It is useful to provide strategies and tips to hospital staff, patients, and carers, on how to improve bedside communication for patients who do not speak. However, it is not always possible or easy for people to implement these strategies in the ‘environment’ where communication occurs, if hospital policies do not support the implementation of these strategies at the bedside.
1. Hospitals need policies on how staff are to communicate with patients who have little or no speech at all stages of the admission: Pre-admission, Admission, Inpatient Stay, Discharge Planning, and Discharge. [Note: This is not the same as policies on the use of interpreters, for ‘CALD’ or ‘Deaf’ or ‘hearing impaired’ populations – many people with little or no speech might not be from CALD populations and might have adequate hearing. Having said that, some patients have ‘overlapping’ communication vulnerabilities (e.g., CALD, and communication disability, and hearing impairment)].
2. Policy documents need to tie-in well with procedures and systems occurring at the ward level so that they are not ’empty’ policies that do not make a difference to bedside communication.
3. Hospital policy-writers can ask for help in drafting new policies from myself (email firstname.lastname@example.org) and their own staff who have personal, clinical, and theoretical expertise on bedside communication for patients with little or no speech (e.g., hospital nurses, speech pathologists, patients, family carers, paid carers, administration staff).
4. Hospitals need procedures for implementing policies and auditing practices surrounding the policies as they are implemented. Behaviour change in staff (and carers, and patients) often rests upon having a way to ‘measure’ and track changes made in response to policy direction. Our research is currently looking at a way to ‘audit’ the communicative behaviours of staff, patients, and carers to track ‘behaviour’ changes that can improve care and communication.
5. Statements from recent research by the author are quoted below – to date, there is little evidence that these policies have moved from being ‘evidence’ into ‘practice’, and more recent research indicates problems in communication at the bedside persist.
POLICY ON CARE OF PATIENTS WITH LIFELONG DISABILITY: “There is also a need to develop policies about care of people with disability in the hospital including a focus on availability of adapted equipment, pre-admission planning, involvement of paid disability support staff, and improved discharge planning that involves not only the carer but also the person with CCN.” p.250 see Hemsley, B., Balandin, S., & Togher, L. (2007). Narrative analysis of the hospital experience for older parents of people who cannot speak. Journal of Aging Studies 21 (2007) 239–254.
POLICY ON THE ROLES OF FAMILY CARERS: “If family carers are to be valued and supported in their roles during the hospitalisation of adults with CP and CCN (and others with long-standing disability), policies and procedures for their involvement in care on the ward need to be developed. New policies should reflect: (a) the important role that family carers play in passing on information, advocacy, and communication support; (b) the need to acknowledge the expertise of family carers and to facilitate their involvement as collaborative partners in care; (c) the need to increase the capacity of hospital staff to provide care to adults with CP and CCN; and (d) the need to increase collaborative links between hospital and disability services to ensure a continuity of supports to family carers across settings. Such policies might assist family carers in the process of transferring their roles in direct care to health care providers (Llewellyn et al., 2004), in preparation for the future when the older family carer is no longer able to provide such care in the hospital setting.” (p. 135). see Hemsley, B., Balandin, S., & Togher, L. (2008). Professionals’ views on the roles and needs of family carers of adults with cerebral palsy and complex communication needs in hospital. Journal of Intellectual & Developmental Disability, June 2008; 33(2): 127–136.