Patient-Centered Communication Survey of Nursing Homes and Rehabilitation Centers

Article excerpt

A surge of research has recently been published on the importance of patient-centered communication (P-CC). However, patients with communication disorders are rarely considered in these discussions. Health care workers in long-term care facilities (L-TCFs) and rehabilitation centers were surveyed in order to: (1) assess the level of P-CC used with people with communication disorders versus those without communication disorders; (2) identify the tools and strategies currently used by health care providers in long-term care facilities and rehabilitation centers to enhance P-CC with people with communication disorders; (3) assess the perceived level of effectiveness of these tools and strategies; and (4) identify the tools desired by health care providers in these settings. The results regarding P-CC levels were fairly consistent across settings. Health care providers reported that they achieve slightly higher P-CC with patients without communication disorders than with those with communication disorders. Respondents in both settings used similar tools and strategies, but the reported level of effectiveness varied greatly between the two settings, with rehabilitation centers indicating better success than L-TCFs. Interestingly, rehabilitation center respondents were more interested in obtaining additional tools than were L-TCF respondents, but the types of tools desired were similar.

Keywords: communication disorders; communication tools; communication strategies; health care

Communication disorders, which may impede patientcentered communication (P-CC), are common among clients served in both long-term care facilities (L-TCF) and rehabilitation centers. In long-term care facilities, communication barriers are apt to include hearing loss, dementia, and age-related communication disorders associated with etiologies such as a history of stroke and Parkinson's disease. Contrastingly, rehabilitation centers tend to serve patients with newly acquired communication disorders due to stroke, traumatic brain injury, and spinal cord injuries. In both of these settings, challenges in communication may be caused by a number of resulting disorders including aphasia, apraxia, dysarthria, reading disability, and cognitive dysfunction.

Although these disorders may be extensive and highly debilitating, "few health care workers, particularly auxiliary health care staff, have received formal training regarding the identification, treatment and needs of patients who have communication disorders" (Odulana, Sarvela, & Sarvela, 1989, p. 68).This article reviews the literature on P-CC in long-term care facilities (L-TCFs) and rehabilitation centers, and reports findings from a study that had the following fourfold purpose:

1. To assess the level of P-CC used with people with communication disorders versus those without communication disorders.

2. To identify the tools and strategies currently used by health care providers in long-term care facilities and rehabilitation centers to enhance P-CC with people with communication disorders.

3. To assess the perceived level of effectiveness of these tools and strategies.

4. To identify the tools desired by health care providers in these settings.

LITERATURE REVIEW

P-CC is defined as (1) obtaining the patient's point of view, (2) involving the patient in a discussion of treatment alternatives, (3) mutually deciding the course of treatment, and (4) establishing a trusting relationship over time (Nagy, 2001). It is essential to achieve patient-centered care, a medical model "that engages the patient in decision-making and self-care" (Silow-Carroll, Alteras, & Stepnick, 2006, p. 7). Without good communication, health care providers can be ignorant of patient needs and expectations, which can lead patients to misunderstand the rights and choices available (Kopp, 2001) and can lead to poor health outcomes (Roter, 1989). The literature is replete with research on P-CC (Roter, 1989; Stewart et al. …