I started another placement today at an acute hospital. I’ll still be completing the intensive fluency placement at the same time, which should be interesting as far as time management goes. My fellow student clinicians and I talked with our educators briefly about the competing needs of swallowing and communication in a hospital setting.
Naturally, dysphagia often takes precedence over dysphasia (or aphasia, as we call it at university) – the reasoning is that swallowing difficulties affect a patient’s medical status, whereas communication difficulties do not. Also, hospitals view Speech Pathology services as primarily serving dysphagia, rather than communication, and sets up funding models and staffing models accordingly.
Abby Foster has authored a paper (with collaborators from the Centre for Clinical Research Excellence in Aphasia Rehabilitation) that describes clinician’s feelings on this divide .
She found that:
- Acute SPs report feeling more medically orientated than (humanties) communication oriented, and often defer to subacute SPs when dealing with aphasia [1 p.6]
- Acute SPs report their knowledge of dysphagia greatly exceeds their knowledge of aphasia [1 p.10]
- Institutional policies, barriers and timelines prevent acute SPs from addressing aphasia. Many SPs felt their mix of service provision was out of their control.
- Acute SPs often enter the workforce intending to spend more time than their colleagues on aphasia management, but become ‘instutionalised’ to the practices of their supervisors.
- There is good evidence that communication impairments may lead to “medical errors, negative health outcomes, increased health care costs, reduced compliance with recommendations, and increased falls risk.” [1 p.18]
As part of my placement, I will be redesigning the hospital’s patient education brochures on modified textures. The current brochures are long, and not particularly communication-friendly. I guess this will mean more study into ‘aphasia-friendly’ language and visual presentation.
Foster, A., O’Halloran, R., Rose, M., & Worrall, L. (2014). “Communication is taking a back seat”: speech pathologists’ perceptions of aphasia management in acute hospital settings. Aphasiology, 1-24. doi: 10.1080/02687038.2014.985185