Interaction between Nursing Staff and Residents with Aphasia in Long-Term Care: A Mixed Method Case Study

Quality in care homes: How wearable devices and social network analysis might help

Social network analysis can support quality improvement in care homes but traditional approaches to social network analysis are not always feasible in care homes. Recalling contacts and movements in a home is difficult for residents and staff and documentary and other sources of individual contacts can be unreliable. Bluetooth enabled wearable devices are a potential means of generating reliable, trustworthy, social network data in care home communities. In this paper, we explore the empirical, theoretical and real-world potential and difficulties in using Bluetooth enabled wearables with residents and staff in care homes for quality improvement. We demonstrate, for the first time, that a relatively simple system built around the Internet of Things, Bluetooth enabled wearables for residents and staff and passive location devices (the CONTACT intervention) can capture social networks and data in homes, enabling social network analysis, measures, statistics and visualisations. Unexpected variations in social network measures and patterns are surfaced, alongside "uncomfortable" information concerning staff time spent with residents. We show how technology might also help identify those most in need of social contact in a home. The possibilities of technology-enabled social network analysis must be balanced against the implementation-related challenges associated with introducing innovations in complex social systems such as care homes. Behavioural challenges notwithstanding, we argue that armed with social network information, care home staff could better tailor, plan and evaluate the effects of quality improvement with the sub-communities that make up a care home community.

The association between patient engagement and quality of care interactions among acute care patients with dementia

Effective staff-patient communication is critical in acute care settings, particularly for patients with dementia. Limited work has examined the impact of quality of staff-patient care interactions on patient engagement. The purpose of this study was to determine whether the quality of staff-patient care interactions were associated with active patient engagement during the interaction after controlling for relevant covariates. The study was a secondary data analysis using baseline data from the Function Focused Care for Acute Care intervention study, with a total sample of 286 patients. Descriptive statistics and a generalized linear mixed model were used. The findings indicated that there was a significant relationship between the quality of care interactions and patient engagement such that receiving positive care interactions resulted in higher odds of active patient engagement. These findings can inform future interventions and training for acute care staff to improve quality of care interactions and patient engagement.

Social interactions and quality of life of residents in aged care facilities: A multi-methods study

Background

The relationship between social contact and quality of life is well-established within the general population. However, limited data exist about the extent of social interactions in residential aged care facilities (RACFs) providing long-term accommodation and care. We aimed to record the frequency and duration of interpersonal interactions among residents in RACFs and identify the association between residents’ interpersonal interactions and quality of life (QoL).

Materials and methods

A multi-methods study, including time and motion observations and a QoL survey, was conducted between September 2019 to January 2020. Thirty-nine residents from six Australian RACFs were observed between 09:30–17:30 on weekdays. Observations included residents’ actions, location of the action, and who the resident was with during the action. At the end of the observation period, residents completed a QoL survey. The proportion of time residents spent on different actions, in which location, and with whom were calculated, and correlations between these factors and QoL were analysed.

Results

A total of 312 hours of observations were conducted. Residents spent the greatest proportion of time in their own room (45.2%, 95%CI 40.7–49.8), alone (47.9%, 95%CI 43.0–52.7) and being inactive (25.6%, 95%CI 22.5–28.7). Residents were also largely engaged in interpersonal communication (20.2%, 95%CI 17.9–22.5) and self-initiated or scheduled events (20.5%, 95%CI 18.0–23.0). Residents’ interpersonal communication was most likely to occur in the common area (29.3%, 95%CI 22.9–35.7), residents’ own room (26.7%, 95%CI 21.0–32.4) or the dining room (24.6%, 95%CI 18.9–30.2), and was most likely with another resident (54.8%, 95%CI 45.7–64.2). Quality of life scores were low (median = 0.68, IQR = 0.54–0.76). Amount of time spent with other residents was positively correlated with QoL (r = 0.39, p = 0.02), whilst amount of time spent with facility staff was negatively correlated with QoL (r = -0.45, p = 0.008).

Discussion and conclusions

Our findings confirm an established association between social interactions and improved QoL. Opportunities and activities which encourage residents to engage throughout the day in common facility areas can support resident wellbeing.

Collaborative talk in healthcare interactions between students and people with aphasia

BACKGROUND

People with language impairments are at a higher risk of receiving inappropriate or inadequate healthcare, often stemming from ineffective exchanges between patients and healthcare professionals. This study explores a possible factor in such exchanges: the use of collaborative forms of talk in interaction with people with aphasia.

AIMS

To investigate if and how collaborative forms of talk are used as a conversational resource in healthcare interactions by students and their effects on the acquisition of information from the patient.

METHODS & PROCEDURES

The transcripts of two simulated healthcare interactions between a man with aphasia and two students (i.e., a nursing student and a speech-language pathology student) were analysed through conversation analysis. The analysis aimed to locate instances of collaborative forms of talk, which included joint productions, acknowledgement tokens, reframing of questions, gesture, laughter and engagement with alternative communication methods. The analysis also tracked the progressivity of the interactions and information checking.

OUTCOMES & RESULTS

The students engaged in a range of collaborative forms of talk, which aided the person with aphasia to participate more fully in conversation. However, some issues arose with progressivity, topic continuity and checking for understanding when turns were left incomplete, no candidate understandings were provided or no repair or joint production sequences were initiated. These occurrences may increase the possibility of misunderstandings or loss of important information.

CONCLUSIONS & IMPLICATIONS

Communication training should include conversational strategies that help to promote collaboration, focusing on enhancing the ability to perceive, and attend to collaboration requests. Training also should help trainees to find ways to frequently check understanding.

WHAT THIS PAPER ADDS

What is already known on the subject People with language impairments, including those with aphasia, face important challenges when communicating with healthcare professionals and are often at risk of receiving inadequate care as a consequence. While it is known that some of the causes of such communicative issues may be tied to limited time availability on the part of healthcare professionals, the exclusion of spouses from interactions, and lack of communication training, it remains unclear whether these issues influence the use of collaborative forms of talk on the part of providers in interaction with people with aphasia. What this paper adds to existing knowledge Healthcare students seemed to be able to engage in a variety of collaborative forms of talk even without formal communication training. However, some issues arose with progressivity, topic continuity and checking for understanding when turns were left incomplete, no candidate understandings were provided, or no repair or joint production sequences were initiated. These occurrences may increase the possibility of misunderstandings or loss of important information in these crucial interactions. Influencing factors may include the nature of institutional interactions, speaker unfamiliarity, concerns about speaking for patients and lack of training. What are the potential or actual clinical implications of this work? Potential clinical implications for communication training include the need to implement modules or activities which increase trainees' ability to perceive and attend to collaboration requests (i.e., pauses, gestures, gaze, etc.) and to frequently check understanding.

Experiences of Social Distancing During Coronavirus Disease 2019 as a Catalyst for Changing Long-Term Care Culture

Purpose In this article, we draw a parallel between the experience of social isolation that occurred throughout the world during the Coronavirus Disease 2019 pandemic and similar experiences occurring in everyday life for people with communication disorders living in long-term care (LTC) facilities. We propose that speech-language pathologists can use the widespread experience of social isolation as a learning catalyst in the effort to shift the LTC culture to one that more highly values a communicative environment that is accessible to all, thereby reducing risk of social isolation for those with communication disorders. Conclusions Many training paradigms for promoting an accessible communicative environment are available in the speech-language pathology literature, yet institutional barriers exist for their widespread implementation. Overcoming these barriers is a challenge that requires awareness and learning on the part of staff and administration regarding the impact of an unfriendly communicative environment on social isolation, and the resulting psychosocial consequences. Learning theory indicates that new learning in adults is motivated by connections between personal experiences and the material to be learned. Explicitly infusing established training programs with the experience of social isolation brought on by the Coronavirus Disease 2019 pandemic may be the key needed for changing the communicative environment in LTC.

Clinical Practice Recommendations for Improving Life Participation for People With Aphasia in Long-Term Care

Purpose

The purpose of this clinical focus article is to present an overview of the Life Participation Approach to Aphasia as it relates to issues in long-term care (LTC) and provide practical recommendations for implementing the approach in this setting. The Framework for Living With Aphasia is used as a guide to (a) highlight specific challenges to life participation for residents with aphasia in LTC and (b) propose clinical tools that might help clinicians move through the therapeutic process when implementing the Life Participation Approach to Aphasia.

Recommendations

Clinicians in LTC facilities have the responsibility of delivering services that have a positive impact on communication, social relationships, emotional health, and quality of life. Clinical tools and approaches most appropriate for LTC settings are identified that help to address these goals. Approaches are discussed across several stages representing the therapeutic process, which is ultimately aimed at moving a resident toward recovery and increased independence. Case demonstrations are provided to illustrate approaches.