Journal of Gerontological Nursing

COMMUNICATION DIFFICULTIES OF NURSING HOME RESIDENTS: How Can Staff Help?

Jill Kato, BSPTHY; Louise Hickson, BSPTHY, MAUD, PHD; Linda Worrall, BSPTHY, PHD

Abstract

ABSTRACT

Recent studies hove found a high prevalence of communication disorders in elderly residents of nursing homes. This study was undertaken to investigate staff attitudes to me communication problems and communicative needs of residents in their care. A questionnaire was administered to 32 staff members from one nursing home. Responses indicate little evidence of the negative staff attitudes previously reported in the literature. Staff wanted more time to spend communicating with residents and wanted to leam more about the residents' communication problems. Implications of the questionnaire responses for staff training are presented.

Abstract

ABSTRACT

Recent studies hove found a high prevalence of communication disorders in elderly residents of nursing homes. This study was undertaken to investigate staff attitudes to me communication problems and communicative needs of residents in their care. A questionnaire was administered to 32 staff members from one nursing home. Responses indicate little evidence of the negative staff attitudes previously reported in the literature. Staff wanted more time to spend communicating with residents and wanted to leam more about the residents' communication problems. Implications of the questionnaire responses for staff training are presented.

There is a considerable body of opinion to suggest that effective communication is essential to the maintenance of quality of life for elderly people living in residential care (Gravell, 1988; Kastenbaum, 1972; Lubinski 1979, 1981; Percy & Alexander, 1989; Teplow, 1988). Communication disorders such as hearing loss, the language of dementia, and aphasia are common in this population (Bryan & Drew, 1989; Chafee, 1967; Geraldton, 1989). In an Australian study by Worrall, Hickson and Dodd (1993), 98% of 215 nursing home residents were found to have at least one communication impairment. Residents were screened for hearing loss, cognitive deficits, aphasia, poor speech intelligibility, voice problems and pragmatic deficits (e.g., poor eye contact, inability to take turns in conversation). The most frequently identified disorder was hearing loss followed by dementia, and a multiplicity of disorders was common with 70% of residents failing two or more screening measures.

In addition to the communication impairments experienced by the elderly residents themselves' their communication environment has itself been described as "impaired" (Lubinski, 1984). Features of the environment which may not be conducive to effective communication are limited access to others, lack of interaction with those outside the residence, lack of privacy, lack of activities that require meaningful communication, the physical arrangement of furniture limiting possibilities for face-to-face conversation and poor acoustic conditions (George & Maddox, 1989; GraveU, 1988; Lubinski, 1984).

The communication problems of nursing home residents may be further complicated by attitudes of staff. Three overall themes emerge in reports of staff attitudes to the communication needs and problems of elderly residents in nursing homes. These can be summarized as negative stereotypes about residents and their communication needs (Gravell, 1988; Peisah, 1990), undervaluing communication compared to the physical and medical aspects of patient care (Evans, Hughes, Wilkin, & Jolley, 1981; Parker, 1987), and restricted communication style (Evans, Hughes, Wilkin, & Jolley, 1981; Lubinski, 1979). In Australia, Percy and Alexander (1989) provided a useful indication of staff attitudes to a variety of communication-related issues. In all, 163 staff members from two large nursing homes responded to the survey. The vast majority of staff (90%) agreed that talking with the residents was part of their role, however 63% also agreed that it was difficult to find time to talk with residents and 75% felt that most of the residents could not hold a normal adult conversation. Percy and Alexander (1989) state that a 62% response rate was achieved, and that not all staff responded to every question. Responses were obtained from only nursing and therapy staff. The numbers of each professional category surveyed were also not reported, although respondents were asked to indicate their current job classification on the questionnaire.

Since all staff who come in contact with the residents are potential communicators and therefore part of the residents' communicative environment, there is a need to extend the scope of the Percy and Alexander (1989) study to a representative sample of all staff who come into contact with residents. Finally, there is considerable agreement in the literature on the need for specialized training for geriatric health care staff (Bryan & Drew, 1989; Gravel!, 1988; Lubinski, 1979; Percy & Alexander, 1989; Steel, 1980; Stevens, LeMay, Gravell, & Cook, 1992). To be effective, training should be designed to take into account staff attitudes toward the communication problems of residents in their care. The aims of the present study were to investigate the attitudes of nursing home staff toward the communication difficulties experienced by elderly residents in their care, to determine staff perceptions of their needs for training, and to determine the staff needs for information specific to the communication problems of nursing home residents.

Table

TABLE 1Subjects' Professional Categories and Employment Details

TABLE 1

Subjects' Professional Categories and Employment Details

METHOD

Subjects

The entire 32 staff members from a 67-bed, church-administered nursing home in Brisbane, Australia participated in this research. The average bed capacity for nursing homes in this region of Australia is 57 (range=4-460). This nursing home was selected since it was average in size. Every member of the staff surveyed had worked at the nursing home for at least six months and all had contact with the residents during waking hours on a regular basis. All subjects were female. All occupational classifications of staff employed at the nursing home were represented (Table 1). The overall proportions of each occupational classification reflect the typical staff structure in Australian nursing homes (Centre of Applied Business Research, 1986).

Procedure

Subjects were asked to complete a questionnaire containing 21 items adapted from Percy and Alexander (1989). The questions were designed to explore the following issues:

a) the priority given to residents' communication needs;

b) perceptions of residents' communicative abilities and problems;

c) perceptions of residents' communication opportunities; and

d) the perceived need for staff to acquire more training, knowledge and skills for communication with nursing home residents.

The questionnaire was divided into two parts: in the first part, the staff were presented with a series of statements and asked to indicate whether they agreed or disagreed with the statement. An example of a statement from this section of the questionnaire is "It is important for the staff to talk with the residents." The five alternative responses were Strongly Agree, Agree, Don't Know, Disagree and Strongly Disagree. In the second part, staff were given a statement and asked to estimate to what percentage of the residents that statement applied. An example of a statement from this section of the questionnaire is "The residents can hold a normal adult conversation." The response choices in this section were 100%, 75%, 50%, 25% and O. When respondents wished, they were permitted to indicate a percentage other than those specified.

Table

TABLE 2Questionnaire Responses-Part 1

TABLE 2

Questionnaire Responses-Part 1

Each member of the staff responded individually in writing to the questionnaire and the researcher was present to answer any queries or clarify where required. Staff were told that the purpose of the research was to examine the communication problems of elderly nursing home residents and see how speech pathologists could assist staff in dealing with those problems. Staff were advised that all responses were confidential.

RESULTS

Responses obtained to statements in the first part of the questionnaire are summarized in Table 2. AU staff responded that talking with the residents was important, and all but one staff member indicated mat residents' communication problems were as important as their physical problems. Moreover, only one staff member expressed the opinion that it was not part of her job to encourage the residents to communicate. Most respondents (72%) expressed a desire to have more time to spend communicating with the residents. Staff generally considered that nursing home residents had relatively fewer opportunities to communicate than their peers living elsewhere. There was also a concern for the quality of residents' communication: 97% of staff members surveyed believed that it was also part of their job to ensure the quality of residents' communication.

Questionnaire responses were also analyzed according to the different occupational categories. There was little or no difference between the occupational groups in their responses to the majority of items. However, for Item 4, which asserted that residents in nursing homes have fewer opportunities to communicate than people the same age living elsewhere, there were differences between the staff groups. The majority of the enrolled nurses (known as licensed practical nurses in the United States) disagreed with the assertion, whereas the physiotherapists and activities officers unanimously agreed with the statement and the majority of each of the other occupational groups agreed with the statement. There was a clear difference between occupational groups in their responses to Items 8 and 9. In general, the staff with more formal nursing training reported being more informed about communication problems in general and in relation to specific residents in their care.

Table

TABLE 3Percentage Questionnaire Responses- Part 2

TABLE 3

Percentage Questionnaire Responses- Part 2

Responses to the second part of the questionnaire are summarized in Table 3. On the basis of the mean responses presented in this Table, it appears that staff considered that only about one-third of residents were able to hold adult conversations or participate in residents' meetings. They also thought that less than half of the residents were aware of their own communication problems. They judged almost two-thirds of the residents to have some degree of hearing loss. However, staff thought that nearly two-thirds of the residents tried to communicate and they could understand, and be understood, by about half of the residents. Staff also indicated that just over half of the residents had plenty to talk about and would like more chances to talk.

DISCUSSION

Many researchers have suggested that the problems of nursing home residents with communication disorders are aggravated by poor staff attitudes (Evans, Hughes, WUkin, & Jolley, 1981; Gravell, 1988; Lubinski, 1979; Parker, 1987; Peisah, 1990), however, the responses of staff surveyed in this study contradict these assertions. The implications of these findings are that nursing home staff, on the whole, do not need to be persuaded to give greater priority to the communication needs of the residents in their care. Staff need and want to spend more time communicating with residents. The problem appears to be one of resource allocation, rather than attitude.

A number of items on the questionnaire were intended to investigate staff attitudes toward various aspects of the communicative abilities and problems of nursing home residents. The majority of staff (75%) agreed that it was possible to communicate in a meaningful way with a resident. Most staff thought that 75% of residents had a hearing loss. Although this shows a high level of awareness of the problem of hearing loss, the prevalence of hearing loss was underestimated. The actual prevalence figures for the Geraldton (1989) and Worrall, Hickson and Dodd (1993) studies were 100% and 84% respectively. There was no reason to expect that the prevalence of hearing loss in the nursing home residents in this study would be substantially lower. The results suggest the need for further training in the identification of hearing loss to increase staff sensitivity to this major problem.

Table

TABLE 4Strategies tor Effective Communication with Nursing Home Residents (Dodd, Worra/t & H/dbon, 1 990)

TABLE 4

Strategies tor Effective Communication with Nursing Home Residents (Dodd, Worra/t & H/dbon, 1 990)

Staff felt that few residents had normal conversational skills and that less than half the residents were aware of their own communication déficits. Comprehension was perceived as a widespread problem, both when staff spoke to residents and residents spoke to staff. Ability to hold an adult conversation is a very subjective concept, which is not readily measurable, so the accuracy of the staff responses cannot be verified. However, the implications are that conversational skills of many residents appear to be inadequate and that staff are likely to need special knowledge and skills to maximize communicative opportunities for residents.

Another issue investigated in this study was that of the staff members' perceived need for further training, knowledge and skills for communication with residents. The majority of staff wanted to learn more about the communication problems of nursing home residents and approximately half felt that they had not had enough training about these communication problems. The more highly qualified nursing staff tended to be more satisfied with their current degree of training. Staff generally agreed that they had enough strategies to help them communicate with residents, but 41% of staff felt that they did not have enough information on the residents' ability to communicate. Table 4 contains some general strategies for effective communication with nursing home residents.

A limitation of this research is that the survey was conducted in only one nursing home and therefore the findings cannot be generalized to a range of residential care facilities. Staff training, knowledge, experience and attitudes in other types of facilities may differ. In order to better understand staff attitudes to the communication problems and needs of residents in their care and to develop appropriate training programs, it is recommended that educators, administrators or speech pathologists administer the questionnaire devised here in their own setting.

To summarize, the questionnaire responses obtained in this study showed essentially positive staff attitudes to the communication needs and problems of nursing home residents. Staff wanted more time to spend communicating with residents and expressed a need to learn more about the residents' communication problems. Further staff training was seen as desirable by the majority of staff, and this training should include information on the prevalence of communication disorders, such as hearing loss, and the implications of such disorders. While it appears that there is little need to convince the staff of the importance of communication, there is considerable scope for devising ways for staff to increase their communicative effectiveness with the residents within the prevailing limitations of staff numbers and time.

REFERENCES

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TABLE 1

Subjects' Professional Categories and Employment Details

TABLE 2

Questionnaire Responses-Part 1

TABLE 3

Percentage Questionnaire Responses- Part 2

TABLE 4

Strategies tor Effective Communication with Nursing Home Residents (Dodd, Worra/t & H/dbon, 1 990)

10.3928/0098-9134-19960501-08

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