Ward talk: Nurses' interaction with people with and without aphasia in the very early period poststroke

Background: Nursing staff are the most frequent communication partners, after family members, for people in hospital poststroke, and they play an essential role in the multidisciplinary team. Recent research has found that patients are more cognitively and socially active when wards provide an enriched environment as compared to standard care. Therefore, language enrichment on acute wards is now being considered as a possible way to discourage learned nonuse of language in people with aphasia. Aims: This study involved an exploration of the nature of nurses' interactions with three patients on an acute stroke ward, two with aphasia and one without, in order to understand the nature of the communicative environment in more detail. Methods & Procedures: Following all necessary ethics approval processes and consents, continuous video recordings of 7.5hr each were run for three male patients (two aged 68years and one aged 48years) on the acute stroke ward within a teaching hospital in an Australian city. Two had left hemisphere strokes resulting in a Wernicke's aphasia (WAB AQ=47) and a global aphasia (WAB AQ=9.2) and one had a right hemisphere stroke and no aphasia. All instances of interaction with nurses over that period were transcribed orthographically and analysed at a discourse level using a speech function analysis based on a systemic functional linguistic framework. Outcomes & Results: Overall, nurses made most of the opening moves, used closed questions, controlled the conversational floor, and did not generally interact about issues other than physical care. The patients with aphasia had restricted opportunity to use continuing and developing moves and most commonly fell into a pattern of closed question and simple response. There was little evidence of communicative repair by nurses and few supported conversation strategies employed. Patterns of moves identified through the speech function analysis revealed the disempowered position of the patients with aphasia compared to the patient without who used a wider range of speech functions that demonstrated more assertive interactions. Conclusions: This study suggests that nurses, in their role as key communication partners on the acute stroke ward, could help counter the development of learned nonuse by integrating more effective communication strategies into their daily care routines. Further conversation partner training could relieve communication breakdown and frustration and increase opportunities for satisfying conversational exchanges in this setting.