Communication Training Program, the workshops, and the SLP support system as highly acceptable approaches to enhance nurses’ communication skills with patients with communication disorders.

Staff SLPs viewed all the components of the intervention as highly valuable and acceptable and enjoyed the intervention. They perceived the workshop to be a beneficial opportunity for nurses to learn, refresh, and practice their communication skills. SLPs also mentioned that patients appeared to be more satisfied with nursing care because they would consistently use the same communication strategies. The SLP who fulfilled the role of the SLP support system indicated that the program was highly acceptable and appeared to be helpful for the nurses. Having nurse–patient dyads as points of reference provided the opportunity for the SLP to demonstrate the effectiveness of specific communication strategies for individual patients and allowed nurses to recognize patient improvement over time. The SLP enjoyed working closely with the nurses and helping them refine their practice in a way that was meaningful and relevant to patient care.

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Effects of the IP Communication Intervention on Nursing Staff Outcomes

Table 3 presents the results of the CIQ and PICS before the IP Communication Training Program, 3 months after implementation, and 1 year follow-up later. There was a significant difference in the CIQ from baseline to 3 months postintervention (mean difference = −0.42, p = .001), indicating that nurses’ attitudes toward communicating with patients with communication disorders improved and that nurses espoused a person-centered approach in relating to individuals with communication disorders. Specifically, results indicated that nurses were able to understand their patients more often and felt that they were able to make their patients understand them more often. The CIQ continued to improve by 0.15 units 1 year later, but this improvement was not significant (p = .123).

Table 3

Table 3

The PICS score significantly improved 3 months after the IP Communication Training Program was delivered (mean difference = −0.97, p = .001). The PICS score continued to improve 1 year later to a statistically significant degree (mean difference = −0.3, p = .03), suggesting an increase in nurses’ perception of their competence, confidence, willingness, frequency, and scope of practice as related to interacting with patients with communication disorders.

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Evaluation of Treatment Fidelity

Prior to the intervention, the mean SU score was 8.4 representing the number of communication strategies used during a random observation of the nurse–patient dyads. After the implementation of the IP Communication Training Program, the mean SU scores were 8.3 and 8.4 in the two follow-up data collection periods. Despite a nonstatistically significant mean SU score change, when we compared the use of communication strategies utilized by nurses, there was 49% increase in using the specific strategy of “announcing topic changes” (p = .08) and “using multiple modes of communication strategies” (p = .09).

The SLP staff support documentation indicated that the SLP would schedule informal meetings with each primary nurse at the patient’s bedside to demonstrate and coach the strategies while answering the nurse’s question; each session was 10–15 minutes long. Then the SLP provided follow-up to the nurse two to three times a week, depending on the patient’s needs and communication changes; each follow-up session was 3–15 minutes long, depending on the nurses’ learning needs. Overall, 15% of the SLP staff support’s time was spent introducing the communication strategies, 75% of her time was spent providing nurse follow-up throughout the week, 5% was spent discussing patients’ communication changes with SLP colleagues, and 5% was spent updating the communication strategies in the care plans.

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Discussion

This study demonstrates the effectiveness of the IP Communication Training Program to improve nursing staff outcomes and clinical practices that are crucial to care for patients with communication disorders secondary to stroke. Nurses reported using a more person-centered approach in relating to individuals with communication disorders; they felt less frustrated and more competent, confident, and comfortable with their scope of practice interacting with patients who have communication disorders. The intervention was unique as it provided a workshop and booster workshop consisting of linguistic and behavioral strategies to reinforce and improve nursing staff knowledge and attitudes. The content provided included how to apply individualized communication strategies that matched the needs of each patient, and then knowledge transfer was facilitated by ongoing SLP staff support that provided coaching and mentorship to nurses at the bedside for 1 year after the workshop. These study findings suggest the intervention was effective to produce clinically and statistically significant improvements in nurses’ attitudes toward, knowledge of, and behaviors related to communicating to patients with communication disorders.

Nurses felt that they were able to understand what the patient was communicating more often and reported that they were able to make the patient understand what they were communicating more frequently, despite the observations of nurse–patient dyads, indicating that nurses used approximately the same number of strategies before and after the training. This finding may mean that nurses were more efficient in identifying and carrying out the appropriate communication strategy per patient as a result of the training and ongoing support they received rather than attempting a number of ineffective strategies by trial and error. The two strategies that nurses consistently applied more in their practice (“using multiple modes of communication” and “announcing topic changes”) were critical to effective nurse–patient interactions. This is consistent with research that shows that training stroke unit staff can effectively alter communication behaviors, such as how staff asked questions (e.g., using yes/no vs. open-ended questions), using more gestures, and verifying patient responses after supported communication training (Horton et al., 2015). The value and benefit of communication education to nursing staff is highlighted by this finding. Furthermore, our study demonstrates that comprehensive education that combines communication with behavioral approaches delivered using adult learning principles can have a positive impact on nurses who care for patients with communication disorders in stroke rehabilitation. Future education programs for nurses working with patients with communication disorders may be more effective if specific, rather than generic, communication strategies are taught and practiced in education sessions. The goal is to support nurses’ use of appropriate communication strategies to meet the needs of the patients, not to encourage arbitrary and indiscriminate use of generic communication strategies. From a behavioral management perspective, nurses are able to reduce patient frustration and agitation with effective communication strategies. Comprehensive education programs can support nurses to incorporate targeted communication strategies for specific patients rather than trying several ineffective strategies that can aggravate patients with communication disorders.

The feedback from the nurse focus groups highlighted the critical role of ongoing SLP staff support to help them understand and apply communication strategies in their practice. Given the high demands nurses routinely face, nurses have difficulty applying what is learned in traditional didactic forms of training (Bowles et al., 2001) and often find it challenging to link communication disorder diagnoses and speech language strategies (Poslawsky, Schuurmans, Lindeman, & Hafsteinsdóttir, 2010). Implementation of SLP support at the bedside in the form of weekly discussions and one-to-one mentorship is an important requirement for knowledge translation of evidence-based practice to occur (Kitson, Harvey, & McCormack, 1998). Demonstrating strategies at the point of care is considered the ideal method to translate knowledge and change practice (Kitson et al., 1998), especially given the barrier of time (Horton et al., 2015). It is important to recognize the important role of the clinical context in supporting knowledge translation and practice change. Additional resources and expertise, such as SLPs, can help nurses translate knowledge about communication disorders and communication strategies into practice (Poslawsky et al., 2010) by providing nurses with the support they need to be able to change their practice and support more effective nurse–patient interactions. Future education programs for nurses about communication with stroke patients with communication disorders may be more effective if a SLP is involved. A practice implication may be for nurse educators and nurses to advocate for the implementation of formal means of collaboration between nurses and SLPs on the unit to support a sustained long-term practice change, perhaps in the form of huddles or communication care plans that can facilitate ongoing interdisciplinary patient care and optimize stroke rehabilitation.

The positive effect on nurses’ confidence in their communication abilities with patients with communication disorders was consistent with our pilot study results (McGilton et al., 2011). We believe that our promising results were influenced by two important variables. First, the SLP support system role was fulfilled by an SLP who was employed by the facility. As such, the nurses already had a preestablished rapport and were aware that the SLP’s office was located on the inpatient stroke unit next to the nursing station, which increased accessibility to the SLP. In addition, the SLP continued to consult with her SLP colleagues and was updated about patients’ communication changes. The SLP support would then inform the nurses, demonstrate communication strategies, as well as provide follow-up for any new strategies. Second, the “buy-in” from unit managers was critical to our positive outcomes. Leadership, institutional culture, and work environment are important factors in promoting successful outcomes related to staff translating communication skills when working with patients with aphasia (Simmons-Mackie et al., 2011). The managers in this study made workshop attendance mandatory for nurses and provided floor coverage so that the nurses could fully engage in the workshop material instead of being preoccupied with tasks that needed to be completed after the workshop. This suggests that future nursing education programs may be more effective if there is administrative support.

Some limitations of the study should be noted. First, the workshop was evaluated using a questionnaire that was not validated or standardized. Second, the nursing staff had access to five-unit SLPs, which may have influenced the amount of change pre- and postintervention, and therefore, there is potential for Type II error. This study took place in one rehabilitation facility, and the results may not be generalizable to other rehabilitation facilities. Future studies are needed to determine which components of nurse education and coaching are most effective for nurses working in various clinical settings. Lastly, more rigorous methods for assessing treatment fidelity are required.

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Key Practice Points

  • This was a quasi-experimental pre–post measure study examining the longitudinal effects of an Interprofessional (IP) Communication Training Program designed to improve nurses’ attitudes toward and knowledge about communication with patients who have communication disorders secondary to stroke.
  • The IP Communication Training Program consisted of a full-day workshop, a booster workshop, and on-going support from a speech language pathologist (SLP) on the unit for 1 year.
  • Nurses’ attitudes and knowledge improved 3 months after the workshop, and nurses knowledge continued to improve significantly whereas nurses’ attitudes continued to improve but not to a significant degree.
  • The results of the current study suggest the importance of providing nurses with education about communication and behavioral strategies with patients with communication disorders as well as ongoing SLP support on the unit. Education should be specific to individual patients being cared for by the nurse, to which the SLP support is able to provide hands-on demonstration, coaching, and problem solving in order to facilitate knowledge transfer into practice.
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Conclusions

Nurses working with patients with communication disorders poststroke can benefit from specialized speech language education that is focused on communication strategies with individual patients and from additional SLP support on the units who reinforced the education. This study demonstrates that an IP Communication Training Program can improve nurses’ attitudes toward, knowledge of, and use of effective strategies when caring for patients with communication disorders. These findings highlight the value of multicomponent interventions and IP collaboration to improve nurses’ practice in stroke rehabilitation inpatient settings.

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Ethical Approval

This study was approved by the Toronto Rehabilitation Institute Research Ethics Board (Reference Code TRI REB #09-009).

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Acknowledgments

We would like to acknowledge the contributions of all the nurses, speech language pathologists, and patients who participated in this research study.

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Funding

This studywas supported by an operating grant from the Canadian Institutes of Health Research (MOP-MOP 93790).

Conflict of interest: None declared.

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Keywords:

Communication disorders; evidence-based nursing; interdisciplinary communication; rehabilitation nursing

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