Communication between therapists and nurses working in inpatient interprofessional teams: Systematic review and meta-ethnography

Purpose: The aim of the synthesis was to develop new understanding about the influences on communication in interprofessional teams from therapist and nurse perspectives. Methods: Six electronic databases were searched, combined with citation tracking and hand searching, yielding 3994 papers. Three researchers were involved in screening and quality appraisal, resulting in 18 papers for synthesis, using the process of meta-ethnography. Concepts were identified, compared and translated under five category headings. Two researchers mapped interpretative summaries and a line of argument was created. Results: The line of argument is that four inter-related contingences underpin effective communication between therapists and nurses. Effective communication depends on there being a genuine need to give and receive information for patient care, the capacity to attend to, hold, and use information, and opportunities to share space to enable communication to occur. The fourth contingency is good quality relationships and this is the glue that holds the contingencies together. Conclusion: This synthesis has provided an opportunity to illuminate how therapists and nurses accomplish interprofessional work through communication. The contingencies of need, capacity, opportunity and quality of relationships create a new structure for understanding what underpins communication between these two groups .Peer reviewedFinal Accepted Versio

Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers

Abstract Purpose: It is important that professionals working with individuals with acquired neurogenic communication disorders consider their clients’ psychological wellbeing. Much is known about the significant emotional, social and psychological consequences of aphasia after stroke, however little is known about individuals’ psychological wellbeing. This paper reports the psychological wellbeing of community-dwelling older adults with chronic aphasia in the context of their unaffected peers. Method: Thirty participants affected by aphasia and 75 unaffected participants completed the 24-item measure How I Feel About Myself drawn originally from Ryff (1989) and the Geriatric Depression Scale (Sheikh & Yesavage, 1986). Results: Individuals with aphasia after stroke had statistically similar range and average psychological wellbeing as the unaffected population, with the exception of lower environmental mastery (independence) and lower mood. Furthermore, a substantial number of individuals (affected and unaffected) reported lower than average psychological wellbeing. Conclusions: Many persons with chronic aphasia need support to manage the demands and responsibilities of their everyday lives and raise their mood. Clinicians need to be aware of this possibility and formally assess all persons with aphasia, as well as explore the potential impact of physical limitations. Identifying low well-being in older adults is important for all professionals working with the ageing population. The implications for speech and language therapy and for multi-disciplinary research and cross-sector joint working (health, social and community services) are discussed

Researching Across Two Cultures: Shifting Positionality

Embodied and creative research methods provoke honesty, emotion, and vulnerability in participants, which add to the richness of the stories they tell and are willing to share. The positionality of the researcher is less of “interviewer” and more “co-producer” or participant in a dialogue. Visual and creative approaches invite participants to share in ways in which they are not able or willing through words alone. The data and outputs they produce, with film, art, or objects, can in turn affect those who see it more than written text and need to be analysed and disseminated along with more traditional transcripts, articles, and presentations. In the context of investigating sensitive issues such as those around embodied identity, these methods, which use embodied methods to explore embodied research questions, may feel the most appropriate. These approaches lie along the boundary of therapy and research, asking much of researchers who are unlikely to have received therapeutic training or ongoing support. Due to this deficit, the researched may find that their experience is not held or contained in a way that the content would demand. Similarly, the data themselves lie on the boundary of art and research, in that they can be seen as more than a tool to facilitate reflection, but as artifacts in their own right. What are the implications in this scenario? Where should we position ourselves and our work along these boundaries? Who holds the space for the researcher and the researched if both are made vulnerable

Strategies used in the pursuit of achievability during goal setting in rehabilitation

We used conversation analysis of six audio- and video-recorded goal setting meetings that were attended by patients and their respective treating team to explore and describe the interaction of participants during interdisciplinary goal setting, and to identify the strategies used to agree goals. The health care professionals involved in the six sessions included four physiotherapists, four occupational therapists, four nurses, one speech and language therapist, and one neuropsychologist. The participants included 3 patients with multiple sclerosis, 2 patients with spinal cord lesions, and 1 patient with stroke from an inpatient neurological rehabilitation unit. Detailed analysis revealed how the treating team shaped the meetings. The most notable finding was that there was rarely a straightforward translation of patient wishes into agreed-on written goals, with the treating team leading goal modification so that goals were achievable. Despite professional dominance, patients also influenced the course of the interaction, particularly when offering resistance to goals proposed by the treating team

Participants’ perspectives of feasibility of a novel group treatment for people with cognitive communication difficulties following acquired brain injury

Purpose: To determine whether treatment was acceptable to participants and perceived as beneficial by exploring the experiences of people with cognitive communication difficulties following acquired brain injury who participated in a novel, group, communication, project-based treatment. The purpose of the treatment was to improve participants’ communication skills and quality of life, by focusing group activity towards the production of a project and by incorporating individualised communication goals into group sessions. Methods: Twenty-one people with acquired brain injury recruited from community settings participated in project-based treatment, which comprised one individual and nine group sessions (of 2-3 people) over six weeks. Structured interviews were conducted post-treatment as part of a broader assessment battery. Interviews were transcribed verbatim and analysed using content analysis to identify codes, categories and themes. Results: Themes identified from the analysis centred around the treatment experience (general experience; group experience; project experience; working on goals) and benefit of treatment (communicative benefit; other benefits; emotional effects; meeting others; something to do). These themes were consistent with the treatment being perceived as acceptable and having initial efficacy for the participant group. Conclusion: The qualitative data presented here provide positive feasibility findings (acceptability and initial efficacy) of project-based treatment for people with acquired brain injury. The results highlight the value of incorporating participants’ views in assessing feasibility in developing novel interventions

The contribution and impact of the International Classification of Functioning, Disability and Health on quality of life in communication disorders

Past discussions of the International Classification of Functioning, Disability and Health (ICF) have focused minimally, if at all, on quality of life. This paper critically discusses the contribution of the ICF to quality of life concept development, and the impact that the ICF has had thus far on health-related quality of life measurement. “Contribution” focuses on modelling the relationship between disablement and quality of life, evaluating the content of existing instruments, and thinking holistically about the individual. “Impact” relates to the association of quality of life with functioning, pathology and outcomes, the trend towards life compartmentalization, and the disproportionate emphasis on individuals' functioning at the expense of their life context. Examples are drawn from adult acquired conditions (mainly aphasia), and terminology used in the paper reflects a rehabilitation stage of service provision. The World Health Organization's approach to quality of life definition and measurement is also discussed. An operational definition of quality of life for adults with acquired communication and swallowing disorders is presented, alongside an alternative conceptualization of quality of life. This paper ends with recommendations for future research concerning the importance of context, the subjective or personal perspective, and having a goals orientation for life as well as rehabilitation. It is also argued here that the ICF and quality of life are different constructs and that quality of life should be the starting point for understanding the client's perspective of his/her goals and/or his/her disability

Health-related quality of life in people with aphasia: Implications for fluency disorders quality of life research

Abstract It is increasingly important that clinicians address the health-related quality of life (HRQOL) of adults with communication disorders in clinical practice. The overall aim of this paper is to draw conclusion about the suitability of the Short Form 36 Health Survey for the communication disorders of aphasia and stuttering. This study reports on the impact of post-stroke aphasia on 30 Australian older adults’ HRQOL. It also comments on the capacity of the SF-36 to measure HRQOL in this population, specifically whether it is sensitive to the three known determinants of post-stroke HRQOL – emotional, physical and social functioning. Comparisons with other data are made to assist interpretation of the SF-36 subscale scores: with 75 older adults with no history of neurological conditions; and with data from the 1995 National Health Survey data. The main findings are: (1) adults with post-stroke aphasia have similar HRQOL to their peers on six subscales, but significantly lower Role emotional and Mental health HRQOL; (2) a substantial number of aphasic adults reported depressive mood; and (3) aphasic adults with depressive mood have significantly worse HRQOL on six subscales than aphasic adults without depressive mood, but similar Role emotional and Body pain HRQOL. In conclusion, stroke and aphasia have minimal impact on older adults’ HRQOL as measured by the SF-36, which conflicts with an established evidence base of the negative consequences of aphasia on life. Thus, the SF-36 is not advisable for use with aphasic adults. Implications of these findings for aphasia and stuttering are discussed. Educational objectives: The reader will be able to: (a) describe the impact of aphasia and depressive mood on quality of life; (b) compare the impact of aphasia on the quality of life of adults to adults who do not have aphasia; (c) describe the similarities and differences between quality of life of adults with aphasia and adults who stutter; and (d) describe the strengths and limitations of the SF-36 as a measure of quality of life in adults who stutter versus adults with aphasia

Facilitating the involvement of people with aphasia in stroke research by developing communicatively accessible research resources

People with aphasia can be marginalized by a communicatively inaccessible society. Compounding this problem, routinized exclusion from stroke research leads to bias in the evidence base and subsequent inequalities in service provision. Within the United Kingdom (UK), the National Institute of Health Research (NIHR) Stroke Research Network (SRN) identified this problem and funded a 6-month project in 2013-14 that resulted in the creation of practical and freely available resources to equip researchers to engage more people with aphasia in research. Critical elements enabled authentic co-construction of new knowledge regarding accessible research documentation including the process structure, timescale and crucially the fundamental engagement of people with aphasia. Stages in this process included mapping existing resources, engaging with researchers, and with people affected by aphasia, and developing a new set of resources comprising images, accessible text, and templates for research forms. These resulted in high quality outputs, as indicated by preliminary feedback from the research community and people with aphasia

Quality of life of the caregivers of people with aphasia. A systematic review.

Purpose: Systematic review to identify the factors associated to the quality of life (QOL) of the caregivers of people with aphasia (PWA). Methods: Studies were searched using Medline, Pubmed, Cochrane Library, CINAHL, PsycINFO and Web of Science databases. Peer-reviewed papers that studied the QOL of PWA’s caregivers or the consequences of aphasia in caregivers’ life were included. Findings were extracted from the studies that met the inclusion criteria. Results: No data is available reporting particularly the QOL of PWA caregivers’ or their QOL predictors. Nevertheless, it was possible to extract aspects related to QOL from the studies that report the consequences of aphasia, and life changes in PWA’s caregivers. Nine (9) studies including PWA’s caregivers were found, but only 5 reported data separately on them. Methodological heterogeneity impedes cross-study comparisons, although some considerations can be made. PWA’s caregivers reported life changes such as: loss of freedom; social isolation; new responsibilities; anxiety; emotional loneliness; need for support and respite. Conclusions: Changes in social relationships, in emotional status, increased burden and need for support and respite were experienced by PWA’s caregivers. Stroke QOL studies need to include PWA caregivers’ and report separately on them. Further research is needed in this area in order to determine their QOL predictors and identify what interventions and referrals better suit their needs