Communication partner training for aged-care workers: A scoping review

BACKGROUND

In aged-care settings, direct care staff play a crucial role in supporting older people with communication needs. Many direct care staff, however, have unmet skill needs in interpersonal, intercultural, and intergenerational communication. Communication Partner Training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication needs encountered in aged-care settings. We sought to identify the key features of existing CPT programs to determine their suitability for the Australian aged-care context.

AIMS

To identify existing CPT programs relevant to aged-care settings and to describe their content and format.

METHODS

A scoping review was conducted in alignment with the Joanna Briggs Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Using a systematic search, we identified peer-reviewed articles from five electronic databases: PubMed, PsycINFO, Embase, Cochrane and CINAHL. All retrieved articles were screened by title and abstract; 20% were independently screened by a second reviewer. All full-text articles were independently assessed by two reviewers. Data describing the content and format of identified CPT programs was extracted using the Intervention Taxonomy and an author-developed tool.

MAIN CONTRIBUTION

This review highlights critical gaps in existing CPT programs for aged-care settings. Identified programs were predominantly disorder-specific (79%), with the vast majority focusing on conditions like dementia or aphasia and failing to address broader communication needs arising from personal, social and environmental factors. Notably, no programs addressed intercultural communication, despite known cultural and linguistic diversity among aged-care workers and recipients in countries such as Australia. Furthermore, few (9%) included intergenerational communication considerations. Most programs relied on in-person delivery methods (67%), often led by health professionals (71%), which may be impractical for resource-constrained and geographically dispersed aged-care services. Furthermore, reported outcome measures varied (187 across 90 articles), and few evaluated both trainee and client (the 'dyad') outcomes. These findings underscore the need for comprehensive, scalable and contextually relevant CPT programs to address the complex communication challenges seen in aged-care settings.

CONCLUSIONS

There is a need for a comprehensive CPT program that is fit-for-purpose for direct care staff in aged-care settings. This program should address the multifaceted and intersecting communication support needs of aged-care recipients, including intercultural and intergenerational communication differences. The program should also incorporate resource-feasible delivery methods and evaluate dyadic communication outcomes. Closing these gaps is vital to enhancing quality of care and life for older adults in aged-care settings.

WHAT THIS PAPER ADDS

What is already known on the subject Many older Australians have complex, unmet communication support needs. In aged-care settings, direct care staff play a crucial role in supporting older people to communicate. Many aged-care workers, however, have their own unmet skill needs in interpersonal, intercultural and intergenerational communication. Communication partner training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication support needs encountered in aged-care settings. What this paper adds to existing knowledge Using a scoping review methodology, we identified and described CPT programs for direct support staff who work with older adults. Most CPT programs were disorder-specific and targeted communication needs in dementia or aphasia. As aged-care recipients have multifaceted, complex and intersecting communication support needs, these programs may fall short of addressing the training needs of aged-care workers. The mode of training delivery was predominately in-person and health professional-led. Such delivery modes may not support implementation given resource constraints across the Australian aged-care sector. CPT that can be feasibly implemented in aged-care settings to address complex and intersecting communication support needs is required. What are the potential or actual clinical implications of this work? Our analysis highlights the need for comprehensive, disorder-agnostic CPT tailored for aged-care staff to address diverse communication support needs. This CPT should consider scalable delivery modes effective across Australia's vast geography and limited trainer availability. It must include outcome measures reflecting the perspectives of communication support partners-older Australians in aged care with communication challenges. To tackle the health, personal and environmental communication barriers in aged care, a fit-for-purpose CPT program, co-designed with key stakeholders, is essential to ensure the training is both feasible and acceptable to meet the unmet needs of intended end-users.

The role of the healthcare assistant on a stroke unit: A scoping review

OBJECTIVE

This scoping review explores the role of a healthcare assistant on a stroke unit, potential barriers to role fulfilment and whether stroke-specific training could enhance rehabilitative practice.

DATA SOURCES

Searches were conducted on CINAHL, MEDLINE and APA PsycInfo in May 2021 and repeated in September 2022.

METHODS

This scoping review was guided by Arksey and O'Malley's framework. Article selection and data extraction were conducted by one researcher using a structured proforma. A narrative approach to data synthesis was undertaken following the research questions.

RESULTS

From a combined total of 533 articles, sixty-six full-text articles were assessed for eligibility. Sixteen full articles were included in this review. A healthcare assistants' role was viewed as caring directly for patients - some individuals felt they contributed to rehabilitation during these tasks, and that they could be undervalued by multidisciplinary team members, patients and their families. The barriers identified to healthcare assistants' role fulfilment were lack of time, training and staffing shortages. Training was perceived to improve healthcare assistants' communication, confidence and knowledge but training needed to be flexible, ward based and accommodate staffing shortages. However, it is unclear whether training has any clinical benefit for patients.

CONCLUSION

Healthcare assistants are well placed to enhance rehabilitative practice with patients; however, there are clear perceived barriers to this occurring. Future research should aim to define the role of healthcare assistants and explore whether further stroke-specific training could cause clinical benefits for patients.

Paid worker and unfamiliar partner communication training: A scoping review

BACKGROUND

Communication partner training could be employed to train people working in the community to facilitate interaction with individuals who live with a variety of communication disorders. However, current evidence syntheses are limited to a single disorder (e.g., aphasia) and focus on a variety of familiar and unfamiliar communication partners. An understanding of the scope of literature across the evidence-base of acquired neurological populations may provide a better basis to develop interventions and future research tailored for community workers.

AIMS

To explore the scope of literature on paid worker and unfamiliar partner communication training for acquired neurogenic communication disorders with a focus on describing: 1) the types of communication disorders addressed by interventions; 2) the types of learners who received the interventions; 3) the nature of the interventions; and 4) the reported effects on trainees and people with a communication disorder.

METHODS & PROCEDURES

A scoping review was conducted. Studies were selected by a systematic keyword search, undertaken through four databases. Eligibility criteria included studies that: (i) reported an intervention directed at paid workers or unfamiliar partners where the primary goal was to improve communication with people with acquired neurogenic communication disorders, (ii) reported original results, (iii) contained quantitative or qualitative data on the effects of the intervention, (iv) were written in English or French and (v) were published in a peer-reviewed journal. The PRISMA-ScR was used to guide design and reporting of the scoping review.

RESULTS

Seventy publications met the inclusion criteria. Interventions were mostly disorder-specific and addressed communication with people with dementia, aphasia or traumatic brain injury. 15/70 studies examined training programs that were not restructured to a specific population (e.g., aphasia). Learners were mostly working or studying in the healthcare field and only 2/70 studies included community workers without primarily health training. Sixty different interventions were reported and were mostly delivered by speech-language pathologists. Training varied in terms of duration (a few minutes to 46 h) and content, but many shared training methods (e.g., presentation of theory on communication disorders). Nearly all studies demonstrated positive results, 23/26 studies suggested that paid worker and unfamiliar partner communication training may increase the knowledge of trainees, 24/26 studies suggested that it could improve their confidence when interacting with people with a communication disorder and 44/46 studies suggested that it could improve the trainees' communication abilities.

CONCLUSION

A small developing evidence-base exists for communication training programs for paid and unfamiliar communications partners that focuses beyond a single diagnosis or disorder. However, there is very limited knowledge on interventions for community workers from non-health professions. Future research should focus on the evaluation of existing programs tailored to, or explicitly designed for this context with the aim of identifying active ingredients that lead to improved and sustainable outcomes.

Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators

BACKGROUND

Communication partners (CPs) find it challenging to communicate with people with communication disorders post-stroke. Stroke communication partner training (CPT) can enhance CPs' ability to support the communication and participation of people post-stroke. While evidence for the efficacy of aphasia-based CPT is strong, implementation in healthcare settings is unclear.

AIMS

To investigate Australian speech pathologists' current stroke CPT practices, factors influencing the implementation of CPT and how reported practice compares with the research evidence.

METHODS & PROCEDURES

Speech pathologists in Australia who had worked with people post-stroke were invited to complete a 99-item online survey. The survey was informed by a comprehensive review of the literature review, the Template for Intervention Description and Replication (TIDieR) intervention taxonomy, and the theoretical domains framework. data were analyzed using descriptive statistics and content analysis.

OUTCOMES & RESULTS

A total of 122 clinicians were surveyed. Most participants reported providing CPT to treat a range of post-stroke communication disorders. While 98.3% reported training familiar CPs, only 66.1% reported training unfamiliar CPs. Current stroke CPT practice is characterized by one to two < 1 h sessions of informal face-to-face education and skills training. Only 13.3% and 10.0% of participants used evidence-based published programmes with unfamiliar and familiar CPs respectively. The main barriers included the perceived lack of behavioural regulation, skills, reinforcement, beliefs about consequences, positive social influences and resources. The main facilitators included clinicians' intentions to provide CPT, perception of CPT as part of their role and perceived compatibility of CPT with clinical practice.

CONCLUSION & IMPLICATIONS

A significant evidence-practice gap exists. Research exploring the implementation of stroke CPT in healthcare settings, expanding evidence to support CPT for the range of post-stroke communication disorders, developing freely accessible step-by-step CPT programmes that consider restrictions in current practice and providing explicit instructions of CPT best practice are warranted. A supportive workplace culture and freely accessible formal training opportunities are also needed.