Whereas stroke is a leading cause of death in the United States and Canada, survival estimates are 75% - 85% in both countries [1, 2]. About 10% of patients with disability post-stroke live in institutions . More than 300,000 stroke survivors in Canada typically live with substantial and lasting physical and neuro-cognitive deficits [4, 5], with 25-40% of them presenting with aphasia, the inability to produce or understand language . These patients often are admitted to a long term care (LTC) facility because of their neurological disorders . Up to 50% of LTC patients have speech and communication impairments . When patients can neither articulate their needs nor be understood following a stroke, depression, agitation and behavioural symptoms often ensue [9–12].
Traditionally, nursing staff have treated behavioural symptoms exhibited by patients with stroke with restrictive interventions such as physical, environmental or chemical restraints , which are regarded as a major threat to patient care quality . Additionally, caring for patients with behavioural symptoms contributes to staff burnout, which eventually leads to staff turnover, and negatively influences care quality . Patient-centred care has emerged as a crucial underlying principle for the delivery of quality care in LTC facilities . A key component of patient-centred care is the ability of staff to communicate in such a way that allows them to understand the patient’s needs. Research indicates that the occurrence of behavioural symptoms can be mitigated by the way nursing staff communicate with patients . Therefore, enhancement of nursing staff’s communication strategies has been identified as a priority for LTC environments  and for maintaining patients’ quality of life . However, two significant limitations of patient-centred care exist. First, the responsibility for ensuring the patient’s best care falls upon the nursing staff (both registered and unregulated care providers). However, many nursing staff lack the requisite specialized skills and abilities to effectively communicate with patients who have communication impairments and hence have difficulties understanding patients’ needs [8, 20]. Providing assistance with personal care activities such as dressing, toileting and transferring requires frequent interactions between patients and nursing staff and if these interactions are compromised by communication breakdown and subsequent agitation, personal care interactions are disrupted and quality of care is undermined . The end result is that the patient’s post-stroke functions and well-being are not optimized. Second, a recent systematic review of communication studies identified an absence of evidence-based interventions designed to enhance communication with patients with stroke living in LTC . Improved staff communication with these patients is the basis for assessing patients’ needs and for providing patient-centered care.
Methodological and theoretical limitations across the studies that evaluated communication- focused interventions have left significant gaps in our understanding of how to effectively improve LTC staff’s communication skills. Approaches to communication training have been based on general recommended linguistic strategies [20, 22]. Only one study had individualized tailored communication training . Conversely, evidence is accumulating that communication enhancement strategies should be based on individualized patients’ remaining communication abilities [24, 25]. Provision of effective and responsive care demands a focus on both communication and behavioural management strategies. How staff communicate with patients when a behavioural symptom occurs can influence patients’ behavioural symptoms [10, 17].
To address some of these limitations, McGilton and colleagues  developed and pilot-tested a patient-centred communication intervention (PCCI) targeting nursing staff caring for patients with communication impairments post-stroke. The PCCI involved training by a Speech-Language Pathologist (SLP) to 18 nurses on 1 LTC unit on communication impairments and supportive conversation strategies. The SLP also developed individualized patient communication care plans based on initial assessments. The recent pilot work referred to as PCCI enhances quality of life, reduces agitation in patients and in turn creates more cooperative and less stressful caregiving situations for nurses . The pilot study provided evidence to support the feasibility of a larger scale study to examine the efficacy of the PCCI, to determine its long-term effects, to test the intervention in new sites, and to determine its effects on a range of outcomes in a large sample of patients.
This study implements the PCCI in Complex Continuing Care (CCC) with the objective to educate, train and support nursing staff in communicating effectively with patients who have communication impairments as a result of a stroke. The specific objectives include 1) to determine the effects of the PCCI on improved patient quality of life (communication and psychosocial domains), satisfaction with care, and agitation, at 1 and 3 months post-intervention; and 2) to examine the extent to which the PCCI improves nursing staff’s attitudes and knowledge about caring for patients with communication impairments at 1 and 3 months post-intervention.