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Kaitsalmi J, Vehkakoski T, Karlsson L, Salanterä S. Nurses and the disabled child's perspective in the anaesthesia procedure preparation process using a picture schedule. Int J Qual Stud Health Well-being 2024; 19:2356927. [PMID: 38801136 PMCID: PMC11134046 DOI: 10.1080/17482631.2024.2356927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE This study's purpose was to investigate how nurses, using a picture schedule, enable or hinder the realization of disabled children's agency in the preparation for an MRI procedure carried out under general anaesthesia. METHODS A qualitative observation study was used to explore the interaction of nurses and children. The data consisted of video recordings of 25 preparation situations of 3 (3-8 years old) children (with challenges in communication and/or cognitive skills) with 4 nurses. Verbal and nonverbal communication was analysed with interventionist applied conversation analysis. RESULTS What was most crucial was how the picture schedule was used during the interaction. Reciprocal information sharing, responding to the child's initiatives by negotiating and allowing the child to take physical action with the picture schedule enabled the realization of the child's agency. CONCLUSIONS The preparation process should aim to help the child prepare in his/her own way. The preparation tools should encourage reciprocal interaction in informing and in responding to the children's initiatives. The preparation practices should include enough time for the child's initiatives and physical participation. The results can be used in assessing preparation tools and how they are used from the perspective of the child's agency.
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Affiliation(s)
| | - Tanja Vehkakoski
- Department of Education, University of Jyväskylä, Jyväskylä Yliopisto, Finland
| | - Liisa Karlsson
- Faculty of Educational Sciences, Department of Education, University of Helsinki, Helsingin Yliopisto, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
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Oshita JY, Gell NM, Reed NS, Stransky ML, MacLean CD. Older adults with communication disabilities and their use of communication support at doctor's visits: a nationally representative study. Disabil Rehabil 2024:1-8. [PMID: 38826064 DOI: 10.1080/09638288.2024.2351155] [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: 10/16/2023] [Accepted: 04/30/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utilization was independently associated with CDs among older adults. We also sought to understand if socioeconomic factors were associated with utilization. METHODS We used the 2015 National Health and Aging Trends Survey (NHATS) to conduct a cross-sectional analysis of Medicare beneficiaries (n = 5954) with functional hearing, expressive, or cognitive difficulties. We calculated a weighted, population prevalence and an adjusted prevalence ratio (APR) controlling for sociodemographic, health and other disability factors. RESULTS Among community dwelling older adults, having CDs was associated with higher utilization of a communication support person at medical visits (APR: 1.41 [CI: 1.27 - 1.57]). Among adults with CDs, Black adults and women had lower levels of utilization as compared to White adults and men, respectively. CONCLUSION Communication support persons may be a way that older adults with CDs self-support their disability. However, not all older adults with CDs bring someone and variation by social factors could suggest that unmet support needs exist.
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Affiliation(s)
- Jennifer Y Oshita
- Center for Bioethics and Humanities, University of Colorado, Aurora, CO, USA
| | - Nancy M Gell
- Nursing and Health Sciences, University of VT, Burlington, VT, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle L Stransky
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boson, MA, USA
| | - Charles D MacLean
- Department of Medicine, University of Vermont The Robert Larner MD College of Medicine, Burlington, VT, USA
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Harrington M, Busz E, Thor A, Gardner MK, Carlin K, Walsh E. Solving the Autism Puzzle: Creating a Broad-Spectrum Tool to Improve Care Delivery in the Clinical Setting. J Perianesth Nurs 2024; 39:349-355. [PMID: 38219081 DOI: 10.1016/j.jopan.2023.08.019] [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: 04/25/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The purpose of this quality improvement (QI) project was to develop and implement an assessment tool to identify a patient's specific needs due to autism spectrum disorder (ASD). The use of an individualized plan of care related to sensory and behavioral differences correlates with improved experiences in the perioperative setting for patients with ASD. DESIGN Mixed methods, pre-post survey, retrospective data comparison. METHODS Metrics planned to evaluate intervention outcomes included: (1) Comparison of pre and postsurvey data obtained from perioperative staff members following ASD education, (2) Evaluation of the number of behavior response team calls made compared to retrospective data, and (3) Survey response data from families assessing the perceived experience of perioperative stay. FINDINGS Two hundred and fifty staff members responded to the learning needs survey; 164 in the preperiod and 86 in the postperiod. The perioperative process for these patients improved from the pre- to the postperiod in its ability to meet the needs of patients with autism (P < .001). Overall, respondents rated the sensory aids and the behavioral and sensory assessment tool as very useful (Median = 5, IQR = 2) and stated that they are likely to continue to use the tools in the future when caring for patients with autism (Median = 5, IQR = 1). CONCLUSIONS The caregivers of study patients felt they had a high level of satisfaction with their surgery or procedure experience. Health care providers also reported increased confidence working with individuals with ASD in the perioperative environment and satisfaction with the intervention program.
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Affiliation(s)
- Melissa Harrington
- School Nurse, Health Services, Federal Way Public Schools, Federal Way, WA; Staff Nurse, Perioperative Services, Seattle Children's Hospital, Seattle, WA.
| | - Erika Busz
- Staff Nurse, Perioperative Services, Seattle Children's Hospital, Seattle, WA; Instructor of Nursing, School of Health Sciences, Seattle Pacific University, Seattle, WA
| | - Amber Thor
- Staff Nurse, Perioperative Services, Seattle Children's Hospital, Seattle, WA
| | - M Katie Gardner
- Consulting Nurse, Perioperative Services, Seattle Children's Hospital, Seattle, WA
| | - Kristen Carlin
- Biostatistics, Epidemiology, and Analytics for Research, Center for Pediatric Nursing Research, Seattle Children's Hospital, Seattle, WA; Seattle Children's Research Institute, Center for Pediatric Nursing Research, Seattle Children's Hospital, Seattle, WA
| | - Elaine Walsh
- Nurse Scientist, Nursing Practice, Professional Development, and Innovation, Seattle Children's Hospital, Seattle, WA; Associate Professor, Vice Chair for Education, Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
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Weitzman C, Nadler C, Blum NJ, Augustyn M. Health Care for Youth With Neurodevelopmental Disabilities: A Consensus Statement. Pediatrics 2024; 153:e2023063809. [PMID: 38596852 DOI: 10.1542/peds.2023-063809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Individuals with a neurodevelopmental disability (NDD) face significant health care barriers, disparities in health outcomes, and high rates of foregone and adverse health care experiences. The Supporting Access for Everyone (SAFE) Initiative was developed to establish principles of health care to improve equity for youth with NDDs through an evidence-informed and consensus-derived process. With the Developmental Behavioral Pediatric Research Network, the SAFE cochairs convened a consensus panel composed of diverse professionals, caregivers, and adults with NDDs who contributed their varied expertise related to SAFE care delivery. A 2-day public forum (attended by consensus panel members) was convened where professionals, community advocates, and adults with NDDs and/or caregivers of individuals with NDDs presented research, clinical strategies, and personal experiences. After this, a 2-day consensus conference was held. Using nominal group technique, the panel derived a consensus statement (CS) on SAFE care, an NDD Health Care Bill of Rights, and Transition Considerations. Ten CSs across 5 topical domains were established: (1) training, (2) communication, (3) access and planning, (4) diversity, equity, inclusion, belonging, and anti-ableism, and (5) policy and structural change. Relevant and representative citations were added when available to support the derived statements. The final CS was approved by all consensus panel members and the Developmental Behavioral Pediatric Research Network steering committee. At the heart of this CS is an affirmation that all people are entitled to health care that is accessible, humane, and effective.
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Affiliation(s)
| | - Cy Nadler
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Nathan J Blum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marilyn Augustyn
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts
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Hickey E, Man B, Helm KVT, Lockhart S, Duffecy J, Morris MA. Preferred Communication Strategies for People with Communication Disabilities in Health Care Encounters: a Qualitative Study. J Gen Intern Med 2024; 39:790-797. [PMID: 38010462 PMCID: PMC11043277 DOI: 10.1007/s11606-023-08526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND People with communication disabilities (CDs), which includes disabilities in speech, language, voice and/or hearing, experience health and healthcare disparities. A barrier to accessing high-quality, equitable care is the lack of effective communication between patients and their providers. OBJECTIVE In designing a patient-prompted tool to facilitate communication, we analyzed qualitative feedback on communication strategies and the experience of people with CDs, caregivers, and providers in healthcare encounters. We aimed to describe communication strategies that patients with CDs find most useful and optimize a tool for patients to share their communication strategy preferences during clinical encounters. While patient-provider communication is paramount in every interaction, we aimed to highlight the intricacies of optimizing communication for this population. DESIGN We performed a qualitative study utilizing focus groups and interviews with patients with CDs, their caregivers, and healthcare providers. PARTICIPANTS A total of 46 individuals participated in focus groups or interviews; 26 participants self-reported a CD, nine were caregivers, and 11 were providers. Participants represented diverse types of CDs, including stuttering, aphasia, hearing loss, and people with autism or cerebral palsy who use assistive technology to communicate. APPROACH Analysis of qualitative interview and focus group data was guided by a qualitative content analysis approach. KEY RESULTS We identified three themes: (1) While communication strategies should be individualized, participants agreed upon a consolidated list of best strategies and accommodations. We used this consolidated list to finalize tool development. (2) Patients and providers preferred disclosure of the CD and desired communication strategies before the appointment. (3) Providers often do not use communication strategies and accommodations during clinical encounters. CONCLUSIONS For patients with CDs, it is critical to acknowledge and document the CD and individualize communication strategies during healthcare visits to facilitate communication. Studies are needed to evaluate whether improved communication strategy usage leads to improved health outcomes for this population.
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Affiliation(s)
- Erin Hickey
- University of Illinois at Chicago, Chicago, IL, USA.
| | - Bernice Man
- University of Illinois at Chicago, Chicago, IL, USA
| | - Kaila V T Helm
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Lockhart
- Adult and Child Center for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Megan A Morris
- Adult and Child Center for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Divisions of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, USA
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Carragher M, Steel G, O'Halloran R, Lamborn E, Torabi T, Johnson H, Taylor NF, Rose ML. Aphasia disrupts usual care: "I'm not mad, I'm not deaf" - the experiences of individuals with aphasia and family members in hospital. Disabil Rehabil 2024:1-12. [PMID: 38444182 DOI: 10.1080/09638288.2024.2324115] [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: 08/25/2022] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Communication difficulties are highly prevalent in the stroke population, with implications for patient experience, safety and outcomes. This study explores the experiences of people with aphasia and family members regarding healthcare communication in acute and subacute stroke settings. METHODS AND MATERIALS A phenomenological approach was used to understand participants' experiences. Participants took part in a focus group and data were analysed using an inductive thematic approach. RESULTS For individuals with aphasia (n = 4) and family members (n = 2), five themes were generated: "aphasia makes it hard to communicate," "hospital staff focus on the patient's medical status only," "people with aphasia do not get the help they need to improve," "staff lack the skills to communicate with people with aphasia," and "staff are crucial to improving healthcare communication." CONCLUSIONS The stroke team has expertise in the medical management of stroke but struggle to communicate with patients with aphasia. Patients' experience of healthcare communication is often one-way and limited to following instructions, with missed opportunities to discuss core topics such as prognosis, rehabilitation, and person-specific needs. Patients and families assert that all members of the stroke healthcare team should be able to adapt communication to accommodate patients.
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Affiliation(s)
- Marcella Carragher
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Gillian Steel
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Robyn O'Halloran
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Edwina Lamborn
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Torab Torabi
- Computer Science and Information Technology, School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, Australia
| | - Hilary Johnson
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Scope Communication and Inclusion Resource Centre, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia and Allied Health Clinical Research Office, Australia
| | - Miranda L Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Rui JR, Guo J, Yang K. How do provider communication strategies predict online patient satisfaction? A content analysis of online patient-provider communication transcripts. Digit Health 2024; 10:20552076241255617. [PMID: 38778866 PMCID: PMC11110499 DOI: 10.1177/20552076241255617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Objective As a result of the growing access to the Internet, online medical platforms have gained increased popularity in China. However, which strategies doctors should use to improve their online communication with patients remains understudied. Drawing upon the performance-evaluation-outcome (PEO) model, the present study seeks to develop a typology of patient-centered communication (PCC) strategies online and identify those strategies that can increase patient satisfaction. Methods We employed the data crawling technique to access text-based patient-provider transcripts through a large medical consultation platform in China and coded 9140 conversational turns of doctors. Results Our analysis revealed 15 PCC strategies that Chinese doctors often used online. In addition, several strategies were found to enhance patient satisfaction including information provision, making diagnosis, information appraisal, emotion expression, emotion recognition and support, in-depth discussion of medical treatments, providing coping strategies, and enabling self-management. Conclusion Chinese patients may have developed multiple needs, which they expect to fulfill through their interactions with doctors. Technological affordances of online medical platforms may pressure doctors to adapt their communication strategies to patients' needs. Our findings develop the PEO model from the perspective of patient-provider communication strategies and add a perspective centering on patients' needs to the scholarship on patient satisfaction. In addition, these results provide practical implications on how to improve patient-provider communication online.
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Affiliation(s)
- Jian Raymond Rui
- College of Journalism and Communication, South China University of Technology, Guangzhou, Guangdong Province, China
| | - Jieqiong Guo
- Chule Cootek Information Technology Limited Company, Shanghai, China
| | - Keqing Yang
- College of Journalism and Communication, South China University of Technology, Guangzhou, Guangdong Province, China
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Evans E, Jones P, Keijzers G. Making clear and effective communication SOuND BETTeR for patients with communication barriers. Emerg Med Australas 2023; 35:1041-1043. [PMID: 37844910 DOI: 10.1111/1742-6723.14323] [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: 06/08/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/18/2023]
Abstract
The consequences of ineffective communication between patients and clinicians in the ED range from frustration to significant adverse events. Unfortunately, scenarios where we are unable to understand what our patient is saying to us are common, due to a multitude of factors including acute illness, disability and patient diversity. Current communication aids can be difficult to access and use in the Emergency setting due to lack of physical resources, specific training and time. Our aim was to develop a communication tool which allowed for the rapid identification of urgent patient needs. In order to overcome current challenges, the tool had to be resource-light, quick to use and not reliant on additional staff training or patient education for its effective use. The SOuND BETTeR communication tool is a list of yes/no questions, formatted as a mnemonic, which aims to identify the most common and urgent needs of patients in the ED. As the list of potential needs is not exhaustive, the tool does not purport to replace formal communication aids in the medium and long term, but to bridge the gap often left in the ED where urgent needs must be met and more formal communication aids are not yet available. The tool can effectively and quickly identify important needs in patients with expressive communication barriers such as those with aphasia, facial trauma and on non-invasive ventilation. In addition, the tool can be modified for use in patients with non-English speaking backgrounds. At this stage the tool has not yet been prospectively validated.
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Affiliation(s)
- Elizabeth Evans
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Phillip Jones
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Gerben Keijzers
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Ong N, Gee BL, Long JC, Zieba J, Tomsic G, Garg P, Lapointe C, Silove N, Eapen V. Patient safety and quality care for children with intellectual disability: An action research study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:885-911. [PMID: 35657332 DOI: 10.1177/17446295221104619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Children with intellectual disability experience significant challenges in accessing and receiving high-quality healthcare leading to poorer health outcomes and negative patient experiences. Families of these children often report a need for healthcare staff to better understand, communicate, and collaborate for better care while staff acknowledge a lack of training. To address this, we utilised an action research framework with a pre- and post- survey to evaluate an integrated continuing professional development and quality improvement program combining strategies from education, behavioural psychology and quality improvement that was delivered in two departments within a tertiary children's Hospital in Metropolitan Sydney in 2019-2020. Parents reported noticeable changes in the clinical practice of staff, and staff acknowledged and attributed their shift in behaviour to raising awareness and discussions around necessary adaptations. The program demonstrates a novel method for knowledge translation to practice and systems improvements.
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Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Brendan Loo Gee
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jerzy Zieba
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia and Department of Psychology, University of Rzeszow, Poland
| | - Gail Tomsic
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Pankaj Garg
- Specialist Disability Health Team, Department of Community Paediatrics, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Caleb Lapointe
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natalie Silove
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, Australia
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Sullivan R, Hemsley B, Harding K, Skinner I. 'Patient unable to express why he was on the floor, he has aphasia.' A content thematic analysis of medical records and incident reports on the falls of hospital patients with communication disability following stroke. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2033-2048. [PMID: 37355936 DOI: 10.1111/1460-6984.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND People with communication disability following stroke are at risk of falls during inpatient rehabilitation. However, they are often excluded from hospital falls research, and little is known about the circumstances or outcomes of their falls to inform risk management strategies. AIMS To examine hospital medical records and incident reports relating to falls of patients with communication disability following stroke for content codes, categories and themes relating to communication. METHODS & PROCEDURES This medical record chart review examined data on 72 patients and 265 falls. A content thematic analysis was used to identify how patient communication is characterized in relation to falls, and their prevention and management strategies. OUTCOMES & RESULTS The data reflected that staff viewed patients having difficulty following simple instructions as contributing to falls. Gaining the attention of staff and communicating basic needs were also considered to be contributing factors for falls. Patients were often described as experiencing a fall when taking a risk or attempting to address an unmet basic need. Furthermore, written notes for patients with more severe communication disability reflected that the patient's communication impairments prevented staff from establishing the circumstances of some falls and complicated the assessment for injury following a fall. CONCLUSIONS & IMPLICATIONS The medical records and incident reports of patients with communication disability following stroke reveal that hospital staff recognize the impact of communication disability as potential risk factors for falls for this group. It was difficult for staff to report the circumstances of the fall for patients with severe communication disability. Despite the recognition of communication as a potential contributing factor, few medical record entries documented strategies related to communication interventions to improve patients' ability to understand instructions, gain attention or communicate basic needs. WHAT THIS PAPER ADDS What is already known on the subject People with stroke are at a high risk of falls during their hospital admission. However, little is known about the circumstances of their falls and the influence of communication disability on these falls. What this paper adds to existing knowledge Patients with communication disability have unique factors that contribute to their falls in the hospital. Patients were described as experiencing a fall when taking a risk or attempting to address an unmet need, and these falls were often related to a patient's difficulties communicating their basic needs, gaining attention from staff, and following simple instructions. What are the potential or actual clinical implications of this work? Communication disability as a risk factor for a fall, and fall prevention strategies tailored to the communication disability, were typically identified and documented by physiotherapists, occupational therapists and nursing staff. The inclusion of speech pathologists in fall risk assessment, management, and prevention strategies may provide crucial information regarding the patient's communication disability that may enhance their fall prevention plan.
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Affiliation(s)
- Rebecca Sullivan
- University of Technology Sydney, Ultimo, NSW, Australia
- Eastern Health, Box Hill, VIC, Australia
| | | | - Katherine Harding
- Eastern Health, Box Hill, VIC, Australia
- La Trobe University, Bundoora, VIC, Australia
| | - Ian Skinner
- School of Allied Health Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, NSW, Australia
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Watson E, Raghavendra P, Lawn S, Watson J. Improving communication access in psychoeducational interventions for people with complex communication needs: a scoping review and stakeholder consultation. Disabil Rehabil 2023; 45:3388-3406. [PMID: 36172972 DOI: 10.1080/09638288.2022.2127932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Psychoeducational interventions are commonly used to improve mental health among the general population; however, their application among people with complex communication needs is under explored. This scoping review aims to identify the psychoeducational interventions utilised with people with complex communication needs, any adaptations to improve communication access, and outcomes for this population. MATERIALS AND METHODS The scoping review was conducted using the Arksey and O'Malley guidelines and included stakeholder consultations. A systematic search of the literature was conducted. Stakeholder consultations were conducted via semi-structured interviews with informants from three populations: people with complex communication needs, everyday communication partners and mental health workers. RESULTS The search yielded 2112 articles. Twenty-four articles were retained for data extraction. Numerical analysis provided an overview of the existing literature. Thematic analysis highlighted the range of communication access strategies applied within psychoeducational interventions. Common aims and outcomes of interventions occurred across three interrelated themes: education, symptom reduction, and improved coping and wellbeing. Stakeholder consultations enabled contextualisation of literature. CONCLUSIONS People with complex communication needs may benefit from psychoeducational interventions when effective, personalised communication access strategies are employed. Future research should include lived-experience perspectives to ensure the relevance of communication access strategies in mental health support.Implications for rehabilitationThis scoping review adds to the evidence base supporting equitable access to mental health support for people with complex communication needs.A range of specific strategies are presented for mental health workers to consider when working with people with complex communication needs.Positive behaviour support (PBS) practitioners must be equipped to address the psychoeducational and mental health support requirements of people with complex communication needs.
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Affiliation(s)
- Eleanor Watson
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Parimala Raghavendra
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
| | - Joanne Watson
- School of Health & Social Development, Deakin University, Melbourne, Australia
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McKenna VB, Gilheaney Ó. Health literacy interventions in adult speech and language therapy: A scoping review. Health Expect 2023; 27. [PMID: 37746677 PMCID: PMC10726155 DOI: 10.1111/hex.13878] [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: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Reduced health literacy can negatively impact care seeking, satisfaction with care and overall health outcomes. These issues are particularly common among people living with communication difficulties who are seeking care from speech and language therapists (SLTs). As such, the SLT must be aware of and sensitive to health literacy needs within their clinical practice, proactively adapting materials and resources to the health literacy needs of their patients. Despite this required core competency, little is known about the health literacy interventions used by SLTs when working with adult patients, and as such, there is limited and unclear guidance for the practicing clinician, leading to potentially suboptimal care delivery. OBJECTIVES To explore the characteristics of health literacy interventions discussed in the literature for use by SLTs with adult patients. SEARCH STRATEGY PubMed, CINAHL, Web of Science and The Cochrane Database of Systematic Reviews were searched. Conference proceedings of the annual scientific meetings of the European Society for Swallowing Disorders and the Dysphagia Research Society were also searched. Grey literature was searched via the Open Grey database and, hand-searches of reference lists from included studies were conducted by both authors. INCLUSION CRITERIA Published and unpublished research investigating health literacy interventions provided by qualified SLTs providing care to adult patients in any setting for any speech and language related concerns. No language, geographic, study design or publication date limitations applied. Eligible participants in these studies were classified as: (1) patients and (2) professionals. DATA EXTRACTION AND SYNTHESIS Data were charted in accordance with guidelines from the Joanna Briggs Institute and the PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) independently by both authors. MAIN RESULTS A total of 1112 potentially eligible studies were identified in the initial search, with 15 studies ultimately included in the synthesis. Study design and quality varied significantly. Most explored basic functional health literacy or narratively described core components of health literacy, which an SLT should understand, without employing an investigative research design. DISCUSSION Limited research has been conducted on the use of health literacy interventions within adult speech and language therapy practices. This finding is significant as SLTs regularly work with people living with communication problems, and therefore, addressing health literacy should be a core tenet of service delivery. CONCLUSION There is a need for valid, reliable and rigorous investigations of health literacy interventions within speech and language therapy to ultimately improve future patient access to and benefit from the care provided. PATIENT OR PUBLIC CONTRIBUTION Patient public involvement in review studies is an emerging area. Due to resource issues, it was not possible to include this element in this study.
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Affiliation(s)
- Verna B McKenna
- Discipline of Health Promotion, School of Health Sciences, University of Galway, Galway, Ireland
| | - Órla Gilheaney
- School of Linguistic, Speech & Communication Sciences, Trinity College Dublin, Dublin, Ireland
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Casey K, O'Halloran R, van den Berg MEL, Rose ML. "We got there in the end…. somehow, we got there": a qualitative study of healthcare professionals providing care in the community to people with chronic aphasia, and how technology could assist. Disabil Rehabil 2023:1-10. [PMID: 37702476 DOI: 10.1080/09638288.2023.2256666] [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: 03/08/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Little is known about the experience of healthcare professionals (HCPs) in the community providing healthcare to people with aphasia. In this study we aimed to explore the experiences of community HCPs in healthcare conversations with people with aphasia, and whether a high-tech, purpose-built aphasia app could assist. METHODS A generic qualitative study was conducted. HCPs from seven different clinical backgrounds were interviewed and data was thematically analysed. RESULTS The experiences of healthcare providers providing healthcare to people with aphasia were identified in six major themes. These were: (1) Healthcare communication topics; (2) HCP knowledge; (3) Communication exchanges during the interactions (4) Communication impacts on care; (5) Interactions and relationships grew easier over time; and (6) How technology could help interactions. CONCLUSIONS HCPs with more aphasia knowledge reported having more positive experiences. Unsuccessful interactions were believed to lead to negative emotional responses in people with aphasia and HCPs, and that miscommunications could lead to compromised care. HCPs reported that interactions and relationships with people with aphasia grew easier over time. HCPs need system level support to acquire the knowledge and skills needed to engage people with aphasia in effective healthcare conversations. Technology has potential to improve interactions.
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Affiliation(s)
- Kylie Casey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Belmont Community Rehabilitation, Barwon Health, Geelong, Australia
| | - Robyn O'Halloran
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | | | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Gilliand M, Bernier Emch A, Perrenoud B. Adults with intellectual disabilities' satisfaction regarding their hospitalization: A correlational descriptive study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231193461. [PMID: 37565271 DOI: 10.1177/17446295231193461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
When hospitalized, adults with intellectual disabilities are more anxious and have more unmet needs than the general population. Despite these problems, studies report contradictory results about their satisfaction with hospitalization. The aim of this study was to determine the level of satisfaction of adults with intellectual disabilities regarding their hospital care and the factors associated with satisfaction. An analysis of the Patient Satisfaction Scale (PSS) and Cognitive Appraisal of Health Scale (CAHS) instruments completed by adults with intellectual disabilities, or their caregivers, after hospitalization was done. The 32 participants' mean PSS score was 3.6/5, with means of 13.3/25 and 8.7/25 on the CAHS' 'harm/loss' dimension and 'challenge' dimension, respectively. None of the factors studied was associated with the total PSS score. Adults with intellectual disabilities were not fully satisfied with their hospital care, experiencing challenges and losses. These findings call for a rethink of the care provided to this population.
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Affiliation(s)
- Morgane Gilliand
- HESAV School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Béatrice Perrenoud
- Lausanne University Hospital (CHUV), Lausanne, Switzerland; La Source School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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Ong N, Lucien A, Long JC, Weise J, Walton M, Burgess A. What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis. BMJ Open 2023; 13:e071494. [PMID: 37491102 PMCID: PMC10373726 DOI: 10.1136/bmjopen-2022-071494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital. DESIGN Qualitative study. SETTING We conducted semi-structured interviews and focus groups of staff of tertiary children's hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis. PARTICIPANTS There were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff. INTERVENTION Questions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital. RESULTS Key themes elicited include Definition of Safety, Need to consider additional vulnerabilities of children and young people with intellectual disability in hospital, Communication is key to safe care, Parent and family perspectives on safe care, Management challenges compromising safety and Service system gaps in preventing, identifying and managing risk. CONCLUSIONS Staff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.
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Affiliation(s)
- Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Child Development Unit, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Merrilyn Walton
- Office of Teaching and Learning in Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Annette Burgess
- Medical Education, Education Office, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Wei W, Jiang Z. A bibliometrix-based visualization analysis of international studies on conversations of people with aphasia: Present and prospects. Heliyon 2023; 9:e16839. [PMID: 37346333 PMCID: PMC10279826 DOI: 10.1016/j.heliyon.2023.e16839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
In recent years, there has been a rapid increase in the number of people with aphasia due to brain lesions worldwide, which has prompted researchers to carry out in-depth studies on the pathogenesis, inducement and prognosis of aphasia from neurology, clinical medicine, psychology and other disciplines. With the deepening of research and understanding of aphasia, it is generally believed that a single discipline can no longer meet the needs of the academic community. Therefore, multidisciplinary integration has emerged and achieved fruitful results. This paper, based on the biblioshiny package run by R, conducts bibliometric analysis on the international interdisciplinary research status of conversation and aphasia, predicts its future development direction, and provides reference for relevant domestic research from international source journals. The results indicate that led by Australia, the United Kingdom, the United States and other countries, the international conversational aphasia research has formed a complete system, and formed a "descriptive study of patients with language disorders" and "applied study of rehabilitation treatment". In the future, while continuing to focus on these two categories of research, the empathy ability of conversational partners and medical staff may be taken into account, in order to better contribute to improving patients' quality of life.
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Affiliation(s)
- Wei Wei
- Graduate School, Xi'an International Studies University, School of Foreign Studies, Xi'an Medical University, Xi'an, China
| | - Zhanhao Jiang
- School of Foreign Languages, Southeast University, Nanjing, China
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17
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Xie Z, Tanner R, Striley CL, Sheffield SW, Marlow NM. Hearing Impairment, Mental Health Services Use, and Perceived Unmet Needs Among Adults With Serious Mental Illness: A Cross-Sectional Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-11. [PMID: 37257284 DOI: 10.1044/2023_jslhr-22-00385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Individuals with hearing impairment have higher risks of mental illnesses. We sought to develop a richer understanding of how the presence of any hearing impairment affects three types (prescription medication, outpatient services, and inpatient services) of mental health services utilization (MHSU) and perceived unmet needs for mental health care; also, we aimed to identify sociodemographic factors associated with outpatient mental health services use among those with hearing impairment and discuss potential implications under the U.S. health care system. METHOD Using secondary data from the 2015-2019 National Survey on Drug Use and Health, our study included U.S. adults aged ≥ 18 years who reported serious mental illnesses (SMIs) in the past year. Multivariable logistic regression was used to examine associations of hearing impairment with MHSU and perceived unmet mental health care needs. RESULTS The study sample comprised 12,541 adults with SMIs. Prevalence of MHSU (medication: 55.5% vs. 57.5%; outpatient: 37.1% vs. 44.2%; inpatient: 6.6% vs.7.1%) and unmet needs for mental health care (47.5% vs. 43.3%) were estimated among survey respondents who reported hearing impairment and those who did not, respectively. Those with hearing impairment were significantly less likely to report outpatient MHSU (OR = 0.73, 95% CI [0.60, 0.90]). CONCLUSIONS MHSU was low while perceived unmet needs for mental health care were high among individuals with SMIs, regardless of hearing status. In addition, patients with hearing impairment were significantly less likely to report outpatient MHSU than their counterparts. Enhancing communication is essential to improve access to mental health care for those with hearing impairment.
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Affiliation(s)
- Zhigang Xie
- Department of Public Health, University of North Florida, Jacksonville
| | - Rebecca Tanner
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
| | | | - Sterling W Sheffield
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Nicole M Marlow
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
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Gormley J, McNaughton D, Light J. Supporting Children's Communication of Choices During Inpatient Rehabilitation: Effects of a Mobile Training for Health Care Providers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:545-564. [PMID: 36763852 PMCID: PMC11062496 DOI: 10.1044/2022_ajslp-22-00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/12/2022] [Accepted: 11/10/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE Children with complex medical and communication needs often experience extensive or frequent hospital stays and rely on augmentative and alternative communication (AAC) strategies to communicate in this environment. Health care providers seldom receive training to effectively communicate with these children, which may lead to limited participation opportunities for the child during inpatient interactions. METHOD A pretest-posttest experimental group design was completed to evaluate the effects of a brief mobile training designed to teach providers a procedure to support children with complex communication needs to communicate choices. Each provider participated in two pretest and two posttest interactions with children with complex communication needs during naturally occurring inpatient activities. Providers in the treatment group completed the video training, whereas providers in the control group did not. RESULTS Following the training, (a) more providers offered choices to the children during hospital routines, (b) providers implemented the trained procedure with increased accuracy, and (c) the children with complex communication needs consistently communicated their choices when given the opportunity to do so. The providers rated the training as easy to use, effective, and suited to the needs of the inpatient setting. CONCLUSIONS This is the first AAC training designed to promote child-provider interactions in inpatient settings that demonstrates results that are efficient, socially valid, and effective in a real-world context. Future work is needed to develop additional brief and focused AAC partner trainings to teach providers to support the participation of children with complex communication needs in health care interactions. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22029008.
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Affiliation(s)
- Jessica Gormley
- Speech-Language Pathology Department, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha
| | - David McNaughton
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Janice Light
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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Söderhielm K, Eriksson K, Möller M. Communicative participation in goal-setting meetings for patients with aphasia after stroke. A study using patients' and healthcare professionals' self-ratings. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:342-356. [PMID: 36218168 DOI: 10.1111/1460-6984.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Communicative participation poses a challenge in meetings between healthcare professionals (HCPs) and people with aphasia (PwA). How communication is affected by aphasia in group meetings, where several healthcare professionals participate together with the patient, is largely unexplored. The aim of this study was to investigate self-rated communicative participation during goal-setting meetings among PwA compared to patients without aphasia and to investigate whether communicative participation among PwA was associated with self-rated knowledge about aphasia among HCPs. A further aim was to investigate if there was a difference in the use of communication strategies among HCPs in the respective situations. METHODS Nine PwA and nine control patients without aphasia rated their experience of communication during a goal-setting meeting. Thirty-eight HCPs rated their knowledge about aphasia and communication, and their use of communication strategies during goal-setting meetings. RESULTS The PwA reported being listened to by the HCPs as well as being able to comprehend the meeting. PwA with more severe language impairment did not report a lower level of communicative participation compared to PwA with milder impairment. Half of the patients from both groups indicated some difficulty asking questions during the meeting. Patients' ratings of communication were not correlated to HCPs' knowledge of communication strategies. There was a significant difference in self-rated use of communication strategies among HCPs for the two conditions, although the individual variation was large. CONCLUSION Results from both PwA and controls imply that patients may need more support to be able to ask questions in meetings with HCPs. Although self-ratings increase the ecological validity of the study of participation, further studies could benefit from using video observations in combination with self-reported experience, since awareness might influence results. WHAT THIS PAPER ADS What is already known on this subject Aphasia is an acquired language disorder that affects patient-provider communication. In stroke rehabilitation, person-centred goal setting is a key component. If healthcare professionals (HCPs) are not able to use adequate communication strategies, a lack of accessible communication can become a barrier to person-centredness. There are evidence-based communication strategies which can be used to overcome this barrier. What this paper adds to existing knowledge This study aimed to investigate communicative participation during goal-setting meetings from the perspective of patients with aphasia and HCPs. To our knowledge, this is the first study where persons with aphasia are asked to rate communicative participation in goal-setting meetings. To broaden the perspective on communication and goal setting, ratings of patients with aphasia are compared to ratings by patients with stroke but no aphasia. The results of this study indicate that there is room for improvement regarding communication during goal-setting meetings. However, asking direct questions on communicative participation to persons with severe aphasia may not be feasible. What are the potential or actual clinical implications of this work? The results of this study imply that both patients with and without aphasia may need more support to be able to express themselves during goal-setting meetings. There also seems to be a need for further education on aphasia and communication strategies among rehabilitation professionals.
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Affiliation(s)
- Kajsa Söderhielm
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eriksson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Geriatrics, Pulmonary Disease and Allergology, Gothenburg, Sweden
| | - Marika Möller
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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20
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Shady K, Phillips S, Newman S. Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-13. [PMID: 35669718 PMCID: PMC9148936 DOI: 10.1007/s40489-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00324-8.
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Affiliation(s)
- Kathryn Shady
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Shannon Phillips
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Susan Newman
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
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21
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Tönsing KM, Dada S, Bastable K, Samuels A. Health information and education needs for youth with complex communication needs during the Covid-19 pandemic: rehabilitation professionals' perspectives. Disabil Rehabil 2022; 45:1619-1628. [PMID: 35508419 DOI: 10.1080/09638288.2022.2069872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The worldwide Covid-19 pandemic has highlighted inequities faced by persons with complex communication needs (CCN) in accessing health information and education. This study reports on the perspectives of South African rehabilitation professionals regarding access to health information and education for youth with CCN. MATERIALS AND METHODS Two asynchronous online written focus groups were conducted with 15 rehabilitation professionals. Participants' contributions were thematically analysed. RESULTS Participants reported that youth with CCN faced a variety of challenges when accessing health information, related, amongst others, to the format and quality of the information. Participants reported on strategies they had successfully used to support comprehension of health information and the youth's communication during healthcare encounters. Participants suggested various Covid-19-related and general health topics of value to youth, as well as a variety of multimodal and multilingual presentation formats to make health information accessible. This information was used in the development of accessible health information resources that are now freely available on the authors' institutional website. CONCLUSIONS The results confirmed that there is an urgent need to make accessible health information available in order to include South Africans with CCN in health services during the pandemic and beyond. Implications for rehabilitationHealth information and education (including information and education provided with respect to the Covid-19 pandemic) has often not been accessible to youth with complex communication needs (CCN).South African rehabilitation professionals reported on a variety of challenges that youth with CCN face when attempting to access health information and education, but also reported on strategies that had helped to support them in this.They also highlighted Covid-19-related and general health topics that would be of value to youth, and suggested a variety of information formats and strategies to make health information more accessible.This information can assist in the design of appropriate and accessible health information resources for youth with CCN and other individuals who experience communication challenges.
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Affiliation(s)
- Kerstin Monika Tönsing
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Shakila Dada
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Kirsty Bastable
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Alecia Samuels
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
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Stogiannos N, Carlier S, Harvey-Lloyd JM, Brammer A, Nugent B, Cleaver K, McNulty JP, dos Reis CS, Malamateniou C. A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:782-797. [PMID: 34961364 PMCID: PMC9008560 DOI: 10.1177/13623613211065542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
LAY ABSTRACT Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.
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Affiliation(s)
| | - Sarah Carlier
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
- University of Lausanne, Switzerland
| | | | | | - Barbara Nugent
- City, University of London, UK
- MRI Safety Matters® Organisation, UK
- NHS National Education for Scotland, UK
| | | | | | - Cláudia Sá dos Reis
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
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Heard R, Anderson H, Horsted C. Exploring the communication experiences of stroke nurses and patients with aphasia in an acute stroke unit. SPEECH, LANGUAGE AND HEARING 2022. [DOI: 10.1080/2050571x.2020.1833284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Goldberg MA, Hochberg LR, Carpenter D, Walz JM. Development of a Manually Operated Communication System (MOCS) for patients in intensive care units. Augment Altern Commun 2022; 37:261-273. [PMID: 35023431 DOI: 10.1080/07434618.2021.2016958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nonvocal alert patients in the intensive care unit (ICU) setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. Innovation of a hand-operated non-touchscreen communication system for nonvocal ICU patients was guided by design concepts including speech output, simplicity, and flexibility. A novel communication tool, the Manually Operated Communication System (MOCS), was developed for use in intensive care settings with patients unable to speak. MOCS is a speech-output technology designed for patients with manual dexterity impairments preventing legible writing. MOCS may have the potential to improve communication for nonvocal patients with limited manual dexterity.
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Affiliation(s)
- Miriam A Goldberg
- MD/PhD Program, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Leigh R Hochberg
- Carney Institute for Brain Science and School of Engineering, Brown University, Providence, RI, USA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA.,Rehabilitation R&D Service, US Department of Veterans Affairs, VA RR&D Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - Dawn Carpenter
- Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Surgical/Trauma Critical Care, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - J Matthias Walz
- Department of Anesthesiology & Perioperative Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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25
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Hur Y, Kang Y. Nurses' experiences of communicating with patients with aphasia. Nurs Open 2022; 9:714-720. [PMID: 34741499 PMCID: PMC8685888 DOI: 10.1002/nop2.1124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/06/2021] [Accepted: 10/14/2021] [Indexed: 12/04/2022] Open
Abstract
AIM This study explored nurses' experiences of communicating with patients with aphasia. DESIGN A naturalistic paradigm approach was adopted to describe the phenomenon of interest. METHODS Participants were neurological nurses employed in various neurological departments and recruited using purposive sampling. Group interviews were conducted for 1 hr and 30 min using semi-structured open-ended questions. The Consolidated Criteria for Reporting Qualitative Research checklist was followed. RESULTS Four generic categories were derived: "Conversations with the aphasic patients are frustrating, which leads to impatience among nurses, and they eventually dismiss the patients," "Feeling responsible for communicating with aphasic patients but also experiencing guilt for not being able to give adequate care in practice," "Concerns about communication methods with aphasic patients" and "Desire to learn ways to communicate with aphasic patients." Appropriate education and support should be given to nurses to facilitate communication with aphasic patients to ensure that they are not excluded from medical benefits because of communication difficulties.
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Affiliation(s)
- Yujin Hur
- Frances Payne Bolton School of NursingCase Western Reserve UniversityClevelandOhioUSA
| | - Younhee Kang
- College of NursingEwha Womans UniversitySeoulKorea
- Graduate Program in System Health Science and EngineeringEwha Womans UniversitySeoulKorea
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Autism-friendly MRI: Improving radiography practice in the UK, a survey of radiographer practitioners. Radiography (Lond) 2021; 28:133-141. [PMID: 34565680 DOI: 10.1016/j.radi.2021.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Autistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers' perspectives and experiences regarding MRI scanning of autistic individuals. METHODS Data collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021. RESULTS 130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations. CONCLUSION Although routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature. IMPLICATIONS FOR PRACTICE MRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s).
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Does volunteering change attitudes towards people with disabilities? A qualitative study of the experience of orthodox Jewish nursing students. Nurse Educ Pract 2021; 55:103141. [PMID: 34256260 DOI: 10.1016/j.nepr.2021.103141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND People with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed. DESIGN A qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultra-orthodox (Haredi) students volunteering with people with disabilities. METHODS Data from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis. RESULTS Volunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability. CONCLUSIONS Projects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.
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Gibson RC, Bouamrane MM, Dunlop MD. Alternative and Augmentative Communication Technologies for Supporting Adults With Mild Intellectual Disabilities During Clinical Consultations: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e19925. [PMID: 34106087 PMCID: PMC8235287 DOI: 10.2196/19925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2020] [Accepted: 04/02/2021] [Indexed: 12/25/2022] Open
Abstract
Background People with intellectual disabilities (IDs) face significant communication barriers when accessing health care services; they find it difficult to identify and describe conditions clearly enough to support practitioners in making an accurate diagnosis. In addition, medical professionals generally have little knowledge and understanding of the needs of people with ID, which may result in the use of consultation techniques that do not cater to their patients’ skills. Objective This review aims to identify and synthesize the literature on alternative and augmentative communication technologies that are used to support adults with mild ID during the exchange of information with medical practitioners. Methods We performed a scoping review of studies published in English that describe the technologies that are used to promote communication with patients with mild ID during medical consultations. The databases searched were PubMed, ACM Digital Library, and Google Scholar. A qualitative framework-based approach was used to synthesize the data and discern key recurring themes across the identified literature. Results Of the 1557 articles screened, 15 (0.96%) met our inclusion criteria. The bulk of the communication aids used focused on low-tech solutions, including patient passports, note-based prompts, Talking Mats, health diaries, and easy-read information sheets. Their influence on current practice ranged from advancing medical professionals’ knowledge of the health and communication needs of people with ID to increasing interagency collaboration, patient advocacy skills, and health promotion activities. The major barriers to the implementation of low-tech aids were a lack of portability and increased maintenance efforts. Only 3 studies explored the use of mobile apps to promote communication. Their findings indicated that high-tech solutions offer greater customization with regard to the accessibility and health care needs of people with ID. Conclusions Alternative and augmentative communication technologies have the potential to increase the quality of care provided to patients with mild ID; however, little work has been carried out in this area. Greater emphasis must be placed on (high-tech) two-way communication aids that empower patients to become involved in decisions regarding their care. Quantitative evaluation methods should be used to discern the true benefits of such aids, and researchers should describe their study protocols in depth to promote replication and generalizability.
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Affiliation(s)
- Ryan Colin Gibson
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matt-Mouley Bouamrane
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark D Dunlop
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Thunberg G, Johnson E, Bornman J, Öhlén J, Nilsson S. Being heard - Supporting person-centred communication in paediatric care using augmentative and alternative communication as universal design: A position paper. Nurs Inq 2021; 29:e12426. [PMID: 34076320 DOI: 10.1111/nin.12426] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022]
Abstract
Person-centred care, with its central focus on the patient in partnership with healthcare practitioners, is considered to be the contemporary gold standard of care. This type of care implies effective communication from and by both the patient and the healthcare practitioner. This is often problematic in the case of the paediatric population, because of the many communicative challenges that may arise due to the child's developmental level, illness and distress, linguistic competency and disabilities. The principle of universal design put forth in conventions and legislation means that the design of products and services should be usable by all people, to the greatest extent possible. Augmentative and alternative communication encompasses strategies, for example pictures and apps, that are typically used with people with communication disability. In this position paper, we argue for the universal use of augmentative and alternative communication to support person-centred communication and care for children, regardless of age or potential disability. Clinical examples are shared from three different paediatric care settings where pictorial supports were applied universally. Interviews were conducted with children and adolescents (with and without disabilities), parents and healthcare practitioners, and the principles of universal design were used as a framework to demonstrate how person-centred communication is supported in paediatric care.
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Affiliation(s)
- Gunilla Thunberg
- Dart Centre for Augmentative and Alternative Communication and Assistive Technology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Speech and Language Pathology Unit, Institute of Neuroscience and Physiology at Sahlgrenska Academy, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | - Joakim Öhlén
- Gothenburg Centre for Person-centred Care, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Nilsson
- Gothenburg Centre for Person-centred Care, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Watson E, Raghavendra P, Crocker R. Mental health matters: a pilot study exploring the experiences and perspectives of individuals with complex communication needs. Augment Altern Commun 2021; 37:102-112. [PMID: 34018881 DOI: 10.1080/07434618.2021.1921845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Mental health and wellbeing are foundational in human interaction and life satisfaction. Persons with complex communication needs are at risk of reduced mental health and wellbeing. The aim of this project was to identify the facilitators and barriers that individuals with complex communication needs experience when attending to their mental health and wellbeing. A qualitative study design using a phenomenological approach was utilized. Data was collected through in-depth interviews with three participants with complex communication needs, observation, and reflexive journaling. An inductive process of cross-case thematic analysis identified common barriers and facilitators experienced by the participants when addressing mental health and wellbeing. The opportunity barriers described in Beukelman and Mirenda's Participation Model were applied to classify the assistive and obstructive roles of communication partners. Barriers and facilitators to obtaining assistance for mental health and wellbeing related predominantly to communication partners' skills, attitudes, and support practices. The findings highlight a need to equip individuals with complex communication needs, carers, support workers, and mental health professionals with the knowledge, skills, and attitudes to promote mental health and wellbeing among this population.
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Affiliation(s)
- Eleanor Watson
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Parimala Raghavendra
- Disability and Community Inclusion, Caring Futures Research Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Ruth Crocker
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
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Louch G, Albutt A, Harlow-Trigg J, Moore S, Smyth K, Ramsey L, O'Hara JK. Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review. BMJ Open 2021; 11:e047102. [PMID: 34011599 PMCID: PMC8137174 DOI: 10.1136/bmjopen-2020-047102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting. DESIGN Scoping review with narrative synthesis. METHODS The review followed the six stages of the Arksey and O'Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria-patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms. RESULTS 45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities. CONCLUSION People with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.
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Affiliation(s)
- Gemma Louch
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Abigail Albutt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | | | - Sally Moore
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kate Smyth
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Lauren Ramsey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Jane K O'Hara
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
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Shrubsole K, Lin TJ, Burton C, Scott J, Finch E. Delivering an iterative Communication Partner Training programme to multidisciplinary healthcare professionals: A pilot implementation study and process evaluation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:620-636. [PMID: 33818902 DOI: 10.1111/1460-6984.12618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite evidence that Communication Partner Training (CPT) can enable health professionals to communicate more effectively with people with aphasia (PWA), an evidence-practice gap exists. To address this, a tailored implementation intervention was developed and trialled to improve health professionals' implementation of communication strategies in a subacute setting. AIMS To explore the outcomes and perceived feasibility, acceptability and potential effectiveness of an iterative CPT implementation intervention on multidisciplinary healthcare professionals' communication with PWA. METHODS & PROCEDURES The CPT implementation intervention was delivered to two groups of healthcare professionals (n = 6 and 7) approximately 6 months apart. The intervention underwent two iterations targeting emerging barriers to implementation success, with Group 2 receiving a modified version of the Group 1 intervention. A concurrent qualitative process evaluation was conducted to understand key factors determining implementation outcomes. Quantitative outcomes were recorded at baseline and 3-month follow-up, including the Measure of Skill in Supported Communication (MSC), a customized behavioural determinants survey mapped to the Theoretical Domains Framework (TDF) and the Organizational Readiness for Change survey. Focus groups and semi-structured interviews were conducted with health professional participants and the speech-language therapist trainer to explore perceptions of feasibility, acceptability and potential effectiveness. Content analysis was used to analyse the qualitative data, with categories and themes generated. OUTCOMES & RESULTS The Group 2 implementation intervention was adapted based on feedback and reflections from Group 1 participants to incorporate more time for practice interactions and discussion during training, individual follow-up sessions and provision of accessible resources to aid communication attempts. There were greater improvements seen in the Group 2 outcomes on both the MSC and the TDF survey, suggesting that the iterative tailoring of the intervention was successful in addressing the barriers to change and led to improved implementation. The difference between the group's outcomes may also partly be explained by the impact of organizational readiness, which decreased during Group 1's implementation period. Despite similar themes emerging from the stakeholder perspectives in both groups (training factors, implementation facilitators, implementation barriers, and changes in knowledge and practice), these diverted in ways which served to explain the different implementation outcomes. CONCLUSIONS & IMPLICATIONS An iteratively adapted CPT implementation intervention targeting healthcare professionals' use of supported communication strategies was feasible and acceptable for most participants. The implementation intervention was potentially effective in changing participants' communication with PWA, particularly for Group 2. Future CPT implementation efforts should continue to incorporate stakeholder input and tailor strategies to the organizational context, and measure whether outcomes are sustained in the long term. What this paper adds What is already known on the subject CPT is a complex intervention that can improve communication access and outcomes for PWA. However, there are barriers to both delivering CPT programmes to staff, and for staff in modifying their communication behaviours. Despite increasing efforts to improve CPT implementation, it remains largely unclear whether CPT implementation interventions are effective in improving interactions between staff and patients, and what elements of an implementation intervention result in changed behaviour. What this study adds to existing knowledge This study showed that adopting an iterative, barriers-focused approach to implementation facilitated practice change for one of the groups that participated in the programme. Incorporating stakeholder feedback in an ongoing way led to improvements in feasibility, acceptability and potential effectiveness, with several of the main barriers being effectively addressed by the intervention. Some key mechanisms of change were identified. What are the potential or actual clinical implications of this work It is necessary to develop active, targeted implementation strategies to support healthcare professionals to modify their communication, monitor implementation barriers as they arise and modify behaviour-change strategies accordingly. In a similar context, it is suggested that CPT implementation interventions should incorporate the use of audit feedback, physical resources and educational lectures paired with interactions with PWA in order to bring about change, with ongoing support and facilitation.
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Affiliation(s)
- Kirstine Shrubsole
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
- The Queensland Aphasia Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Victoria, Australia
| | - Tz-Jie Lin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Christine Burton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Julie Scott
- Sunshine Coast University Hospital, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Johnson E, Heyns T, Nilsson S. Nurses' perspectives on alternative communication strategies use in critical care units. Nurs Crit Care 2021; 27:120-129. [PMID: 33624908 DOI: 10.1111/nicc.12612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Critically ill patients have the right to communicate and participate in their treatment to avoid adverse medical outcomes due to the severity of their illness, their responsiveness, and level of consciousness. This human right has often been neglected by health care professionals, as a result of limited alternative communication support provided to patients who are unable to speak due to, for example, endotracheal intubation. Despite the successful use of alternative communication strategies in critical care units (CCUs) in other countries, limited implementation in South African hospitals has been reported. AIMS AND OBJECTIVES This study aimed to determine the perspectives of South African nurses working in CCUs on the frequency of use of alternative communication strategies to support patient-centred communication with critically ill adult patients. DESIGN The study followed a quantitative non-experimental survey research design. METHODS A total of 210 nurses working in both private and public hospitals completed a survey on their perspectives on the use of alternative communication strategies in CCUs. RESULTS Nurse participants reported experience working with critically ill and communication-vulnerable patients. Nurse-patient communication mainly involved the use of pen and paper, facial expressions and gestures to obtain information relating to patients' needs and their health history. Limited use of speech-generating communication devices was reported. CONCLUSION Nurse training on the use and implementation of alternative communication strategies, such as communication boards or electronic speech-generating devices, should be investigated to improve nurses' communication with communication-vulnerable patients in South Africa. RELEVANCE TO CLINICAL PRACTICE The results are applicable in clinical practice due to patients' need for alternative communication. The nurses mainly used low-tech solutions, which are cheap and easy to access. However, there exists an opportunity to increase the use of available digital solutions.
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Affiliation(s)
- Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Tanya Heyns
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Stefan Nilsson
- Institute of Health and Care Sciences, University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mahakwe G, Johnson E, Karlsson K, Nilsson S. A Systematic Review of Self-Report Instruments for the Measurement of Anxiety in Hospitalized Children with Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041911. [PMID: 33669455 PMCID: PMC7920462 DOI: 10.3390/ijerph18041911] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
Anxiety has been identified as one of the most severe and long-lasting symptoms experienced by hospitalized children with cancer. Self-reports are especially important for documenting emotional and abstract concepts, such as anxiety. Children may not always be able to communicate their symptoms due to language difficulties, a lack of developmental language skills, or the severity of their illness. Instruments with sufficient psychometric quality and pictorial support may address this communication challenge. The purpose of this review was to systematically search the published literature and identify validated and reliable self-report instruments available for children aged 5–18 years to use in the assessment of their anxiety to ensure they receive appropriate anxiety-relief intervention in hospital. What validated self-report instruments can children with cancer use to self-report anxiety in the hospital setting? Which of these instruments offer pictorial support? Eight instruments were identified, but most of the instruments lacked pictorial support. The Visual Analogue Scale (VAS) and Pediatric Quality of Life (PedsQL™) 3.0 Brain Tumor Module and Cancer Module proved to be useful in hospitalized children with cancer, as they provide pictorial support. It is recommended that faces or symbols be used along with the VAS, as pictures are easily understood by younger children. Future studies could include the adaptation of existing instruments in digital e-health tools.
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Affiliation(s)
- Gomolemo Mahakwe
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa; (G.M.); (E.J.)
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa; (G.M.); (E.J.)
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden;
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
- Correspondence: ; Tel.: +46-738538951
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Gormley J, Light J. Child-Parent-Provider Interactions of a Child With Complex Communication Needs in an Inpatient Rehabilitation Facility: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:105-118. [PMID: 33316177 PMCID: PMC8164726 DOI: 10.1044/2020_ajslp-20-00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/17/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
Purpose Children with complex medical needs often require extensive hospitalizations in the first years of life. Many of these children also experience complex communication needs and use augmentative and alternative communication (AAC) strategies to interact with health care staff. Unfortunately, suboptimal communication experiences have been reported among these children, their families, and hospital staff; however, no studies have described the patterns of interactions beyond measures of self-report. The purpose of this study was to describe child-parent-provider interaction patterns that occurred in an inpatient unit. Method Observational techniques were used to systematically describe the interactions of a 28-month-old child with complex communication needs, her parents, and 26 health care providers on an inpatient rehabilitation unit over 10 days. Results Results indicated that substantial variability in the child's routine occurred across days and providers. Interactions were generally short and occurred for only a small proportion of the child's waking hours. The child and her mother actively communicated to varying degrees across sessions, yet health care providers often dominated interactions. The child used multiple modes of communication in each interaction; however, no aided AAC systems were used despite availability. Conclusions Training is urgently required to equip health care providers to (a) incorporate the use of aided AAC strategies during inpatient interactions and (b) increase the active participation of both children with complex communication needs and their parents during these interactions. Supplemental Material https://doi.org/10.23641/asha.13345187.
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Affiliation(s)
- Jessica Gormley
- Department of Speech-Language Pathology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Janice Light
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
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Gormley J, Fager SK. Personalization of Patient-Provider Communication Across the Lifespan. TOPICS IN LANGUAGE DISORDERS 2021; 41:249-268. [PMID: 34421170 PMCID: PMC8375497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
People with disabilities are more likely to be hospitalized and use healthcare services relative to people without disabilities. They also report experiencing negative experiences interacting with health care providers during these encounters placing them at risk for preventable adverse medical events, poor quality of life, and dependence on others. Fortunately, providers and people with communication disabilities can take steps to improve these interactions by personalizing and implementing communication supports to empower people with communication disabilities to actively participate in these interactions and improve outcomes. The purpose of this article is to describe strategies that health care providers can use to develop and implement personalized communication supports for children and adults with communication disorders during health care interactions. Additional strategies are provided to guide people with disabilities as well as their community/school providers and families to prepare for health care interactions. Case examples are provided to illustrate use of these strategies in acute care, inpatient rehabilitation, and outpatient settings. The use of emerging training tools (e.g., video visual scene displays) and AAC partner training formats (e.g., just-in-time training) are also presented as future directions to expedite learning and implementation of communication supports in fast-paced and time-limited health care interactions.
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Affiliation(s)
- Jessica Gormley
- Department of Speech-Language Pathology Department, Munroe-Meyer Institute, University of Nebraska Medical Center, 985450 Nebraska Medical Center Omaha, NE, 68198-5450
| | - Susan Koch Fager
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE
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Charles ML. Communication experiences of family caregivers of hospitalized adults with intellectual and developmental disabilities-A qualitative study. Nurs Open 2020; 7:1725-1734. [PMID: 33072356 PMCID: PMC7544848 DOI: 10.1002/nop2.557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To explore communication experiences between family caregivers of adults with intellectual and developmental disabilities (I/DD) and healthcare personnel during hospitalization. Design A qualitative descriptive study approach with interviews of family caregivers was used. Method Face-to-face, semi-structured interviews were conducted from June-September 2015 with ten family caregivers of adults with I/DD. Participants were recruited through an advocacy organization in the north-eastern United States. Data were analysed by content analysis. The Standards for Reporting Qualitative Research was the chosen checklist. Results The four overarching themes: "Need for Advocacy"; "Need for Better Communication"; "Sense of Abandonment"; and "Lack of Confidence" along with 12 subthemes were identified. Overall, participants reported miscommunications leading to instances of mistrust in hospital staff's competence to deliver quality patient care.
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Affiliation(s)
- Marie Lourdes Charles
- College of Health ProfessionsLienhard School of NursingPace UniversityNew YorkNew YorkUSA
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The Use of Communication Technology to Affect Patient Outcomes in the Intensive Care Unit. Comput Inform Nurs 2020; 38:183-189. [PMID: 32068538 DOI: 10.1097/cin.0000000000000597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Effective two-way patient-provider communication is challenging and is even more difficult when patients are communication vulnerable. The results of being unheard and unacknowledged can contribute to negative feelings and may manifest as symptoms of anxiety and depression. Researchers explored symptoms of anxiety and depression when using a team-developed, patient-centered, and nurse-led intervention called Speak for Myself-Voice (formerly published as Speak for Myself) in five intensive care units at a Magnet status, university-affiliated medical center in East Tennessee. This was an equivalent control group design. The data were analyzed with a mixed-effect analysis of variance (between and within groups) with repeated measures to see if the treatment group changed differently than the control group across time (48 hours). This study report adds information about anxiety and depression in patients who are communication vulnerable and using communication technology.
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Gormley J, Fager SK. Preference and visual cognitive processing demands of alphabetic and QWERTY keyboards of individuals with and without brain injury. Assist Technol 2020; 34:341-351. [PMID: 32955379 PMCID: PMC9122035 DOI: 10.1080/10400435.2020.1826006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Following a severe brain injury (BI), some literate individuals who require augmentative and alternative communication (AAC) strategies to support communication may benefit from the use of onscreen keyboards to generate text. A range of layouts are available to these individuals within specialized communication software. However, a paucity of information is available to describe user preferences, user perceptions, as well as the visual-cognitive processing demands of such layouts. Such information is critical to guide clinical decision-making for keyboard selection and to provide patient-centered services. This study: (a) described the preferences and perceptions of two onscreen keyboard layouts (QWERTY and alphabetic) and (b) used eye-tracking analysis to investigate the visual-cognitive processing demands between these onscreen keyboards for individuals with and without BI. Results indicated participants in both groups held a strong preference for QWERTY keyboard interfaces and had extensive prior experience using the QWERTY keyboard layout on mobile devices. Eye-tracking analysis revealed less visual-cognitive processing demands using a QWERTY keyboard layout for both groups but were only statistically significant for those without BI. Results suggest that use of a keyboard layout that aligns with client preferences and prior experiences (i.e., the QWERTY keyboard for these participants) may lead to increased satisfaction with the communication experience and increased communication efficiency.
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Affiliation(s)
- Jessica Gormley
- Department of Speech-Language Pathology Department, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Susan Koch Fager
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospital, Lincoln, Nebraska, USA
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Kroll A, Karakiewicz B. Do caregivers' personality and emotional intelligence modify their perception of relationship and communication with people with aphasia? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:661-677. [PMID: 32558042 DOI: 10.1111/1460-6984.12551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is a wide agreement that family and friends of people with aphasia (PWA) can play a crucial role in the rehabilitation of interpersonal communication. Therefore, speech and language therapists (SLTs) should include family and friends in the process of therapy. However, little has been said about the role of caregivers of severely disabled PWA in the rehabilitation of communication functions. AIMS To examine how caregivers of severely disabled PWA perceive their relationship and communication with PWA, how they facilitate communication with PWA, and whether the caregiver's personality and emotional intelligence modify the abovementioned processes. METHODS & PROCEDURES The study involved 123 caregivers of severely disabled stroke survivors with aphasia. Participants took part in a structured interview based on a structured interview guide created for the purpose of this study. The standardized psychological questionnaires NEO Five-Factor Inventory (NEO-FFI) and Schutte Emotional Intelligence Scale (SEIS) were used. OUTCOMES & RESULTS The caregiver's positive attitude towards the PWA correlated with the active facilitation of communication. The personality traits of caregivers and their level of emotional intelligence were associated with the tendency to use certain techniques to facilitate communication with PWA. CONCLUSIONS & IMPLICATIONS Caregivers' positive attitude towards PWA is beneficial for the rehabilitation of communicative functions. Personality traits and emotional intelligence could modify the caregiver's strategy of coping with aphasia-related challenges and should be taken into consideration when providing support. What this paper adds What is already known on the subject Interpersonal communication must by definition involve at least two people. Therefore, there are a lot of approaches in SLT where support is given not only to the PWA but also to the communication partners. The most important group is significant others, which is usually understood as family members and friends. There is an increasing recognition that SLTs should include them in therapy. What this paper adds to existing knowledge For those PWA who need constant care, caregivers may have a significant influence on the quality of communication. Their positive attitude towards PWA corresponds with more active facilitation of communication and can make rehabilitation more efficacious. Caregivers should be educated on the cognitive and behavioural aspects of aphasia and encouraged to look actively for a PWA's positive characteristics. Caregivers' personality traits play a role in facilitating communication. For example, caregivers with high agreeableness are more likely to enjoy providing care, while those with higher conscientiousness declare using more techniques to facilitate communication with the PWA. What are the potential or actual clinical implications of this work? Caregivers' personality traits play a role in caring. Their positive attitude towards PWA corresponds to more active facilitation of communication, which can lead to more effective rehabilitation. This should be taken into account when training caregivers. Training programmes should include cognitive and behavioural aspects of aphasia as well as emphasize the need to maximize the PWA's abilities.
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Affiliation(s)
- Aleksandra Kroll
- Department and Clinic of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Beata Karakiewicz
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
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Colbert A, Kronk R. Equity Access: Online Nursing Education on Care for People With Disabilities. J Nurs Educ 2020; 59:349-351. [DOI: 10.3928/01484834-20200520-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
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Segerlantz M, Axmon A, Ahlström G. End-of-life care among older cancer patients with intellectual disability in comparison with the general population: a national register study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:317-330. [PMID: 32067284 DOI: 10.1111/jir.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/13/2019] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Increasing life expectancy for people with an intellectual disability (ID) is resulting in more persons with cancer and a greater need for end-of-life (EoL) care. There is a need for knowledge of health care utilisation over the last year of life to plan for resources that support a high quality of care for cancer patients with ID. Therefore, the aims of the study were to compare (1) health care utilisation during the last year of life among cancer patients with ID and cancer patients without ID and (2) the place of death in these two groups. METHODS The populations were defined using national data from the period 2002-2015, one with ID (n = 15 319) and one matched 5:1 from the general population (n = 72 511). Cancer was identified in the Cause of Death Register, resulting in two study cohorts with 775 cancer patients with ID (ID cohort) and 2968 cancer patients from the general population (gPop cohort). RESULTS Cancer patients with ID were less likely than those without ID to have at least one visit in specialist inpatient (relative risk 0.90, 95% confidence interval 0.87-0.93) and outpatient (0.88, 0.85-0.91) health care, during their last year of life. Those with ID were more likely to have no or fewer return visits than the patients in the gPop cohort (5 vs. 11, P < 0.001), also when stratifying on sex and median age at death. Most cancer patients with ID died in group homes or in their own homes and fewer in hospital (31%) as compared with cancer patients in the gPop cohort (55%, 0.57, 0.51-0.64). CONCLUSIONS Older cancer patients with ID were less likely to be assessed or treated by a specialist. This may suggest that people with ID have unaddressed or untreated distressing symptoms, which strongly contributes to a decreased quality of EoL care and a poor quality of life. There is a need to acquire further knowledge of the EoL care and to focus on adapting and evaluating quality indicators for older cancer patients with ID.
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Affiliation(s)
- M Segerlantz
- Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Region Skåne, Lund, Sweden
| | - A Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - G Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Fager SK, Burnfield JM, Pfeifer CM, Sorenson T. Perceived importance of AAC messages to support communication in rehabilitation settings. Disabil Rehabil Assist Technol 2020; 16:796-801. [PMID: 32141784 DOI: 10.1080/17483107.2020.1736652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Permanent or temporary speech loss can occur due to a variety of medical conditions and often requires individuals to use augmentative and alternative communication (AAC) strategies and technologies to support communication. The use of AAC in medical and rehabilitation settings is critical to ensure the health, safety and psychological well-being of communicatively vulnerable individuals. METHOD This study surveyed the perceived importance of communication messages within five categories (Basic Needs, Patient-Provider Specific Communication, Social, Feelings, and Messages for Young Children) by individuals with disability who have undergone recent medical care as well as by rehabilitation care providers. RESULTS Results indicated that, with only a few exceptions, participants with disability more frequently selected all of the messages listed under the Patient-Provider Specific, Social, and Feelings categories compared to rehabilitation care providers' responses. Additionally, the individuals with disabilities selected messages that were more personalised to their specific care needs under Basic Needs. Both participant groups were asked to also suggest other messages that they perceived as important under each category. The other suggested messages demonstrated the potential need to provide personalisation to AAC displays to best meet the communication needs of individuals with disability.Implications for RehabilitationThere is a critical need for individuals who find themselves in medical settings (ICU, acute care hospital, rehabilitation hospital, etc.) to be able to communicate. This study provides preliminary information on the breadth of communication content that is perceived as relevant by individuals with disability and rehabilitation care providers. The need to provide personalized as well as a wide range of communication content options was of particular importance to individuals with disability. This information may provide specific guidance on how to best develop augmentative and alternative communication options for individuals in medical settings.
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Affiliation(s)
- Susan Koch Fager
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Chase M Pfeifer
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Tabatha Sorenson
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Cheraghi-Sohi S, Panagioti M, Daker-White G, Giles S, Riste L, Kirk S, Ong BN, Poppleton A, Campbell S, Sanders C. Patient safety in marginalised groups: a narrative scoping review. Int J Equity Health 2020; 19:26. [PMID: 32050976 PMCID: PMC7014732 DOI: 10.1186/s12939-019-1103-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/27/2019] [Indexed: 12/05/2022] Open
Abstract
Background Marginalised groups (‘populations outside of mainstream society’) experience severe health inequities, as well as increased risk of experiencing patient safety incidents. To date however no review exists to identify, map and analyse the literature in this area in order to understand 1) which marginalised groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for such groups and 3) what contributes to or is associated with these safety issues arising. Methods Scoping review. Systematic searches were performed across six electronic databases in September 2019. The time frame for searches of the respective databases was from the year 2000 until present day. Results The searches yielded 3346 articles, and 67 articles were included. Patient safety issues were identified for fourteen different marginalised patient groups across all studies, with 69% (n = 46) of the studies focused on four patient groups: ethnic minority groups, frail elderly populations, care home residents and low socio-economic status. Twelve separate patient safety issues were classified. Just over half of the studies focused on three issues represented in the patient safety literature, and in order of frequency were: medication safety, adverse outcomes and near misses. In total, 157 individual contributing or associated factors were identified and mapped to one of seven different factor types from the Framework of Contributory Factors Influencing Clinical Practice within the London Protocol. Patient safety issues were mostly multifactorial in origin including patient factors, health provider factors and health care system factors. Conclusions This review highlights that marginalised patient groups are vulnerable to experiencing a variety patient safety issues and points to a number of gaps. The findings indicate the need for further research to understand the intersectional nature of marginalisation and the multi-dimensional nature of patient safety issues, for groups that have been under-researched, including those with mental health problems, communication and cognitive impairments. Such understanding provides a basis for working collaboratively to co-design training, services and/or interventions designed to remove or at the very least minimise these increased risks. Trial registration Not applicable for a scoping review.
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Affiliation(s)
- Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England. .,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Gavin Daker-White
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Lisa Riste
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Sue Kirk
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Bie Nio Ong
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Keele University, Citylabs, Nelson St, Manchester, M13 9NQ, England
| | - Aaron Poppleton
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.,NIHR School for Primary Care Research, Citylabs, Nelson St, Manchester, M13 9NQ, England.,Health Innvoation Manchester, Citylabs, Nelson St, Manchester, M13 9NQ, England
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O'Halloran R, Douglas J, Cruice M, Davidson B, McKinley K, Bigby C. Representation and reporting of communicatively vulnerable patients in patient experience research. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:524-535. [PMID: 30810412 DOI: 10.1080/17549507.2019.1567815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/03/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
Purpose: To apply a human rights lens to measuring patient experience. Specifically, to determine if the perspectives of communicatively vulnerable people have been included in the patient experience research used to inform the development of the Australian Hospital Patient Experience Question Set (AHPEQS). Method: Thirty-nine qualitative studies on patient experience that informed the development of AHPEQS were critically appraised in terms of reporting on: population of interest, eligibility criteria, communicative demands of the research and communicative supports provided. Result: Eleven of 39 studies included sufficient information about the population to determine that communicatively vulnerable people would have been approached to participate. Three of these studies explicitly excluded people who were communicatively vulnerable, and four did not report on the provision of any communication supports to enable communicatively vulnerable people to participate. Conclusion: Intentional exclusion and/or a lack of communication supports restrict the rights of people who are communicatively vulnerable to express their opinions about what matters to them in hospital. Inadequate reporting of qualitative research on patient experience also makes it difficult to determine if the perspectives of people who are communicatively vulnerable have informed the development of the AHPEQS.
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Affiliation(s)
- Robyn O'Halloran
- Living with Disability Research Centre, La Trobe University Bundoora , Victoria , Australia
- Speech Pathology Department, St Vincent's Hospital Melbourne , Victoria , Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, La Trobe University Bundoora , Victoria , Australia
| | - Madeline Cruice
- Division of Language & Communication Science, School of Health Sciences City, University of London , London , UK , and
| | - Bronwyn Davidson
- Department of Speech Pathology, University of Melbourne Melbourne , Victoria , Australia
| | - Kathryn McKinley
- Speech Pathology Department, St Vincent's Hospital Melbourne , Victoria , Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University Bundoora , Victoria , Australia
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Santiago R, Howard M, Dombrowski ND, Watters K, Volk MS, Nuss R, Costello JM, Rahbar R. Preoperative augmentative and alternative communication enhancement in pediatric tracheostomy. Laryngoscope 2019; 130:1817-1822. [DOI: 10.1002/lary.28288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rachel Santiago
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Augmentative Communication ProgramBoston Children's Hospital Boston Massachusetts
| | - Michelle Howard
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Augmentative Communication ProgramBoston Children's Hospital Boston Massachusetts
| | - Natasha D. Dombrowski
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
| | - Karen Watters
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Mark S. Volk
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Roger Nuss
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - John M. Costello
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Augmentative Communication ProgramBoston Children's Hospital Boston Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication EnhancementBoston Children's Hospital Boston Massachusetts
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
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Gormley J, Light J. Providing Services to Individuals With Complex Communication Needs in the Inpatient Rehabilitation Setting: The Experiences and Perspectives of Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:456-468. [PMID: 31136227 DOI: 10.1044/2018_ajslp-18-0076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose To guide the development of future trainings in the inpatient rehabilitation setting, this study aimed to expand the current understanding of (a) the experiences of speech-language pathologists (SLPs) who work in inpatient rehabilitation settings when providing augmentative and alternative communication (AAC) services to individuals with complex communication needs and (b) the challenges and facilitating factors related to AAC services within this context. Method An online focus group was used to explore experiences of 11 SLPs who work within the inpatient rehabilitation setting. Information was gathered about (a) the role of the inpatient SLP in AAC service delivery, (b) rehabilitation team service delivery, (c) successes and challenges to supporting individuals with complex communication needs within this setting, and (d) communication training opportunities. Results Themes that emerged related to (a) the complicated logistics of rehabilitation; (b) the centrality of the rehabilitation team; (c) the limited AAC tools, knowledge, and trainings for rehabilitation providers; and (d) SLPs' attitudes. Participants reported navigating complicated logistics unique to the inpatient rehabilitation related to time constraints, limited AAC funding, the continuum of rehabilitation care, and limited AAC policies in attempting to meet patient needs. Generally, participants suggested successful team collaboration, yet limited time, expertise, tools, and training opportunities challenged attempts to support individuals with complex communication needs. Conclusions Increased access to AAC tools and the development of AAC trainings are recommended to equip rehabilitation professionals with skills to build interprofessional and AAC skills so patients with complex communication needs can maximally participate in the rehabilitation experience. Supplemental Material https://doi.org/10.23641/asha.7728710.
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Affiliation(s)
- Jessica Gormley
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Janice Light
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
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Straus J, Coburn S, Maskell S, Pappagianopoulos J, Cantrell K. Medical Encounters for Youth With Autism Spectrum Disorder: A Comprehensive Review of Environmental Considerations and Interventions. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519842816. [PMID: 31065222 PMCID: PMC6488780 DOI: 10.1177/1179556519842816] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
Approximately 1 in 59 youth are currently diagnosed with autism spectrum disorder
(ASD), a neurodevelopmental disorder. In comparison to typically developing
peers, youth with ASD encounter hospitalization at higher rates due to their
heightened health care needs. While visiting the hospital is a stressor for
youth with neurotypical needs, the experience contains unique challenges for
those with ASD. This systematic literature review highlights research that
considers the psychosocial impact of the hospital environment on the coping and
adjustment of youth with ASD. Specifically, the review focuses on
recommendations and interventions that may be used by health care professionals
while supporting this population as they encounter the health care system.
Ninety-six articles were identified as meeting inclusion and exclusion criteria.
The findings suggest that practicing clinicians should implement a wide variety
of interventions for youth with ASD including diversion techniques, comfort
positions, and picture schedules. Although there are published evidence-based
interventions for supporting youth with ASD in the hospital, most clinicians
lack ASD-specific training. This article concludes with recommendations for
future research.
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Affiliation(s)
- Jolie Straus
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Sarah Coburn
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Stephanie Maskell
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | | | - Kathryn Cantrell
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
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Dahm MR, Georgiou A, Balandin S, Hill S, Hemsley B. Health Information Infrastructure for People with Intellectual and Developmental Disabilities (I/DD) Living in Supported Accommodation: Communication, Co-Ordination and Integration of Health Information. HEALTH COMMUNICATION 2019; 34:91-99. [PMID: 29068261 DOI: 10.1080/10410236.2017.1384431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors' interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27; grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. 'Work-as-imagined' as outlined in policies, does not align with 'work-as-done' in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.
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Affiliation(s)
- Maria R Dahm
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation , Macquarie University
| | - Andrew Georgiou
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation , Macquarie University
| | - Susan Balandin
- b School of Health and Social Development , Faculty of Health, Deakin University
| | - Sophie Hill
- c Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University
| | - Bronwyn Hemsley
- d School of Humanities and Social Science, Faculty of Education and Arts , The University of Newcastle
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An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders. Rehabil Nurs 2018; 43:E25-E34. [DOI: 10.1097/rnj.0000000000000041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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