Ways to improve communication and support in healthcare centres according to people with aphasia and their relatives: a Dutch perspective

Background: There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. Objectives: This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. Methods: An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Results: Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. Conclusions: People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives

"Because we see them naked" - Nurses' experiences ini caring for hospitalized patients with dementia: considering artificial nutrition or hydratation (ANH)

ABSTRACT The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described as encompassing the various stages of the care process: the nurses’ initial meeting with the vulnerable patient; the intense decisionmaking process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses’ involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given.status: publishe

Mealtime care on a geriatric-psychiatric ward from the perspective of the caregivers: a qualitative case study design

This study aims to obtain insight into the care process surrounding mealtimes within a geriatric-psychiatric ward from the perspective of the caregivers. A qualitative study was carried out in accordance with the case study method. Data was generated by participant observation, semi-structured interviews, and focus groups. A mealtime turned out to be a much more complex event than it appears to be, looking at it superficially. The caregivers recognize the valuable therapeutic meaning of the mealtime. Nevertheless, they experience internal conflict when it comes to certain significant problem areas in their search for a balance between the functional-organizational approach and the patient-oriented approach

QUAGOL: A Guide for Qualitative Data Analysis

Background: Data analysis is a complex and contested part of the qualitative research process, which has received limited theoretical attention. Researchers are often in need of useful instructions or guidelines on how to analyze the mass of qualitative data, but face the lack of clear guidance for using particular analytic methods. Objectives: The aim of this paper is to propose and discuss the Qualitative Analysis Guide of Leuven (QUAGOL), a guide that was developed in order to be able to truly capture the rich insights of qualitative interview data. Method: The article describes six major problems researchers are often struggling with during the process of qualitative data analysis. Consequently, the QUAGOL is proposed as a guide to facilitate the process of analysis. Challenges emerged and lessons learned from own extensive experiences with qualitative data analysis within the Grounded Theory Approach, as well as from those of other researchers (as described in the literature), were discussed and recommendations were presented. Strengths and pitfalls of the proposed method were discussed in detail. Results: The Qualitative Analysis Guide of Leuven (QUAGOL) offers a comprehensive method to guide the process of qualitative data analysis. The process consists of two parts, each consisting of five stages. The method is systematic but not rigid. It is characterized by iterative processes of digging deeper, constantly moving between the various stages of the process. As such, it aims to stimulate the researcher’s intuition and creativity as optimal as possible. Conclusion: The QUAGOL guide is a theory and practice-based guide that supports and facilitates the process of analysis of qualitative interview data. Although the method can facilitate the process of analysis, it cannot guarantee automatic quality. The skills of the researcher and the quality of the research team remain the most crucial components of a successful process of analysis. Additionally, the importance of constantly moving between the various stages throughout the research process cannot be overstated.status: publishe

How do healthcare professionals experience communication with people with aphasia and what content should Communication Partner Training entail?

Purpose: Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. Materials and methods: The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. Results: Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). Conclusions: According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP. Implications for rehabilitation Communication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools. An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content. This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality. The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level

How do healthcare professionals experience communication with people with aphasia and what content should communication partner training entail?

Purpose: Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. Materials and methods: The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. Results: Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). Conclusions: According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP.Implications for rehabilitation Communication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools. An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content. This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality. The suggestions that HCP have concerning the content of communication partner trainings can be placed under “education” and “implementation and post-training support.” HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level

Ways to improve communication and support in healthcare centres according to people with aphasia and their relatives: a Dutch perspective

Background There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. Objectives This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. Methods An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Results Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. Conclusions People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives

Ways to improve communication and support in healthcare centres according to people with aphasia and their relatives: a Dutch perspective

Background: There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. Objectives: This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. Methods: An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Results: Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. Conclusions: People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives