Communication disability in hospital: tangible and intangible aspects of the communicative environment for adults with developmental disability.



Permission has been granted by the University of Sydney conference organisers to publish this abstract on my blog.

Acknowledgements: This study was funded by the National Health and Medical Research Council of Australia, through a postdoctoral fellowship to the first author. The authors would like to acknowledge and thank organisations assisting with recruitment and participants for contributing their views and experiences to this study.

  • Hemsley, B., Balandin, S., & Worrall, L. (2011). Communication disability in hospital: tangible and intangible aspects of the communicative environment for adults with developmental disability. Paper presented at the World Report on Disability: Implications for Asia and the Pacific, Symposium organised by The University of Sydney and the World Health Organization, 5-6 Dec 2011, Sydney Australia.

The World Health Organisation (WHO) World Report on Disability (WHO, 2011) calls for research on the needs, barriers to general health care, and health outcomes for people with specific disabilities and to include people with disabilities in research on general health care services. In this study we examined the views of adults with cerebral palsy and complex communication needs (n = 15), paid carers (n = 15), and hospital nurses (n = 15) on communication in hospital and barriers to and facilitators for effective communication to improve care. In-depth narrative interviews explored situations where communication was successful or unsuccessful and the impact of this upon care. Participants highlighted various methods of communication and a range of environmental factors (ICF, 2001) to communication, including the time taken to communicate, and the use of aids and equipment for communication. Intangible aspects of the environment included working relationships and role negotiation between paid carers and hospital staff, and differences in the views of communication partners on the person with disability’s need to communicate. Although all participants agreed it was important to communicate about pain and basic physical states (hunger, thirst, comfort, position, nausea, hot, cold) there was little acknowledgement that people with disability also needed to communicate about information on their health or for emotional or social closeness during hospitalisation.  Most paid carers in the study viewed that the person with disability would have little need to communicate as they could rely on the carer to speak on their behalf. However, people with disability and no speech reported valuing the opportunity to ask about their care and wanted to know what would happen to them, including discharge planning. Without attention to the interaction patterns of communication partners, provision of communication aids alone might not be sufficient to remove barriers to communication and improve care for people with communication disability in hospital.


Title: The “Big 5” and beyond: Nurses, paid carers, and adults with developmental disability discuss communication needs in hospital
Author(s): Hemsley, B.; Balandin, S.; Worrall, L.
Source: Applied Nursing Research Volume: Early view online. Retrieved from is on:

Title: Time: ‘Enemy’ or ‘friend’ for nurses communicating with patients with developmental disability and complex communication needs
Author(s): Hemsley, B.; Balandin, S.; Worrall, L.
Source: J Adv Nurs. 2011 Aug 10. doi: 10.1111/j.1365-2648.2011.05722.x. [Epub ahead of print]

Nursing the Patient With Developmental Disability in Hospital: Roles of Paid Carers

Author(s): Hemsley, B.; Balandin, S.; Worrall, L.

Source: Qualitative Health Research

Read the World Report on Disability here:


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