Helping aphasic patients accomplish greeting exchanges

Background: This study explores greeting exchanges in stroke care, in particular the use of the ‘wai’ gesture. Method: Seventeen patients with Broca’s aphasia, some family members, six nurses from district public health centers, and four nurses from a district hospital in northern Thailand were given written consent forms for participation. Thirty counseling sessions were video-recorded in patients’ homes and analyzed using conversation analysis. Direct observation and in-depth interview were also used for supplementary data collection. Results: These showed a patient’s daughter helping her to accomplish a greeting. She was encouraged to use one hand to raise the other hand up. Another patient was only able to raise one hand to conduct the normal ‘wai,’ a potential cause of embarrassment for the patient, as the greeting is always formed by putting the two palms of the hands together. The nurse encouraged him to perform the greeting using one hand through different questions and statements. Discussion and conclusion: While the ‘wai’ gesture and the spoken greeting ‘sawatdi’ used for social functions plays an important role in stroke counseling, the nursing guidelines in the Barthel Index excluded them in the section on non-verbal communication assessment. This article suggests that they should be taken into account, in order to improve the nursing guidelines to fit the Thai context.