Person-centred care and communication disorders: Exploration and facilitation of conversational interaction involving people with acquired neurogenic communication disorders and health care providers

Abstract: Functional communication is a prerequisite for person-centred care. However, the presence of acquired neurogenic communication disorders makes the delivery of person-centred care challenging for health care providers and they must therefore depend on using supportive communicative strategies. Purposes: This thesis has three overall purposes: (1) To describe the experiences of communication in health care settings from the perspectives of people with acquired neurogenic communication disorders, enrolled nurses and medical students, (2) To explore the effects of two methods that are designed to facilitate communicative interaction in clinical practice, and (3) To investigate how the effects of intervention on conversational interaction may be evaluated using quantitative and qualitative methods. Methods: The thesis entails four studies. Study I is an interview study involving 8 enrolled nurses. Study II is an implementation study with multiple-case design using goal attainment measurements, questionnaire data and interviews. This study involves 32 enrolled nurses, 10 residents and 6 unit managers. Study III is an intervention study of 69 medical students (including 33 medical students in a reference group) in which outcomes are assessed using questionnaires, and observation and quantification of communicative strategies. Study IV is a methods study that uses quantitative coding systems and a qualitative analysis to explore a conversation between an enrolled nurse and a person suffering from dementia. Results: In study I, the enrolled nurses reported on their knowledge of several supportive communication strategies and their awareness of the importance of personal relationships with residents in facilitating interaction. However, factors in the environment were found to present barriers to communication. In study II, the success rate for implementation at each of the two nursing homes that were studied was moderate, and the motivation among staff to bring about changes differed. The enrolled nurses reported that they found communication with residents challenging while the residents felt that it worked well. In study III, the students reported that they experienced communicating with patients as challenging both before and after they had received training. However, the students’ knowledge and use of supportive communication strategies had increased to a statistically significant degree after the training workshop. In study IV, it was found that only one of the two coding systems used in the analysis identified issues besides those relating directly to facilitating strategies, while the qualitative analysis yielded important results that neither of the coding systems could provide. Conclusions: Enrolled nurses and medical students find communication with people who are suffering from communication disorders challenging, though they realise that they can play an important role in facilitating communication. However, the perspectives of enrolled nurses and medical students differed from that of the people suffering from the disorders. Interactive training of students as part of their basic education may help improve their knowledge and skills in practicing supportive communication. It was also found that factors, such as management, time allocation and staff continuity, are crucial for the successful implementation of communication routines in nursing homes. It is clear that there is a need for reliable and valid methods of assessing communicative interaction in person-centred care. Neglecting contextual factors in the analysis of interaction presents problems when used to assess person-centred communication.