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Hersh D, Morrisby C, Ryan B. The kitchen assessment: an interactional analysis of assessment and feedback between an occupational therapist and a patient with aphasia post stroke. Disabil Rehabil 2024:1-13. [PMID: 38850043 DOI: 10.1080/09638288.2024.2361805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE After stroke, patients undergo frequent multidisciplinary assessments. Little is known about patients' experiences of being assessed and the impact of assessment interactions and feedback for ongoing engagement in rehabilitation. This research aims to stimulate reflection on clinical interactions, even during routine clinical assessments, and the provision of assessment feedback. MATERIALS AND METHODS This study involved a detailed analysis of an authentic kitchen assessment interaction between an occupational therapist and a patient with aphasia following stroke. It used a speech function analysis based on systemic functional linguistics resulting in both dynamic and synoptic data, and a consideration of interactive framing, to explore assessment explanation and feedback. RESULTS The analysis revealed the clinician's interactive dominance in terms of number and type of moves, and misalignment of interactional framing at different points in the exchange. The session appeared to result in patient disengagement related both to the clinician's misjudged response to the patient's aphasia, and the context of assessment itself, characterised by reliance on question-and-answer exchanges, and a tendency to highlight deficit. CONCLUSIONS Assessment sessions may be emotionally challenging for patients after stroke and feedback may be interpreted as bad news. Sensitive communication is required to support psychological wellbeing and engagement in rehabilitation.IMPLICATIONS FOR REHABILITATIONAfter stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning.Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news.The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received.Greater awareness is needed of how feedback following assessment might impact patients' psychological wellbeing and engagement in rehabilitation.
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Affiliation(s)
- Deborah Hersh
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
- School of Allied Health Science and Practice, Adelaide University, Adelaide, Australia
| | - Claire Morrisby
- Occupational Therapy, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Brooke Ryan
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
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van Muijden T, Gräler L, van Exel J, van de Bovenkamp H, Petit‐Steeghs V. Different views on collaboration between older persons, informal caregivers and care professionals. Health Expect 2024; 27:e14091. [PMID: 38924218 PMCID: PMC11196834 DOI: 10.1111/hex.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 05/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. METHODS Using Q-methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow-up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by-person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. RESULTS Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision-making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. CONCLUSIONS Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. PATIENT OR PUBLIC CONTRIBUTION An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications.
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Affiliation(s)
- Teyler van Muijden
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
| | - Leonoor Gräler
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
| | - Job van Exel
- Department of Health EconomicsErasmus School of Health Policy & ManagementRotterdamNetherlands
| | | | - Violet Petit‐Steeghs
- Healthcare GovernanceErasmus School of Health Policy & ManagementRotterdamNetherlands
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3
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Bachmann-Windler A, Heine M, Ernst J, Koch A. [Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study]. Pflege 2024; 37:49-55. [PMID: 37294171 DOI: 10.1024/1012-5302/a000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study Abstract. Background: Numerical assessment instruments allow foreign language patients to quantify their pain. However, for a complete assessment of the pain situation, the description of pain quality is also important. Problem: To assess pain quality completely, the treatment team lacked a tool. Objective: Foreign language-speaking patients can communicate their pain to the treatment team and are actively involved in the treatment process. The treatment team develops tools for recording the quality of pain and reflects on their experiences. Method: In a practice development project, pictograms of the Iconic Pain Assessment Tool 2 (IPAT2) where chosen to assess pain quality. The pictograms were prepared for everyday use, tested, and evaluated. Results: With the help of pictograms, quality of pain of 72 patients was documented almost 50% more frequently than before the study. The nursing team experienced IPAT2 as helpful in obtaining information and deepening the quality of the relationship. A feeling of being seen and understood emerged. Discussion: Pictograms are a valid method for nonverbal pain assessment. However, there is a risk of misunderstanding. The study only allowed an external assessment of patient's perceptions. An empirical investigation of the patient's view would be desirable. Conclusions: Further use and development of pictograms for communicating with foreign language-speaking patients are recommended.
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Affiliation(s)
| | - Michelle Heine
- Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Schweiz
| | - Jutta Ernst
- Zentrum Klinische Pflegewissenschaft ZKPW, Universitätsspital Zürich, Schweiz
| | - Astrid Koch
- Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Schweiz
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Brunet-Pagé É, Mathieu J, Rivard MC, Ruchat SM. Strategies used by midwives to support prenatal physical activity: A scoping review. Midwifery 2023; 126:103799. [PMID: 37774509 DOI: 10.1016/j.midw.2023.103799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023]
Abstract
CONTEXT Despite the well-known benefits of prenatal physical activity for the health of both the mother and her future child, and the existence of international Guidelines for prenatal physical activity, few pregnant women are sufficiently active. Prenatal health care providers, notably midwives, play an important role in promoting prenatal physical activity. Unfortunately, they face several challenges that hinder strategies used to support prenatal physical activity to their clients. The mode of communication used when giving advice and counselling is part of these strategies, as is the content of the information provided. However, little is known about how midwives communicate with their clients when it comes to recommendations about prenatal physical activity, whether it is general or specific recommendations, and about personal factors that may influence their recommendations. OBJECTIVE To present a comprehensive analysis of the existing literature on strategies used by midwives to support prenatal physical activity to their clients, focusing on the mode of communication used, the content of the recommendation provided, as well as personal factors that can influence their recommendations. METHOD A scoping review was conducted to retrieve original research articles on strategies used by midwives to support prenatal physical activity, published up to May 2023 and available in English and French. The search databases included CINAHL, MEDLINE, Cochrane, Scopus, PubMed, Psychology and behavioural Sciences Collection, and APA PsycINFO. Studies that fulfilled the eligibility criteria were selected for data extraction. The main findings were organized by the mode of communication used (unidirectional and bidirectional) and the type of recommendation provided (general versus specific). Midwives' knowledge, beliefs and attitudes towards prenatal physical activity were also extracted. RESULTS A total of 1 307 articles were retrieved and 19 were included. The use of unidirectional mode of communication was identified in 64 %, 64 % and 14 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. The use of bidirectional mode of communication was identified in 43 %, 21 % and 7 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. Midwives had knowledge gaps about prenatal physical activity, their beliefs were not always aligned with the most recent recommendations, and they sometimes feel vulnerable in the way they support physical activity. However, they expressed the desire to improve the support they are providing. CONCLUSION Results of this study highlight that when it comes to support prenatal physical activity, the unidirectional mode of communication is the most often used by midwives. Unfortunately, it is not considered effective as it does not allow discussing and explaining the information provided. Moreover, midwives exhibited some knowledge gaps about prenatal physical activity. Future work will be needed to better understand their challenges and needs in order to improve their initial training and clinical practice.
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Affiliation(s)
- Émilie Brunet-Pagé
- Department of Midwifery, Université du Québec à Trois-Rivières, 3351 Boulevard Des Forges, Trois-Rivières (Québec) G9A 5H7, Canada.
| | - Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boulevard Des Forges, Trois-Rivières (Québec) G9A 5H7, Canada
| | - Marie-Claude Rivard
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Boulevard Des Forges, Trois-Rivières (Québec) G9A 5H7, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Boulevard Des Forges, Trois-Rivières (Québec) G9A 5H7, Canada
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Zinkevich A, Uthoff SAK, Boenisch J, Sachse SK, Schnack H, Garbe C, Bernasconi T, Ansmann L. Making a voice heard: evaluation of a new service delivery in augmentative and alternative communication through qualitative interviews with people without natural speech. BMC Res Notes 2023; 16:42. [PMID: 36991499 DOI: 10.1186/s13104-023-06310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE Due to communication barriers, people without natural speech who use augmentative and alternative communication (AAC) are rarely interviewed about their healthcare needs, expectations, and experiences. This qualitative interview study aims to investigate how AAC users evaluate a new service delivery (nSD) in AAC care in Germany. RESULTS We conducted 8 semi-structured qualitative interviews with 8 AAC users. The results of the performed qualitative content analysis show a positive evaluation of the nSD among AAC users. Contextual factors were identified that seem to hinder the achievement of the intervention goals. These include caregivers' prejudice and inexperience with AAC and an unfavourable environment in which AAC is used.
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Affiliation(s)
- Anna Zinkevich
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | | | - Jens Boenisch
- Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Stefanie Kalén Sachse
- Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Helge Schnack
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Carolin Garbe
- Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Tobias Bernasconi
- Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Chair of Medical Sociology, University of Cologne, Cologne, Germany
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van Rooijen M, van Dijk‐de Vries A, Lenzen S, Dalemans R, Moser A, Beurskens AJHM. Implementation of a patient-reported experience measure in a Dutch disability care organization: A process evaluation of cocreated tailored strategies. Health Expect 2022; 26:132-145. [PMID: 36346158 PMCID: PMC9854305 DOI: 10.1111/hex.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In 24/7 disability care facilities, patient-reported experience measures (PREMs) are important to help healthcare professionals understand what matters to care users and to improve the quality of care. However, the successful implementation of a PREM is complex. In a Dutch disability care organization, stakeholders cocreated tailored implementation strategies aimed at improving the use and integration of a qualitative PREM. This study gives insights into the uptake and experiences with these cocreated implementation strategies and the perceived impact of the set of strategies. METHODS We performed a prospective process evaluation between February 2020 and February 2021. We collected data in three disability care facilities from 35 care users, 11 professionals, 3 facility managers and 4 organization representatives. Data collection included observations during kick-offs and learning goal meetings and several attendance checklists. We collected 133 questionnaires (Time 0 and Time 1). We conducted 35 individual semistructured interviews and an online focus group interview. Quantitative data were analysed using descriptive statistics and qualitative data using directed content analysis. RESULTS The exposure to and adoption of strategies was between 76% and 100%. Participants were positive about tailoring the strategies to each facility. Implementation was hindered by challenges in care users' communication and COVID-19. The perceived impact referred to an improved understanding of the goal and added value of the PREM and better preparation and execution of the PREM. The impact of the set of strategies was mainly experienced on the micro level. CONCLUSION The uptake of the cocreated implementation strategies was acceptable. The participants valued the tailored approach, which enabled them to focus on facility-specific learning goals. Stakeholder engagement and co-created strategies may have strengthened the adoption of and experiences with the implementation. PATIENT OR PUBLIC CONTRIBUTION In this article, we present the process evaluation of implementation strategies for the integrated use of a PREM in disability care. A development group consisting of communication vulnerable care users, trainers and professionals developed the implementation strategies. The disability care organization was responsible for the planning and organization of the implementation process. During the process evaluation the end users, trainers, professionals and managers tailored the implementation strategies to their own settings and needs. Researchers observed this implementation process and interviewed the stakeholders about their experiences and the perceived impact.
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Affiliation(s)
- Marjolein van Rooijen
- Department of Family Medicine, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
| | - Anneke van Dijk‐de Vries
- Department of Family Medicine, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
| | - Stephanie Lenzen
- Research Centre for Autonomy and Participation of Persons with a Chronic IllnessZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Ruth Dalemans
- Research Centre for Autonomy and Participation of Persons with a Chronic IllnessZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Albine Moser
- Research Centre for Autonomy and Participation of Persons with a Chronic IllnessZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Anna J. H. M. Beurskens
- Department of Family Medicine, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
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7
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Steultjens E, Lindenschot M, Diepeveen S, Zajec J, de Groot I, Nijhuis-van der Sanden R, Koene S, Graff M. Tailored interviewing to uncover the perspectives of children with multiple disabilities on daily activities: A qualitative analyses of interview methods and interviewer skills. Aust Occup Ther J 2022; 70:175-189. [PMID: 36149673 DOI: 10.1111/1440-1630.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Uncovering the perspective of children with multiple disabilities is important in health care to enable person-centred health care. For occupational therapists, uncovering the child perspective on meaningful activities is necessary to set appropriate goals for treatment. It is not always evident that children with multiple disabilities can express themselves in an interview. The interviewer should adapt his communication to the child. In literature, alternative communication is widely studied, but a clear algorithm for deciding what to use to successfully gain insight into the child perspective is missing. This study aims to identify helpful interview techniques and interviewer skills and how they can be used to effectively uncover the perspective of children. METHODS Videos of nine interviews with children with a mitochondrial disorder, conducted by an occupational therapist, were analysed by five researchers. The interviews were analysed to see how well the interviewee had obtained the child's perspectives followed by observation of communicative abilities of the child and the types of questions the interviewer asked. A qualitative directed content analysis of the semi-structured interviews followed. FINDINGS An interview pattern was observed in the children's communication leading to six successful interviews. Children communicated verbally on four different levels and also used non-verbal communication. The interviewer used five types of questions, which varied between and within the children. The content analysis resulted in two themes: parental influences and interviewer skills. CONCLUSION Results show the importance of matching the type of questions to the verbal communication level of the child and revealed several interviewer skills and techniques. An overview to guide tailor-made interviewing is presented. The interviewer has a major role in successful interviewing and thus in enabling the inclusion of the child perspective in research and care.
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Affiliation(s)
- Esther Steultjens
- Department of Occupational Therapy/Speech and Language Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marieke Lindenschot
- Department of Occupational Therapy/Speech and Language Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sanne Diepeveen
- Department of Occupational Therapy/Speech and Language Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jana Zajec
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda de Groot
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ria Nijhuis-van der Sanden
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia Koene
- Department of Paediatrics, Radboud Center for Mitochondrial Medicine, Nijmegen, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Maud Graff
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
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Baylor C, Brown C, Mroz TM, Burns M. Understanding How Older Adults with Communication Difficulties Access Health Services: What We Can Learn from the National Health and Aging Trends Study (NHATS). Semin Speech Lang 2022; 43:176-197. [PMID: 35858604 DOI: 10.1055/s-0042-1749618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015-2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Cait Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Michael Burns
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
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Güner Ö, Öztürk R. Psychological and social impact and lifestyle changes among pregnant women of COVID-19 pandemic: A qualitative study. Arch Psychiatr Nurs 2022; 36:70-77. [PMID: 35094829 PMCID: PMC8797055 DOI: 10.1016/j.apnu.2021.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed to examine the challenges faced by pregnant women and their daily life activities during the COVID-19 pandemic, to assess the psychological impacts of the pandemic and their expectations to improve women's mental health, thereby increasing the awareness of healthcare professionals of the subject. METHODS The research was conducted with the participation of 30 pregnant women, who were selected by purposive sampling using the phenomenological approach, between 15 June 2020 and 15 August 2020. Telephone interviews were conducted with pregnant women due to social isolation measures during the Coronavirus pandemic. RESULTS In the study, the following four themes were determined: (a) measures taken against the pandemic, (b) problems regarding the antenatal period during the pandemic, (c) gestation period and change in social life, (d) psychological effects of the pandemic and methods for coping with them. Also, 14 sub-themes were determined regarding these themes. CONCLUSION The results of the study revealed that the pandemic had multidimensional impacts on pregnant women, including their social life and physical health. Psychologically, it caused many negative emotional states, particularly concerns and fears. During the pandemic, healthcare professionals should be aware of the needs of pregnant women and plan protective and informative interventions for both their physiological and psychological health.
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Affiliation(s)
- Özlem Güner
- Sinop University, Faculty of Health Sciences, Department of Midwifery, Sinop, Turkey
| | - Ruşen Öztürk
- Ege University Faculty of Nursing, Women Health and Disease Nursing Department, İzmir, Turkey.
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William Go TW, Mok HT, Acharyya S, Suelo DC, Ho EC. Communication Vulnerability within Singapore’s Healthcare Environment. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211068601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication difficulties can, and often do, create barriers between patients and healthcare workers (HCWs). We examined the perceptual differences between patients and caregivers; and HCWs with regards to their perceived communication vulnerabilities and identified communication needs in a tertiary hospital. A survey was conducted in selected outpatient settings among patients, their caregivers and HCWs, in a cross-sectional study. Respondents rated the reasons and frequency of encountering the communication difficulties during a hospital visit. Fifty-four percent of patients and caregivers cited poor hearing in the presence of noise, while HCWs cited patient’s poor vision (87%) as their primary communication barrier that requires improvement. Majority of HCWs (90%) had encountered patients who presented multiple communication barriers a quarter of the time. A third of HCWs felt that such encounters were especially challenging during communication, with very limited strategies available to deal with such communication vulnerable individuals. Patients, caregivers and HCWs universally experience communication challenges, even if their perceived barriers to communication happen to differ. Such perceptual difference between patients and HCWs may lead to inconsistent use of communication strategies by HCWs, potentially compromising patient’s healthcare needs. Nonetheless, the onus is on healthcare providers to bridge this communication gap to improve patient care.
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Affiliation(s)
- Teck W. William Go
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hoi T. Mok
- TTSH Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sanchalika Acharyya
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Darlin C. Suelo
- Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eu C. Ho
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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Super S, Wagemakers A. Understanding empowerment for a healthy dietary intake during pregnancy. Int J Qual Stud Health Well-being 2021; 16:1857550. [PMID: 33317432 PMCID: PMC7738301 DOI: 10.1080/17482631.2020.1857550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose: In order for health professionals to encourage pregnant women with a low socioeconomic status (SES) to move towards empowerment for a healthy dietary intake, crucial steps are to understand the perspectives of pregnant women of food and eating and to identify opportunities for empowerment. This study aimed to examine the perspectives of pregnant women on food and eating and to identify the opportunities for empowerment towards a healthy dietary intake. Methods: This was a qualitative participatory study. Thirteen semi-structured interviews were conducted with low SES pregnant women in the Netherlands and analysed using an inductive approach. Results: Five perspectives on food and eating emerged: 1) health-promoting foods and products, 2) challenges in healthy eating, 3) risky products, 4) strategies for healthy eating, and 5) motivational aspects. Opportunities for empowerment were: searching balanced and personalized information, developing strategies to implement healthy diets, navigating the social environment, and dealing with different motivations. Conclusion: Pregnant women hold diverse perspectives regarding food and eating, signalling the need to adjust dietary support from health-care professionals. Professionals in antenatal care could optimize their interactions by engaging in pregnant women's empowerment processes to make healthy modifications to their dietary intake.
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Affiliation(s)
- Sabina Super
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society, Social Sciences Group, Wageningen University, Wageningen, The Netherlands
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12
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van Rooijen M, van Dijk-de Vries A, Lenzen S, Dalemans R, Moser A, Beurskens A. How to foster successful implementation of a patient reported experience measurement in the disability sector: an example of developing strategies in co-creation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:45. [PMID: 34167588 PMCID: PMC8229276 DOI: 10.1186/s40900-021-00287-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The integrated uptake of patient-reported experience measures, using outcomes for the micro, meso and macro level, calls for a successful implementation process which depends on how stakeholders are involved in this process. Currently, the impact of stakeholders on strategies to improve the integrated use is rarely reported, and information about how stakeholders can be engaged, including care-users who are communication vulnerable, is limited. This study illustrates the impact of all stakeholders on developing tailored implementation strategies and provides insights into supportive conditions to involve care-users who are communication vulnerable. METHODS With the use of participatory action research, implementation strategies were co-created by care-users who are communication vulnerable (n = 8), professionals (n = 12), management (n = 6) and researchers (n = 5) over 9 months. Data collection consisted of audiotapes, reports, and researchers' notes. Conventional content analysis was performed. RESULTS The impact of care-users concerned the strategies' look and feel, understandability and relevance. Professionals influenced impact on how to use strategies and terminology. The impact of management was on showing the gap between policy and practice, and learning from previous improvement failures. Researchers showed impact on analysis, direction of strategy changes and translating academic and development experience into practice. The engagement of care-users who are communication vulnerable was supported, taking into account organisational issues and the presentation of information. CONCLUSIONS The impact of all engaged stakeholders was identified over the different levels strategies focused on. Care-users who are communication vulnerable were valuable engaged in co-creation implementation strategies by equipping them to their needs and routines, which requires adaptation in communication, delimited meetings and a safe group environment. TRIAL REGISTRATION Reviewed by the Medical Ethics Committee of Zuyderland-Zuyd (METCZ20190006). NL7594 registred at https://www.trialregister.nl/ .
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Affiliation(s)
- Marjolein van Rooijen
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands.
| | - Anneke van Dijk-de Vries
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
| | - Stephanie Lenzen
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Ruth Dalemans
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Albine Moser
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Anna Beurskens
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
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13
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Donner L, Wiklund Gustin L. Navigating between Compassion and Uncertainty - Psychiatric Nurses' Lived Experiences of Communication with Patients Who Rarely Speak. Issues Ment Health Nurs 2021; 42:307-316. [PMID: 32790482 DOI: 10.1080/01612840.2020.1793246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Caring conversations are considered essential in psychiatric and mental health nursing. However, some patients are more or less silent and rarely express themselves verbally. This can be challenging for nurses who also need to find ways of communicating with these patients. Therefore, the aim of this study is to describe psychiatric nurses' lived experiences of communication with patients who rarely speak. Five nurses were recruited from a psychiatric nursing home. Participants were encouraged in interviews to reflect on their experiences of caring for patients who are more or less silent. The transcribed interviews were subject to a phenomenological hermeneutic analysis. The findings are reflected in three main themes: (i) giving space for the unspoken narrative, (ii) remaining in uncertainty, and (iii) being in reflective vigilance. The themes were synthesised and reflected on in the light of Fredriksson's theory of caring conversations. The comprehensive understanding reveals that nurses' understanding of the patient's unspoken narrative relies both on compassion and a willingness to engage, but also on a preparedness to remain in the uncertainty of not knowing. Balancing good intentions and the fear of one's own shortcomings requires reflections not only in actions during encounters with the patient, but on actions. When nurses can apprehend and respond to what the patient expresses non-verbally, a joint narrative can emerge.
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Affiliation(s)
- Lucas Donner
- Stiftelsen Hemmet ("The Home Foundation"), Lemland, Finland.,School of Health, Care and Social Welfare, Mälardalen University Sweden, Västerås, Sweden
| | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University Sweden, Västerås, Sweden.,Department of Health and Care Sciences, UiT/The Arctic University of Norway, Tromsø, Norway
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14
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Damman OC, Jani A, de Jong BA, Becker A, Metz MJ, de Bruijne MC, Timmermans DR, Cornel MC, Ubbink DT, van der Steen M, Gray M, van El C. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract 2020; 26:524-540. [PMID: 31840346 PMCID: PMC7155090 DOI: 10.1111/jep.13321] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The recent emphasis on value-based health care (VBHC) is thought to provide new opportunities for shared decision-making (SDM) in the Netherlands, especially when using patient-reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. AIM To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. APPROACH Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. RESULTS The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. CONCLUSION Successful implementation of SDM within VBHC initiatives may not be self-evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time-consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.
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Affiliation(s)
- Olga C. Damman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Anant Jani
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Brigit A. de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center AmsterdamAmsterdam Neuroscience Research InstituteAmsterdamThe Netherlands
| | - Annemarie Becker
- Department of Pulmonary Diseases, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversiteit van AmsterdamAmsterdamThe Netherlands
| | - Margot J. Metz
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral SciencesGGz Breburg and Tilburg UniversityTilburgThe Netherlands
| | - Martine C. de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Danielle R. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Martina C. Cornel
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Dirk T. Ubbink
- Department of SurgeryAmsterdam UMC, Universiteit van AmsterdamAmsterdamThe Netherlands
| | - Marije van der Steen
- Department of Strategy and PolicyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Muir Gray
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Carla van El
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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15
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van Rooijen M, Lenzen S, Dalemans R, Moser A, Beurskens A. Implementation of a Patient Reported Experience Measure in a Dutch disability care organisation: a qualitative study. J Patient Rep Outcomes 2020; 4:5. [PMID: 31938941 PMCID: PMC6960272 DOI: 10.1186/s41687-019-0169-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient Reported Experience Measures are promoted to be used as an integrated measurement approach in which outcomes are used to improve individual care (micro level), organisational quality (meso level) and external justification (macro level). However, a deeper understanding of implementation issues of these measures is necessary. The narrative Patient Reported Experience Measure "Dit vind ik ervan!" (English "How I feel about it!") is used in the Dutch disability care sector, but insight into its' current use is lacking. We aimed to provide insight into experiences with the implementation and current ways of working with "Dit vind ik ervan!" as an integrated measurement strategy. A descriptive qualitative study was done at a disability care organisation. Data were collected by nine documentations, seven observations, 11 interviews and three focus groups. We applied deductive content analysis using the Consolidated Framework for Implementation Research as a framework. RESULTS Our analysis revealed facilitators and barriers for the implementation of "Dit vind ik ervan!". We found most barriers at the micro level. Professionals and clients appreciated the measure's narrative approach, but struggled to perform it with communication vulnerable clients. Some clients, professionals and team leaders were unfamiliar with the measure's aim and benefit. On the meso level, implementation was done top-down, and the management's vision using the measure as an integrated measurement approach was insufficiently shared throughout the organisation. CONCLUSIONS Our study shows that Patient Reported Experience Measures have the potential to be used as an integrated measurement strategy. Yet, we found barriers at the micro level, which might have influenced using the measurement outcomes at the meso and macro level. Tailored implementation strategies, mostly focusing on designing and preparing the implementation on the micro level, need to be developed in co-creation with all stakeholders.
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Affiliation(s)
- Marjolein van Rooijen
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.
| | - Stephanie Lenzen
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands
| | - Ruth Dalemans
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands
| | - Albine Moser
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.,Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands
| | - Anna Beurskens
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.,Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, Netherlands
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16
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Johnsson A, Wagman P, Boman Å, Pennbrant S. Striving to establish a care relationship-Mission possible or impossible?-Triad encounters between patients, relatives and nurses. Health Expect 2019; 22:1304-1313. [PMID: 31588667 PMCID: PMC6882259 DOI: 10.1111/hex.12971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022] Open
Abstract
Background When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction. Objective To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people. Design A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective. Method Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015‐September 2016 and analysed together with field notes using ethnographic analysis. Result The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view. Conclusion The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives’ stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health‐care setting, therefore making the mission to establish a care relationship possible.
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Affiliation(s)
- Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden.,School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Petra Wagman
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Åse Boman
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Sandra Pennbrant
- Department of Health Sciences, University West, Trollhättan, Sweden
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17
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Stans SEA, Dalemans RJP, Roentgen UR, Smeets HWH, Beurskens AJHM. Who said dialogue conversations are easy? The communication between communication vulnerable people and health-care professionals: A qualitative study. Health Expect 2018; 21:848-857. [PMID: 29671920 PMCID: PMC6186534 DOI: 10.1111/hex.12679] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To gain insight into how communication vulnerable people and health‐care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies. Methods Communication vulnerable clients and health‐care professionals in a long‐term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis. Results Seven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies. Conclusion Professionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.
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Affiliation(s)
- Steffy E A Stans
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Ruth J P Dalemans
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Uta R Roentgen
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Hester W H Smeets
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Anna J H M Beurskens
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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