JCPSLP Vol 22 No 2 2020

Learning from our clients

Around the journals

Clancy, L., Povey, R. & Rodham, K. (2020). “Living in a foreign country”: Experiences of staff–patient communication in inpatient stroke settings for people with post-stroke aphasia and those supporting them. Disability and Rehabilitation , 42 (3), 324–334. doi:10.1080/09638288.2018.1497716 Laurelie Wishart This article sought to explore perspectives of stroke survivors, their carers, and health care professionals, into the experiences of staff–patient communication and interaction in inpatient stroke settings. Using qualitative methodology underpinned by a critical realist approach, the authors undertook semi-structured interviews and/or focus groups with 6 stroke survivors with aphasia, 10 carers, and 6 health care professionals in the UK. Unfortunately, though eligibility criteria permitted, the study did not recruit any speech pathologists as participants (three physiotherapists, two consultant stroke physicians and one registered nurse participated). Interview transcripts were analysed using Braun and Clarke’s (2006) method of thematic analysis, with themes gleaned from each stakeholder group, before further integrative analysis was conducted to explore the commonalities and differences between the groups. The authors presented three overarching themes. The first theme was “being in a foreign country”: all three groups characterised the experience of and recovery from stroke as a significant and life-changing event, with key aspects of the ward environment impacting negatively on staff–patient communication, exacerbating a sense of confusion, shock, and the uncertainty of being ill. Theme 2 centred around “finding a voice”, where the process of regaining functional communication was discussed, with emphasis on challenges as well as the role of carers and health professionals to facilitate meaningful and necessary interactions in the inpatient setting. Finally, theme 3 covered “You’re just a number”, where stroke survivors with aphasia and carers reported perceived challenges in the individualisation of their care, and the relative focus on physical rehabilitation, sometimes at the expense of improving communication. Carers, in particular, highlighted communication breakdowns, and issues of infantilisation exemplified by inappropriate communication, which staff linked to a lack of knowledge and confidence in supporting people with aphasia. This study is compelling in its ability to triangulate the perceptions of different stakeholder groups and identify both unique and shared themes. The critical need for speech pathologists to champion greater attention to our clients’ unique experiences of, and adjustment to stroke, and to the provision of an aphasia-friendly and communicatively stimulating ward environment with appropriate training and support for ward staff, is strongly articulated.

Porter, K. L., Oetting, J. B., & Pecchioni, L. (2020). Caregivers’ perceptions of speech-language pathologist talk about child language and literacy disorders . American Journal of Speech-Language Pathology , 1–19. doi:10.1044/2020_ajslp-20-00049 The aim of this article was to understand how speech pathologists’ communication is perceived by caregivers of children receiving speech pathology intervention. In an exploratory qualitative study, the authors undertook semi-structured interviews with 12 English-speaking caregivers of 10 school-aged children with language and literacy disorders who had attended a US university clinic within the past 1–1.5 years. Interviews sought to elucidate what types of information caregivers recalled and retained, and how they understood and interpreted this information. This included information regarding their child’s speech- language evaluation(s), their understanding of the written report(s) they received, their impressions of their child’s current status as well as their hopes for the future. Interviews were analysed to identify categories/themes within and across transcripts, and connections between themes were mapped visually using ATLAS.ti software. Several key themes emerged that related to the type and quality of information received from SLPs, and caregivers’ understanding of their child’s language and literacy disorders. As a whole, the diagnosis was the most sought-after information for caregivers, with participants universally focusing first on whether they received a clear diagnostic label. In regards to caregivers’ understanding of language and literacy disorders, participants described their child’s language/ literacy disorder as a problem that needed a solution. But many acknowledged it was difficult for them to understand what it was like for their child to have a disorder, especially if it did not coalesce with their personal learning experiences. Caregivers perceived that topics such as long-term outcomes, clear prognostic information, and the relationship between language disorders and other areas of learning such as reading were not adequately addressed or made clear. However, all caregivers described receiving an abundance of information about speech and language services provided, including goals and objectives that had been articulated by the SLP. Caregivers placed a high value on receiving information from the SLP, and consistently connected their level of satisfaction with the level of information they perceived they were given during assessment and/or intervention. The findings showed the value caregivers place on receiving clear and timely diagnostic information, as well as the complexity associated with caregivers’ understanding of language and literacy disorders. This paper provides novel and important insight into how we as professionals must be cognisant of client values and perspectives, as well as our own communication strategies, within an evidence-based practice approach. Laurelie Wishart

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JCPSLP Volume 22, Number 2 2020

Journal of Clinical Practice in Speech-Language Pathology