ACQ Vol 12 No 3 2010

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.

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

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ACQ Volume 12, Number 3 2010

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