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Participation in healthcare in jeopardy for people with speech and language disorders


Patients with speech and language disorders risk losing out on their right to have a say in their care. Research at Sahlgrenska Academy is now highlighting the need for uninterrupted communication with healthcare staff, clear strategies from the care provider’s side and individual communication plans for elderly residents in long term care facilities.

“When there’s lack of knowledge in how to communicate with these patients, it can result in health care staff not talking to them at all, thus avoiding their inclusion in their own care,” says Emma Forsgren, PhD at the Institute of Neuroscience and Physiology and licensed speech and language pathologist.

In her thesis, she has studied the experiences of enrolled nurses (40 people) and medical students (69) regarding communication in healthcare situations for patients with speech and/or language disorders caused by, for example, stroke or dementia.

Two methods of facilitating communication between patients/residents and health care staff have been evaluated. Firstly, practical training for medical students in supportive communication strategies, and secondly, the introduction of more structured communication routines at two different long term care facilities for elderly people. Two heads of unit and ten residents were also interviewed.

Challenging conversations

Both enrolled nurses and medical students found it quite challenging to communicate with people with speech and language disorders. However, after around half of the medical students had undergone practical training in the form of role-play with other students, their knowledge of supportive communication strategies increased.

Several enrolled nurses perceived that they already had some knowledge of supportive communication strategies and they were aware of the importance of personal relationships with residents. Time constraints and constant interruptions in conversations were however clear obstacles.

“This is a major problem. How can we provide person-centred care to people we have difficulties talking to? Another factor is that there are so many different languages in long term care facilities. The residents might have both dementia and a different language background,” says Emma Forsgren.

Uninterrupted conversations and adaptation to the individual are described as key factors for successful communication in the case of speech and language disorders. If the patient lacks the ability to find and produce the words themselves, staff can also ask more questions, offer alternatives and perhaps use images as a complement.

Body language and eye contact can also be crucial, but require knowledge of the individual. Therefore, Emma Forsgren believes that in order to bridge the gap and convey knowledge to new staff, individual communication plans are necessary as a part of residents’ healthcare plans. The trials in her work were based on creating documents of a few pages that contained information about how the resident wants to communicate and the difficulties that exist.

Moderate success

“Results were mixed. We made some progress but came across a lot of obstacles on our way to the ultimate goal of everyone having a communication plan. It was difficult to achieve continuity when staff left or changed position or shift,” she explains.

Modest successes then, which is not favourable in light of the Swedish patient law which state that care providers must ensure the patient is capable of understanding the information they receive.

“This places new demands on education and training of students and professionals in the healthcare sector as they require information on both how to provide person-centred care in general and how to provide it to people with different types of communication disorders,” says Emma Forsgren.

Read more in the thesis.

Send an email to Emma Forsgren.

Portrait: Walle Grünewald