Nurses' clinical observation and interpretation of communication disorders in patients admitted with stroke

Abstract

Background - Communication disorders are very common and a serious outcome of stroke. Early diagnosis of communication disorders is highly important for patients to enhance recovery. Care provided by nurses offers the opportunity to collect relevant information concerning patients' communication impairments. To optimize care and rehabilitation of stroke patient, it is important to gain insight if the nurses’ clinical observation and interpretation of communication disorders is adequately.

Aim - The objective is to evaluate the criterion validity and reliability of the nurses clinical observation and interpretation of communication disorders in comparison with validated screenings instruments, the Frenchay Aphasia Screening Test and Mini Mental State Examination, or the diagnose of a speech therapist.

Method - A multicenter prospective observational study was conducted on a neurology ward in a university and a general hospital. Consecutive sampling technique was used to examine all patients and their nurses admitted in the neurology ward with stroke. The validity of the nurses' clinical observation and interpretation is determined in comparison with diagnose of a speech therapist or screening instruments. Interrater reliabilty was determined by asking two nurses independently if the patient was able to communicate adequately.

Results - In total, 85 patients (75%) were not properly diagnosed for the absence or presence of a communication disorder in contrast to 28 properly diagnosed patients (n=113). Sensitivity (44%), specificity (11%), positive predicted value (25%) and negative predicted value (24%) showed a poor to moderate clinimetric properties. The interrater reliability (Cohen's Kappa=0.54) showed a moderate agreement (n=83).

Conclusion - It appears that nurses make different judgments regarding the communication abilities of patients in comparison to validated screening instruments.

Recommendations - Advanced future studies conducted with larger sample groups will provide results that are more definitive.