Communication disorders in palliative care: investigating the views, attitudes and beliefs of speech and language therapists.

AIM: Speech and language therapists (SLTs) provide intervention for communication and swallowing to patients with life-limiting conditions, such as dementia and head and neck cancer. The role of the SLT in palliative care is difficult to define. Much is known about the clinical aspects of this role; however, little is known about the core values, beliefs and expectations of SLTs working in this sector, particularly with regard to their role in supporting patients' communication. Through a series of semi-structured interviews and a follow-up focus group, this report aimed to form a picture of the experiences and views of SLTs about their communication role in palliative care. Results suggest that SLTs are forging a self-identity in a sector that is itself constantly evolving, which causes difficulties in defining their role. Participants report that other health professionals have a poor understanding of the SLT's role. SLTs may benefit from palliative care-specific guidelines and increased interprofessional awareness of their role in order to become better integrated into the palliative care sector.

Nurses' experiences of communicating with hospitalized, suddenly speechless patients.

We used a qualitative focus group design to explore the experiences and challenges of nurses who work with hospitalized patients experiencing the sudden inability to verbalize their needs, also known as sudden speechlessness. In response to open-ended questions in facilitated focus groups, 18 nurses discussed issues around the care and communication needs of suddenly speechless (SS) patients. Nurses identified multiple, commonly occurring communication challenges when caring for SS patients. They believed these challenges led to poorer recognition of patient needs, with the potential for compromised patient care. Nurses described how the lack of reliable strategies to facilitate communication sometimes resulted in negative patient outcomes, including unmet psychosocial needs and the potential that informed consent and educational issues were being inadequately addressed for the SS patients. Even experienced nurses indicated ongoing problems in communicating with SS patients, despite using a multitude of strategies, leaving many to deal with issues of frustration and role conflict.

Associations between caregiving, social support, and well-being among parents of children with childhood apraxia of speech.

This study tested a path model that examined the impact of contextual caregiving variables (i.e., severity of child's symptoms, caregiving demands, and perceived caregiving) and different forms of received romantic partner social support (i.e., emotional, esteem, network, tangible, and information) on depressive and somatic symptoms among parents with a child diagnosed with childhood apraxia of speech (CAS), a severe childhood speech disorder. In total, 169 parents of a child with CAS participated in this study. Results provide some support for one stress process model of caregiving, which further highlights the need to look at relational variables as mediators between contextual stressors and health outcomes in caregiving contexts.

Speech pathology services to children with cancer and nonmalignant hematological disorders.

Children with cancer and nonmalignant hematological disorders may require speech pathology (SP) support; however, limited evidence is available describing prevalence and severity of swallowing/feeding and communication impairments in this population. A retrospective chart review of 70 children referred to SP at the newly formed Queensland Children's Cancer Centre was conducted to describe the prevalence and severity of swallowing/feeding and communication dysfunction, and the association between impairment, oncology and hematology diagnosis, and service utilization (time and occasions of service). Swallowing/feeding disorders were the most commonly observed impairments at initial assessment (58.6%). Children with central nervous system tumors (P = .03) and nonmalignant hematological disorder (P = .03) had significantly higher rates of feeding impairment than other oncology and hematology diagnostic groups. Children with central nervous system tumors had the highest rates of oral phase (P = .01) and pharyngeal phase (P = .01) dysphagia (swallowing disorder). No significant difference was found between diagnostic groups for intensity of SP service delivery. Prospective research is required to examine prevalence and severity of disorders, and service utilization in a more established clinic, and to investigate interactions between cancer treatment and swallowing/feeding and communication dysfunction.

Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital.

BACKGROUND: Effective nurse-patient communication is an essential aspect of health care. Time to communicate, however, is limited and subject to workload demands. Little is known about how nurses manage this 'lack of time' when caring for patients with developmental disability and complex communication needs, who typically communicate at a slow rate. AIM: The aim of this study was to investigate nurses' expressed concepts of 'time' in stories about communicating with patients with developmental disability and complex communication needs in hospital. METHOD: In 2009, 15 hospital nurses from a range of wards in two metropolitan hospitals participated in interviews about barriers to and strategies for successful communication with patients with developmental disability and complex communication needs in hospital. The data were analysed using narrative inquiry methodology and the stories verified with the participants. RESULTS: Nurses identified 'time' as a barrier and a facilitator to successful communication. Time as a barrier was related thematically to avoiding direct communication and preferring that family or paid carers communicated on behalf of the patient. Time as a facilitator was related to valuing communication, investing extra time, and to applying a range of adaptive communication strategies to establish successful communication. CONCLUSIONS: Time is perceived by nurses as both an enemy and friend for improving communication. Nurses who perceive that communication takes too long may avoid communication and miss opportunities to improve communication through increased familiarity with the person's communication methods. Those who take time to communicate narrate applying a range of strategies to achieve success in basic needs communication.

Use of a speech-generating device for hospitalized postoperative patients with head and neck cancer experiencing speechlessness.

PURPOSE/OBJECTIVES: To test the feasibility of using a programmable speech-generating device (PSGD) in hospitalized adults with head and neck cancer experiencing speechlessness. DESIGN: Time-series design. SETTING: Tertiary care institution, inpatient setting. SAMPLE: 9 female and 12 male postoperative patients (mean age = 62 years) experiencing speechlessness as a result of a surgical intervention to treat head and neck cancer. METHODS: Patients participated in a communication intervention that incorporated use of a PSGD during their hospital stay. Data about PSGD use and functionality- and technology-related issues were collected. Satisfaction and usability of the PSGD were rated with the Satisfaction and Usability Instrument. MAIN RESEARCH VARIABLES: Use of, satisfaction with, and usability of the PSGD. FINDINGS: Participants demonstrated significant improvement in ability to use the PSGD over a four-day period for all communication functions assessed. Results indicated that participants were "quite satisfied" with using the device and considered the technology to be "quite important" during the postoperative period. PSGD messages generated by participants via the hospital call system were understood by clerks. However, participants admitted to intensive care units experienced issues associated with accessibility of the device. CONCLUSIONS: Participants demonstrated proficient and independent use of the PSGD to communicate programmed messages; however, other strategies were necessary to meet their communication needs as the postoperative period progressed. Additional research on technologic communication options and strategies to tailor technology to meet the needs of speechless patients is warranted. IMPLICATIONS FOR NURSING: PSGDs may offer a more reliable option to facilitate communication between patients and nurses during the postoperative period. Technology should be tailored to meet speechless patients' unique needs as they progress through the rehabilitation process.

Dificuldades de comunicação verbal do cliente laringectomizado / Dificultades de comunicación verbal del cliente sometido a la retirada quirúrgica de la laringe / Verbal communication difficulties in client with laryngectomy

Estudo descritivo e qualitativo foi realizado com 10 adultos laringectomizados, em hospital filantrópico, em Fortaleza-CE. Teve como objetivos analisar a importância da comunicação verbal para o cliente estomizado, avaliar se ele foi informado sobre a alteração da fala e descrever seus sentimentos diante da dificuldade de comunicação verbal. A coleta de dados foi realizada no período de abril a maio de 2008, com o emprego da entrevista semi-estruturada e a observação livre. Os resultados evidenciaram que a comunicação verbal é um instrumento indispensável, e, sem ela, é impossível ter uma vida de qualidade. Os clientes foram esclarecidos sobre o prejuízo na comunicação verbal, embora tenha havido relatos de falta de orientação. Ante a dificuldade de comunicação, os sentimentos foram: tristeza, ansiedade e medo de nunca mais falar.  A maioria dos clientes foi orientada sobre a dificuldade de comunicação, mas nenhum citou a participação do enfermeiro.

This descriptive and qualitative study involved ten patients who underwent laryngectomy at a philanthropic hospital in Fortaleza, Ceará, Brazil. It aimed both at analyzing the importance of verbal communication for windpipe users, evaluating if those clients were informed about their speech impediment, and at describing the feelings aroused in view of verbal communication difficulties. Data were collected in April and May 2008, using semi-structured interview and observation. Results evidenced that verbal communication is an essential instrument, and that the lack of it definitely compromises life quality. Clients were informed about the loss of verbal communication, despite reports to the contrary. Sadness, anxiety, and fear of never speaking again stood out as the feelings aroused by their communication hindrance. The majority of clients received orientation on the communication difficulty, but none of them mentioned the nurse’s participation.

Estudio descriptivo y cualitativo fue realizado con diez pacientes sometidos a la retirada quirúrgica de la laringe en un hospital filantrópico de Fortaleza-CE-Brasil. Tuvo como objetivos analizar la importancia de la comunicación verbal para el cliente estomizado, evaluar si fueron informados sobre la alteración de la habla y describir los sentimientos surgidos ante la dificultad de comunicación verbal. La recolección de datos fue realizada en el período de abril a mayo de 2008, mediante entrevista semiestructurada y observación libre. Los resultados evidenciaron que la comunicación verbal es un instrumento indispensable y que, sin ella, es imposible tener una vida de calidad. Los clientes fueron informados sobre el perjuicio en la comunicación verbal, aunque fueron encontrados relatos de falta de orientación. Ante la dificultad de comunicación, los sentimientos fueron: tristeza, ansiedad y miedo de nunca más hablar.  La mayoría de los clientes fue orientada sobre la dificultad de comunicación, pero ninguno citó la participación del enfermero.

Evaluation of comfort in bedridden older adults using an air-cell mattress with an automated turning function: measurement of parasympathetic activity during night sleep.

This study objectively evaluated the degree of comfort in bedridden older adults using an air-cell mattress with an automated turning mechanism. The sample included 10 bedridden women with verbal communication difficulties. The high frequency (HF) components of heart rate variability, which reflect parasympathetic nervous activity, were compared for the manual and automated turning periods. No significant differences in the HF component were observed in 5 of the participants. Significant increases in the HF component associated with automated turning were observed in 3 participants; however, the two participants with the lowest body mass index values exhibited a significant reduction in the HF component during the automated turning period. The results revealed that comfort might not be disturbed during the automated turning period.

Early intervention for speech impairment in children with cleft palate.

OBJECTIVE: This study explored the effectiveness of a parent-implemented, focused stimulation program on the speech characteristics of children younger than 3 years with cleft lip and palate. The research questions included the following: (1) Can parents be trained to deliver an early intervention (EI) program for children with cleft palate? (2) Does a parent-implemented EI program result in positive changes in speech characteristics? PARTICIPANTS: Ten mother-child pairs in which the child had cleft lip and palate (CLP) and 10 mother-child pairs in which the child did not have a cleft (NCLP). The children ranged in age from 14 to 36 months of age and were matched between the CLP and the NCLP groups for vocabulary size, age, and socioeconomic status. MAIN OUTCOME MEASURES: Group differences (CLP and the NCLP) for preintervention and postintervention language and speech measures were compared. RESULTS: The results of this study showed that the mothers could be trained to deliver the intervention reliably. Furthermore, the results indicated that the intervention resulted in increased sound inventories, increased speech accuracy, and reduced use of glottal stops for the children with clefts. CONCLUSIONS: While the intervention resulted in speech gains for the children with clefts, speech measures did not exceed those made by the children without clefts. The results of the study have implications for service delivery models where the services of speech-language pathologists are limited.

A communication protocol to help patients with sensory impairment.

Patients with sight, hearing and speech impairment are entitled in law to equal access to health care according to the Disabilities Discrimination Act. More and more patients experience these problems as the population grows older. This paper reports on how a group of staff in one trust helped set up a protocol to ensure that this group's communication needs are tackled.

Augmentative and alternative communication: the role of community nurses in the rehabilitation of people with severe disabilities.

This article focuses on the importance of community nurses' involvement in the identification and early referral and intervention of children and adults who have very little or no speech. The use of Augmentative and Alternative Communication strategies with nonspeaking children and adults are described in terms of the different kinds of systems that can be used as well as the general principles involved in working with people with severe disabilities. In conclusion, it is emphasized that close collaboration between community nurses and rehabilitation specialists is vital in ensuring that a difference is made in the lives of people with severe disabilities in this country.

A program to assist sensory-impaired patients.

The recent enactment of the Americans with Disabilities Act challenges health care institutions to provide facilities and services to persons with a variety of disabilities. A hospital-wide Sensory Assistance Program was developed and implemented to identify and assist patients with visual, hearing, or speech impairments. Preliminary evaluation of the program indicates very positive patient and staff approval and acceptance and minimal cost outlays to the institution.

Managing communication disorders in stroke.

Dysphasias, dyspraxias, and dysarthrias are communication disorders that may be experienced following a stroke. Nursing assessment of language and speech is based on an understanding of normal language and speech systems. Location of the stroke and clinical assessment findings uncovered through the history and physical examination allow identification of language and speech deficits. Language is examined by assessing spontaneous speech, verbal comprehension, reading, writing, and ability to name and repeat. Speech is examined by testing motor function and reflexes of cranial nerves VII, IX, X, and XII. The identification of intact language and speech functions and language and speech deficits enables the nurse to plan and implement interventions based on the assessment findings in four areas--environmental manipulation, supportive behaviors, behaviors designed to enhance communication, and teaching of the person and family.