ACQ Vol 12 No 3 2010

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ACQ Volume 12, Number 3 2010 113
In summary, the results of the evaluations demonstrated
that the participants valued the program, the training
program met the participants’ objectives and benefited
their clinical practice. The participants self-rated their
understanding of communication difficulties and their
confidence in communicating with someone with a
communication difficulty higher after the training and
participants were able to change their practice.
Following the one-day training program, staff have
expressed interest in attending the “Making your service
accessible: Communication matters” workshop. Other
units and teams within Austin Health have also requested
information about communication access through shorter
training sessions, leading to the development of a one-hour
in-service. Over 120 staff including those working in the new
day surgery centre, radiotherapy interns and allied health
working in oncology have attended this shorter training
session.
A larger scale rollout of the one-day training program
across Austin Health is currently being explored. Issues
requiring consideration that were outside the scope of this
project include: future funding, sustainability, support for
participants to continue to implement initiatives, and more
thorough evaluation, in terms of outcomes for patients and
families.
Project 2: Identifying
communication barriers in a
subacute setting
Historically, speech pathologists in the subacute setting at
Austin Health have assessed and managed patients who
were directly referred by other healthcare professionals.
Although no data is currently available, it is believed that
patients who have not been referred for intervention may
have unmet needs that affect communication outcomes.
A quality improvement project was conducted to
investigate the communicative environment at the Heidelberg
Repatriation Hospital, one of Austin Health’s subacute sites.
The project had three aims:
• to identify communication barriers between patients and
staff,
• to provide intervention immediately if specific barriers to
communication were identified for individual patients, and
• to assess the data at the end of the data collection period
in order to develop and implement strategies to improve
communication between staff and patients on the wards
over the long term.
The Inpatient Functional Communication Interview (IFCI;
O’Halloran et al., 2004) was developed to provide speech
pathologists working in the acute setting with a measure
to identify how well hospital inpatients can communicate
in everyday hospital situations. Examples of everyday
situations include the patient explaining why they are in
hospital, relating any current medical concerns and following
instructions. Information on medical and contextual factors
is also collected, such as hearing or vision impairment and
cultural background. It was assumed that patients in a
subacute setting would experience similar situations.
Two speech pathologists used the IFCI to conduct
interviews with a series of patients on two aged-care
rehabilitation wards who had not been referred for speech
pathology assessment. Over a one-month period 39 patients
were interviewed, on average 8 days after admission.
The interviews were analysed for medical and contextual
factors likely to cause barriers to communication, such
Results
The one-day training program was conducted on three
occasions across Austin Health and a total of 43 people
participated in the training. Participants were from a variety
of backgrounds, including nursing, allied health,
management, administration, and other support services,
and were working in a variety of areas of the health service,
including intensive care, acute medical wards, subacute
services including aged care and inpatient rehabilitation, and
outpatient and community services. The training was
evaluated using:
1. a Department of Human Service (DHS) mandatory
training evaluation,
2. questionnaires and self-rating scales given immediately
before and after the training exploring changes to
participants’ knowledge of communication access,
3. semi-structured interviews conducted three months after
the training exploring changes to participants’ behaviour
and practice as a direct result of the training.
The visual analogue self-rating scales gathered information
about participants’ confidence levels in communicating
with people with communication difficulties and knowledge
about communication difficulties pre and post training. The
questionnaires asked specific questions about participants’
knowledge about communication difficulties, strategies to
assist communication and improve communication access
pre and post training. These results were then compared
and analysed.
The training was well received with all participants
rating the training overall as very good or excellent. All
participants reported that the training met their expectations
and that the training would benefit their clinical practice.
Analysis of the questionnaires showed that participants’
knowledge of communication access had increased,
and their understanding of communication difficulties
and their confidence in communicating with people with
communication difficulties had improved.
Twelve of the participants consented to an interview at
three months after training. The semi-structured interviews
were conducted by the author via telephone or face to face
and ranged from 11 minutes in length to 40 minutes. With
consent, the interviews were recorded and transcribed and
a thematic analysis was performed from the transcriptions.
During the interviews, the participants described a number of
changes in their behaviour and practice as a direct result of
the training. Some examples include:
• development of an accessible falls prevention and
management document for patients and family members;
• changes to the way staff communicate with people
with communication difficulties – allowing extra time for
people with communication difficulties, using picture
based resources such as visual rating scales to support
communication, and writing information down for patients
to help them recall what has been discussed
• development of a “way-finding” document for patients
and families to help them find their way to various parts of
the hospital;
• booking of longer initial appointments for patients
attending the Cognitive, Dementia and Memory Service,
as well as booking of longer appointments for patients
who require an interpreter;
• improving the working environment in both patient and
non-patient areas through purchasing plants, hanging up
pictures and improving signage, making the environment
more comfortable and more accessible for both people
with and without communication difficulties.