Robyn O'Halloran

Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: an observational study

BACKGROUND Many people have communication-related impairments when they are patients in acute hospital stroke units. One way to improve a persons ability to communicate is by providing a supportive communicative environment. AIMS Using the World Health Organisations (WHO) International Classification of Functioning, Disability and Health (ICF) framework, this research sought to identify the environmental factors that either create barriers to and/or facilitate communication between patients and their healthcare providers in acute hospital stroke units. METHODS & PROCEDURES A qualitative research methodology was used. Sixty-five patients were observed communicating with their healthcare providers in healthcare events. Interactions were transcribed and analysed to identify any environmental factors that may have influenced the interaction. OUTCOMES & RESULTS In total, 126 environmental factors were identified, which were grouped into 89 subcategories, 28 categories, and seven overall themes. Four themes related to the healthcare providers knowledge, communication skills, attitudes and individual characteristics. The other three themes included the presence of family, the physical environment, and hospital systems. CONCLUSIONS & IMPLICATIONS There are many environmental factors that influence communication between patients and their healthcare providers in the acute stroke unit. Removing barriers and maintaining factors that facilitate communication may contribute towards the development of communicatively accessible stroke units.

Environmental factors that influence communication between people with communication disability and their healthcare providers in hospital : a review of the literature within the International Classification of Functioning, Disability and Health (ICF) framework

The importance of effective healthcare communication between healthcare providers and people needing healthcare is well established. People with communication disabilities are at risk of not being able to communicate effectively with their healthcare providers and this might directly compromise their health, healthcare and their right to participate actively in decisions about their healthcare. This paper reviews the literature on the environmental factors that influence communication between adults with communication disabilities and their healthcare providers in the acute hospital setting within the framework of the World Health Organizations International Classification of Functioning, Disability and Health (ICF) (2001). It focuses in particular on the environmental factors that facilitate or create barriers for people with communication disabilities because environmental factors can be modified so that acute care hospitals can become more accessible communicative environments for all people. The paper describes the particular environmental factors that have been identified in acute hospitals that influence the ability of people with specific types of communication disabilities and their healthcare providers to communicate. It then goes on to describe the common environmental factors that have been identified across people with different types of communication disabilities when they are communicating with their healthcare providers. This paper concludes with suggestions for directions of future research.

Environmental Factors That Influence Communication for Patients With a Communication Disability in Acute Hospital Stroke Units: A Qualitative Metasynthesis

OBJECTIVE To develop a taxonomy of the environmental factors that influence communication between patients with communication disabilities and their health care providers in hospital stroke units. DATA SOURCES We conducted a metasynthesis of 3 qualitative studies conducted by our research team on the environmental factors that influence communication between patients and health care providers in hospital stroke units. STUDY SELECTION These studies identified environmental factors which influence communication from the perspectives of 10 patients with communication disabilities, 10 health care providers, and by direct observation of 65 patients interacting with health care providers. DATA EXTRACTION The findings of each study formed the data for the metasynthesis. DATA SYNTHESIS The findings of the qualitative studies were analyzed and then synthesized using reciprocal translation. The environmental factors were grouped into 11 higher order categories and 2 overall themes. The themes were (1) health care providers (knowledge, skills, attitude, experience, characteristics) and (2) stroke unit structure and processes (patient opportunities to communicate, family, use of communication aids and equipment, opportunities to learn, policies and procedures, physical environment). CONCLUSIONS Acute stroke inpatients with communication disabilities need knowledgeable and skilled health care providers to communicate as effectively as possible. However, there are many environmental barriers and facilitators at the level of stroke unit structures and processes that also impact on the ability of health care providers to communicate with patients. Interventions to improve the communicative accessibility of stroke units need to focus on health care providers and on the processes that govern the unit.

The ICF Activities and Participation related to speech-language pathology

Increasingly speech-language pathologists are considering the effects of a clients communication and/or swallowing disability on the clients day to day life. The activities and life situations that make up a persons everyday life are described in the Activities and Participation component of the World Health Organizations International Classification of Functioning, Disability and Health (ICF). This paper describes the Activities and Participation component of the ICF and how communication is currently represented in this component. This paper then explores the current debate between the concepts of activities and participation and how this can continue to inform and develop our understanding of communication activity and communication participation into the future.

Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method

Objectives To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. Design Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). Participants A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. Main outcome measures Statements that achieved a high level of agreement and an overall median score of 7–9 on a nine-point scale were rated as ‘appropriate’. Results 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. Conclusions This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation.

The number of patients with communication related impairments in acute hospital stroke units

Effective communication between patients who have had a stroke and their healthcare providers is vital. However, this may be difficult if patients have communication related impairments as a result of the stroke and/or have age related impairments that impact on their ability to communicate. This study sought to identify how many patients admitted into two acute hospital stroke units had a hearing, vision, speech, language and/or cognitive communicative impairment regardless of the cause. A total of 69 patients participated in this study. The majority (88%) of patients had one or more mild or more severe communication related impairments, 69% of patients had two or more communication related impairments and 39% of patients had three or more communication related impairments. The most common type of impairment was hearing impairment, followed by near vision impairment. That a high number of patients in acute hospital stroke units have communication related impairments suggests that many patients in acute stroke units may experience difficulty communicating their healthcare needs with healthcare providers and that alternative ways to support patients with communication related impairments in acute stroke units need to be available.

Factors affecting speech pathologists’ implementation of stroke management guidelines: a thematic analysis

Abstract Purpose: Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. Methods: A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundations Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Results: Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Conclusions: Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. Implications for Rehabilitation In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

A psychometric investigation of speech, language and cognitive communicative rating scales for adults with acquired neurogenic communication disorders in the acute hospital setting

Speech-language pathologists working in hospitals have limited opportunities to identify patients with newly acquired communication related impairments and to support patients with communication related impairments to communicate their healthcare needs. The International Classification of Functioning, Disability and Health conceptualizes these different roles as within the Body Functions and Structures component and within the Activities and Participation component respectively. The Inpatient Functional Communication Interview (IFCI) is a measure of how well a patient is able to communicate their healthcare needs in hospital. This study investigated whether a speech-language pathologist could conduct the IFCI and have sufficient information to rate a patients level of communication related impairments, on newly developed speech, language and cognitive communicative rating scales (named the OHW scales) in a reliable and valid way. This research indicated that the OHW scales had strong and significant concurrent criterion validity and significant interrater reliability. However the most important aspect of interrater reliability for the OHW scales was interrater agreement. Interrater agreement was moderately high for the OHW speech and cognitive communicative scales but low for the OHW language scale. Interrater agreement on the OHW language scale requires further investigation.

'I do the best I can': an in-depth exploration of the aphasia management pathway in the acute hospital setting

Abstract Purpose: While research has begun to explore the management of aphasia across the continuum of care, to date there is little in-depth, context specific knowledge relating to the speech pathology aphasia management pathway. This research aimed to provide an in-depth understanding of the current aphasia management pathway in the acute hospital setting, from the perspective of speech pathologists. Method: Underpinned by a social constructivist paradigm, the researchers implemented an interpretive phenomenological method when conducting in-depth interviews with 14 Australian speech pathologists working in the acute hospital setting. Interview transcripts and interviewer field notes were subjected to a qualitative content analysis. Results: Analysis identified a single guiding construct and five main categories to describe the management of aphasia in the acute hospital setting. The guiding construct, First contact with the profession, informed the entire management pathway. Five additional main categories were identified: Referral processes; Screening and assessment; Therapeutic intervention; Educational and affective counselling; and Advocacy. Conclusions: Findings suggest significant diversity in the pathways of care for people with aphasia and their families in the acute hospital setting. Additional support mechanisms are required in order to support speech pathologists to minimise the evidence-practice gap. Implications for Rehabilitation Significant diversity exists in the current aphasia management pathway for people with acute post-stroke aphasia and their families in the acute hospital setting. Mechanisms that support speech pathologists to minimise the evidence-practice gap, and consequently reduce their sense of professional dissonance, are required.

Central Auditory Processing Disorder: a systematic search and evaluation of clinical practice guidelines.

RATIONALE, AIMS AND OBJECTIVES An increased interest in Central Auditory Processing Disorder has seen the publication of several guidelines to help inform clinical practice. The aim of this study was to conduct a systematic search and critically evaluate published guidelines to inform the ongoing development of evidence-based practice in this area. METHOD A systematic search of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews guidelines. Nominated guidelines were then critiqued using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. RESULTS Five clinical practice guidelines in the area of Central Auditory Processing Disorder were identified. The British Society of Audiology guideline achieved the highest rating for scope and purpose, rigour of development and applicability and overall score. CONCLUSIONS The AGREE II tool is an effective way to critically evaluate the quality of methodological reporting of clinical practice guidelines in the area of Central Auditory Processing Disorder and provides direction for the ongoing development of these guidelines in the future.