JCPSLP Vol 18 no 2 2016

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National Disability Insurance Scheme
JCPSLP Volume 18, Number 2 2016 89
KEYWORDS
APHASIA
COMMUNICA-
TION PARTNER
TRAINING
HOSPITAL
NURSES
ONLINE
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Kathryn
McKinley (top)
and Robyn
O’Halloran
impairment(s), as well as the number and type of barriers
to communication in the health care environment. A
2012 meta-synthesis identified a range of environmental
factors that influence health care communication. These
related to the individual health care provider, such as the
provider’s knowledge and attitude, and hospital processes,
such as opportunities for communicating (O’Halloran,
Grohn, & Worrall, 2012). The lack of knowledge and skills
of the communication partner has also been cited as a
communication barrier specifically for people with aphasia
(Parr, Byng, Gilpin, & Ireland, 1997). An observational study
by Hersh, Godecke, Armstrong, Ciccone, and Bernhardt
(2014) suggests that the lack of knowledge and skills of the
communication partner continues to be barrier for patients
with aphasia in hospital. In their study, three inpatients, two
of whom had aphasia, were videorecorded continuously
for 7.5 hours. The two patients with aphasia had few
opportunities to engage in conversation with nursing staff
and the nurses employed very few conversation strategies
to support communication with them.
Communication partner training (CPT) is a proven
intervention that focuses on enhancing the knowledge and
skills of the communication partner in order to support
the person with aphasia to participate in conversation
more successfully (Simmons-Mackie, Raymer, Armstrong,
Holland, & Cherney, 2010). CPT has also been extended
to support communication with people with a range of
different communication disabilities. Simmons-Mackie
(2014) describes four levels of CPT training. The aim of
level 1 training is to raise the awareness of communication
partners about aphasia, how aphasia can impact on
communication, and how communication support can help
the person with aphasia communicate. Level 2 training aims
to build awareness plus provide communication partners
with strategies to facilitate communication in a specific
activity, such as teaching a doctor how to use strategies
to facilitate taking a medical history. Level 3 training builds
on level 2 training and aims to develop the person’s skills
in facilitating communication across a variety of situations
using a range of different supports and resources.
Finally, level 4 training is directed towards teaching the
communication partner how to train others.
CPT is needed at all levels and while CPT may be
necessary for health care providers, it may not be sufficient
in the hospital setting to ensure communicative access
for people with aphasia (see Simmons-Mackie, Kagan,
O’Neill Christie, Huijbregts, McEwen, & Willems, 2007).
However, level 1 training that aims to raise awareness
Communication partner training improves the
communication skills of conversation
partners of people with aphasia. Health care
providers who work nightshifts or on
weekends may not be able to access this
training. This study investigated if an online
education program was associated with
improved nursing knowledge of
communication strategies and improved
perceived knowledge and confidence when
communicating with patients with aphasia.
This mixed method study found that an online
education program significantly increased
nurses’ perceived knowledge about aphasia,
knowledge of communication strategies, and
perceived confidence communicating with
patients with aphasia. Further research is
needed to determine the effects of this
training on interactions with patients.
Effective health care communication between
patients and health care providers is a central tenet
of patient-centred care (Bensing, Verhaak, van
Dulmen, & Visser, 2000), and has been linked directly and
indirectly to a range of positive health outcomes such as
improved pain control, increased functional ability, and
emotional well-being (Street, Makoul, Arora, & Epstein,
2009). Yet many patients with communication disabilities
and their health care providers are unable to communicate
effectively. Approximately half of all patients observed
communicating with health care providers in acute stroke
units were unable to communicate their typical health care
needs (O’Halloran, Worrall, & Hickson, 2012). When asked,
patients with communication disabilities describe a range of
communication difficulties such as “difficulty remembering
what to say, not being understood, feeling the doctor did
not believe them, being rushed, and not following what
the doctor said” (Murphy, 2006, p. 55). The inability to
effectively communicate puts patients with communication
disabilities at risk of a range of poor health outcomes
including misdiagnosis (Hines, 2000), preventable adverse
events (Hemsley, Werninck, & Worrall, 2013), inadequate
pain relief and even death (Mencap, 2007).
Being unable to communicate effectively may be due in
part to the nature and severity of a person’s communication
Communication partner
training for nurses
A pilot study of an online learning program
Kathryn McKinley and Robyn O’Halloran