Patients’ experiences of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward following stroke: a qualitative description approach

Abstract

Background

Patients in hospital following stroke express a desire to continue therapy tasks outside of treatment activities. However, they commonly describe experiences of boredom and inactivity. An enriched environment aims to provide opportunities for physical, cognitive and social activity and informed the development of a Communication Enhanced Environment (CEE) model to promote patient engagement in language activities.

Purpose

Explore patient perceptions of a CEE model, and barriers and facilitators to engagement in the model.

Methods

A qualitative description study from a larger project that implemented a CEE model into acute and rehabilitation private hospital wards in Western Australia. Semi-structured interviews were conducted with seven patients, including four with aphasia, within 22 days post-stroke who had access to the CEE model.

Results

Patients described variable experiences accessing different elements of the CEE model which were influenced by individual patient factors, staff factors, hospital features as well as staff time pressures. Those who were able to access elements of the CEE model described positive opportunities for engagement in language activities.

Conclusions

While findings are encouraging, further exploration of the feasibility of a CEE model in this complex setting is indicated to inform the development of this intervention.

Implications for rehabilitation

• Patient access to a CEE model is challenging in a hospital setting.

• Patients who were able to access elements of the CEE model described positive opportunities for engagement in language activities.

• Patients’ access to the CEE model was influenced by patient factors, staff factors, hospital features as well as staff time pressures.

Keywords:

• Stroke
• aphasia
• Communication Enhanced Environment model
• enriched environment
• rehabilitation

Acknowledgement

The authors sincerely thank all the stroke survivor participants in this study who were willing to share their insights into their experiences in hospital during their early recovery. The authors thank the hospital working party team who developed and embedded the CEE model and all the staff who participated in this research. The authors extend this thank you to Claire Tucak, Millie Gallan-Dwyer, Sarah Wynn and Toni Dalzell for all their work in the design and development of this study and to Dominie Scott, Jamie Smith and Lana Rojas for their willingness to assist the site champions in screening potential study participants.

Disclosure statement

The authors have no other competing interests to declare.

Data availability statement

Data are available upon reasonable request. Data are stored in the Edith Cowan University data storage repository. These 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 grant number RF087. SD received an Australian Post Graduate Award Scholarship for the first year of this study and received an ECU Research Travel Grant.