CHHS Nursing Students Develop Care Solution for Resident Diagnosed with Expressive Aphasia

During the spring semester, a group of first-semester School of Nursing clinical students, led by clinical instructor Mitzi Averette, went above and beyond to develop a care solution for a resident at The Davis Community. Diagnosed with expressive aphasia, the resident struggled to put her thoughts into words.

“I think the big issue for people with aphasia is that they’re embarrassed,” Averette said. “…it’s very frustrating understanding everything that is said to you and not being able to respond.”

According to the National Aphasia Association, 2,000,000 Americans have been diagnosed with aphasia, an impairment of speech usually resulting from a stroke or traumatic brain injury. Although aphasia takes many forms, expressive or Broca’s aphasia is characterized by the reduction of speech. Individuals with expressive aphasia comprehend most or all of what is being said to them but lack the ability to reciprocate coherently.

“It’s very embarrassing, because they can’t think of a word or they use the wrong words or things don’t make sense… and they can sometimes shut down. And that is kind of like what happened to this lady,” Averette said.

The resident could only respond to yes or no questions by nodding her head up and down or shaking her head. When asked if she had access to a notepad that she could use to communicate, the resident pointed to her arm.

“Her right arm was flaccid, not moving,” Averette recalls. “Her stroke (a left cerebral vascular accident) also resulted in right sided paralysis. The right arm was completely not functioning and she was right-handed. So, one of the simple options, which is to write down what you want to say, was also not as available to her.”

Averette brought the problem to her clinical group. Her first thought was to use word magnets that the resident could arrange into sentences. Her students, digital natives, had a better solution.

“Another one of my classmates, Abby, mentioned she had seen an iPad in the room and suggested we give a look at apps,” Nursing student Anna Grauel said. “… I told her it was a great idea, and we immediately pulled out our phones and began to search for the app that would work best.”

All eight first-semester clinical students worked together to compile a list of apps that they thought might be a good option for the resident. One of their primary goals was to find an app that would both help the resident communicate effectively and be easy for her to use. Given her age, they did not want to introduce anything too complicated for fear it would discourage her from using it.

The students downloaded several apps to their own devices and tested them to find one that would suit the resident’s needs. After several attempts, the group settled on the app Smalltalk by Lingraphica. Unlike similar apps they had looked at, the app was free with a feature for the Ipad to speak aloud in a male or female voice. With the app, the user can select words or phrases from a list and have the device speak it out loud. It also has an assortment of food/drink options and medical terminology.

“We believed [the medical terminology] could prove useful if she was in any pain or [had a] problem with a medication while in the long-term care setting,” Nursing student Abby Grove said. “It gave a lot of options for locations on the body and varying types of descriptive feelings, which could be helpful to any caretakers if they were looking to assist the [resident] with a problem.”

The resident and all the staff at Davis were very impressed with the students’ solution. “I was really excited about this outside the box thought,” Averette said. “Their goal was to develop a plan of care and they came up with a completely new and very effective idea.”

Clinical Instructor Averette believes that stories like this show the importance of giving students access to technology in the classroom. “You know, away from class or away from clinical, they’re Googling stuff—you know they are—so let’s teach them how to Google correctly. To me, it is critical that we, as faculty, incorporate professional use of technology.”

With the resident’s permission, the students downloaded the app to her Ipad and taught her how to use it.  Nursing student Abby Grove said the patient teared up after they got the apps set up and working because of her new opportunity to communicate.

 “The huge grin on her face when she first used it was so great,” Grauel said, “and the feeling we all had when we had successfully improved her stay at the facility was absolutely unforgettable. I will look back on this experience in clinicals for years to come as a reminder that there is always something you can do to improve your patient care.”