Kathleen Lane

Supporting communication for people with aphasia in stroke rehabilitation: transfer of training in a multidisciplinary stroke team

Background: Participation of people with aphasia in clinical care and rehabilitation is an area of increasing research interest. Supported communication (SC) training, which aims to enhance the participation of aphasic patients, has been shown to improve conversation partner knowledge and skills. However, there is a lack of evidence for transfer of SC training to practice in post-acute rehabilitation settings. Aims: We aim to develop an understanding of causal mechanisms implicated in the transfer of SC training by examining the nature of the setting, staff perspectives, and the situated character of the action. Methods and Procedures: Twenty-eight staff from a multidisciplinary team were trained in SC. We collected detailed and varied data, including staff experiences of SC training and implementation, and video data of routine practice. Using a critical realist approach, we develop explanatory mechanisms for barriers to and enablers of transfer. Eleven team members (nursing, therapy, and assistant staff) took part in focus groups and interviews at the end of the study; 54 learning logs were collected over a 10-month period. Six aphasic patients and eight staff took part in video-recordings of therapy and care sessions. Outcomes & Results: Three main themes derived from staff experience data are linked to key components of the setting, indicating processes implicated in transfer of training, and impacting on outcomes such as perceptions of quality and staff confidence. Barriers, constraints, and problem-solving approaches in enacting SC were evidenced through patient factors, spaces and events, and time constraints. Staff flexibility and team working were key factors in problem-solving these obstacles. Staff reported responsive use of skills and resources and perceived impact of SC training, with most, but not all, staff reporting benefits, including increased confidence in interactions with aphasic patients. Activity analysis of video data illustrates how some mechanisms may be operating in practice, with evidence of rich use of interactional strategies and resources; a focus by staff on getting the work done; opportunities for patient active participation or emotional support that are realised or not; strategies for aphasia-related trouble and repair sequences. Conclusions: This model of SC training has clear benefits for staff communication practices and confidence, but transfer of training is subject to complex processes. Training should therefore address systems-level practices and be extended for staff who need more advanced skills. The values implicit in SC have the potential to create a culture of access and inclusion, encouraging and supporting active participation of all stroke patients.

Enhancing the spaces of reflection: A buddy peer-review process within physical education initial teacher education

Innovation in enhancing the reflective abilities of physical education trainee teachers was explored in this study through establishing peer ‘training buddies’ during their school placements. Opportunities for active engagement in peer- and self-reflection were provided to full-time Post-Graduate Secondary Physical Education trainee teachers (n = 23). Data were collected through surveys, focus group interviews and trainee reflections shared through online discussion boards. Prior to their first school placement trainees were assigned a peer training buddy. Whilst on placement, they recorded each other teaching a physical education lesson; immediately afterwards, the pair watched the recorded lesson and conducted a joint evaluation. This dialogue allowed them to engage in reflective discussion. The process was repeated during the trainees’ second placement with a different peer training buddy. Grounded theory methodology informed an emergent model of reflective practice. By being and having a training buddy, trainees created, enabled and negotiated their own rules, structures and practices for implementing the process. Common themes emerging from the data pointed to a series of mutually-created spaces: safe – non-judgemental and creating a sense of solidarity; relaxed – non-pressured and conversational; equal – involving all participants at the same stage and status; pedagogic – collaborative and involving the sharing of ideas; negotiated – allowing autonomy and ownership of the process; and alternative – experiencing a different school environment. Trainees endorsed the peer review process as a method of engaging in critical reflection. The data illustrated the positive benefits that can be derived from sharing feedback with a peer. The emergent theory presented suggests that the collaborative spaces created by training buddies enhance reflective ability and practice.

Methodological issues in the design and evaluation of supported communication for aphasia training: a cluster-controlled feasibility study

Objective To assess the feasibility and acceptability of training stroke service staff to provide supported communication for people with moderate–severe aphasia in the acute phase; assess the suitability of outcome measures; collect data to inform sample size and Health Economic evaluation in a definitive trial. Design Phase II cluster-controlled, observer-blinded feasibility study. Settings In-patient stroke rehabilitation units in the UK matched for bed numbers and staffing were assigned to control and intervention conditions. Participants 70 stroke rehabilitation staff from all professional groups, excluding doctors, were recruited. 20 patients with moderate-severe aphasia were recruited. Intervention Supported communication for aphasia training, adapted to the stroke unit context versus usual care. Training was supplemented by a staff learning log, refresher sessions and provision of communication resources. Main outcome measures Feasibility of recruitment and acceptability of the intervention and of measures required to assess outcomes and Health Economic evaluation in a definitive trial. Staff outcomes: Measure of Support in Conversation; patient outcomes: Stroke and Aphasia Quality of Life Scale; Communicative Access Measure for Stroke; Therapy Outcome Measures for aphasia; EQ-5D-3L was used to assess health outcomes. Results Feasibility of staff recruitment was demonstrated. Training in the intervention was carried out with 28 staff and was found to be acceptable in qualitative reports. 20 patients consented to take part, 6 withdrew. 18 underwent all measures at baseline; 16 at discharge; and 14 at 6-month follow-up. Of 175 patients screened 71% were deemed to be ineligible, either lacking capacity or too unwell to participate. Poor completion rates impacted on assessment of patient outcomes. We were able to collect sufficient data at baseline, discharge and follow-up for economic evaluation. Conclusions The feasibility study informed components of the intervention and implementation in day-to-day practice. Modifications to the design are needed before a definitive cluster-randomised trial can be undertaken. Trial registration number ISRCTN37002304; Results.

Older women's reduced contact with food in the Changes Around Food Experience (CAFE) study: choices, adaptations and dynamism

ABSTRACT Many older women reduce the amount of cooking and food preparation they do in later life. While cooking may be seen as traditionally associated with womens family roles, little is known about the impact of such reduced engagement with food on their lives. This paper presents the findings from a one-year qualitative study (Changes Around Food Experience, CAFE) of the impact of reduced contact with preparing and cooking meals from scratch for 40 women, aged 65–95 years, living in Norfolk, United Kingdom. Data were collected through semi-structured interviews, focus groups and observations. Womens reasons for reducing food-related activities included changes in health, loss of a partner or a caring role, and new patterns of socialising. Disengagement from cooking and shopping was not found to entail predominantly negative feelings, passive acceptance or searching for forms of support to re-enable more cooking from scratch. Accounts evidenced the dynamic adaptability of older women in actively managing changed relationships with food. In exploring new meal options, older women were not simply disengaging from their environments. CAFE findings linked womens engagement with their environments to how they were using formal services and, even more, to the value they placed on social engagement and being out and about. Through the connections they fostered with friends, family and community, older women actively enabled their continued involvement in their social, public and family spheres. Reduced contact with preparing and cooking meals from scratch, therefore, did not induce or imply passivity or debility in the CAFE cohort. By contrast, it involved their exploring new means of retaining what was important to them about food in the context of their lived situation and social connections with friends, family, the community and public spheres.

Older care-home residents as collaborators or advisors in research: a systematic review

Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused. Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors. Methods: a systematic literature search of 12 databases, covering the period from 1990 to September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers. Results: nineteen reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents involvement in small-scale and large-scale studies and (ii) the barriers to and facilitators of involvement. Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process.

Perils, pitfalls and reflexivity in qualitative research in education

Context, avers Emeritus Professor Barry MacDonald, is everything and here is a book which illustrates its central significance tellingly. Perils, pitfalls and reflexivity in qualitative research in education brings together a series of papers addressing key issues of methodology, ethics and reflexivity by those conducting and engaging with research in the South. The book is an outcome of an international conference held at the University of Karachi in November 2006 on the theme, ‘Qualitative research in developing countries: possibilities and challenges’. Editors Fauzia Shamim and Rashida Qureshi set out to address the lacuna in published literature of ‘the voices of indigenous researchers undertaking qualitative research within novel research environments’ (viii) by bringing together conference presentations, along with three commissioned papers. Their book is timely and instructive. Eight papers discuss fieldwork and research issues emanating from countries outside the North: the majority of examples are based in Pakistan; Kenya, Iran and Mexico are among the others. Specific settings, which vary from a remote rural village in northern Pakistan to a state prison in south-west Mexico, capture the diversity of environments and cultures typical of qualitative research practised in both North and South. In addition, the ethical and methodological challenges presented across the papers are germane not only to those whose work, like these ‘local researchers’, engages with the South and with the international context; this engaging book is also relevant for researchers immersed in the procedural apparatus of the North. The book is presented in three sections. The first section, which contains the editors’ Introduction (2–9) and Adrian Holliday’s paper, ‘Submission, emergence, and personal knowledge: New takes and principles for validity in decentred qualitative research (10–30), is sub-titled, ‘Research North and South’. Shamim and Qureshi state that the book aims to help equip educational researchers beginning their studies ‘in varied socio-cultural settings in developing countries’ (2) and sketch some of the sensitivities with which researchers must equip themselves to do their research in indigenous settings. The editors also emphasize the role reflexivity plays in dealing with the complexities of the researcher role, much of which reflects tensions of the ‘outside-insider’ or ‘inside-outsider’. Holliday makes a convincing case for the value of the long-term revisiting of data by applying the principles of submission, emergence and personal knowledge. By examining earlier material from his own and others’ research from contexts in Egypt, China and Hong Kong through the lens of his three principles, Holliday produces a ‘take 2’ on the data Compare Vol. 41, No. 4, July 2011, 549–555

Pupil voice on being gifted and talented in physical education: ‘They think it's just, like, a weekend sort of thing’

Background: Pupils’ views have been elicited in physical education over a long period, but is a comparatively under-examined area within literature on gifted and talented (G&T) in physical education concerns pupil voice and their accounts of being placed on their schools’ G&T register. Purpose: This small-scale qualitative study consulted pupils in physical education about being on the G&T register, the demands of their academic work, academic support available to them, what could support them and their thoughts on post-16 and career aspirations. The findings emerged from a larger research project exploring key stakeholders’ views on provision for G&T pupils in physical education within an Excellence in Cities (EiC) cluster in rural eastern England. Participants, research design and data collection: Data for this study were collected within a 4-month period from four secondary schools, three of which formed part of an EiC cluster and included a Sports College. The fourth school, which was outside the EiC cluster, worked closely with the Sports College, linking its own G&T programme to the work already established at the Sports College. Thirty-one Year 10 and 11 pupils (17 male, 14 female) were selected by the schools from their G&T registers. Seven separate focus group interviews were held and pupils also completed a questionnaire. Findings: Common patterns were reported by pupils within and across the schools reflecting their positive perceptions of being on the G&T register for physical education. While pupils valued the schools’ nurturing of their abilities, the positive nurturing of talent was not always transferred to the nurturing of their academic potential. They felt they would benefit from more support for their academic needs, especially in managing their workloads. They expressed a tension between fulfilling their commitments to training and sport on the one hand and meeting the requirements of their academic work on the other. Support offered through individual mentoring was received positively. For most, however, mentoring was sparse and appeared to be an unstructured process. In addition, many pupils spoke of the toll their dedication to their sport took on their social lives. The majority of pupils expressed a desire to continue study beyond post-16 and several mentioned the aim of attending university. Conclusions: The need for personalised and tailored individual support to help pupils meet the demands of both academic and sporting commitments was articulated in this study. Implications from the findings also indicate that a Junior Athlete Education framework might be in place at some schools but it may not always be utilised effectively or meet the authentic needs of the pupils on the G&T register for physical education. As a consequence, unstructured and informal processes, as well as patchiness of support, have been seen to work against the effectiveness of G&T programmes. These findings reinforce previous research and add valuable insight in the form of pupils’ voices and experiences.

“Are you going to come and see us again soon?” An intergenerational event between stroke survivors and school-children

Purpose n n n n nA one-hour intergenerational event held at an infant school in Norfolk, England, aimed to increase the citizenship experience of young children and their awareness of what it means to live with stroke, and to address social isolation or self-confidence in communicating among stroke survivors with aphasia. It was also intended to gauge whether this activity might provide a basis for future research. The paper aims to discuss these issues. n n n n nDesign/methodology/approach n n n n nFour community-dwelling stroke survivors with aphasia were recruited. In total, 12 pupils aged six and seven were selected by their Year 2 teacher and head-teacher. At the event, participants sat in groups of one adult and three pupils and engaged in writing, hand-tracing and talking about pictures. The author circulated among the groups to facilitate engagement. n n n n nFindings n n n n nAll participants enjoyed interacting together in the activities. The pupils gained insights into the stroke survivors’ lived experience and wanted them to return to “see us again soon”; the adults valued being in the “real world” and practising their conversation in activities different from their usual routines. Feedback indicated the value of the engagement and that participants welcomed similar intergenerational opportunities. The author will develop a research application exploring enablers, barriers and benefits of this type of engagement. n n n n nOriginality/value n n n n nThe event gave a rare opportunity for stroke survivors with aphasia to participate in intergenerational activities and for children to engage with vulnerable older adults. It demonstrated the value of interactions in which learning and insights are obtained on both sides. It also provided evidence that pursuing research in this field is feasible.