Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients.

The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.

Evaluating the MESSAGE Communication Strategies in Dementia training for use with community-based aged care staff working with people with dementia: a controlled pretest-post-test study.

AIMS AND OBJECTIVES: The study aims to evaluate the effects of a communication skills training programme on community aged care staff's knowledge of communication support in dementia and on staff's care experience. BACKGROUND: Dementia can lead to impairments in communication. Therefore, quality community-based dementia care requires that staff be skilled communicators, equipped to facilitate interactions with people with dementia. The current investigation evaluated the effectiveness of the MESSAGE Communication Strategies in Dementia for Care Staff training programme with respect to knowledge of communication support and the staff/caregiver experience. DESIGN: A multi-centre controlled pretest/post-test design with randomised cohort allocation was used. Outcome measures were completed at baseline, immediately after training (training group only), and at three-month follow-up. METHODS: Thirty-eight care staff working in community aged care participated and completed all outcome measures (training = 22; control = 16).Training and control groups completed the following outcome measures: knowledge of communication support strategies, self-efficacy, preparedness to provide care, strain in nursing care and attitude to dementia care. Staff in the training group provided written feedback on the training. RESULTS: A significant improvement in knowledge scores from baseline was found for the training group both immediately after training and at three-month follow-up. There was also a significant training effect for self-efficacy and preparedness to provide care. No significant difference was found for the control group for any measure. No significant training effects were found for measures of strain or attitudes to dementia care. Feedback from staff suggests that the training was well received. CONCLUSIONS: The MESSAGE training was positively received by staff and had a significant effect on care staff knowledge, and confidence to provide care for people with dementia. RELEVANCE TO CLINICAL PRACTICE: The easily accessible multimedia training programme is well received by staff and has the potential to improve quality of care.

Exploratory investigation of communication management in residential-aged care: a comparison of staff knowledge, documentation and observed resident-staff communication.

BACKGROUND: There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in residential-aged care and factors impacting optimal communication management is lacking. AIMS: To use data triangulation across multiple sources to describe resident-staff communication and communication management in residential-aged care. METHODS & PROCEDURES: Participants included a sample of 14 residents and 29 staff directly involved in communication interactions with residents. Data were obtained from: (1) resident file review (n = 14), (2) observation of resident-staff communication (n = 14), (3) resident surveys (n = 14) and (4) staff surveys (n = 29). Data from each source were examined separately then triangulated. OUTCOMES & RESULTS: All residents had limited opportunity for meaningful communication with staff. Documentation of residents' communication needs and strategies to facilitate resident-staff communication was insufficient to provide individualized recommendations. Although staff were observed to use various strategies to facilitate communication with residents, staff agreement about the applicability of these strategies to individual residents was inconsistent. Differences in resident-staff communication for residents who experience nil/mild versus moderate/severe communication difficulty were also found. CONCLUSIONS & IMPLICATIONS: Resident-staff communication and communication management in residential-aged care is limited in scope and challenged in meeting residents' individual communication needs. Improvements in both documentation and staff knowledge of residents' communication needs are necessary. Strategies to facilitate communication with individual residents must be tailored, evidence based, documented in care plans and delivered to staff through ongoing education. Increased involvement of specialist providers such as speech pathologists to support better communication management in residential-aged care may provide one way of facilitating such change.

[How to communicate with patients suffering from dementia]. / Mit geriatrischen Patienten richtig umgehen: Wenn alte, kognitiv beeinträchtigte Patienten ins Krankenhaus müssen.

The prevalence of patients with cognitive impairment will inevitably increase in general hospitals. Communication with these patients is difficult. However, it can be improved by implementing organisational measures and behaviour changes of the hospital staff.

Role of the speech-language pathologist: augmentative and alternative communication for acute care patients with severe communication impairments.

BACKGROUND: Severe communication deficits occur frequently in acute care. Augmentative and alternative communication (AAC) may improve patient-nurse communication, yet it remains underutilized. OBJECTIVE: The objective of this study was to assess the impact of training student nurses (SNs) in acute and critical care on the use of AAC with regard to confidence levels and likelihood of implementation of AAC by SNs in acute care. METHODS: Training in AAC techniques was provided to SNs. A pretraining and posttraining assessment was completed along with follow-up surveys conducted after the SNs had an opportunity to use AAC. RESULTS: A 6-fold increase in confidence (P < .01) was reported by the SNs after AAC training, as was an approximately 3-fold increase in likelihood of use (P < .01). The reliable yes/no was the most reported AAC technique (34.7% of the students). DISCUSSION: Providing SNs with AAC tools accompanied by brief training increases their confidence in the use of AAC and the likelihood that they will use them. Inclusion of AAC education in nursing curricula and nursing orientations could be an important step in risk reduction among patients with severe communication disorders. Further study is needed of the relationship between training student nurses in the use of AAC as a way to change practice and improve communication outcomes.

Patologías de la comunicación. Proyecto docente para enfermería infantil. Dislalias / Communication pathology. Teaching project for child nursing. Dyslalias

La dislalia, mal conocida como trastorno del lenguaje, es sin duda una de las patologías de la comunicación, concretamente del habla, más común en la infancia. A pesar de que en los distintos servicios de salud en los que presta sus cuidados la profesión de enfermería se encuentran niños con estas dificultades, la formación profesional tanto pre como postgrado es muy deficiente en lo que a patología de la comunicación respecta. Mediante una exhaustiva búsqueda bibliográfica actualizada en la Biblioteca Virtual del Sistema Público de Salud de Andalucía, se pretende dar a conocer los aspectos más relevantes de las dislalias con un objetivo púramente docente, lo que resultará en una mejora en los registros de enfermería, en el uso correcto de la terminología logopédica y en un avance en la coordinación interprofesional, consiguiendo con ello dar calidad e identidad a los cuidados de enfermería (AU)

Dyslalia, bad known as a language disorder, is undoubtedly one of the most common childhood speech communication pathologies. Although nursing provide health care to children with these difficulties along different services, pregraduate and postgraduate training regarding communication pathology is very poor. Through an extensive updated searched literature in the Virtual Library System of Andalusia Public Health, is intended to present the most relevant aspects about dyslalia with pure teaching objective with the aim of improving nursing records, getting correct use in speech therapy terminology and achieving quality and identity in providing nursing care (AU)

Portraits of people with dementia: three case studies of creating portraits.

Communication difficulties associated with late-stage dementia can make it difficult for care staff in residential environments to get to know people with dementia. This lack of knowledge can have a negative effect on the social environment of residential facilities, which can have a detrimental effect on the health and well-being of the residents and the job satisfaction of the staff. In this article, we discuss the creation of portraits of people with dementia to aid care staff in understanding the individual. The major findings of these case studies include that it is possible for families to create portraits of their relatives within a relatively short period of time and families found the process enjoyable and a good trigger for reminiscence.

Understanding, identifying and supporting speech, language and communication needs in children.

Communication is a fundamental life skill and acts as the foundation on which many other areas of development are based. Any child who is not developing their speech, language and communication skills in the expected way is considered to have speech, language and communication needs (SLCN). These range from children with delayed speech and language development, whose difficulties will resolve with the correct intervention, to children with long term, persistent difficulties in one or more areas of their speech, language and communication development. Speech, language and communication is a skill central to other areas of development, meaning the impacts of SLCN can be significant. These impacts can be minimised by ensuring early identification and support for those children and young people who are presenting with SLCN.

Central nervous system injury and neurobiobehavioral function in children with brain tumors: a review of the literature.

BACKGROUND: Children with brain tumors present a complex set of factors when considering treatment decisions, including type and location of tumor and age of the child. Two-thirds of children will survive, but historically have had poorer neurocognitive and quality-of-life outcomes when compared with survivors of other childhood cancers. Delaying or forgoing cranial radiation completely is thought to lead to improved neurobiobehavioral outcomes, but there is still relatively little research in this area. OBJECTIVES: The objectives of this study were to review and consolidate what is known about the effects of cranial radiation and chemotherapy on normal brain tissue and to synthesize that information relative to neurobiobehavioral findings in children with brain tumors. METHODS: A literature search using PubMed and PsycINFO from 2000 to 2011 was done using a variety of terms related to childhood brain tumor treatment and outcome. A total of 70 articles were reviewed, and 40 were chosen for inclusion in the review based on most relevance to this population. RESULTS: Both cranial radiation and certain chemotherapy agents cause damage to or loss of healthy neurons, as well as a decrease in the number of progenitor cells of the hippocampus. However, in general, children treated with chemotherapy alone appear to have less of a neurobiobehavioral impact than those treated with cranial radiation. CONCLUSIONS: The trend toward delaying or postponing cranial radiation when possible may improve overall neurocognitive and quality-of-life outcomes. IMPLICATIONS FOR PRACTICE: Nurses require knowledge of these issues when discussing treatment with families and with caring for long-term survivors.

Warning signs in the development of speech, language, and communication: when to refer to a speech-language pathologist.

TOPIC: Because of the link between communication impairments and psychiatric disorders, it is important for nurses and other healthcare professionals to know the warning signs for the need for a communication/speech/language evaluation for children during infancy through early childhood. PURPOSE: This article presents an overview of the role of speech-language pathologists (SLPs); the expected developmental achievements for youngsters from infancy to age 5 in speech, language, and communication; and the clinically significant warning signs that indicate a need for speech/language assessment. SOURCES: Sources for this article included published literature on the topic along with the clinical judgment and expertise of the author, a certified SLP. CONCLUSIONS: Warning signs for referral to an SLP may be subtle and may present in developmental, academic, behavioral, or social-emotional realms. Collaboration between nurses and communication professionals will allow for early identification and intervention. Early detection of speech and language disabilities is key to maximizing the effects of early intervention, resulting in more positive communication outcomes in later life. It has been found that speech and language delays and disorders, with symptoms left untreated, can cause difficulties in learning and socialization that can last into adolescence and beyond. Early identification of children with developmental delay or developmental disabilities may lead to intervention at a young age when chances for improvement may be best.

Communication, swallowing and feeding in the intensive care unit patient.

BACKGROUND: It is not uncommon for patients requiring a period of time in the intensive care unit (ICU) to experience difficulties with communication and/or swallowing, either as a result of their illness or as a result of the treatments they receive. These difficulties can be both short term and long term and require timely and appropriate intervention in order to improve the patient's experience and expedite recovery/rehabilitation. AIMS: The purpose of this article is to provide critical care nurses with an update on aspects of communication, swallowing and feeding in the ICU. The paper will focus on each area in relation to the current evidence base and factors of 'best practice' (as determined by expert opinion). IMPLICATIONS FOR CRITICAL CARE NURSING PRACTICE: Enabling communication can improve well-being, increase compliance and reduce length of stay; Simple modes of communication, e.g. writing/gesture/pictures can be very effective; Coded eye blinking may be unreliable because of confusion with reflexive blinking; Non-oral nutrition will generally not meet the psychological and physical needs and benefits of oral intake; Not all patients with a tracheostomy in situ will experience dysphagia; however, those considered 'at risk' should have their swallow assessed by an appropriately trained professional, e.g. speech and language therapist/dysphagia trained professional; An inflated tracheostomy cuff will not prevent aspiration. The decision to commence oral intake in the presence of an inflated cuff should be made as a team and take into consideration the patient's medical and psychological status; The use of blue dye to assess the swallow carries a high false-negative rate and cannot be relied on alone to predict either the presence or the absence of aspiration. CONCLUSION: There is still much more research to be performed and evidence to be gained regarding the input into communication, swallowing and feeding in the ICU; however, a full-team approach to these areas can have very positive effects on the patient's experience.

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication.

AIMS AND OBJECTIVES: To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed. BACKGROUND: Effective nurse-patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN. DESIGN: Systematic review. METHOD: This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided. CONCLUSIONS: Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option. RELEVANCE TO CLINICAL PRACTICE: Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak.