Staff and volunteers' perceptions of a Communication Enhanced Environment model in an acute/slow stream rehabilitation and a rehabilitation hospital ward: a qualitative description study within a before-and-after pilot study

Abstract

Purpose

A lack of social interaction during early stroke recovery can negatively affect neurological recovery and health-related quality of life of patients with aphasia following stroke. A Communication Enhanced Environment (CEE) model was developed to increase patient engagement in language activities early after stroke. This study aimed to examine staff (n = 20) and volunteer (n = 2) perceptions of a CEE model and factors influencing the implementation and use of the model. This study formed part of a broader study that developed and embedded a CEE model on two hospital wards.

Materials and methods

Six focus groups and one interview with hospital staff were conducted and analysed using a qualitative description approach. Feedback emailed by volunteers was included in the data set.

Results

Staff and volunteers perceived the CEE model benefitted themselves, the hospital system and patients. Staff identified a range of factors that influenced the implementation and use of the CEE model including individual staff, volunteer and patient factors, hospital features, the ease with which the CEE model could be used, and the implementation approach.

Conclusions

This study provides valuable insights into staff perceptions which may inform the implementation of interventions and future iterations of a CEE model.

Implications for Rehabilitation

• A CEE model may promote efficiency and increased patient engagement in stroke rehabilitation.

• The CEE model information session and aphasia communication partner training, and the provision of resources, may be useful strategies to increase staff confidence in using communication supporting strategies with patients with aphasia.

• Behaviour change and implementation science strategies may provide a framework to address barriers and promote facilitators to embed hospital-based interventions that require individual, ward, cultural and systems level change to reduce the evidence-based gap in clinical practice.

Keywords:

• Communication Enhanced Environment model
• stroke
• aphasia
• rehabilitation
• recovery
• enriched environment

Acknowledgements

The authors thank all hospital staff and volunteers for engaging in the development of the CEE model and implementing the intervention in the ward environment, and for participating in this study’s focus groups and interviews. We would particularly like to thank the CEE model working party (Claire Tucak, Toni Dalzell, Mary McCurdy, Helen Morell, Tracey Sariago, and Millie Gallan-Dwyer). The authors also thank Claire Tucak, Sarah Wynn, Millie Gallan-Dwyer and Toni Dalzell for their invaluable contribution to the larger study procedure development, participant screening and their role in the uptake of the CEE model on the wards. The authors also thank Dominie Scott, Jaimie Smith and Lana Rojas for being so flexible and assisting with site champions duties when they were needed.

Disclosure statement

This work was funded by the Hollywood Private Hospital Research Foundation. SD received an Edith Cowan University Research Travel grant and was funded by an Australian Post Graduate Award Scholarship for the first year of this study. The authors have no other conflicts of interest to report.

Data availability statement

Focus group data are stored in the Edith Cowan University data storage repository. This data will be available in a de-identified format by request through the first author ORCiD https://orcid.org/0000-0001-6221-3229. The availability and use of the data are governed by Edith Cowan University Research Ethics.

Additional information

Funding

This work was supported by the Hollywood Private Hospital Research Foundation under Grant [number RF087]; and by the Edith Cowan University: Research Travel Grant. SD received an Australian Post Graduate Award Scholarship for the first year of this study.