Rehabilitation staff’s perception of communication with patients in post-traumatic confusional state

Objective: Communication difficulties are described as a key feature for people in Post-Traumatic Confusional State (PTCS) alongside cognitive and behavioural difficulties, but limited studies have been conducted on the experiences of their communication partners. The aim of the current study was to understand the experience of rehabilitation staff in their communication with patients in PTCS prior to an implementation study of communication partner training (CPT).
Methods: All clinical staff members from a subacute rehabilitation unit for patients with moderate to severe TBI were invited to complete a 10-item questionnaire. The questionnaire evaluated staff's perception of communication with patients in PTCS in a variety of formats including yes-no questions, multiple-choice, 4-point scaled questions, and free text responses. The content covered (i) basic demographic information about respondents, (ii) knowledge of the patient group’s communication, (iii) respondents’ perception of their own interaction with patients in PTCS, (iv) their use of strategies in communication, and (v) a brief description of experiences with non-successful and successful communication. The responses were analysed with descriptive and inferential statistics and content analysis.
Results: 78 interdisciplinary staff were included (65% response rate). Respondents consisted of occupational therapists, physiotherapists, nurses, nurse assistants, doctors, porters, neuropsychologists, social workers, pedagogues and secretaries. The majority of respondents found communication difficult (72%) and time consuming (67%) and half of the respondents reported not feeling confident communicating with patients in PTCS. The level of perceived confidence in communication was not significantly different between professions or related to the length of clinical experience working with PTCS. Eighty-five percent of respondents reported using strategies to support communication, largely focused on (i) using objects to support verbal communication and to compensate (e.g. for cognitive difficulties) and (ii) structuring the environment (e.g. by limiting own speech and shielding the patient from external stimulation). The main reason for non-successful communication was attributed to patient behaviour with emphasis on negative emotional reactions (e.g. anger, frustration). In describing successful communication respondents’ answers focused on their own use of strategies and own behaviour (e.g. simplifying verbal language, being calm).
Conclusion and implications for clinical practice: To our knowledge this is the first study to investigate rehabilitation staffs’ perception of communication in the subacute state with patients in PTCS. Overall, staff finds communication difficult and their level of confidence does not improve with length of experience. This suggests that educating and training staff in communication with this patient group is worth exploring. The strategies reported rarely involved use of writing or drawing to support verbal communication, suggesting that certain strategies for successful communication might possibly be augmented by an intervention.