Religion, Spirituality and Speech-Language Pathology: A Viewpoint for Ensuring Patient-Centred Holistic Care

Aphasia Awareness Among Spiritual Healthcare Providers in the United States

Spiritual healthcare providers (e.g., chaplains) working in healthcare settings across the United States were surveyed with the goals of (1) understanding their awareness of aphasia (a language disorder affecting reading, writing, verbal communication, and auditory comprehension); (2) determining whether they have received any training in aphasia and what type of training has been received; (3) whether they altered their approach to assessing the spiritual well-being of a person with aphasia; and, (4) what tools were used to augment communication. From a convenience sample of 203 respondents, the results indicated that 96% of respondents had previously heard of aphasia and 85% of respondents correctly identified the definition of aphasia. Seventy-three percent of respondents (N = 128) altered their approach to spiritual well-being assessment due to the aphasia diagnosis. Most respondents did not indicate receiving any formal training related to aphasia.

Global Citizenship: Cultural, Religious and Spiritual-An Exploratory Scoping Review

This paper seeks to provide an exploration of the interplay between global citizenship, culture, religion and spirituality. Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19-32, 2005) scoping literature review framework was utilised to qualify the research question, develop inclusion and exclusion criteria, select relevant studies, chart data and collate information. From the available peer-reviewed literature, a total of 44 articles were initially identified using the selection criteria, 19 of which were subsequently analysed. Eight main themes were identified within the literature; (1) development of global citizenship identity, (2) prosocial values and perspectives, (3) cultural competence and influence, (4) religion and religious teachings, (5) immersion experiences, (6) normative influence, (7) political compass and (8) spirituality. The literature suggests a clear link between global citizenship and spirituality. There were, however, some inconsistencies in the relationship between formalised religion and global citizenship across the studies, with evidence of religion both contributing to and detracting from prosocial values related to global citizenship. Additionally, cultural experiences, including immersion experiences, volunteering and study aboard were all positively linked to prosocial values related to global citizenship. Global citizenship provides individuals with an opportunity to develop intercultural skills, respect, sensitivity, empathy and concern for all of humanity. It is recommended that future global citizenship research should ensure adequate definitions of religion and spirituality, with caution to not generalise the two terms into one concept. Additional research into the relationship between spiritualty and global citizenship could provide a strong basis to increase understanding of the contributing factors to global citizenship identity.

A Qualitative Study of Occupational Therapists' Understanding of Spirituality in South Africa

Occupational therapy is a holistic profession that assists clients to restore meaning to their lives-a vital spiritual task. Spirituality is a multifaceted and multidimensional construct that occupational therapists need to integrate into everyday practice. In this study, Occupational Therapy educators' and clinicians' understanding of spirituality in their practice was qualitatively explored by purposively selecting 24 participants who attended a workshop based on an appreciative approach, in Gauteng, South Africa. Data were collected through self-report interview schedules and focus group inquiries and were analysed using the creative hermeneutic method. Participants expressed spirituality in occupational therapy as connectedness, meaning of life and client-centred practice.

'I don't really know where I stand because I don't know if I took something away from her': Moral injury in South African speech-language therapists and audiologists due to patient death and dying

BACKGROUND

Speech-language therapists and audiologists (SLT&As) may encounter difficulties when confronted with patient death and dying, which may conflict with their moral beliefs and result in moral injury. Furthermore, South African SLT&As practice in a country with a high mortality rate, which may add to the complexity of their experience. Moreover, they may be influenced by African philosophies promoting care, which might conflict with their experiences of patient death and dying.

AIMS

To explore the moral injury experienced by South African SLT&As in patient death and dying, and how they overcame the injury.

METHODS & PROCEDURES

This article forms part of a larger qualitative study that explored SLT&As' experiences of patient death and dying in South Africa. Thematic analysis was conducted on the transcripts of 25 episodic narrative interviews conducted with South African SLT&As on their experiences of patient death and dying.

OUTCOMES & RESULTS

Findings suggest that South African SLT&As experienced helplessness, guilt and anger in patient death and dying. However, with support from the allied team, engaging in self-reflection and religious practices, they reported alleviation of moral injury.

CONCLUSIONS & IMPLICATIONS

In order to mitigate moral injury in South African SLT&As, they require professional education, self-care strategies, guidelines and support from the teams in which they work and their supervisors. Research is needed that explores how SLT&As' biographical characteristics and interactions with significant others of dying and deceased patients, may result in moral injury. WHAT THIS PAPER ADDS?: What is already known on this subject? Moral injury and measures used to overcome the injury have been explored in military personnel, doctors and nurses, but not in SLT&As. However, studies that explored the perceptions of SLTs and/or audiologists regarding providing palliative care and of death and dying, particularly that by Rivers et al. in 2009, suggested that these professionals may be at risk of experiencing emotional trauma due to patient death, particularly when not receiving undergraduate education on this subject. However, the extent of this trauma and the support needed to overcome it is unknown because the participants in these studies may have not experienced patient death, and were only students or just SLTs. What this article adds? This article highlights the complexity of speech-language therapy and audiology practice when confronted with patient death and dying. South African SLT&As may have to make decisions that conflict with their morals and professional practice standards, especially as the helping nature of their profession is characterized by African philosophies that promote care, which may result in moral injury. Clinical implications of this article This article indicates that in addition to undergraduate education on patient death and dying, SLTs and audiologists require continuous professional education on this topic, self-care strategies, support from the teams in which they work, and their supervisors and guidelines for when they encounter patient death and dying.

Systems Approaches to Occupational Vocal Health: Considerations for Community Faith Leaders

Systems thinking approaches can benefit the occupational vocal health of vocally reliant workers. This paper explores community faith leaders as an example of a highly vocally reliant occupation, who may benefit from systems thinking being used to support their vocal occupational health and safety. A scoping review of the current literature regarding faith leaders' occupational voice use and vocal health is detailed, including recognised occupational hazards. This article then discusses the unique and potential use of systems thinking for facilitating faith leaders' vocal occupational health and safety. Rather than using a solely clinical perspective, the sociotechnical systems approach and the biopsychosocial-spiritual approach are noted as particularly pertinent for this occupational group.

'There's this big fear around palliative care because it's connected to death and dying': A qualitative exploration of the perspectives of undergraduate students on the role of the speech and language therapist in palliative care

BACKGROUND

Speech and language therapy in palliative care is a developing discipline of clinical practice. Research literature has highlighted that undergraduate palliative care education in speech and language therapy is inconsistent and inadequate. However, limited research has been carried out to date in relation to student speech and language therapists and palliative care.

AIM

To explore the role of speech and language therapists in palliative care from the perspective of speech and language therapy students in Ireland.

DESIGN

A qualitative descriptive research study was conducted, involving focus group interviews.

SETTING/PARTICIPANTS

Purposive sampling was used to recruit 12 student speech and language therapists from one university site for this study. Undergraduate second, third and fourth year students were eligible for inclusion.

RESULTS

This study revealed that undergraduate student speech and language therapists collectively agree that there is a role for speech and language therapy in palliative care. Although students acknowledged that speech and language therapists can make a positive difference to patients' lives, and academic lectures were positively received, insufficient exposure to palliative care has resulted in fear, uncertainty and a lack of confidence amongst student speech and language therapists.

CONCLUSIONS

A greater emphasis on palliative care is needed in undergraduate speech and language therapy education to ensure confidence and competency development. An exploration of student speech and language therapists' experiences in a specialist palliative care unit would be advantageous to determine the appropriateness of this setting for clinical placements.

Speech-language pathologists and adult palliative care in Australia

PURPOSE

This research explored the role of Australian Speech-Language Pathologists (SLPs) to identify SLP experiences and practices regarding adult palliative care (PC) management.

METHOD

Utilising mixed methods, phase one comprised a literature scoping review of SLP practices in PC. Phase two involved a survey compiling demographic data of Australian SLPs working in adult PC. Phase three involved in-depth interviews exploring SLP experiences in PC.

RESULT

It was found that minimal resources or published literature existed regarding SLPs in PC, however the available literature indicated SLPs can be valuable and influential members of a PC team. Interviewed SLPs acknowledged their proficiency in end-of-life communication and swallowing, nevertheless initially they felt ill-prepared given insufficient knowledge or skills to manage palliative cases based upon their tertiary education and were poorly supported once in the field given a lack of clinical practice guidelines (CPGs). Participants also noted a lack of knowledge among medical, nursing and allied health clinicians about a SLP's contribution to PC, causing barriers for SLPs being professionally accepted within palliative environments.

CONCLUSION

Recommendations included the development of improved resources specifically about SLP practice in end-of-life care, the need for greater exposure at the tertiary level of SLP palliative care practices, and CPGs for SLPs working in adult palliative care.

Speech-Language Pathologists in Pediatric Palliative Care: An International Study of Perceptions and Experiences

Purpose The purpose of this study is to gather qualitative data regarding the experiences and perceptions of speech-language pathologists (SLPs) practicing in pediatric palliative care (PPC) and investigate their approaches for working with patients, families, and the multidisciplinary team. Method Ten participants from Australia, Canada, and the United States were recruited from a previous survey study. In-depth interviews were conducted via videoconferencing. Two coders used NVivo software to record and organize the data into themes. Interrater reliability of the coding was established with a third coder. The COnsolidated criteria for REporting Qualitative research 32-item checklist has been used for reporting the research. Results Interrater coding reliability (using weighted kappa) was .81, indicating "almost perfect" agreement on the selection of themes from the code frame. Emerging themes included clinical interventions, unique SLP skills in PPC, multidisciplinary team relationships, workforce issues, education and training, governance, medicolegal considerations, bioethical issues, and holistic care. Additional subthemes are also noted. In the absence of research evidence and practice recommendations, SLPs rely on client perspectives and clinical experience to guide their professional practice in PPC. Conclusions Qualitative survey analysis of the perceptions and experiences of SLP clinicians from three postindustrial countries identified nine major themes regarding PPC. Results expand on limited literature to date in the area of PPC. Future research using larger samples is needed to provide clinicians with best practice recommendations for working with patients, families, and the broader care team.

Community service providers' roles in supporting communication disability rehabilitation in Majority World contexts: An example from Ghana

Purpose: In Majority World countries, where speech-language pathology services are extremely limited, people with communication disabilities (PWCD) may seek help from a range of service providers. This qualitative research aimed to explore the nature of community services offered to people with communication disabilities who seek help in Accra, Ghana.Method: Semi-structured interviews were conducted with nine individuals from three professions: pastors (3), doctors (3), and herbalists (3) exploring services that they may offer to PWCD seeking help. Interviews were analysed using Thematic Network Analysis.Result: Six global themes described beliefs about communication disability, types of intervention, explanations provided to people with communication disabilities, promoting communication, processes for selecting treatments, and links between service providers. Interventions encompassed physical, spiritual, psychosocial and environmental approaches, with the notion of plural beliefs interwoven through a number of themes.Conclusion: In Ghana, and other Majority World contexts, service providers in sectors not commonly associated with communication disability rehabilitation may have important roles to play in supporting people with communication disabilities. Understanding the contributions of other service providers may assist the growing profession of speech-language pathology to collaborate across sectors, to develop specific, culturally responsive approaches to service development.

Perspectives of speech and language therapists in paediatric palliative care: an international exploratory study

BACKGROUND

The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus-based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics.

AIMS

This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices.

METHODS & PROCEDURES

An anonymous cross-sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed-ended survey responses and content analysis of open-ended responses are presented.

OUTCOMES & RESULTS

A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients.

CONCLUSIONS & IMPLICATIONS

This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper adds What is already known on the subject The published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches. What this paper adds to existing knowledge This study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta-perceptions of themselves within the multidisciplinary team. What are the potential or actual clinical implications of this work? Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC.

Global citizenship: Defining capabilities for speech-language pathology

Purpose: This paper outlines the findings of a scoping review of the literature relating to global citizenship. The purpose of the review was to develop a working definition and associated capabilities for assessing global citizenship among speech-language pathologists (SLPs), which may also prove helpful to other health professionals and for educating tertiary students. Method: Using Arksey and O'Malley's scoping review framework, key databases were searched, namely Medline, CINAHL, PsycINFO, the Cochrane Library and Google Scholar. Subsequently the Medical Subject Heading (MeSH) terms were applied for coding and categorising initial research findings. Articles were individually appraised using the Critical Appraisal Skills Programme tool (CASP). Result: Of the 2126 articles identified, 21 articles were determined to satisfy the search criteria. The literature revealed nine capabilities associated with global citizenship appropriate for health professionals including SLPs. Conclusion: Based on the findings, a working definition is determined for assessing professional global citizenship capabilities, which will prove useful for improving occupational standards, for charting competencies, and ultimately enhancing professional capability.

Speech-language pathology in paediatric palliative care: A scoping review of role and practice

PURPOSE

Attempts have been made within the literature to clarify the role and scope of speech-language pathologists (SLPs) within paediatric palliative care (PPC). As SLP literature regarding adult/geriatric populations is gaining traction, it is fitting to investigate the role of SLPs in the management of infants and children in end-of-life care.

METHOD

Arksey and O'Malley's ( 2005 ) scoping review method was utilised for searching multiple databases. Two database searches were undertaken. The first located literature in which SLP PPC intervention is specifically addressed. The second search utilised internationally recognised SLP scope of practice areas. Manual searching of reference lists was also utilised.

RESULT

Themes identified included management of communication, feeding, upper-airway and oral health as well as the role of SLPs within a multidisciplinary PPC team.

CONCLUSION

There is acknowledgement that SLPs have a role in PPC. However, there is little information identifying SLP involvement in the diagnosis and management of swallowing, cognition/communication, oral hygiene and upper airway issues. The available literature predominantly relies on limited adult palliative care research and does not address age-specific management approaches across the paediatric life-stage. Given an absence of SLP PPC guidelines, further research is warranted to explicitly define SLP scope of practice within this population.

The role of speech-language pathologists in adult palliative care

PURPOSE

Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines.

METHOD

A scoping review was conducted utilising Arksey and O'Malley's framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings.

RESULT

Over 1200 articles were initially identified. Of the 1200 articles, 13 academic papers were considered relevant as they recommended, or at least suggested, the need for speech-language pathology therapy guidelines to be implemented within adult palliative care settings.

CONCLUSION

The main focus of these articles was on ethical considerations and clinical recommendations for SLPs. Recommendations arising from this scoping review include providing goals to support current practising SLP clinicians and developing clinical guidelines to manage swallowing and/or communication needs of people receiving palliative care.