Getting the Message Across

Bronwyn Hemsley's research is helping people with severe speech disabilities communicate their needs in healthcare settings.

Communication is critical for all patients in healthcare situations but is extremely difficult for people who cannot speak and have developmental disabilities.

NHMRC Postdoctoral Fellow and speech pathologist Dr Bronwyn Hemsley is leading a major study, titled Communication during hospitalisation: The path to better healthcare, that aims to enhance the health interactions of adults with little or no speech in order to improve their care and safety in hospital.

"We know that people with developmental disabilities go to hospital more frequently than people without disability and also tend to have higher health needs that increase with age," Hemsley says.

"We also know that people who have communication disabilities have three times the risk of preventable and harmful patient safety incidents in hospital, so it is clear their difficulty in communicating with hospital staff affects their care.

"We are documenting and observing the interactions that take place in hospital between patients with developmental disabilities and their healthcare providers, with the aim of developing policies and practices to improve communication and care."

Hemsley's work is supported by a four-year National Health and Medical Research Council postdoctoral fellowship. The initial stage of the research involved interviews with carers, healthcare providers and people with complex communication needs, to determine their views on communication requirements in hospital and any barriers to or facilitators for better communication.
 
"We wanted to establish the main things people need to communicate in hospital and found that, as for other patients, these included basic needs like pain, hygiene, eating and drinking, positioning, general information about their stay and their social and emotional needs," Hemsley says.

"We also looked at whether they had access to tools like communication boards and speech-generating devices and, if not, what the barriers were to them having this type of technology available."

The study found that one barrier to communication was that people were often reluctant to take their own communication aids, particularly speech-generating devices, to hospital for fear of loss or damage. Another barrier was reliance upon carers to speak for the patient.

"We found that adults with disability want to be able to talk directly to the nurses, even if carers are present - they want to have a say in their own healthcare decisions," Hemsley says.

Hemsley's findings on the first part of the study have been reported in national and international peer-reviewed journals. The second part of the study involves observing people with developmental disabilities communicating with hospital staff and carers.

"We need to see what kinds of strategies nurses, patients and carers use together, in various situations, to prepare all involved in the interaction for better communication in the time available,
she says.

Outcomes of the research will inform hospital policies and the training of healthcare staff in communicating with patients who cannot speak.

 "It would be great to observe people who do actually take and use their communication aids in hospital, as it may well be these people who manage more effectively when their family carers are no longer able to support them," Hemsley says.

"We hope to identify and devise a range of strategies that can be put in place that will ultimately make a difference - to patient safety, to satisfaction with hospital experiences and to the effectiveness of care."