AAC training from the patient and the carer’s perspective Version 1.0
Research type
Research Study
Full title
Training from the patient and the carer’s perspective: The development of a care staff training programme in AAC based on the views of AAC users and carers in a long-term care setting
IRAS ID
244181
Contact name
Mark Jayes
Contact email
Sponsor organisation
Manchester Metropolitan University
Duration of Study in the UK
4 years, 4 months, 3 days
Research summary
Summary of Research
Research Question: Can a care staff training programme in Augmentative and Alternative Communication (AAC) based on the views of adults with communication difficulties and their care staff in a long-term care setting, be effective at improving communication interactions between these two groups?For adults with communication difficulties, face-to-face interactions between themselves and care staff is often difficult, with many staff lacking the requisite skills and abilities to effectively communicate with these individuals. This can lead to communication breakdown, poorer quality of care and medical errors. This research aims to train staff to effectively use AAC with their patients. AAC = Augmentative and Alternative Communication - communication aids which can be low technology, such as a letter chart, or high technology, such as a computer which has a voice.
The participants will be care staff (nurses and care assistants) and adults with acquired conditions recruited from a healthcare organisation, the Royal Hospital for Neuro-disability. This qualitative study will consist of interviewing 6 adults who use AAC and inviting 5-8 care staff to be part of a focus group to find out how both of these groups feel about their communication with each other, and their views on methods of training. Following analysis of this data, a training intervention will be developed.
A separate group of 30 care staff will undergo the training. Pre-and post measures of knowledge and satisfaction with using AAC will be taken in the form of surveys. AAC users will again be interviewed for their views on the effectiveness of the training. These results will be fed into a final version of a training programme. The results from this study will help us to deliver more effective and targeted training for care staff, to help them to communicate with adults for whom AAC is their only means of communication.Summary of Results
Study title: Training from the patient and the nursing staff’s perspective: The development of a nursing staff training programme in AAC based on the views of AAC users and nursing staff in a long-term care settingAugmentative and alternative communication (AAC) is a set of tools and strategies that an individual uses when they have communication difficulties. In this study I am referring to aided communication which involves the use of physical tools and techniques. These can include paper-based materials (low-tech AAC) as well as electronic devices (high-tech AAC).
The study took place between 2019-2024 within the Compass service of the Royal Hospital for Neuro-disability (RHN). The RHN is an independent medical charity and specialist setting that provides care and support for adults aged 18 and over, with complex neurological conditions. The Compass Assistive Technology Service, based within the RHN, provides AAC to inpatients and community patients as part of both the RHN charity funding and the NHS Specialised Services AAC funding pathway.
The study is made up of two phases.
Research questions:Phase 1:
1. How do AAC users and nursing staff feel about their communication with each other?
2. How do nursing staff and AAC users feel about current AAC training?
3. How do nursing staff and AAC users feel about their ideal AAC training?Phase 2:
1. What impact did the nursing staff training intervention have on the nursing staff’s knowledge and confidence in using AAC?
2. How feasible and acceptable is the nursing staff training intervention to the AAC users and the nursing staff?
Why was this study needed?:
Nursing staff (registered nurses and health care assistants (HCAs)) who work in hospitals and care homes are important communication partners for adults with communication difficulties who rely on Augmentative and Alternative Communication (AAC). If a nurse or HCA does not understand how to use and support an individual’s AAC system this places the AAC user at risk of poor quality of care, miscommunications and adverse health events.
There was no clear evidence-base or guidance for how best to support and improve nursing staff’s knowledge and confidence in AAC use within long-term care settings, with little guidance for those working in the AAC field on how to deliver training.
The study:
This study was a feasibility study which aimed to address this gap in the literature by developing and evaluating a nursing staff AAC training programme based on the views of AAC users and nursing staff in a rehabilitation and long-term care setting.
Using a pragmatic approach, a mixed-methods study (using quantitative and qualitative methods) was conducted with 5 AAC users and 42 nursing staff. Phase 1 involved a systematised literature review, semi-structured interviews with AAC users and focus groups with nursing staff. These methods were adapted to maximise communication accessibility to participants through the use of Talking Mats ™. Talking Mats is a communication framework that was developed to help people with communication difficulties to express their views about a range of topics (Murphy et al., 2010). The results were then triangulated (different results were combined to verify findings) with a methodological literature review exploring intervention and behaviour change literature. A training intervention programme was then developed based on these results. The feasibility and acceptability of this intervention were then investigated in Phase 2, as well as its impact on nursing staff’s knowledge and confidence, using interviews and surveys.
Study results:
Phase 1:
1. AAC users and nursing staff can find AAC use complex and difficult
2. Nursing staff are highly motivated to learn about and use AAC
3. AAC users want to support nursing staff’s learning
All participant research data and the literature reviews found that the following were preferred in training:
4. Patient focussed, individualised training
5. Practical content
6. Information about AAC
7. Constructive feedback on performance
8. Train the trainer
9. AAC user involvement in training
10. Ward-based learning
11. Performance checklistsIntervention development
From the above results of Phase 1, an individualised, practical training programme was developed to address this, which included the use of personalised videos, AAC strategy instruction and checklists. It was based on the National Institute of Health Research (NIHR) and the Medical Research Council (MRC) (Skivington et al., 2021a) guidance for developing and evaluating complex interventions, as well as Gagné’s Instructional Design Model (Gagné, 1985; Gagné et al., 2005). The intervention programme was a 9-step process which was followed within each training session which lasted about 20 minutes each. 11 sessions took place and the numbers of nursing staff within each session varied from 2 – 6 on each ward.
Study results:
Phase 2:
The impact of the training programme:
1. Increased nursing staff knowledge of safe AAC device set up
2. Increased nursing staff knowledge and confidence in interacting with AAC users
3. Increased awareness by nursing staff of AAC user’s skills and knowledge
4. Increased nursing staff knowledge about AAC
The following were found to be feasible and acceptable to the AAC users and the nursing staff:
1. Receiving feedback from an AAC user
2. Nursing staff practising with AAC set up and use with the AAC user themselves
3. Nursing staff learning from each other
4. Competency checklist
5. Training video
6. Practical elements of training
7. Duration and location of the training (on the ward)
These findings are consistent with previous AAC research and intervention studies. In line with a pragmatic approach to research, this study has produced actionable knowledge and explored how to solve an issue, based on respondent experiences, ensuring the research is practical and relevant.This study adds the following contributions to knowledge in the field of AAC:
i. It adds to our understanding of what AAC users need and want from communication partner training, and the potential for how they can be involved in the design and delivery of it.
ii. It includes the previously marginalised voice of the health care assistants who complete much of the face-to-face care delivery, and explores what supports them to learn in training.
iii. It provides some key strategies and principles to follow when designing and delivering training on AAC to nursing staff.
iv. It highlights an area in need of development – that of co-designed and co-delivered training with AAC users and nursing staff.REC name
North West - Preston Research Ethics Committee
REC reference
19/NW/0003
Date of REC Opinion
4 Mar 2019
REC opinion
Further Information Favourable Opinion