Use of Communication Plans by Certified Nursing Assistants: Little Things Mean a Lot

Background: Many residents in long-term care facilities in the United States have communication disorders that impede interactions with staff, particularly certified nursing assistants (CNAs) who provide direct care and are in a position to communicate with residents the most. Researchers in Canada have successfully used individualized communication plans to facilitate staff–resident communication in long-term care settings, but the viability of using communication plans to facilitate staff–resident communication in long-term care facilities in the United States has not been investigated. Aims: This study sought to determine the usefulness of communication plans by CNAs working in long-term care settings when providing personal care to residents with communication disorders and to explore the role support from the speech-language pathologist (SLP) might play in this process. Method & Procedures: The study used a grounded theory qualitative research design. Participants included 10 CNAs working in two long-term care facilities. Each CNA chose two residents with a communication disorder whom they felt might benefit from a communication plan. Communication plans were collaboratively developed by the SLP and the CNA for the selected residents. CNAs used the plans to facilitate communication during daily care of their residents for two weeks. Five CNAs from one facility received support from the SLP; five CNAs from a second facility did not. Following 2 weeks of communication plan use, all CNAs were interviewed. Interviews were transcribed verbatim and data were analyzed using open, axial, and selective coding per grounded theory methodology. Outcomes & Results: Findings indicated that communication plans were useful in facilitating CNA–resident communication. CNA’s negative views of certain aspects of their jobs were altered positively through use of communication plans. They gradually became more familiar with residents which made work less effortful and enriched relationships with residents. Findings also indicated that support for CNAs from a SLP may provide an incentive to use information in the communication plan to more effectively communicate with the resident while providing daily personal care and potentially improving the quality of that care. Conclusions: Communication plans are useful to CNAs in facilitating communication with residents in long-term care facilities and a minimal amount of support from the SLP enhances this process