JCPSLP Vol 21 No 3 2019

Multimodal communication

Prevalence of patients requiring assistance to communicate their health care needs Jacqui McCrabb, Tracy Sheldrick, and Jemma Tulloch

Effective communication is essential in health care. A restriction in the ability to communicate with health care providers can contribute to inappropriate care, difficulty participating in discharge planning, and in understanding written information. The aim of this project was to determine the prevalence of hospital patients who experience difficulty communicating their health care needs. Data was analysed using frequency distribution. The communication disability screener (CDS) was chosen to screen inpatients admitted on the rehabilitation geriatric and evaluation unit (GEM) and acute medical units. The CDS is a semi-structure interview survey that provides an overall evaluation of an individual’s ability to independently communicate about their health care needs. Results indicated that 46% (GEM) and 66.6% (acute) of patients in a regional health service were unable to independently communicate with all hospital staff without any specialist assistance or support during their inpatient stay. C ommunication is an essential component in the provision of quality health care. It is present in every interaction and the medium through which quality health care is provided (Burns, Baylor, Morris, McNalley & Yorston, 2012). Communication has relevance for virtually every aspect of health and well-being, including disease prevention, health promotion and quality of life (Rimal & Lapinski, 2009). At any one time patients with communication disabilities may comprise up to 15% of the hospital population but this may be as high as 88% on some specialised units such as neurology (Hemsley, Georgiou, Hill, Rollos, Steel & Balandin, 2015). Effective communication between patients and their health care providers can enhance patient health outcomes, increase safety, and deliver improved person centred and value- based care (O’Halloran, Grohan, & Worrall, 2012). Ineffective communication in hospitals is a major contributor to patient safety incidents (Steel, Georgiou, Balanda, Hill, Worrall & Hemsley, 2019). A study in the United States reported that communication failures were among the top three leading causes of sentinel events

(Joint Commission, 2014). Further research has shown that individuals who have communication impairments are three times more likely to experience a preventable adverse event in hospital than the general population (Bartlett, Blais, Tamblyn, Clermont, & MacGibbon, 2008). An integrative study by Hemsley et al. (2015) found that when communication in hospital is not optimised for people with communication disabilities patients had increased suffering from being isolated and not having means to communicate with nurses. Furthermore, the consequences of communication breakdown may include death, drug treatment errors, extensions in hospital stay, increased patient pain and misdiagnoses (Patak, Gawlinski, Fung, Doering, Berg, & Henneman, 2006). There is also emerging research suggesting that there may be a link with communication disability and increased risk of falls and inadequate clinical documentation of communication diagnosis and support needs of patients (Hemsley, Steel, Worrall, Hill, Bryant, Johnston, Georgiou & Balandin, 2018; Steel, Georgiou, Balandin, Hill, Worrall, & Hemsley, 2019). The Australian Bureau of Statistics (ABS) 2015 Survey of Disability, Ageing and Carers, estimated that 1.2 million Australians had some level of communication disability. Communication disability is said to affect 5–10 percent of the general population (Bartlett et al., 2008). Other groups of people that may have additional communication needs and may be at increased risk of communication breakdown include people with vision or hearing loss, limited proficiency in the language spoken by health care providers, cultural, ethnic, sexual orientation, or temporary conditions such as head injury, intubation and sedation (Blackstone & Pressman, 2016). Difficulty communicating in hospital is not confined to people with a communication impairment. The nature of communication between patients and health care providers are often complex and laden with emotional content. Although there are groups of people that may be more vulnerable to communication breakdown, anyone in the community can experience breakdown in health communication regardless of their background or abilities (Blackstone & Pressman, 2016). As such, it is important to recognise that issues around health communication affect more people than just those with a communication disability. The term health literacy is defined as the ability to understand, act on health information and make health decisions (Australian Commission on Safety and Quality in Health Care, 2015). People with low health literacy are more likely to be hospitalised, go to an emergency department and have poorer health outcomes (Australian Commission

KEYWORDS COMMUNICATION HEALTH THIS ARTICLE HAS BEEN PEER- REVIEWED

Jacqui McCrabb (top), Tracy Sheldrick (centre), and Jemma Tulloch

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JCPSLP Volume 21, Number 3 2019

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