Students Who Stop Talking to the Patient: The Analysis Phase of an Instructional Design Project on Communicating With Adults Who Have Aphasia
[Student Name]
University of Phoenix
NSG/534: Facilitating Engaged Learning
Week 1 Assignment
[Instructor Name]
[Date]
The school, the students and all data are a composite written for a model paper.
I teach in the adult health clinical course of a baccalaureate nursing program, where junior students spend four weeks on a neurological and stroke rehabilitation unit. For three semesters, clinical instructors and unit nurses have described the same problem: when assigned a patient with aphasia, many students stop talking to the patient. They speak to the family instead, ask yes-or-no questions the patient cannot reliably answer or finish care quickly and leave. This paper completes the analysis phase of an instructional design project to address that problem.
The ADDIE Model and the Purpose of Analysis
Instructional design organizes the creation of instruction into five phases: analysis, design, development, implementation and evaluation, known by the initials ADDIE. Branch (2009) describes the analysis phase as the step that identifies the probable causes of a performance gap and determines whether instruction is the right response, before any content is written. Analysis protects a project from the most common design error, building an excellent solution to the wrong problem.
Evidence of the Gap
Four sources describe the problem. First, clinical instructors' written comments from the last three semesters mention difficulty communicating with patients with aphasia for 31 of 142 students, more than any other single communication concern. Second, a nurse manager on the unit reported that two patients' families complained that students "talked about their mother as if she was not there." Third, a survey of 48 students completing the rotation found that 39 had cared for a patient with aphasia, and 33 of those rated their confidence at 2 or less on a five-point scale. Fourth, observation of six students during care of patients with aphasia, done with permission, found that five relied on closed questions, four spoke mainly to family members and none used written key words, gestures or pictures.
Why the Gap Matters
Aphasia is common and consequential. A systematic review found median frequencies of aphasia after mixed stroke of 30% in acute settings and 34% in rehabilitation settings, and aphasia was associated with greater odds of in-hospital death, longer length of stay and greater disability up to two years after stroke (Flowers et al., 2016). Patients with aphasia depend on their communication partners to understand and express needs, including pain, fear and choices about care. A nurse who cannot communicate with them cannot fully assess or respect them.
Is This an Instruction Problem?
Not every performance gap needs instruction. Some are caused by missing tools, lack of time or unclear expectations. I tested these explanations. Communication boards and pictures are available on the unit, so tools are not missing, although students did not know where they were. Students have the same time with patients with aphasia as with other patients. Expectations are clear in the course objectives, which include therapeutic communication with all patients. The survey and observation instead point to missing knowledge and skill: students did not know techniques for supported conversation and had not practiced them. The curriculum review confirmed this. Aphasia appears in one lecture slide in the neurology unit, and communication labs practice interviewing patients without communication disorders. The gap is primarily an instruction problem, with one environmental fix, showing students where the communication tools are kept.
Learner Analysis
The learners are junior BSN students, about 48 per semester, typically 20 to 24 years old, with a minority of second-career students. They have completed a communication course and a fundamentals course and are skilled with technology. Most have never spoken with a person with aphasia. The survey shows they are anxious about "saying the wrong thing" and embarrassed when they cannot understand a patient. Their schedules are full: three clinical courses and a pharmacology course, with clinical days of ten hours. They value learning that is directly useful the next day on the unit.
Context Analysis
Instruction must fit into the adult health course without adding a class session, because the schedule is fixed. The program uses a learning management system in which students complete online modules, and the simulation center has standardized patients who can be trained for specific roles. The clinical unit has speech-language pathologists who are willing to help. The product must be completed before the students' rotation, which begins in week six of the semester.
Content and Evidence
The content is supported conversation, a set of techniques that help a person with aphasia understand and express themselves. Kagan (1998) described methods and resources for training conversation partners, including acknowledging the person's competence, using short sentences, gestures, written key words and drawings, checking understanding and giving the person time and ways to respond. A systematic review of communication partner training found that all 25 studies in the updated review reported positive changes, and recommended partner training to improve partners' skill in facilitating the communication of people with chronic aphasia (Simmons-Mackie et al., 2016). Most studies trained family members and volunteers rather than nursing students, which is a limit to note, but the techniques are the same.
Constraints and Resources
Constraints: no added class time, a budget limited to existing software and staff time, six weeks until the rotation begins and students' heavy workload. Resources: the learning management system, video recording in the simulation center, two standardized patients, a speech-language pathologist's time for consultation and review and my own time as designer.
Stakeholders in the Project
Several groups have a stake in the outcome. Patients with aphasia and their families are the people most affected, and the rehabilitation unit's peer support program can bring their perspective into the design. Unit nurses and speech-language pathologists will work alongside students and can reinforce or undermine what they learn. Clinical instructors will observe and evaluate students' communication. The course coordinator controls the schedule and must approve any change. Involving these groups during analysis, rather than after development, makes the product more likely to fit the unit and to be supported there.
What Success Would Look Like
Defining success during analysis gives the evaluation a target from the start. If the project works, clinical instructors' comments about students' difficulty communicating with patients with aphasia should fall well below the current rate of about one in five students, students' confidence ratings should rise, and observed students should speak directly to patients, use supported conversation techniques and assess pain with accessible methods. Family complaints about students talking over patients should stop.
Statement of the Instructional Goal
The analysis leads to one goal: before their stroke rehabilitation rotation, junior nursing students will be able to use supported conversation techniques to communicate directly with a patient who has aphasia during routine nursing care. The goal will be turned into measurable objectives in the design phase.
Conclusion
The analysis confirmed a real, recurring performance gap caused mainly by missing knowledge and skill, among learners who are motivated but anxious and busy, in a setting that requires instruction to fit an existing course. The evidence on supported conversation gives the content a firm base. Week 2 will design the instruction.
References
Branch, R. M. (2009). Instructional design: The ADDIE approach. Springer. https://doi.org/10.1007/978-0-387-09506-6
Flowers, H. L., Skoretz, S. A., Silver, F. L., Rochon, E., Fang, J., Flamand-Roze, C., & Martino, R. (2016). Poststroke aphasia frequency, recovery, and outcomes: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 97(12), 2188-2201. https://doi.org/10.1016/j.apmr.2016.03.006
Kagan, A. (1998). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12(9), 816-830. https://doi.org/10.1080/02687039808249575
Simmons-Mackie, N., Raymer, A., & Cherney, L. R. (2016). Communication partner training in aphasia: An updated systematic review. Archives of Physical Medicine and Rehabilitation, 97(12), 2202-2221. https://doi.org/10.1016/j.apmr.2016.03.023
How this NSG 534 Week 1 example is structured
The NSG/534 description is built around the analysis, design, development, implementation and evaluation model. This paper completes the first phase in full: it defines the performance gap with evidence, analyzes the learners and the setting, lists constraints and resources, identifies the content and the evidence behind it and ends with a clear statement of what instruction must accomplish, so every later phase can be traced to it. Students search this week as NSG 534 Week 1, NSG534 Wk 1 or NSG/534 Wk 1; all three are the same assignment.
NSG/534 Week 1 questions, answered
What does NSG/534 Week 1 usually ask for?
The course description centers on the ADDIE model. Many sections begin with the analysis phase: identifying a performance gap, analyzing learners and context and stating what an instructional product must accomplish.
What is a performance gap?
The difference between what learners currently do and what they need to do. Instructional design addresses gaps caused by missing knowledge or skill; gaps caused by other factors, such as lack of time or equipment, need other solutions.
Why focus on aphasia in nursing education?
Aphasia is common after stroke, and patients with aphasia depend on the communication skill of the people caring for them. Nursing students often receive little specific preparation for it.
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