STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
Receptive Communication
(Aphasia)
Altered receptive communication as
evidenced by difficulty
understanding, hearing and/or
reading due to stroke.
Chapter 6, Section 6.1 Taking Action
for Optimal Community and Long Term
Stroke Care, A Resource for
Healthcare Providers (2015)
GOAL(S)
Resident’s receptive
communication will improve from
___ to ____as measured on the
communication outcomes scale
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Conduct communication
assessment using validated
tool. Review hearing and
vision status.
Speech Language
Pathologist/Registered
Staff
Position yourself where you
will be easily heard.
Confirm with the resident
that they can hear you.
All staff interacting with
resident.
Verify that resident is
wearing working hearing
aid and glasses as needed.
All staff interacting with
resident.
Speak in a normal
tone/volume or your
speech may be distorted
and can overload hearing
aids, which can be painful.
All staff interacting with
resident.
Provide opportunities for
the resident to
communicate.
All staff interacting with
resident.
Allow the resident time and
opportunity to respond.
All staff interacting with
resident.
Be patient and persistent in
communication. Do not
change the topic too
quickly.
All staff interacting with
resident.
Try drawing or printing, use
objects, pictures or use
different words to support
conversation with the
resident.
All staff interacting with
resident.
January 2016
Page 1 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Use maps, calendars,
schedules and clocks when
talking about times and
places.
All staff interacting with
resident.
Ask family members for
photos or other materials
that can be used as starting
points for conversation.
Registered
Staff/PSW/HCA/recreation
Staff
Be sure you position
yourself and place
communication materials
so that the resident can see
you.
All staff interacting with
resident.
Be supportive. Tell the
resident that you
understand that they know
what they want to say.
All staff interacting with
resident.
Make sure there are few
distractions. Talk to the
resident face-to-face in a
quiet room.
All staff interacting with
resident.
Approach the resident
slowly and from the front. If
needed, gently touch a
hand or arm to help get
their attention.
All staff interacting with
resident.
Introduce yourself. Make
sure name tag is visible.
Address resident by their
preferred name and follow
other interventions as
recommended by OT/PT.
All staff interacting with
resident.
January 2016
Page 2 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Make eye contact at level
of resident when possible.
All staff interacting with
resident.
Always include the resident
in a conversation.
All staff interacting with
resident.
Introduce topics clearly.
Give one message at a
time. Ask one question at a
time.
All staff interacting with
resident.
Keep printed information
short and direct and use
large, clear print.
All staff interacting with
resident.
Repeat important
information using the same
words if you are not sure
that your message was
understood.
All staff interacting with
resident.
Speak slowly in a normal
voice.
All staff interacting with
resident.
Repeat what you have
understood. Ask the
resident to explain anything
you have not understood
All staff interacting with
resident.
Communicate about
important issues when the
resident is rested.
All staff interacting with
resident.
Ask questions to verify that
your message have been
heard accurately.
All staff interacting with
resident.
January 2016
Page 3 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
Expressive Communication
(Aphasia)
Altered expressive communication
as evidenced by (specify) slurring
of speech, difficulty with word
finding, problems producing words
and sentences, difficulty writing,
problems forming thoughts,
physical impairments (inability to
access communication devices
such as picture themeboard,
phone, computer, paper & pen) due
to stroke.
Chapter 6, Section 6.1 Taking Action
for Optimal Community and Long Term
Stroke Care, A Resource for
Healthcare Providers (2015)
GOAL(S)
Resident’s expressive
communication will improve from
___ to ____as measured on the
communication outcomes scale.
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Educate family members
on interventions to improve
communication.
Registered
Staff/PSW/HCA/Recreation
Staff
Conduct communication
assessment using validated
tool. Assess resident’s
need for augmentative or
alternative communication
(AAC) aids. Provide
resident with AAC aids if
warranted (specify).
Speech Language
Pathologist/Registered
Staff
Provide time and
opportunity for the resident
to speak and to respond.
All staff interacting with
resident.
Communicate in a quiet
place.
All staff interacting with
resident.
Ask resident to speak
slowly and loudly if the
communication impairment
has resulted in a weak, soft
or slurred voice.
All staff interacting with
resident.
Speak to the resident
slowly. Use a normal voice
level.
All staff interacting with
resident.
Keep choices limited and
use ‘yes’ or ‘no’ questions if
resident has trouble
expressing preferences.
All staff interacting with
resident.
January 2016
Page 4 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Repeat what you have
understood. Ask the
resident to explain anything
you have not understood.
All staff interacting with
resident.
Place communication aids
within easy reach and on
unaffected side.
Use an alphabet
board/communication
board /computer/tablet
All staff interacting with
resident.
Provide resident with paper
and pen or white board and
marker so they can write
their message.
All staff interacting with
resident.
Make notes to keep track of
conversation.
All staff interacting with
resident.
Communicate about
important issues when the
resident is rested.
All staff interacting with
resident.
Give the resident time to
respond. Supply the word
if the resident seems to be
getting frustrated.
All staff interacting with
resident.
Position yourself where you
will be heard easily and ask
if the resident can hear
you.
All staff interacting with
resident.
Ask questions to verify that
your messages have been
heard accurately.
All staff interacting with
resident.
January 2016
Page 5 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Develop non-verbal codes
(e.g. thumbs-up, thumbsdown) if resident tends to
say “yes” when they mean
“no” and vice versa.
All staff interacting with
resident.
Check if resident is wearing
glasses, if they are needed.
PSW/HCA/Registered
Staff/SLP
Ensure resident is wearing
dentures if required to
support verbal
communication.
PSW/HCA
Educate family members
on interventions to improve
communication.
All staff interacting with
resident.
.
Visual Impairment/Neglect
Affecting Communication
Resident has other impairments
(specify) (e.g., blurred vision,
double vision, right/left sided
neglect) related to stroke as
evidenced by difficulty
communicating.
Chapter 6, Section 6.1 Taking Action
for Optimal Community and Long Term
Stroke Care, A Resource for
Healthcare Providers (2015)
Resident will be able to
compensate for a vision
impairment by using appropriate
strategies (specify)
.
Follow interventions for
visual neglect as
recommended by OT
All staff interacting with
resident.
Cue resident to scan
environment right to left or
left to right.
All staff interacting with
resident.
For a visual field loss,
move yourself and any
materials so they are easily
seen in the remaining
visual field.
All staff interacting with
resident.
Ensure resident has
assistive visual device(s) in
place.
All staff interacting with
resident.
January 2016
Page 6 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
Inability to Change Facial
Expression Affecting
Communication
Impaired communication related to
stroke as evidenced by inability to
change facial expression.
GOAL(S)
Resident will be aware of and be
able to compensate for lack of
expression when communicating
with others by using appropriate
strategies (specify).
Chapter 6, Section 6.1 Taking Action
for Optimal Community and Long Term
Stroke Care, A Resource for
Healthcare Providers (2015)
Inappropriate Emotional
Reactions Affecting
Communication
Altered communication as
evidenced by inability to respond
with appropriate emotional reaction
due to stroke
Chapter 6, Section 6.1 Taking Action
for Optimal Community and Long Term
Stroke Care, A Resource for
Healthcare Providers (2015)
Resident will experience
decreased number of
inappropriate emotional
responses (specify).
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Educate family members
on interventions related to
vision impairment.
PSW/HCA/Registered
Staff/SLP
Verify that resident’s facial
expression is reflecting
their emotion by asking the
resident. (e.g., you look
happy, you look sad)
All staff interacting with
resident.
Educate family members
on interventions to verify
that facial expression is
reflecting emotion.
PSW/HCA/Registered
Staff/SLP
Identify and record triggers
for inappropriate emotional
responses and avoid
triggers where possible.
All staff interacting with
resident.
Remember that the
resident is not being rude
on purpose.
All staff interacting with
resident.
Help the resident recognize
and change responses that
appear rude by telling them
how you feel about this
behaviour and what would
work better.
All staff interacting with
resident.
Educate family members
on interventions to adjust
emotional responses.
PSW/HCA/Registered
Staff/SLP
January 2016
Page 7 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.
STROKE CARE PLAN: COMMUNICATION
All selected interventions must be implemented, monitored, evaluated and documented as per Home policy.
Any changes (improvements or deterioration) must be reported to the RN/RPN.
Resident/family must be involved with and agree to plan of care.
FOCUS
GOAL(S)
TIMELINES
INTERVENTIONS
ACCOUNTABILITY
Alignment with Best Practice
 BP Blogger Newsletter - June 2007 Best Practice in LTC Initiative – Volume 5 Issue 1 Jan/Feb 2010 http://www.theria.ca/resources/bp-bloggers/
 Aphasia Institute http://www.aphasia.ca/
 Quality-Based Procedures: Clinical Handbook for Stroke (Acute and Postacute) 2015, Module 9, Community Treatment – QBP Stroke
 Canadian Best Practice Recommendations for Stroke Care – Communication
January 2016
Page 8 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.