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J AN

JOURNAL O F A DVANCED N URSING


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
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'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&
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