ACQ Vol 12 No 3 2010

References Costello, J. (2000). AAC intervention in the intensive care unit: The Children’s Hospital Boston model. Augmentative and Alternative Communication , 16 , 137–153. Garrett, K., Happ, M., Costello, J., & Fried-Oken, M. (2007). AAC in the intensive care unit. In D. Beukelman, K. Garrett & K. Yorkston (Eds.), Augmentative communication strategies for adults with acute or chronic medical conditions (pp. 17–57). Baltimore: Paul H Brookes Publishing. Happ, M. (2000). Interpretisation of nonvocal behaviour and the meaning of voicelessness in critical care. Social Science & Medicine , 50 , 1247–1255. Kagan, A. (1995). Revealing the competence of aphasic adults through conversation: A challenge to health professionals. Topics in Stroke Rehabilitation , 2 (1), 15–28. Legg, C., Young, L., & Bryer, A. (2005). Training sixth-year medical students in obtaining case-history information from Environmental factors that influence communication between people with communication disability and their healthcare providers in hospital: A review of the literature within the International Classification of Functioning, Disability and Health (ICF) framework. International Journal of Language and Communication Disorders , 43 (6), 601–632. O’Halloran, R., Worrall, L., Toffolo, D., Code, C., & Hickson, L. (2004). Inpatient functional communication interview . Oxon: Speechmark. Parr, S., Wimborne, N., Hewitt, A., & Pound, C. (2008). The communication access toolkit . London: Connect Press. Roter, D., & Hall, J. (2006). Doctors talking with patients/ Patients talking with doctors: Improving communication in medical visits (2nd ed.). Westport, CT: Praeger. Wong, D. (2001). Wong’s essentials of pediatric nursing (6th ed.). St Louis, MI: Mosby. Kathryn McKinley graduated from La Trobe University in 1999 and worked at Austin Health while completing the training project. Kathryn has received two scholarships, allowing her to visit Connect and the Aphasia Institute in 2005 and Connect again in 2008. Kathryn also received Royal Talbot Rehabilitation Centre’s Health Professionals Scholarship in 2008 which funded the Communication Access Training project. Kathryn is now the Speech Pathology Manager at St Vincent’s Hospital in Melbourne. Shauna Poole graduated from La Trobe University in 1992 and has worked in aged-care rehabilitation at Austin Health since 1998. Shauna has a special interest in making the hospital environment communicatively accessible for all patients. Melanie White graduated from La Trobe University in 1995. She has worked at Austin Health for the past 10 years, specialising in the areas of spinal injury, intensive care and tracheostomy management. Melanie co-authored an article in 2003 on the removal of the tracheostomy tube in the aspirating spinal cord injured patient. She has been the recipient of the RACV Sir Edmund Herring Memorial Study Grant, which she used to visit centres of excellence in spinal injury centres in Denver and Atlanta, USA. adults with aphasia. Aphasiology , 19 (6), 559–575. O’Halloran, R., Hickson, L., & Worrall, L. (2008).

and issues of infection control. Laminated 2mm perspex was found to be firm enough to write on and light enough for a weak or deconditioned patient to pick up and rest on their torso or lap as needed. It can be thoroughly cleaned between patients as per Austin Health infection control policies. In collaboration with Scope (a disability service provider) three modalities were chosen: 1) picture images (Board-maker) with words beneath, 2) the alphabet for letter spelling, and 3) blank space for writing. These alternative options ensured that the device would be suitable for patients with various levels of alertness and literacy. The Wong-Baker FACES Pain Rating Scale (Wong, 2001) and body diagrams were also included to assist patients to communicate the severity and location of pain, as per recommendations from the Austin Health pain team. A marker was attached to the board for the patient to use if appropriate, or for the family to write translations of the pictures into other languages if the patient was not literate in English. The board hangs over the bed rail so that the patient can access it independently and initiate communication as desired.

Family member helping the patient to recall events leading up to his medical admission – an unexpected use of the ICU communicator Results The board was trialled in a small group of patients and feedback was sought from nursing staff in ICU before final amendments were made. Feedback included some changes to picture images (deletion of “I want the doctor” and inclusion of “ I feel sick”, for example) and addition of cleaning instructions. A limitation of the study was that feedback could not be gained from patients due to their poor recollection of their ICU stay. The ICU communication board is now part of the standard equipment in every ICU bay. It has also been purchased by a number of other facilities. Conclusion The importance of effective communication between healthcare providers and the public they serve is well known (O’Halloran, Hickson and Worrall, 2008). Hospital settings can be perceived by patients and their families as intimidating and confusing places. Experience of hospital can be one of anxiety and stress, compounded by being unable to communicate effectively. This article describes three projects conducted independently by speech pathologists working within a hospital. In each project communication access was improved by addressing environmental factors and thus reducing barriers to communication.

Correspondence to: Kathryn McKinley Speech Pathology Manager St Vincent’s Hospital 41 Victoria Parade Fitzroy VIC 3065 phone: +613 9288 3846 email: kathryn.mckinley@svhm.org.au

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ACQ Volume 12, Number 3 2010

www.speechpathologyaustralia.org.au