JCPSLP Vol 21 No 3 2019

Table 4. Primary admission diagnosis

Neurological n (%)

Cognitive n (%)

Functional decline n (%)

Medical n (%)

Orthopaedic n (%)

Unknown n (%)

Acute

5 (10.4)

5 (10.4)

3 (6.3)

34 (70.8)

1 (2.1)

0 (0)

GEM

1 (3.6)

3 (10.7)

8 (28.5)

8 (28.6)

7 (25)

1 (3.6)

Table 5. Patient self-reporting of communication ability compared with CDS rating

CDS rating

Self-reported: able n (%)

Self-reported: unable n (%)

Unable to self-report n (%)

Total n (%)

Acute

Able Unable Able Unable

16 (100) 15 (46.9)

0 (0) 12 (37.5) 3 (20) 5 (38.5)

0 (0) 5 (15.6)

16 (100) 32 (100) 15 (100) 13 (100)

GEM

12 (80)

0 (0) 3 (23)

5 (38.5)

the CDS. The severity of the communication impairment, premorbid or new onset status of the communication impairment and the patient’s ability to compensate all may have been contributing factors to this observation. Given the large numbers of people in hospital that require assistance with communication, providing assistance to all using a universal precautions approach could be considered. A universal precautions approach assumes any patient may have difficulty comprehending health information and accessing health services. It aims to support communication and confirm all patients’ understanding. The ultimate aim is to minimise the risk of miscommunication and make the health care system easier to navigate, supporting patients’ efforts to improve their health (AHRQ, n.d.). There are a variety of universal approaches to health literacy that address spoken and written communication practices. Frontline personnel, therapists, nursing, medical, allied health and hospital support services can all use these approaches at a system level to have a broader impact on patients’ health care experience. Teach-Back is an example of an effective health literacy tool that confirms a patient’s understanding of information (Jager & Wynia, 2012). Teach-Back consist of four stages, explaining, assessing, clarifying, and understanding. As health care workers we often stop at explaining. Formal communication skills training at university is varied and dependent upon the undergraduate course. Communication skills may not be followed up once health care workers are employed in the clinical environment. Clinicians often develop their communication skills on the job through modelling those of colleagues, mentors or supervisors. There are opportunities to consider formal communication skills training in the health care environment and to look at how this may align with university curriculums. SLPs have an important role to play with regards to the support required for people with diagnosed communication impairments. Patient advocacy, staff education and skill development in specific communication systems and techniques for individuals with complex needs are essential. Effective communication with all health care workers facilitates a patient’s understanding, experience and involvement in their health care. Effective communication is in the best interest of the patient and the health care organisation as a whole. Healthy communities and individuals are informed, educated and active in health care.

is not uncommon for patients to misunderstand health information or to be reluctant to ask questions to clarify information (Hadden, 2015). An individual’s understanding of their health information can impact on how, when and why they access the health system and their health outcomes. The data from this study showed that that a high number of patients in the acute medical inpatient and GEM unit required specific assistance to successfully participate in communication activity related to their health care. Almost half of GEM patients and two-thirds of acute medical patients required varied levels of support to be able to actively participate in their health care conversations. These figures are closely aligned with the ABS estimation that 59% of Australians are functionally health illiterate (ABS, 2015). Communication impairment due to cognitive change is an invisible impairment as the mechanics of speech and language remain intact but the ability to use speech and language in a functional way is affected (American Speech-Language-Hearing Association, n.d.). Cognitive communication disorders can be defined as difficulty with any aspect of communication that is affected by disruption of cognition. Problems in these areas can affect verbal and non-verbal communication in activities of daily living (American Speech-Language Hearing Association, 2018). Communication impairment due to a cognition issue was most prevalent with the greatest impact on independence with health communication. A crucial finding from this study was that as health professionals we cannot reliably predict an individual’s independence in communication from observation, presence of communication impairment, medical diagnosis, or an individual’s self-perception of their communication ability. This is the challenge we face in provision of health care. It is well documented that good health communication practices are critical to optimise every individual’s health literacy (Hadden, 2015). There are challenges in identifying who requires assistance and in reliably predicting an individual patient’s health literacy. Introducing a communication assessment for all in-patients may be inefficient and a poor use of resources to identify those patients who will need support and be challenged by health care information. The diagnosis of a communication impairment did not always predict an individual being rated as unable to independently communicate effectively in a health care setting. Anecdotal reporting noted that some individuals with identified communication impairment were scored as able to communicate their health care needs as per

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology