JCPSLP Vol 22 No 1 2020

Table 2. Literature review results (continued)

Year

Author

Source

Type

Region Key points

Evaluation rating

24:B

Quantitative study

America Investigates burnout in long-term care nursing staff. American aged-care system differs from Australia which may impact generalisation. Canada Critiques current approaches to psychosocial services in RACFs and proposes an alternative approach. QOL is a concern in RACF. Current methods to address this focus on entertainment and do not reduce loneliness. Fundamental changes to resident psychosocial care are needed. Australia Investigates organisational culture in RACFs. Study covered 21 RACFs in two states. Organisational culture was observed to impact well-being of residents. Improvements are needed in staffing levels, staff culture and management. Australia Improvements needed in palliative care at 16 rural RACFs. Discusses palliative care education and psychosocial support needs of aged care nurses. Did not address SLP. Australia Aims to inform policy development by investigating management skills in RACFs. A national strategy is needed to prepare a management workforce which is patient-centred and skilled appropriately for the setting.

Journal of Applied Gerontology

2016 Woodhead, Northrop, & Edelstein 2015 Theurer, Ben

24:B

Journal of Aging Studies

Discussion of literature

Mortenson, Stone, Suto, Timonen, & Rozanova

24:A

Cross- sectional observational study

Public Library of Science (PLOS One)

2013 Etherton- Beer, Venturato, & Horner

24:B

Mixed method study

Australian Journal of Primary Health

2011 Mitchell,

Nicholson, McDonald, & Bucetti

24:A

Literature review

BioMed Central Health Services Research

2010 Jeon,

Glasgow, Merlyn, & Sansoni

Poor understanding of SLP scope of practice in RACFs

Where communication services were provided, this was usually on an individual basis resulting from family enquiry rather than screening or medical referral (Bennett, Cartwright, & Young, 2019). This is consistent with literature suggesting productivity pressure and limited clinician autonomy are barriers to provision of holistic, evidence- based client care in RACFs (Bennett et al., 2015; Bennett et al., 2015a, 2015b; Bennett et al., 2016; Jeng, 2015). Several authors claim that there is a pervasive lack of RACF staff adherence to SLP recommendations in RACFs, potentially compromising patient outcomes (Beer et al., 2011, Bennett et al., 2016; Bennett et al., 2015). Poor staff retention, remuneration structures, nursing-assistant training levels and staffing ratios are also noted as confounding factors influencing outcomes in this setting (ACWST, 2018; Smith, 2019). Despite speech-language pathologists’ consensus regarding the importance of mealtime, communication and palliative-care management, these services remained underrepresented and speech-language pathologists reported not advocating for them (Bennett, Cartwright, & Young, 2019; Bennett, Young, & Cartwright, 2019; Bennett et al., 2016; Bennett et al., 2015). Despite clear correlations between resident needs and the SLP scope of practice, literature suggests disparities exist between best and actual practice (Bennett, Cartwright, & Young, 2019; Bennett, Young, & Cartwright, 2019). Reasons for this disparity are explored in the following theme. Theme 2: Factors influencing provision of best-practice SLP in RACFs Evaluation of the literature identified six factors influencing speech-language pathologists’ ability to fulfil best-practice guidelines in RACFs.

Research outlines a lack of RACF staff awareness of SLP services. Authors note that referrals to SLP are usually limited to swallowing assessment with little awareness of mealtime management, communication or palliative-care services (Bennett, Cartwright, & Young, 2019; Bennett et al., 2016: Bennett et al., 2015; Bennett et al., 2015a; Pascoe et al., 2015). Consequently, SLP intervention in these areas is infrequent despite data suggesting population needs (Bennett et al., 2015; Bennett et al., 2015a; Jeng, 2015; Smith, 2019). One example of this is in the palliative-care sector. Palliative care is often provided in RACFs. Since the 1970s, literature has identified SLP contributions to palliative care; however, current research suggests services are underutilised (Pascoe et al., 2015). No Australian SLP clinical guidelines exist and services are generally requested on a case-by-case basis (Chahda et al., 2017). Speech- language pathologists took an adjunctive role rather than as central members of palliative-care teams. Therapeutic nihilism is suggested as a contributing factor, where SLP is viewed as rehabilitative with services undervalued where functional improvement is no longer a goal (Chahda et al., 2017). SLP training in palliative care and service advocacy are profession-wide challenges (Chahda et al., 2017; Pascoe et al., 2015; Smith & Kenny, 2015). Awareness of ethical and legal obligations including advanced-care directives and palliative-care approaches such as comfort feeding are also entailed (Smith & Kenny, 2015). Finally, even when speech-language pathologists are present, because they are primarily referral-based contractors in Australian RACFs (Bennett, Young, & Cartwright, 2019),

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JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology