ORI GI NAL R ESEARCH Nursing the patient with cop!e" counication nee#s$ tie as a %arrier an# a &aci!itator to success&u! counication in hospita! 'ronw(n Hes!e() Susan 'a!an#in * Lin#a +orra!! Accepte# &or pu%!ication ,- .arch /0,, Correspon#ence to '1 Hes!e($ e2ai!$ %1hes!e(3 u 41e#u1au 'ronw(n Hes!e( 5hD Certi&ie# 5ractising Speech 5atho!ogist) Registere# 67LD8 NH.RC 5ost#octora! Fe!!ow Counication Disa%i!it( Centre) Uni9ersit( o& 7ueens!an#) 'ris%ane) Austra!ia Susan 'a!an#in 5hD Fe!!ow o& Speech 5atho!og( Austra!ia 5ro&essor Schoo! o& Socia! +or:) Uni9ersit( Co!!ege) .o!#e) Norwa( Lin#a +orra!! 5hD Fe!!ow o& Speech 5atho!og( Austra!ia 5ro&essor Counication Disa%i!it( Centre) Uni9ersit( o& 7ueens!an#) 'ris%ane) Austra!ia H E .S LE ; ' 1 ) ' A L A N D I N S1 * + O R RAL L L 1 6 / 0 ,/8 Nursing the patient with cop!e" counication nee#s$ tie as a %arrier an# a &aci!itator to success&u! counication in hospita!1 Journa! o& A#9ance# Nursing <=6,8) ,,<>,/<1 #oi$ ,01,,,,?@1,A<B2/<C=1/0,,10BD//1" A%stract 'ac:groun#1 E&&ecti9e nurse>patient counication is an essentia! aspect o& hea!th care1 Eie to counicate) howe9er) is !iite# an# su%@ect to wor:!oa# #ean#s1 Litt!e is :nown a%out how nurses anage this F!ac: o& tieG when caring &or patients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s) who t(pica!!( counicate at a s!ow rate1 Ai1 Ehe ai o& this stu#( was to in9estigate nursesG e"presse# concepts o& FtieG in stories a%out counicating with patients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s in hospita!1 .etho#1 In /00-) ,B hospita! nurses &ro a range o& war#s in two etropo!itan hospita!s participate# in inter9iews a%out %arriers to an# strategies &or success&u! counication with patients with #e9e!openta! #isa%i!it( an# cop!e" cou2 nication nee#s in hospita!1 Ehe #ata were ana!(se# using narrati9e in4uir( eth2 o#o!og( an# the stories 9eri&ie# with the participants1 Resu!ts1 Nurses i#enti&ie# FtieG as a %arrier an# a &aci!itator to success&u! co2 unication1 Eie as a %arrier was re!ate# theatica!!( to a9oi#ing #irect cou2 nication an# pre&erring that &ai!( or pai# carers counicate# on %eha!& o& the patient1 Eie as a &aci!itator was re!ate# to 9a!uing counication) in9esting e"tra tie) an# to app!(ing a range o& a#apti9e counication strategies to esta%!ish success&u! counication1 Conc!usions1 Eie is percei9e# %( nurses as %oth an ene( an# &rien# &or ipro9ing counication1 Nurses who percei9e that counication ta:es too !ong a( a9oi# counication an# iss opportunities to ipro9e counication through increase# &ai!iarit( with the personGs counication etho#s1 Ehose who ta:e tie to counicate narrate app!(ing a range o& strategies to achie9e success in %asic nee#s counication1 He(wor#s$ cop!e" counication nee#s) #e9e!openta! #isa%i!it() hospita!) nurses) tie %arrier ,,< /0,, '!ac:we!! 5u%!ishing Lt# JAN$ ORIGINAL RESEARCH FEieG an# counication in hospita! Intro#uction E&&ecti9e counication is the Fcornerstone o& the nurse> patient re!ationshipG 6She!#on et a!1 /00<) p1 ,C,8 an# 9ita! to the pro9ision o& goo# care to patients in a hospita! 6+atson ,--=) .en#es et a!1 ,---81 Howe9er) counication in hospita! is pro%!eatic &or peop!e with #e9e!openta! #is2 a%i!it( 6DD8 an# !itt!e or no &unctiona! speech or cop!e" counication nee#s 6CCN8 6'a!an#in et a!1 /00D8 an# the nurses who care &or the 6Hes!e( et a!1 /00,81 5eop!e with CCN ha9e Fa wi#e range o& ph(sica!) sensor( an# en9iron2 enta! causes which restrict?!iit their a%i!it( to participate in#epen#ent!( in societ(G 6'a!an#in /00/) p1 /8) an# a( %ene&it &ro using A!ternati9e or Augentati9e Counica2 tion 6AAC8 6i1e1 counication %oar#s) gesture or signing s(s2 tes) interpreters) or speech generating #e9ices8 6'eu:e!an * .iren#a /00B81 Furtherore) peop!e with DD are ore 9u!nera%!e to hea!th con#itions that !ea# to hospita! a#ission 6'eange et a!1 ,--B) Lenno" * Herr ,--D) ;oung et a!1 /00B8 an# enter hospita! up to si" ties ore &re4uent!( an# with signi&icant!( !onger hospita! sta(s than age2atche# peers without #isa%i!it( 6;oung et a!1 /00D81 A!though an( o& these a#u!ts re!( upon their parents to gi9e %asic care an# support in counication 6'a!an#in et a!1 /00D) Hes!e( et a!1 /00D) /00=a) /00=c8) their &ai!( carers are ageing an# wi!! not a!wa(s %e a%!e to gi9e such care 6Hes!e( et a!1 /00D) /00=%81 Signi&icant!() counication #isa%i!it( in patients is associate# with increase# ris: &or pre9enta%!e an# u!tip!e a#9erse e9ents in hospita! 6'art!ett et a!1 /00=81 It is iper2 ati9e) there&ore) to in9estigate the #(naics o& counicati9e interaction in hospita!) to in&or appropriate inter9entions that wi!! ipro9e nurse>patient counication in hospita! an# ipro9e the care o& patients who e"perience couni2 cation pro%!es associate# with DD an# CCN1 F!eischer et a!1 6/00-8 note# that the purpose o& cou2 nication within nurse>patient interaction is to in&!uence the patientGs hea!th or we!!2%eing) an# that this ta:es p!ace through the a!!ocation o& ro!es an# use o& #i&&erent registers in counication1 Furtherore) in a hospita! war#) nurse> patient counication happene# F#uring other inter9ention an# tas:sG 6p1 AA-8) an# success re!ie# upon pro9i#er) patient) en9ironenta! an# situationa! 9aria%!es 6see a!so 'eu:e!an * .iren#a /00B) She!#on et a!1 /00<) OGHa!!oran et a!1 /00=) /0,,81 Fin:e et a!1 6/00=8 re9iewe# a growing %o#( o& research on counicating with hospita! patients with CCN) an# conc!u#e# that e&&ecti9e counication with patients with CCN in hospita! #ean#s the app!ication o& a range o& strategies) inc!u#ing 6a8 esta%!ishing a o#e o& counica2 tion 6&or (es?no an# other etho#s8) 6%8 pausing an# a!!owing tie &or the patient to respon#) 6c8 con&iring the patientGs essage an# 6#8 using AAC strategies to support un#erstan#2 ing 6Fin:e et a!1 /00=81 A!! o& these strategies are !i:e!( to in9o!9e nurses in spen#ing ore tie counicating than the( wou!# use when interacting with natura! spea:ers1 Ne9erthe!ess) it is on!( the use o& AAC that is an a##itiona! strateg( to a nurseGs goo# counication with a!! patients 6She!#on et a!1 /00<81 Fin:e et a!1 6/00=8 conc!u#e# that nurses nee#e# training an# support in the use o& AAC) an# that ore in&oration is nee#e# a%out nurse>patient inter2 action to a##ress the #i&&icu!ties e"perience# %( patients with CCN1 Recent!() Ee@ero 6/0,08 o%ser9e# nurses interacting with patients to easure engageent an# %on#ing) an# &oun# that interactions o& !onger #uration resu!te# in signi&icant!( higher !e9e!s o& %on#ing an# a!!owe# &or ore Fin&oration) inter9entions an# interpersona! e"changeG to occur 6Ee@ero /0,0) p1 <,,81 Con9erse!() when nurses #iscuss %arriers to e&&ecti9e counication with patients) insu&&icient tie an# wor:!oa# #ean#s are 9iewe# as ipe#ing the nurse>patient re!ationship 6e1g1 5ar: * Song /00B) 'ec:stran# et a!1 /00<) .agnus * Eur:ington /00<81 OGHa!!oran et a!1 6/00=8 re9iewe# the !iterature on en9ironenta! &actors ipacting on counication with patients with counication #is2 a%i!it( accor#ing to the Internationa! C!assi&ication o& Func2 tioning) Disa%i!it( an# Hea!th 6ICFI +HO /00,8) an# c!assi&ie# FtieG as a F%arrierG to e&&ecti9e counication in two #oains o& the ICF$ Fser9ice s(ste an# po!ic(G an# Fattitu#esG1 Howe9er) no research to #ate has e"aine# how nurses ight 9iew tie as a &aci!itator to e&&ecti9e cou2 nication in hospita! with patients) with counication #isa%i!it(1 It is not uncoon &or nurses to 9iew hea9( wor:!oa# an# har# nursing tas:s as the ain %arriers to counicating with patients 65ar: * Song /00B) Anoosheh et a!1 /00-81 Despite tie !iitations e"perience# %( nurses) there is soe e9i#ence to suggest that nurses 6a8 ip!eent a range o& tie anageent strategies in response to this) inc!u#ing the routiniJation an# prioritiJation o& tas:s 6+aterworth /00A8) 6%8 are a#ept at a#@usting their interactions to suit the a9ai!a%!e tie) an# 6c8 are a%!e to anage their wor:!oa# whi!e counicating with patients in the tie a9ai!a%!e 6'arrere /00D81 In a #iscourse ana!(sis o& interactions %etween patients an# nurses in hospita!) 'arrere 6/00D8 i#enti&ie# that hospita! nurses counicate with patients in %rie& e"changes aroun# the #ai!( tas:s o& nursing1 Such interactions are e&&ecti9e an# can he!p esta%!ish positi9e nurse>patient interactions 6Hagert( * 5atus:( /00A81 Encouraging nurses to ta:e a ore positi9e approach to tie &or counication) the authors conc!u#e# that) Finstea# o& &ee!ing #iscourage# %ecause o& tie constraints) nurses can /0,, '!ac:we!! 5u%!ishing Lt# ,,D '1 Hes!e( et a!1 9iew their %rie& interactions as positi9e an# potentia!!( e&&ecti9eG 6Hagert( * 5atus:( /00A) p1 ,C-81 Howe9er) the patients with DD an# CCN a( %e #isa#9antage# in %rie& interactions %( the increase# tie it ta:es &or the to counicate essages using AAC copare# to those who use natura! speech 6'eu:e!an * .iren#a /00B81 IeJJoni et a!1 note# that patients with counication #isa%i!it( were ore !i:e!( than other patients to %e #issatis&ie# with the aount o& tie spent #iscussing their pro%!es an# answering 4uestions 6IeJJoni et a!1 /00A) /00C81 ;et it is not :nown how the co%ina2 tion o& 6a8 %rie& nurse>patient interactions an# 6%8 the patientsG nee# &or increase# tie to counicate) ipacts on nursesG counication with patients with DD1 A!though nurses cite F!ac: o& tieG as a %arrier to counicate with a!! patients) it is not :nown how nursesG perceptions o& tie ight ipact upon their counication strategies in #ai!( care situations) i& the( use a#apti9e strategies) an# i& the( 9iew such strategies as tie e&&icient in caring &or patients1 Ehe ai o& this stu#( was to e"aine nursesG perceptions o& FtieG as a %arrier to or &aci!itator &or e&&ecti9e couni2 cation in interactions with hospita! patients with DD an# CCN1 .etho# Ehe stu#( was appro9e# %( the huan research ethics coittees o& the Uni9ersit( o& 7ueens!an# an# participating hospita!s an# #isa%i!it( organiJations1 5articipants In /00-) ,B hospita! nurses were recruite# through Nurse Unit .anagers in two etropo!itan hospita!s in 'ris%ane) Austra!ia1 5urposi9e sap!ing was use# to gain a wi#e 9ariet( o& perspecti9es &ro nurses across two #i&&erent hospita! settings an# si" #i&&erent war# t(pes1 Criteria &or inc!usion inc!u#e# ha9ing counicate# with at !east three patients with DD an# CCN in the past / (ears1 5articipantsG (ears o& e"perience in nursing range# &ro , to A0 (ears 6a9erage ,C (ears81 Inter9iew topic gui#e In consu!tation with an e"pert re&erence group 6consisting o& a speech patho!ogist wor:ing with a#u!ts with inte!!ectua! #isa%i!it() a speech patho!ogist wor:ing with a#u!ts with cere%ra! pa!s() an a#u!t with cere%ra! pa!s( who ha# %een hospita!iJe# in the past / (ears) a &ai!( carer) a #isa%i!it( support wor:er) a #isa%i!it( !iaison nurse an# a hospita! nurse8 a topic gui#e was #e9e!ope# to ai# consistenc( across inter9iews1 Eopics inc!u#e# the nurseGs counication e"periences with these patients) the nurseGs ro!e in supporting counication with these patients) the ro!e o& pai# or &ai!( carers) the patientGs counication nee#s) %arriers to an# strategies &or counication) an# etho#s &or e"changing patient2re!ate# in&oration1 Con#uct o& the inter9iews Ehe &irst author con#ucte# a con9ersationa!2st(!e in2#epth inter9iew with each participant in a 4uiet area at the participantGs wor:p!ace1 Inter9iews coence# with the 4uestion) FCan (ou te!! e a%out (our e"periences in caring &or a#u!ts with #e9e!openta! #isa%i!it( an# cop!e" co2 unication nee#s in hospita!KG In :eeping with narrati9e in4uir( etho#o!og() the inter9iewer encourage# partici2 pants to #escri%e situations an# e9ents to i!!ustrate their responses to 4uestions 6Riessan ,--A81 Inter9iews !aste# &ro /0 to CB inutes with an a9erage o& A0 inutes1 A!! inter9iews were au#io recor#e#1 Ie#iate!( &o!!owing each inter9iew the &irst author a#e &ie!# notes on the inter9iew) transcri%e# the recor#ing 9er%ati an# #e2i#enti&ie# the inter9iew transcripts1 In this wa() procee#ing inter9iews contri%ute# to a constant coparati9e ana!(sis o& the #ata 6Ea(!or * 'o#gan ,--=81 Narrati9e ana!(sis Ehe authors con#ucte# a narrati9e ana!(sis 6Riessan ,--A) 5o!:inghorne ,--B8) !ocating stories within the participantsG accounts %( a structura! ana!(sis) then a content ana!(sis o& the stor( p!ots an# thees 6Riessan ,--A) 5o!:inghorne ,--B81 Ehe &irst author then wrote an o9era!! interpreti9e Fsuar( stor(G o& each participantGs account encapsu!ating the e9ents an# the stor( p!ot an# thees1 5articipants were sent their own suar( stories an# in9ite# to chec: the #ocuent an# 9eri&() change) or a## an( in&oration or &urther insights1 A!! participants 9eri&ie# that the suar( stories re&!ecte# their 9iews an# none #ispute# the research2 erGs interpretations1 One re4ueste# a inor change to c!ari&( her state# ro!e on the war# which was cop!ete# an# appro9e#1 Fo!!owing the ana!(sis o& stories across a!! partic2 ipants) se9en o& the nurses were inter9iewe# a secon# tie on the %asis o& their #i9ergence o& 9iews to chec: on the authorsG interpretations across inter9iews an# to gain &urther insights an# con&iring &in#ings1 Fo!!ow2up inter9iews) !asting on a9erage ,B inutes 6range ,0>/0 inutes8 were con#ucte# on the phone an# au#io recor#e#) #e2i#enti&ie#) transcri%e# an# inc!u#e# in !ater ana!(sis1 Ehe three authors #iscusse# the ,,= /0,, '!ac:we!! 5u%!ishing Lt# JAN$ ORIGINAL RESEARCH FEieG an# counication in hospita! resu!ting narrati9es across a!! inter9iews to i#enti&( the coon narrati9e thees across the participants1 FEieG was a coon thee across a!! %ut two LN/) N,,M o& the participantsG stories o& interacting with patients an# it is this thee that is presente# an# #iscusse# here1 Resu!ts Eie as the ene( Eie constrains counication Supporting pre9ious research on nurse>patient interaction with a!! patients 6see F!eischer et a!1 /00-8) the a@orit( o& nurses 6n N -8 pre&ace# their stories o& counication with the a#age that Fnurses are 9er( %us( an# 9er( tie con2 straine# in their wor:!oa#G LN,CM1 Ehus) the nurses a#e c!ear that patients with CCN are su%@ect to the sae tie2 !iite# con#itions on the war# as other patients1 Howe9er) o9er one2thir# o& nurses 6n N <8 state# that such tie con2 straints pre9ente# the &ro %eing a%!e to a!!ocate the e"tra tie the( sai# was nee#e# &or interactions with patients with DD an# CCN1 N, sai# that the tie to counicate with these patients F#epen#s on the patient !oa#) i& itGs rea!!( hea9( then I wou!# sa( tie is the ene() i& it is !ight I wou!# ha9e ore tieG1 Howe9er) nurses a!so note# that a patientGs pro%!es counicating increase# the nurseGs wor:!oa#$ ItGs #i&&icu!t %ecause O weG!! o&ten ha9e &i9e patients each on an a&ternoon > an# where at hoe the( ight not %e incontinent) in here the( ten# to %e) a(%e %ecause o& the counication #i&&icu!t( in sa(ing Fgoing to the toi!etG1 Fai!( carers o&ten &eature# in the stories as the nursesG pre&erre# counication partners1 In#ee#) si" nurses in this stu#( reporte# a!!owing tie to pass) in waiting &or &ai!( carers) %e&ore counicating with the patient to arri9e at a #iagnosis or p!an inter9ention1 Howe9er) not a!! patients with DD wi!! ha9e a carer present 6Hes!e( et a!1 /00D8) an# waiting &or &ai!( carers to arri9e u!tiate!( #e!a(s the process o& assessent an# #iagnosis) as N,0) an Eergenc( nurse) narrate#$ I& the(Gre %( these!9es an# (ouGre waiting &or soeone to arri9e O thereGs no #iagnostic process that goes on an# the #octor wi!! o&ten sa( FOh we!!) IG!! wait unti! the &ai!( gets hereG1 ;ou canGt assess the) the( canGt te!! (ou an(thing) or uch) soeties) so (ou #onGt :now) an# (ou canGt #iagnose or %ase a #ecision on Fwe!!) a(%e itGs thisG so that then #e!a(s their treatent) then that :eeps the in Eergenc( !onger) :eeps the on an unco&orta%!e %e# !onger) itGs not goo#) itGs a %ig &!ow2on e&&ect1 Ehe 9iew that tie constraints ipe#e# #irect counica2 tion with patients with CCN was not !iite# to Eergenc( nurses1 N,A) wor:ing on an orthopae#ic war#) sai# F(ou get the ones that canGt counicate at a!! e&&ecti9e!( > the( a( a:e soe noises O the( a( ha9e eanings %ut o&ten (ou #onGt ha9e the !ong enough to wor: that outG1 Eie constraints an# patient un#erstan#ing Stories a%out Fnot ha9ing enough tieG to Fstrugg!eG with spo:en counication an# not ha9ing an( other wa( to counicate a!so high!ighte# the coon perception that the patient a!so ha# inte!!ectua! #isa%i!it( an# as such wou!# not un#erstan# or %e a re!ia%!e in&orant1 NC repeate#!( re&erre# to FtieG as a %arrier when she e"p!aine# her 9iews on wh( counication with this popu!ation ight %e #i&&i2 cu!t) an# re!ate# it to the nurseGs attitu#es towar#s patients with #isa%i!it($ Nurses &in# it e"tree!( #i&&icu!t to ta!: to an(one with an( :in# o& ipairent1 DonGt ha9e tie1 Ea:es !onger) peop!e assue that i& the( canGt ta!: proper!( that the( ha9e an inte!!ectua! #isa%i!it( as we!!) peop!e patroniJe) peop!e g!oss o9er things O peop!e @ust #onGt get tie O the( are @ust not prepare# to put the tie into it1 N=Gs account %e!ow supports this assertion) suggesting that attepting counication with patients who ight not un#erstan# cou!# %e a waste o& tie$ .( pro%!e is when (ou sa( soeoneGs got cere%ra! pa!s( or soething !i:e that) thereGs #i&&erent #egrees o& when the( canGt ta!: or when the(Gre s!ow > so when (ou see soeoneGs got inte!!ectua! #isa%i!it( > not that (ou assue it %ut (ou sort o& > (ou start thin:ing FOh we!!) how e!se a I going to get the in&orationKG cause itGs so #i&&erent with each person) itGs rea!!( har# to %e !i:e) FOh we!! a(%e I shou!# @ust go ta!: to theG) %ecause (ou thin: (ouGre a(%e going to waste (our tie1 LN=M A!though N=) a recent gra#uate nurse) a( ha9e %een war( o& a#itting to assuing that a patient has inte!!ectua! #isa%i!it( on the %asis o& !ac: o& speech) N,/) a nurse with o9er /0 (ears e"perience state# it open!($ FitGs an assuption that the( #onGt rea!!( un#erstan#G1 N=Gs account a!so re&!ects that soe nurses) rea!iJing #i9ersit( in the popu!ation o& a#u!ts with DD) a( !ac: con&i#ence an# copetence in their interactions with these patients1 N, re&!ecte# on the issue o& copetence$ FI wou!# thin: i& soe%o#( wou!#nGt un#erstan# e an# IG tr(ing to e"p!ain soething then I wou!# usua!!( get soeone e!se to &i!! that ro!e) soeone who is a %etter counicator than eG1 Ehus) peop!e with DD an# CCN ight not %e a&&or#e# enough tie or an opportunit( to counicate with nurses who 6a8 e"pect that it ight %e a /0,, '!ac:we!! 5u%!ishing Lt# ,,- '1 Hes!e( et a!1 waste o& tie) 6%8 !ac: access to a#apti9e counication strategies) 6c8 assue that the patient wou!# not un#erstan#) 6#8 !ac: con&i#ence or copetence in counicating with the patient) or 6e8 #ou%t that such counication wou!# %e success&u!1 Stories a%out tie %eing the ene( &eature# nurses app!(ing a range o& strategies to ta!: to the patient 6e1g1 as:ing repeate# 4uestions or Fguessing) no##ing) tr(ing to use han# gestures) an# (es) noG LN,BM8) %ut #i# not &eature access to ai#e# AAC s(stes 6e1g1 picture %oar#s) a!pha%et %oar#s) counication #e9ices81 One Eergenc( nurse sai#$ +e #onGt ha9e pictures or an(thing so thatGs har#) we @ust ha9e to ta!: rea!!( s!ow!( an# go through that process an# use rea!!( %asic wor#s > an# a !ot o& the tie that pre9ents us &ro counicating with the1 In that instance we rea!!( nee# a carer or we nee# a &ai!( e%er or soething1 ItGs not that we ignore the %ut 2 I #onGt :now 2 itGs so har# an# (ouG9e got !iite# tie in the &irst p!ace an# that ta:es up a !ot o& (our tie1 LN=M Our resu!ts suggeste# that using 9er%a! strategies without AAC was unsuccess&u! an# increasing!( &rustrating &or %oth parties when the purpose o& the counication was Fsoe2 thing ore cop!e"G than %asic nee#s counication1 Ehree o& the nurses high!ighte# that nurses ight %e a%!e to Fwor: outG the %asic nee#s counication nee#s &ro !iite# 9oca!iJations or F(esG FnoG %ut that un#erstan#ing the patientGs ore cop!e" essages was Fsoeties not that straight&or2 war#G LN,BM an# utua!!( #istressing$ Soeties (ouG9e got to spen# a !ot o& tie with the tr(ing to wor: out that one thing that the(Gre tr(ing to sa( an# itGs rea!!( har# on a %us( e#ica! war# to spen# that tie tr(ing to &in# out whatGs that one thing that the( nee#1 ItGs har#1 An# soeties the( @ust gi9e up an# the( get &rustrate# %ecause the( canGt spea: what the( nee# to sa( 2 an# (ou &ee! rea!!( gui!t( an# horri%!e 2 %ut soeties (ou @ust coe %ac: !ater when the(G9e a(%e ca!e# #own an# tr( an# gi9e it another go1 LN,BM Ehe resu!ts o& this stu#( a!so suggest that Fwa!:ing awa(G as a strateg( &or easing the &rustration is associate# o&ten with negati9e eotions Fgui!t( an# horri%!eG &or the nurse1 Nurses a( a!so &ee! gui!t( a%out FignoringG counication$ FItGs not that we ignore the) %ut I #onGt :now > itGs so har#G1 LN=M1 A!ong with noting a sense o& #isco&ort when wa!:ing awa( &ro unsuccess&u! interaction) nurses a!so spo:e a%out &ee!ing uncertain i& the( ha# #one a!! the( cou!# &or the patient1 In her secon# inter9iew) N, sai# FI& soeone is #isa%!e# an# the(Gre not a%!e to con9e( their nee#s to us) I thin: thereGs a!wa(s a gap or a gui!t( &ee!ing that we ha9enGt #one enough) ha9e we #one the right thingK Or is the patient co&orta%!e or notKG Ehis in turn a( &urther a&&ect the !i:e!ihoo# o& success in interactions) as She!#on et a!1 6/00<8 state#$ FnursesG negati9e eotions such as he!p!essness) hope!essness) an# sa#ness a#e counication with patients ore #i&&icu!tG 6p1 ,CA81 In this stu#() N,C recog2 niJe# that the eotiona! response o& the nurse to the patientGs presenting #isa%i!it( ight a!so ipact upon counication1 She state# that Fi& (ouGre got a %it ta:en a%ac: %( that Lthe patientGs #isa%i!it(M) the( pic: up that (ouGre not as accepting o& the1 I& the( &ee! co&orta%!e that (ouGre wi!!ing to go that step &urther (ouG!! %e a%!e to e!icit ore in&orationG1 Eie as a &rien# to counication +or:ing with tie Just o9er ha!& o& the nursesG 6n N =8 stories re&!ecte# wor:ing with tie1 Ehis in9o!9e# Fta:ing ore tieG to approach #i&&icu!t counication situations with 6a8 an open attitu#e to the possi%i!it( o& counication %eing success&u!) an# 6%8 the intention o& app!(ing a range o& a#apti9e strategies in see:ing a wor:a%!e etho# o& counication) an# was 9a!ue# %( participants see:ing to un#erstan# the patientGs point o& 9iew1 N,C high!ighte# the iportance o& %e!ie&s an# 9a!ues in coitting ore tie to the en#ea9our o& counication$ FI& the nurses %e!ie9e that what the( Lthe patientM are going to sa( is 9a!ua%!e) so (ouGre wi!!ing to wait a %it !ongerG1 Nurses who narrate# spen#ing ore tie in counication a!so 9oice# an awareness o& the patientGs right to autono() nee# to un#erstan# what wou!# happen to the) an# nee# &or reassurance1 NC sai# that Fi& (ou counicate %etter) an# (ou ha9e a person with an inte!2 !ectua! #isa%i!it( who un#erstan#s what is happening) the(Gre going to %e ore cop!iant with a proce#ure an# itGs going to %e uch easier to #oG1 In#ee#) &aci!itating the un#erstan#ing o& patients in hospita! has %een shown to ipro9e their we!!%eing 6.artin * 'ar:an ,-=-81 N-) an eergenc( nurse) pre&erre# #irect counication with patients) e9en in the copan( o& a &ai!( carer) an# sai#$ FItGs their !i&e > the( shou!# sti!! ha9e soe in9o!9eent in it) an# the( :now %etter than an(one e!se how the(Gre &ee!ing) e9en i& their carer has as:e# the I sti!! want to hear it &ro theG1 Ea:ing tie &or counication encopasse# nurses using a range o& a#apti9e counication strategies1 N,C sai# FthereGs so an( #i&&erent wa(s o& counicating that is @ust not to re!( on 9er%a!) i& soeoneGs wi!!ing to go outsi#e the s4uare (ou &in# that (ouGre a%!e to counicate a !ot %etterG1 Ne9erthe!ess) e9en a&ter in9esting e"tra tie in counica2 tion) nurses reporte# that counication ight sti!! &ai!) particu!ar!( i& the essage &e!! outsi#e the topics o& F%asic ,/0 /0,, '!ac:we!! 5u%!ishing Lt# JAN$ ORIGINAL RESEARCH FEieG an# counication in hospita! nee#s counicationG Lthese %eing$ pain) toi!et) hunger? thirst) hot?co!#) co&ort?position) an# nausea 6Hes!e( et a!1 /0,08M1 N,C sai#$ I& I rea!!( canGt un#erstan#) IG!! coe %ac:) weG!! change the su%@ect > tr( to !ea9e with a positi9e1 I& soething %ecoes #i&&icu!t it ight %e not one o& the L%asic nee#sM O then honest!( (ou ight sa( FI @ust canGt get there IG!! coe a %it !aterG > %eing on the goo# si#e I nora!!( sa( FitGs e) IG not getting (ouG1 In such stories) nurses spent e"ten#e# perio#s o& tie persisting with counication) an# stories a%out wor:ing with tie re&!ecte# that e9en i& unsuccess&u! the nurses wishe# the interaction to %e positi9e1 5atient!( a!!owing ore tie an# prioritiJing counication F'eing patientG an# prioritiJing counication o9er other tas:s was a recurring thee across &i9e participantsG accounts1 A!though ip!icit!( ta:ing the nurse Fore tieG) %eing patient in #i&&icu!t counication situations was !in:e# with sa9ing tie) as NA state#$ F'eing patient sa9es tie in the !ong run) it a:es things easierG1 N-) a new gra#uate nurse) attri%ute# her co&ort an# patience in counicating with patients with no speech to her own persona! e"perience o& counicating with a re!ati9e with counication #isa%i!it($ FIG 4uite a patient person) an# IG!! ha9e the tie to sit an# ta!: > %ut i& I ha#nGt ha9e ha# that e"perience I #onGt thin: I wou!# ha9e #e9e!ope# that (etG1 'etter counication was a!so high2 !ighte# as %eing a&&or#e# to the patient in recognition o& their huanit( an# 9a!ue as a person who shou!# %e inc!u#e# in #ecisions to their capacit(1 NC note# that) in her 9iew) this was not a!wa(s the case) an# that o&ten nurses were tas: oriente# an# care proce#ures were o&ten not e"p!aine# to patients with DD$ LEhe( areM a!ost super&!uous) itGs @ust a proce#ure an# the person @ust gets on an# #oes it1 ItGs !i:e thereGs a !ac: o& respect > the(Gre @ust a !up o& eat %asica!!( O so tas: orientate# that the guts o& who the person rea!!( is) is !ost1 N- a!so re!ate# tie in counication to the patientGs huanit() an# sai#$ F+e!!) (ou nee# to :now what the( want to te!! (ou) so itGs worth ha9ing the tie O heGs sti!! a huan %eing1 Just %ecause he canGt counicate #oesnGt ean heGs !ess o& a personG1 ND an# N,C a!so connecte# Fta:ing ore tieG to counicate with patients with Fnot %eing con2 &ronte#G %( the patientGs #isa%i!it( or a9oi#ing counica2 tion$ ;ou canGt @ust go in there an# %e tas: orientate# at a!! > without engaging) thatGs where (ou get the pro%!e O a !ot o& peop!e #onGt :now how to #ea! with it these!9es > the(Gre a %it con&ronte# %( the &act that the patient canGt counicate %ac: to the1 LNDM Ehe passage o& tie ipro9es counication Ewo o& the nurses who #escri%e# ta:ing the tie to cou2 nicate note# that this %ecae easier o9er tie as a resu!t o& %ecoing &ai!iar with the patientGs counication #uring routine interactions on the war#1 N,A) who #escri%e# Fa !ot o& iso!ation when (ouGre with the patientG) sai#$ FEhose that canGt counicate) (ou tr( to pic: up o9er the #a(s a particu!ar grunt or cr() or e"c!aation eans soething O itGs a!so a thing that (ou !earn o9er tie with (our patientsG1 Ehe repeate# e"posure to a patientGs responses an# o%ser9ation o& their interactions with others on the war# a( a!so he!p nurses to !earn how to %ui!# share# eaning) e9en &or patients with 9er( !iite# or in&ora! counication 6e1g1 grunts) oans81 Ehis counication ight %e !iite# to %asic nee#s such as FpainG$ Fi& (ou ro!! the o9er to #o the pressure area care) i& the( start to oan an# groan) i& the( start to twitch or soething !i:e that it te!!s us i& the(G9e got painG LN/M1 N,A a!so #escri%e# his ro!e in o%ser9ing the patient interacting with others on the war#$ FO9er the tie getting other peop!e to counicate with the) ph(sios or OEs) (ouG9e !earne# a &ew wa(s that the( counicate) either %o#( or 9er%a!G1 Using tie to app!( a#apti9e strategies Nurses who #iscusse# F%eing patientG a!so out!ine# a range o& counication strategies to app!( that ight suit soe patients an# not others) an# there&ore se!ecting a etho# was a thought&u! process1 ND sai#$ FI ha9e to thin: through a !ot o& stepsG1 N- pre&ace# her s(steatic approach %( reassuring the patient that going through this process wou!# ta:e soe tie an# that$ FIG9e got a!! the tie) !etGs @ust wor: through itG1 In spen#ing tie with the patient) participants re&erre# to a:ing these!9es approacha%!e) %eing &rien#!( an# ha9ing a @o:e whi!e persisting with tr(ing to counicate) particu!ar!( to a9ert &rustration1 Ehese non29er%a! strategies con9e( co2 &ort) open2ness an# con&i#ence in counicating 6F!eischer et a!1 /00-) Sun#in et a!1 /00081 N- !iste# %oth pro"eic an# 9er%a! strategies to ipro9e# counication as &o!!ows$ Sitting #own at e(e !e9e!) sa(ing Fnow what is it (ouGre tr(ing to te!! e) can (ou sa( it another wa(K Is it (our ar) is it (our !eg > i& the( can rephrase it > I usua!!( @ust sa( Fsorr() can (ou repeat thatK I #i#nGt 4uite get itG1 Her account re&!ects the co&ort) re&erre# to %( ND an# NC) in approaching a patient who has CCN) an# persistence with speech in the a%sence o& AAC1 Such stories a%out nurses app!(ing strategies to increase success in the interaction /0,, '!ac:we!! 5u%!ishing Lt# ,/, '1 Hes!e( et a!1 re&!ecte#$ 6a8 wi!!ingness to attept counication an# stri9ing &or success) 6%8 reassuring the patient that FtieG is not a !iiting &actor) 6c8 coitting e"tra tie) 6#8 %eing patient) an# 6#8 sharing the Fwor:G o& counication in %ui!#ing share# eaning with the patient1 Using the patientGs AAC s(ste On!( three nurses narrate# using either the patientGs AAC s(ste or generic AAC s(stes 6:ept on the war# &or patients with aphasia or #i9erse !anguage nee#s8 in caring &or patients with DD an# CCN1 Gi9en the high proportion o& a#u!ts with cere%ra! pa!s( who a!so ha9e counication #isa%i!it( 6up to =0P8) are non29er%a! 6/BP8 6Access Econoics /00=8 an# use AAC) the proportion o& nurses reporting AAC use in this stu#( is re!ati9e!( !ow1 Nonethe!ess) those who ha# use# the patientGs AAC s(stes in interactions reporte# that this Fsa9e# tieG an# ease# &rustration in counication1 In response to #irect 4uestions a%out use o& AAC in hospita!) nurses reporte# that patients t(pica!!( #o not %ring their counication s(stes to hospita!) which one Eer2 genc( nurse #escri%e# as Fa #isaster &or usG1 6N,081 Nurses note# that counication %oar#s) that the( sai# a#e %rie& interactions a%out %asic nee#s ore e&&ecti9e) were not a!wa(s a9ai!a%!e1 One war# nurse sai# it was Fsuch a re!ie&G when patients #i# retrie9e their own AAC %oar# &ro hoe a&ter a &ew #a(s in hospita!1 N< note# that using AAC sa9e# tie in the a%sence o& a carer$ I& the carer #oesnGt sta( here the who!e /C hours then (ou nee# to %e a%!e to counicate with the) an# we nora!!( a:e sure that there is soething !e&t so weGre not guessing) Fcause it sa9es tie &or us) %ut ore iportant!( a:es it ore co&orta%!e &or the patient O i& we ha9enGt et the patient %e&ore weGre not going to get a grasp o& Lthe counicationM straight awa( %ut i& we ha9e the %oar#s) itGs &aster1 Using a counication %oar# to counicate with the patient was iportant %ecause it sa9e# tie) re#uce# guessing an# was ore co&orta%!e &or the patient) an# sta&& cou!# usua!!( &igure out the essage using the %oar#1 N,/ sai#$ FSoe wi!! %ring in their counication %oar# O which is easier &or us) that he!ps) getting o9er the %arrier o& it) whereas i& the( #i#nGt ha9e that it is a &rustrating thing &or the patient) i& the(G9e got this %oar# the( can te!! us straight awa(G1 Discussion Ehe resu!ts o& this stu#( suggest that a!though nurses cite FtieG as a critica! &actor in counication with patients with DD an# CCN) when consi#ere# in the wi#er conte"t o& their stories o& counication$ 6a8 !ac: o& tie a( not %e the on!( %arrier to counication) an# 6%8 the a##ition o& tie a!one a( not %e su&&icient to proote counicati9e success1 Soe nurses in this stu#( re!ate# the e"perience o& spen#ing tie caring &or an# counicating with patients with DD) to a gra#ua!!( increasing &ai!iarit() ease) or success in counication1 Ehere&ore) nurses who a9oi# #irect counication with these patients a( not achie9e the %ene&its o& increase# &ai!iarit( an# e"posure o9er tie in ipro9ing counication1 In#ee#) patients with CCN 6a8 report waiting &or !ong perio#s without :nowing what wi!! happen ne"t as #istressing an# iso!ating 6'a!an#in et a!1 /00,) /00D) Hes!e( et a!1 /00=c8 an# 6%8 a( 9iew nurse a9oi#ance or the nurse Fnot ha9ing tieG &or the as re&!ecting negati9e or #iscriinator( attitu#es towar#s the 6'a!an#in et a!1 /00D) Hes!e( et a!1 /00=c81 Ehe strateg( o& Fs!owing #ownG counication an# using Frea!!( %asic wor#sG when spea:ing to patients who #o not spea:) as reporte# %( nurses in this stu#() can %e e"p!aine# %( counication accoo#ation theor( as it is app!ie# to counication #isa%i!it( 6+orra!! * Hic:son /00A81 Un&or2 tunate!() re#ucing speech rate without a##ing a##itiona! conte"tua! cues to eaning 6e1g1 pictures) gestures) re2casting in&oration8 in this case cou!# %e consi#ere# a!a#apti9e Fo9er2accoo#ationG to the patientGs counication #i&&i2 cu!t( in that it 6a8 #oes not necessari!( increase un#erstan#ing in patients with cogniti9e #e&icits) an# 6%8 anno(s) &rustrates) angers) or #epresses patients who #o un#erstan#) %ut cannot respon# 6'a!an#in et a!1 /00D81 5atients with #isa%i!it( interpret nurses spea:ing to the !ou#!( an# s!ow!( report such counication %eha9iours as in&anti!iJing an# patron2 iJing 6Newe!! ,---) Gi%%s et a!1 /00=81 E9en nurses who coitte# ore tie to persisting with counication reporte# ha9ing to Fgi9e upG an# Fwa!: awa(G as strategies &or re!ie9ing &rustration associate# with pro%!es in counicating Fore cop!e"G essages than %asic nee#s1 +hi!e the strateg( o& wa!:ing awa( is presente# in this stu#( as a &aci!itator to potentia! &uture counication success) patients 9iew this strateg( as a %arrier 6Hes!e( et a!1 /00=c81 5atients a!so report &ee!ing &rustrate# when successi9e attepts to counicate &ai!) %ut note that nurses Fwa!:ing awa(G increases their #istress or !ea#s the to hope!essness or #epression 6'a!an#in et a!1 /00D81 Apart &ro N,B sa(ing that Fsoeties (ou coe %ac: !aterG) nurses who #escri%e# this strateg( LN,C) N,BM #i# not narrate returning to the patient to attept counication a secon# tie or that Fta:ing a %rea:G re#uce# &rustration or !e# to success in counication1 Ehe resu!ts o& this stu#( support the &in#ings &ro pre9ious research in that an( o& the counication #i&&icu!ties re!ate# to Fa %rea:#own in un#erstan#ing arising &ro the !ac: o& a rea#i!( interpreta%!e counication s(ste that ,// /0,, '!ac:we!! 5u%!ishing Lt# JAN$ ORIGINAL RESEARCH FEieG an# counication in hospita! +hat is a!rea#( :nown a%out this topic Q Nurses 9iew !ac: o& tie to counicate as a %arrier to %ui!#ing e&&ecti9e re!ationships with patients in hospita!1 Q 5atients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s an# their &ai!ies report that nursing sta&& not ta:ing the tie to counicate has a negati9e ipact on their hospita! care1 +hat this paper a##s Q Nurses percei9e tie as %oth a %arrier an# a &aci!itator to success&u! counication with patients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s1 Q Nurses who 9iew tie as a %arrier consi#er that counication wi!! ta:e too !ong or waste their tie1 Conse4uent!() the( a( a9oi# #irect counication with the patient an# re!( upon &ai!( carers &or counication1 Q Nurses who percei9e tie as a &aci!itator report that spen#ing ore tie in counication an# using a#apti9e counication techni4ues are e&&icient practices that ipro9e care1 Q NursesG attitu#es towar#s patients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s a( in&!uence their perceptions o& tie in their encounters an# etho#s o& counicating with these patients1 Ip!ications &or practice an#?or po!ic( Q E"tra tie to counicate with patients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s ight %e use&u! i& nurses are con&i#ent an# copetent in using a range o& a#apti9e counication strategies1 Nurses with counicati9e s:i!!s cou!# entor an# support nurses who !ac: e"perience) con&i#ence) or copetence in using a#apti9e counication strategies in counicating with these patients1 Q Nurses who cite tie constraints as reasons &or not counicating #irect!( with patients who ha9e #e9e!openta! #isa%i!it( nee# to %e aware that patients with #e9e!openta! #isa%i!it( an# cop!e" counication nee#s 9iew a9oi#ance o& counication as a re&!ection o& negati9e or #iscriinator( attitu#es towar#s the1 Q Eo a:e %est use o& tie in %rie& interactions with these patients) nurses nee# to rein# patients an# their &ai!ies to %ring e"isting counication ai#s to hospita! an# hospita! po!icies ust support the sa&e storage an# use o& these s(stes in the hospita! setting1 cou!# %e use# e&&icient!( %( %oth nurse an# patientG 6Hes!e( et a!1 /00,) p1 =AA81 It is apparent that these patients continue to ha9e !iite# or no access to these s(stes in the hospita! setting 6Hes!e( * 'a!an#in /00C8 that ight potentia!!( o&&er the &aster counication with nurses who are pushe# &or tie1 It is) perhaps) e9en ore iportant in this patient group than in others that %rie& interactions are a#e positi9e an# e&&ecti9e 6Hagert( * 5atus:( /00A81 Ehese aspects o& the conte"tua! en9ironent &or counication ust %e a##resse# in hospita! po!icies on nursesG counication with patients with #isa%i!it() an# in increasing the counication accessi%i!it( o& hospita! war#s &or patients with counica2 tion #isa%i!it( 6Hes!e( et a!1 /0,,81 In#ee#) hospita! ser9ice pro9i#ers ight a!so consi#er whether !iitations in FtieG cou!# ipe#e patients with counication #isa%i!it( &ro ha9ing e4ua! access to the hea!th ser9ice as pro9i#e# to other patients1 Un#er re!e9ant Disa%i!it( Discriination Acts 6e1g1 in Austra!ia) the Disa%i!it( Discriination Act) ,--/8 hea!th ser9ices ha9e an o%!igation to a:e reasona%!e a#@ustents to practices in or#er that peop!e with #isa%i!it( ha9e e4ua! access to the hea!th ser9ice1 Ser9ice pro9i#ers who #o not a:e reasona%!e a#@ustents to the tie pro9i#e# &or counication with a#u!ts with DD an# CCN ight contra9ene re!e9ant Disa%i!it( Discriination Acts an# !ea9e ser9ice pro9i#ers 9u!nera%!e to !ega! action %eing ta:en in re!ation to the percei9e# #iscriination1 Sii!ar to recoen#ations &or hea!th ser9ice pro9i#ers interacting with #ea& patients 6Da9ies * Channon /00C8) e"tra tie a( %e re4uire# &or counication with patients with DD an# CCN to &u!&i! ethica! an# !ega! re4uireents in pro9i#ing a hea!th ser9ice1 In a##ition) nurses who report #i&&icu!t( in counicating within the tie a9ai!a%!e or e9en with a##itiona! tie a9ai!a%!e a( %ene&it &ro$ 6a8 #isa%i!it( awareness an# counication training to a##ress attitu#es an# %e!ie&s towar#s patients with CCN) 6%8 greater access to sip!e counication s(stes &or use in hospita!) an# 6c8 support &ro carers) ore a#ept nurse entors an#?or hospita! speech patho!ogists to #e9e!op copetence in s(steatica!!( app!(ing a range o& e&&ecti9e a#apti9e co2 unication strategies) inc!u#ing AAC) to suit #i&&erent patients in #i&&erent situations1 Liitations FEieG is a perceptua! an# re!ati9e phenoenon) an# nurses in this stu#( were not as:e# to &ocus speci&ica!!( on tie or the aount o& tie ta:en to counicate #uring e9ents in the stories narrate#1 Ehere&ore) resu!ts can on!( %e interprete# as re&erring to tie in genera!) an# participantsG #i&&ering perceptions !iit coparisons across the group1 Ehe /0,, '!ac:we!! 5u%!ishing Lt# ,/A '1 Hes!e( et a!1 re!ati9e!( sa!! group o& nurses participating in this research !iits genera!iJation o& the resu!ts to other hospita! nurses wor:ing with patients with DD an# CCN in other hospita! conte"ts1 Fina!!() on!( se9en nurses were inter9iewe# a secon# tie a%out the o9era!! narrati9e ana!(sis) an# it is possi%!e that i& a!! nurses ha# %een inter9iewe# a secon# tie &urther insights wou!# ha9e %een gaine# on the resu!ts1 Conc!usions Ehe resu!ts o& this stu#( re&!ect that nurses #o not e"perience or respon# to the usua! tie constraints o& wor:ing in a %us( hospita! war# in a uni&or wa( when counicating with patients with DD an# CCN1 Ehe narrati9e in4uir( etho# capture# situations where counication was iportant an# strategies that nurses 9iewe# ease# counication with patients who strugg!e to counicate using natura! speech1 In this stu#() nurses cite# F!ac: o& tieG as a %arrier to e&&ecti9e counication in stories that a!so re&!ecte# negati9e attitu#es an# eotions1 Ehis &in#ing suggests that nurses ight nee# to anage their own #isco&orts re!ating to #isa%i!it() an# %e con9ince# that the patientGs opinion is o& 9a!ue) an# that the patient ight un#erstan# the i& ore tie were a!!ocate# to counication1 Researchers ha9e consi#ere# the eotiona! ipact on nurses o& #i&&icu!t counicating with patients 6.agnus * Eur:ington /00<) She!#on et a!1 /00<8 %ut the ipact on counication o& the nurseGs eotiona! responses to caring &or a patient with DD an# CCN has not %een e"p!ore#1 O%ser9ationa! stu#ies o& interactions %etween nurses an# patients with DD an# CCN ight pro9i#e use&u! in&or2 ation on the re!ationship %etween the &re4uenc( or #uration o& interactions an# success in counication1 Further research is nee#e# to #isco9er how the &u!! app!ication o& strategies out!ine# %( Fin:e et a!1 6/00=8) a!ong with support %( hospita! po!ic( an# action 6inc!u#ing a strong ephasis on non2#iscriination8) ight sa9e nurses tie an# ipro9e the care o& the patient with DD an# CCN in a hospita!1 Ac:now!e#geents Ehe authors wou!# !i:e to ac:now!e#ge the assistance o& participating organiJations in recruiting nurses &or this stu#() an# than: the nurses in9o!9e# &or gi9ing ost generous!( o& their tie an# e"pertise #uring inter9iews1 Fun#ing Ehis research was &un#e# %( the Nationa! Hea!th an# .e#ica! Research Counci! o& Austra!ia through a post#oc2 tora! research &e!!owship awar#e# to the &irst author1 Con&!ict o& interest No con&!ict o& interest has %een #ec!are# %( the authors1 Author contri%utions 'H) S' an# L+ were responsi%!e &or the stu#( conception an# #esign1 'H per&ore# the #ata co!!ection1 'H) S' an# L+ per&ore# the #ata ana!(sis1 'H was responsi%!e &or the #ra&ting o& the anuscript1 S' an# L+ a#e critica! re9isions to the paper &or iportant inte!!ectua! content1 'H) S' an# L+ o%taine# &un#ing1 'H pro9i#e# a#inistrati9e) technica! or ateria! support1 Re&erences Access Econoics 6/00=8 Ehe Econoic Ipact o& Cere%ra! 5a!s( in Austra!ia in /00D) Report %( Access Econoics 5t( Liite# &or Cere%ra! 5a!s( Austra!ia) Access Econoics) Can%erra1 Anoosheh .1) Rar:hah S1) FaghihJa#eh S1 * Vaisora#i .1 6/00-8 Nurse2patient counication %arriers in Iranian nursing1 Inter2 nationa! Nursing Re9iew B<) /CA>/C-1 'a!an#in S1 6/00/8 .essage &ro the 5resi#ent1 Ehe 'u!!etin ISAAC <D) /1 'a!an#in S1) Hes!e( '1) Siga&oos J1) Green V1) For%es R1) Ea(!or C1 * 5arenter E1 6/00,8 Counicating with nurses$ the e"peri2 ences o& ,0 in#i9i#ua!s with an ac4uire# se9ere counication ipairent1 'rain Ipairent /6/8) ,0->,,=1 'a!an#in S1) Hes!e( '1) Siga&oos J1 * Green V1 6/00D8 Couni2 cating with nurses) Ehe e"periences o& ,0 a#u!ts with cere%ra! pa!s( an# cop!e" counication nee#s1 App!ie# Nursing Research /06/8) B<></1 'arrere C1 6/00D8 Discourse ana!(sis o& nurse2patient counication in a hospita! setting$ ip!ications &or sta&& #e9e!opent1 Journa! &or Nurses in Sta&& De9e!opent /A6A8) ,,C>,//1 'art!ett G1) '!ais R1) Ea%!(n R1) C!eront R1J1 * .acGi%%on '1 6/00=8 Ipact o& patient counication pro%!es on the ris: o& pre9enta%!e a#9erse e9ents in acute care settings1 C.AJ ,D=6,/8) ,BB>,</1 'eange H1) .cE!#u&& A1 * 'a:er +1 6,--B8 .e#ica! #isor#ers o& a#u!ts with enta! retar#ation$ a popu!ation stu#(1 Aerican Journa! on .enta! Retar#ation --6<8) B-B><0C1 'ec:stran# R1) Ca!!ister L1 * Hirchho&& H1 6/00<8 5ro9i#ing a Fgoo# #eathG$ critica! care nursesG suggestions &or ipro9ing en#2o&2!i&e care1 Aerican Journa! o& Critica! Care ,B) A=>C<1 'eu:e!an D1 * .iren#a 51 6/00B8 Augentati9e an# A!ternati9e Counication) Supporting Chi!#ren an# A#u!ts with Co2 p!e" Counication Nee#s) Ar# e#n1 5au! H1 'roo:es) 'a!ti2 ore1 Da9ies .1C1 * Channon '1E1 6/00C8 Dea& patients in the e#ica! iaging #epartent > a 4ua!itati9e stu#(1 Journa! o& Diagnostic Ra#iograph( an# Iaging B) -->,0<1 Disa%i!it( Discriination Act 6,--/8 Coonwea!th o& Austra!ia1 Retrie9e# &ro http$??w w w1aust!ii1e # u1au?au?!eg is?cth?conso!Sac t? ##a,--//<C? on C .a( /0,01 ,/C /0,, '!ac:we!! 5u%!ishing Lt# JAN$ ORIGINAL RESEARCH FEieG an# counication in hospita! Fin:e E1H1) Light J1 * Hit:o L1 6/00=8 A s(steatic re9iew o& the e&&ecti9eness o& nurse counication with patients with cop!e" counication nee#s with a &ocus on the use o& augentati9e an# a!ternati9e counication1 Journa! o& C!inica! Nursing ,D6,<8) /,0/>/,,B1 F!eischer S1) 'erg A1) Rierann .1) +uste H1 * 'ehrens J1 6/00-8 Nurse2patient interaction an# counication$ a s(steatic !iterature re9iew1 Journa! o& 5u%!ic Hea!th ,D) AA->ABA1 Gi%%s S1.1) 'rown .1J1 * .uir +1J1 6/00=8 Ehe e"periences o& a#u!ts with inte!!ectua! #isa%i!ities an# their carers in genera! hospita!s$ a &ocus group stu#(1 Journa! o& Inte!!ectua! Disa%i!it( Research B/) ,0<,>,0DD1 Hagert( '1.1 * 5atus:( H1L1 6/00A8 Reconceptua!iJing the nurse2 patient re!ationship1 Journa! o& Nursing Scho!arship AB6/8) ,CB> ,B01 Hes!e( '1 * 'a!an#in S1 6/00C8 +ithout AAC$ the stories o& unpai# carers o& a#u!ts with cere%ra! pa!s( an# cop!e" counication nee#s in hospita!1 Augentati9e an# A!ternati9e Counication /06C8) /CA>/B=1 Hes!e( '1) Siga&oos J1) 'a!an#in S1) For%es R1) Ea(!or C1) Green V1 * 5arenter E1 6/00,8 Nursing the patient with se9ere cou2 nication ipairent1 Journa! o& A#9ance# Nursing AB6<8) =/D> =AB1 Hes!e( '1) 'a!an#in S1 * Eogher L1 6/00D8 O!#er unpai# carersG e"periences supporting a#u!ts with cere%ra! pa!s( an# cop!e" counication nee#s in hospita!1 Journa! o& De9e!openta! an# 5h(sica! Disa%i!ities ,-6/8) ,,B>,/C1 Hes!e( '1) 'a!an#in S1 * Eogher L1 6/00=a8 Fai!( caregi9ers #iscuss ro!es an# nee#s in supporting a#u!ts with cere%ra! pa!s( an# cop!e" counication nee#s in the hospita! setting1 Journa! o& De9e!openta! an# 5h(sica! Disa%i!ities /06A8) /BD> /DC1 Hes!e( '1) 'a!an#in S1 * Eogher L1 6/00=%8 5ro&essiona!sG 9iews on the ro!es an# nee#s o& &ai!( carers o& a#u!ts with cere%ra! pa!s( an# cop!e" counication nee#s in hospita!1 Journa! o& Inte!2 !ectua! * De9e!openta! Disa%i!it( AA6/8) ,/D>,A<1 Hes!e( '1) 'a!an#in S1 * Eogher L1 6/00=c8 +e nee# to %e the centrepieceG$ a#u!ts with cere%ra! pa!s( an# cop!e" counica2 tion nee#s #iscuss the ro!es an# nee#s o& &ai!( carers in hospita!1 Disa%i!it( an# Reha%i!itation A06/A8) ,DB->,DD,1 Hes!e( '1) 'a!an#in S1 * +orra!! L1 6/0,08 Ehe FF'ig BGG an# %e(on#$ nurses) pai# carers) an# a#u!ts with #e9e!openta! #is2 a%i!it( #iscuss counication nee#s in hospita!1 App!ie# Nursing Research1 DOI$ ,01,0,<?@1apnr1/0,010-100,1 Hes!e( '1) 'a!an#in S1 * +orra!! L1 6/0,,8 Nursing the patient with #e9e!openta! #isa%i!it( in hospita!$ ro!es o& pai# carers1 7ua!itati9e Hea!th Research) #oi$ ,01,,DD?,0C-DA/A,,C,B/=-1 IeJJoni L1I1) Da9is R1'1) Sou:up J1 * OGDa( '1 6/00A8 7ua!it( #iensions that ost concern peop!e with ph(sica! an# sen2 sor( #isa%i!ities1 Archi9es o& Interna! .e#icine ,<A6,D8) /0=B> /0-/1 IeJJoni L1I1) OGDa( '1L1) Hi!!een .1 * Har:er H1 6/00C8 Co2 unicating a%out hea!th care$ o%ser9ations &ro persons who are #ea& or har# o& hearing1 Anna!s o& Interna! .e#icine ,C06B8) AB<>A</1 Lenno" N1G1 * Herr .151 6,--D8 5riar( hea!th care an# peop!e with an inte!!ectua! #isa%i!it($ the e9i#ence %ase1 Journa! o& Inte!2 !ectua! Disa%i!it( Research C,6B8) A<B>AD/1 .agnus V1 * Eur:ington L1 6/00<8 Counication interaction in ICU > patient an# sta&& e"periences an# perceptions1 Intensi9e an# Critica! Care Nursing //) ,<D>,=01 .artin L1L1 * 'ar:an H1 6,-=-8 C!inica! counication strategies o& nurse practitioners with patients1 Journa! o& the Aerican Aca#e( o& Nurse 5ractitioners ,) DD>=A1 .en#es I1A1) Ere9iJan .1A1) Nogueira .1S1 * Sawa#a N1O1 6,---8 HuaniJing nurse2patient counication$ a cha!!enge an# a coitent1 .e#icine an# Law ,=6C8) <A-><CC1 Newe!! C1 6,---8 Disa%!ing hea!th s(stes1 Access June?Ju!() /A>/<1 OGHa!!oran R1) Hic:son L1 * +orra!! L1 6/00=8 En9ironenta! &actors that in&!uence counication %etween peop!e with co2 unication #isa%i!it( an# their hea!thcare pro9i#ers in hospita!$ a re9iew o& the !iterature within the Internationa! C!assi&ication o& Functioning) Disa%i!it( an# Hea!th 6ICF8 &raewor:1 Internationa! Journa! o& Language * Counication Disor#ers CA6<8) <0,> <A/1 OGHa!!oran R1) +orra!! L1 * Hic:son L1 6/0,,8 En9ironenta! &actors that in&!uence counication %etween patients an# their hea!thcare pro9i#ers in acute hospita! stro:e units$ an o%ser9a2 tiona! stu#(1 Internationa! Journa! o& Language an# Counica2 tion Disor#ers C<6,8) A0>CD1 5ar: E1H1 * Song .1 6/00B8 Counication %arriers percei9e# %( o!#er patients an# nurses1 Internationa! Journa! o& Nursing Stu#ies C/6/8) ,B-1 5o!:inghorne D1E1 6,--B8 Narrati9e con&iguration in 4ua!itati9e ana!(sis1 7ua!itati9e Stu#ies in E#ucation =6,8) B>/A1 Riessan C1H1 6,--A8 Narrati9e Ana!(sis1 9o!1 A0) Sage 5u%!ications) New%ur( 5ar:) CA1 She!#on L1H1) 'arrett R1 * E!!ington L1 6/00<8 Di&&icu!t couni2 cation in nursing1 Journa! o& Nursing Scho!arship A=6/8) ,C,>,CD1 Sun#in H1) Jansson L1 * Nor%erg A1 6/0008 Counicating with peop!e with stro:e an# aphasia$ un#erstan#ing through sensation without wor#s1 Journa! o& C!inica! Nursing) -) C=,>C==1 Ea(!or S1 * 'o#gan R1 6,--=8 Intro#uction to 7ua!itati9e Research .etho#s) A Gui#e%oo: an# Resource) Ar# e#n1 +i!e() New ;or:1 Ee@ero L1.1S1 6/0,08 De9e!opent an# 9a!i#ation o& an instruent to easure nurse2patient %on#ing1 Internationa! Journa! o& Nurs2 ing Stu#ies) CD) <0=><,B1 +aterworth S1 6/00A8 Eie anageent strategies in nursing prac2 tice1 Journa! o& A#9ance# Nursing) CA6B8) CA/>CC01 +atson J1 6,--=8 Nursing) Huan Science an# Huan Care$ A Eheor( o& Nursing1 Nationa! League &or Nursing) New ;or:1 +or!# Hea!th Organisation 6+HO8 6/00,8 Internationa! C!assi&ica2 tion o& Functioning) Disa%i!it( an# Hea!th1 +or!# Hea!th Orga2 nisation) Gene9a1 +orra!! L1 * Hic:son L1 6/00A8 Counication Disa%i!it( in Aging$ Fro 5re9ention to Inter9ention1 De!ar Learning) Ehoson) New ;or:1 ;oung N1L1) Stee!e C1) Feh!ings D1) Jutai J1) O!ste# N1 * +i!!ias I1J1 6/00B8 Use o& hea!th care aong a#u!ts with chronic an# cop!e" ph(sica! #isa%i!ities o& chi!#hoo#1 Disa%i!it( * Reha%i!i2 tation) /D6/A8) ,CBB>,C<01 ;oung N1L1) Gi!%ert E1H1) .cCoric: A1) A(!ing2Capos A1) 'o(#e!! H1) Law .1) Feh!ings D1L1) .u:her@ee S1) +e#ge J1H1 * +i!!ias J1I1 6/00D8 ;outh an# (oung a#u!ts with cere%ra! pa!s($ their use o& ph(sician an# hospita! ser9ices1 Archi9es o& 5h(sica! .e#icine * Reha%i!itation ==6<8) <-<>D0/1 /0,, '!ac:we!! 5u%!ishing Lt# ,/B '1 Hes!e( et a!1 Ehe Journa! o& A#9ance# Nursing 6JAN8 is an internationa!) peer2re9iewe#) scienti&ic @ourna!1 JAN contri%utes to the a#9anceent o& e9i#ence2%ase# nursing) i#wi&er( an# hea!th care %( #isseinating high 4ua!it( research an# scho!arship o& conteporar( re!e9ance an# with potentia! to a#9ance :now!e#ge &or practice) e#ucation) anageent or po!ic(1 JAN pu%!ishes research re9iews) origina! research reports an# etho#o!ogica! an# theoretica! papers1 For &urther in&oration) p!ease 9isit JAN on the +i!e( On!ine Li%rar( we%site$ www1wi!e(o n !ine!i%rar(1co ?@ourna!?@an Reasons to pu%!ish (our wor: in JAN$ Q High2ipact &oru$ the wor!#Gs ost cite# nursing @ourna! an# with an Ipact Factor o& ,TBC0 > ran:e# -th o& =B in the /0,0 Ehoson Reuters Journa! Citation Report 6Socia! Science > Nursing81 JAN has %een in the top ten e9er( (ear &or a #eca#e1 Q .ost rea# nursing @ourna! in the wor!#$ o9er A i!!ion artic!es #own!oa#e# on!ine per (ear an# accessi%!e in o9er ,0)000 !i%raries wor!#wi#e 6inc!u#ing o9er <)000 in #e9e!oping countries with &ree or !ow cost access81 Q Fast an# eas( on!ine su%ission$ on!ine su%ission at http$??c 1anuscrip tcentra!1co?@ a n1 Q 5ositi9e pu%!ishing e"perience$ rapi# #ou%!e2%!in# peer re9iew with constructi9e &ee#%ac:1 Q Ear!( View$ rapi# on!ine pu%!ication 6with #oi &or re&erencing8 &or accepte# artic!es in &ina! &or) an# &u!!( cita%!e1 Q Faster print pu%!ication than ost copetitor @ourna!s$ as 4uic:!( as &our onths a&ter acceptance) rare!( !onger than se9en onths1 Q On!ine Open$ the option to pa( to a:e (our artic!e &ree!( an# open!( accessi%!e to non2su%scri%ers upon pu%!ication on +i!e( On!ine Li%rar() as we!! as the option to #eposit the artic!e in (our own or (our &un#ing agenc(Gs pre&erre# archi9e 6e1g1 5u%.e#81 ,/< /0,, '!ac:we!! 5u%!ishing Lt# Ehis #ocuent is a scanne# cop( o& a printe# #ocuent1 No warrant( is gi9en a%out the accurac( o& the cop(1 Users shou!# re&er to the origina! pu%!ishe# 9ersion o& the ateria!1