Communicating with nurses: the experiences of 10 individuals with an acquired severe communication impairment

Successful communication is integral to quality health care and successful nursing practice. Ten people who had been in hospital in the 12 months prior to the study and who had no functional speech at that time were interviewed about their communication experiences with nurses. Overall, these individuals experienced difficulties, some of which appeared to be related to a lack of augmentative and alternative communication (AAC) resources and a lack of knowledge of AAC among nurses. In addition, the participants noted that nurses did not always have the time or the skills to communicate effectively with them. The participants suggested strategies to improve communication interactions between patients with no or limited functional speech and nurses. These strategies include pre-admission briefing and training nurses about effective strategies for communicating with patients who are unable to speak, including the use of augmentative and alternative communication systems.

Nursing the patient with severe communication impairment

Background. Effective communication with patients is critical to effective nursing practice. Surprisingly, there is little information on nurses' experiences in caring for patients who are unable to speak. Purpose and method. This study provides descriptive information from interviews with 20 nurses who cared for patients with severe communication impairment. The interview protocol explored positive and negative experiences of nursing patients with severe communication impairment. Frequency counts and descriptive analyses were conducted to identify the major themes emerging from the interviews. Results. The results suggest that nurse-patient communication is difficult when the patient has severe communication impairment, although some nurses discovered effective strategies to facilitate communication with such patients. Many of the difficulties could be viewed as a breakdown in understanding arising from the lack of a readily interpretable communication system that could be used by nurse and patient. Conclusions. The results suggest a need for training nurses in the use of alternative modes of communication. Nurses also need access to a variety of simple augmentative communication devices for use with patients who are unable to speak. Finally, nurses should collaborate with speech pathologists on the development of preadmission information and bedside training for people who are admitted to hospital with severe communication impairment.

Crews, wusses, and whoppas: core and fringe vocabularies of Australian meal-break conversations in the workplace

Conversational samples were collected from 34 nondisabled subjects across four worksites. The total sample was analyzed for core vocabulary, and the five most frequently referenced topics were analyzed for core and fringe vocabularies and the commonality of fringe vocabulary across topics. The results indicated that there was a small stable core vocabulary of 347 words containing words unique to this study, which accounted for 78% of the conversational sample. A total of 21 words in the fringe vocabulary was common to all topics. Implications of this study for vocabulary selection for augmented communicators in employment are discussed.

A few well-chosen words

Ten professionals (five speech pathologists, three rehabilitation counsellors, and two teachers) participated in a survey to investigate their ability to predict the topics and vocabulary of meal-break conversations at work. Participants selected two topics that they thought were likely to occur during meal-break conversations between nondisabled employees for each day of the week. They selected five key words appropriate to each chosen topic. The topics and key words were analyzed for frequency and commonality and compared to the topics and vocabulary from actual meal-break conversations in the workplace. The professionals accurately predicted some topics that occurred in the actual conversational sample. However, one-third of the key words (33%) predicted by the participants did not occur in the conversational sample. The implications of these findings for vocabulary selection for augmented communicators are discussed.

Topics of meal-break conversations

Meal-break conversational samples were collected from 34 nondisabled participants across four worksites. The samples were analyzed for topics referenced and also for patterns of topics associated with days of the week. The results of the analysis indicated that the participants referenced 73 different topics. Analysis of the 10 most frequently referenced topics in each composite day file revealed 19 topics, of which 5 (i.e., work, fact finding, judgments, food, and family life) were referenced every day. Analysis of the number of communication segments in each of the 19 topics indicated that fact finding was the most frequently referenced topic, but work was the largest topic (i.e., contained the greatest number of words). There was some pattern to topic reference associated with the day of the week. Implications of this information for individuals with severe communication impairments who wish to access the work force are discussed.

AAC and Australian speech pathologists: a report on a national survey

A total of 971 speech pathologists from across Australia participated in a survey that investigated their knowledge of augmentative and alternative communication (AAC), their AAC practices, the AAC resources available to them, and their preferred format for further education. The results indicated that 98% of respondents had at least some knowledge of AAC and only 13% never recommended AAC in their practice. However, 29% had recommended a device they had never seen and 36% indicated that they would not recommend AAC for a client who was presymbolic. Access to resources appeared to be related to the location of respondents in relation to a capital city. Overall, there appeared to be a lack of AAC expertise within the profession in Australia. A lack of interest in obtaining further information on AAC and an unwillingness to enroll in further education highlighted the need for collaboration among the professional organization, training institutions, and employment bodies in ensuring adequate levels of knowledge and skills among speech pathologists.

A metasynthesis of patient-provider communication in hospital for patients with severe communication disabilities: informing new translational research

Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.

Facilitated communication and authorship: a systematic review

Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages--the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity.

Alternative service delivery models for families with a new speech generating device: perspectives of parents and therapists

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

Interações comunicativas entre uma professora e um aluno com transtorno invasivo do desenvolvimento na escola regular

Inclusion of students with autism in regular education settings is a topic that has not been much explored by the national scientific literature. This matter is complex and, due to the extent of various aspects involved, it is essential to delimitate a focus of investigation. The direction taken by this study was to evaluate the effects of an intervention program in the communicative interactions between a student with autism and his teacher in a regular classroom. Data were collected in an elementary private school, located in the city of Natal, Rio Grande do Norte during the 2010 academic school year. The study included a teacher and a non-vocal, 10-year-old student diagnosed with autism. A quasi-experimental A-B research design was employed. During the intervention program the teacher was trained to use Naturalistic Teaching Strategies and Alternative and Augmentative Communication (AAC) resources to increase the frequency of interactions with the student during three classroom routines (entry time, snack and pedagogical activity). The results indicated qualitative and quantitative changes in the interactions of the dyad after the implementation of the intervention program. The student began to use pictograms to communicate with the teacher in two of the three routines investigated. The frequency of AAC use was also observed in the teacher‟s repertoire, especially when the student failed to understand gestures and words. The teacher positively evaluated the intervention program

Caracterização dos enunciados de um aluno não-falante usuário de recurso suplementar de comunicação durante a construção de histórias

A narrativa pode conectar elementos diversos e, assim, promover a construção de sentenças verticais e horizontais, frente à mediação de interlocutor. Esta pesquisa visou analisar a extensão e a organização sintática dos enunciados de narrativas construídas por um aluno não-falante usuário de recurso suplementar de comunicação. Previamente à construção das narrativas, selecionadas de acordo com os centros de interesse, idade, grau de escolaridade e temáticas trabalhadas na escola do aluno, símbolos gráficos do Picture Communication Symbols eram confeccionados e adaptados para que, por meio destes e dos recursos verbais e não-verbais inerentes à atividade discursiva, a história pudesse ser contada, por acesso visual e auditivo, pelo interlocutor e recontada pelo aluno, após a estruturação e organização dos múltiplos signos em sentenças. Todas as interações foram filmadas e complementadas com anotações de um diário de registro contínuo. Após a análise das transcrições das fitas e das anotações do diário, foi possível determinar três estágios de unidades significativas: 1) Caracterização ou natureza dos elementos constituintes dos enunciados das narrativas em: a) objeto; b) símbolo gráfico; c) escrita; d) vocalização; e) gesto representativo; 2) Extensão dos enunciados das narrativas de 1 a 6 elementos, linearmente, e 7 ou mais elementos; 3) Organização sintática dos elementos constituintes das narrativas em sujeito, verbo e objeto isolados, em sentenças verticais, e associados, em sentenças horizontais. Ressaltou-se, assim, a ampliação e aprimoramento da organização e da estrutura sintática dos enunciados das narrativas construídas pelo aluno mediado pelo interlocutor.

Identification of the Communicative Abilities of Brazilian Children With Cerebral Palsy in the Family Context

This article highlights the importance of the information obtained from the family in the implementation of the augmentative and alternative communication (AAC) system. The objective was to investigate the communicative abilities of children with severe communication deficit through their parents' reports within the family routine. Eleven parents of children affiliated with a rehabilitation program in a public university in Brazil participated in this research. Per their parents' reports, the children demonstrated a variety of communication skills related to comprehension, expressive skills, and vocabulary. Parents further reported their children's daily communication routines including social partners, communication environment, and the materials the children enjoyed the most. These results emphasize the importance of family involvement in planning AAC so that it is functional within the family context.

Introdução da comunicação suplementar e alternativa na terapia com afásicos

Sabe-se que o tratamento fonoaudiológico de pacientes com afasia severa é limitado. A ausência de fala articulada, algumas vezes, impede o diagnóstico da afasia. O paciente grave pode não falar devido à inabilidade de articulação, como ocorre na disartria e/ou apraxia. Essa ausência de fala não permite afirmar se a linguagem está comprometida. O uso da comunicação suplementar e alternativa tem sido um método eficaz na reabilitação desses pacientes. Esse estudo visou descrever o uso da comunicação suplementar e alternativa associada a outras modalidades de linguagem (escrita, gestos), a partir do relato de dois casos de afasia. A análise dos dados foi composta por dois blocos: a introdução da comunicação suplementar e alternativa no diálogo; e o uso da leitura e escrita associado aos símbolos. A comunicação suplementar e alternativa foi um apoio para a oralidade, leitura e escrita dos pacientes.