Content validity of the electronic faces thermometer scale for pain in children: is a picture worth more than a thousand words?

Introduction: Early recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0-10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children. Methods: A mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8-17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations. Results: A total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0-1) and pain (level 2-10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2-10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments. Discussion: The variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits.

The person-centred care game: a reflective tool for learning person-centred care in higher education.

Person-centred care (PCC) is being implemented within many health care systems and educational institutions are important enablers of learning PCC. Teachers in higher education are responsible for helping students develop the ability to reflect. One approach is with serious games, which allow students to reflect on realistic situations and shape their skills with virtual patients. This paper describes the development of a serious game, the person-centred care game - (PCC game), which was designed to promote learning of PCC by reflection. We demonstrated how this PCC game could be used to induce PCC knowledge and skills by student reflection in an academic course on PCC.

The use of text-mining software to facilitate screening of literature on centredness in health care.

Research evidence supporting the implementation of centredness in health care is not easily accessible due to the sheer amount of literature available and the diversity in terminology and conceptualisations used. The use of text-mining functions to semi-automate the process of screening and collating citations for a review is a way of tackling the vast amount of research citations available today. There are several programmes that use text-mining functions to facilitate screening and data extraction for systematic reviews. However, the suitability of these programmes for reviews on broad topics of research, as well as the general uptake by researchers, is unclear. This commentary has a dual aim, which consists in outlining the challenges of screening literature in fields characterised by vague and overlapping conceptualisations, and to exemplify this by exploratory use of text-mining in the context of a scoping review on centredness in health care.

Implementation of communication routines facilitating person-centred care in long-term residential care: A pilot study.

BACKGROUND: Specific routines such as the development of personal communication plans can improve the interaction between people with communication disorders and healthcare staff. OBJECTIVE: This pilot study explores a model for implementing communication routines including personal communication plans in long-term residential care. DESIGN, SETTING AND PARTICIPANTS: This multiple case study includes two residential care facilities that differ in size and the number of languages spoken. Intervention or main variables studied implementation strategies involved workshops, individual coaching and follow-up visits. Main outcome measure implementation was assessed using goal attainment measurements, and the staff's views about facilitators and barriers to implementation were explored through structured interviews using the Theoretical Domains Framework. RESULTS: The overall implementation success rate for the facilities was moderate, and one of the facilities showed promising results related to personal communication plans. Both facilities experienced barriers to implementation, including management problems and a lack of reminders. However, the two facilities seem to have different motivations for change. DISCUSSION AND CONCLUSIONS: Regardless of the features of the facility, successful implementation requires stable and committed leadership. Moreover, experiences with language diversity may motivate staff to implement communication routines. PATIENT OR PUBLIC CONTRIBUTION: The content of the implementation model used (i.e., choice of specific routines and implementation strategies) was coproduced by staff, managers and the researchers involved in this project. The staff and managers were responsible for the implementation of the new routines under the supervision of the researchers.

Centredness in health care: A systematic overview of reviews.

INTRODUCTION: The introduction of effective, evidence-based approaches to centredness in health care is hindered by the fact that research results are not easily accessible. This is partly due to the large volume of publications available and because the field is closely linked to and in some ways encompasses adjoining fields of research, for example, shared decision making and narrative medicine. In an attempt to survey the field of centredness in health care, a systematic overview of reviews was conducted with the purpose of illuminating how centredness in health care is presented in current reviews. METHODS: Searches for relevant reviews were conducted in the databases PubMed, Scopus, Cinahl, PsychINFO, Web of Science and EMBASE using terms connected to centredness in health care. Filters specific to review studies of all types and for inclusion of only English language results as well as a time frame of January 2017-December 2018, were applied. RESULTS: The search strategy identified 3697 unique reviews, of which 31 were included in the study. The synthesis of the results from the 31 reviews identified three interrelated main themes: Attributes of centredness (what centredness is), Translation from theory into practice (how centredness is done) and Evaluation of effects (possible ways of measuring effects of centredness). Three main attributes of centeredness found were: being unique, being heard and shared responsibility. Aspects involved in translating theory into practice were sufficient prerequisites, strategies for action and tools used in safeguarding practice. Further, a variety and breadth of measures of effects were found in the included reviews. CONCLUSIONS: Our synthesis demonstrates that current synthesized research literature on centredness in health care is broad, as it focuses both on explorations of the conceptual basis and the practice, as well as measures of effects. This study provides an understanding of the commonalities identified in the reviews on centredness in healthcare overall, ranging from theory to practice and from practice to evaluation. PATIENT OR PUBLIC CONTRIBUTION: Patient representatives were involved during the initiation of the project and in decisions about its focus, although no patient or public representatives made direct contributions to the review process.

Person-centred care in speech-language therapy research and practice for adults: A scoping review.

BACKGROUND: Person-centred care (PCC) has shown positive effects in various health-care settings and therefore is desirable in clinical work. However, as PCC is still being developed, the literature reflects a heterogeneous use of both terminology and conceptualisation. This lack of consistency hinders the implementation or adaptation of PCC in general and in select fields of practice such as speech-language therapy (SLT). AIMS: To describe how the concept of PCC manifests in current speech and language therapy research and practice for adult patients. METHODS & PROCEDURES: Searches for published literature were conducted in five databases (PubMed, Scopus, CINAHL, Psych INFO, and Linguistics and Language Behaviour Abstracts) using search terms related to PCC and SLT. Records were included if they involved an adult population, were written in English, and focused on PCC and SLT irrespective of year of publication. MAIN CONTRIBUTION: A total of 134 records published 1996-2020 were included in this review. Many of these records were discussion papers that described how speech-language therapists (SLTs) can or should work in a person-centred way. The search did not find any records that explore the implementation, effects, or patients' views of person-centred SLT. This literature review revealed that person-centred SLT practice mainly relates to the International Classification of Functioning, Disability, and Health framework, and the Life Participation Approach to Aphasia. Studies incorporating exploration of proposed clinical routines of PCC demonstrate specific context-dependant aspects including barriers to eliciting a patient narrative, involving patient and family members, and documenting SLT. CONCLUSIONS & IMPLICATIONS: This study provides information that can be used to implement person-centred care in SLT education, clinical practice, and research by providing an inventory of the current knowledge and the existing gaps. WHAT IS ALREADY KNOWN ON THE SUBJECT: PCC has shown positive effects and is currently being implemented in various health-care settings worldwide. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study provides an account of the current state in research and practice on how PCC for adults is described, discussed, and evaluated. While related concepts such as family-centred care have mainly been explored within paediatrics, little is known about how PCC manifests in SLT for adults. Our results show that PCC is presently being discussed and valued in SLT although obstacles exist, and few studies explore whether current practice is person centred and the potential effects of such practice. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: This study provides clinicians, researchers, and policymakers' guidance on what aspects to consider when working to implement person-centred SLT for adults.

Interactional practices in person-centred care: Conversation analysis of nurse-patient disagreement during self-management support.

BACKGROUND: Person-centred care implies a change in interaction between care professionals and patients where patients are not passive recipients but co-producers of care. The interactional practices of person-centred care remain largely unexplored. OBJECTIVE: This study focuses on the analysis of disagreements, which are described as an important part in the co-production of knowledge in interaction. DESIGN: A qualitative exploratory study using conversation analysis. SETTING AND PARTICIPANTS: Data were collected from a nurse-led person-centred intervention in a hospital outpatient setting. Interactions between adult patients with irritable bowel syndrome (n = 17) and a registered nurse were audio-recorded. COREQ guidelines were applied. RESULTS: Disagreements were found after demonstration of the nurse's or patients' respective professional or personal knowledge. Disagreements were also evident when deciding on strategies for self-management. Although negotiations between opposing views of the nurse and patient were seen as important, the patient generally claimed final authority both in knowing how IBS is perceived and in the right to choose self-management strategies. The nurse generally oriented towards patient authority, but instances of demonstration of nurse authority despite patient resistance were also found. DISCUSSION AND CONCLUSIONS: This study provides information on how co-production of knowledge and decisions occur in the context of a person-centred care intervention. Negotiations between nurse and patient views require a flexible approach to communication, adapting interaction to each context while bearing in mind the patients having the final authority. To facilitate co-production, the patient's role and responsibilities in interaction should be explicitly stated.

Improving medical students' knowledge and skill in communicating with people with acquired communication disorders.

PURPOSE: To explore the effects of an interactive workshop on medical students' knowledge and skill in communicating with people with acquired communication disorders. METHOD: Sixty-nine medical students received a lecture on acquired communication disorders. Thirty-six of these students also participated in a workshop where they practised using supportive strategies in interaction with a simulated patient with aphasia. All students completed a questionnaire exploring attitudes, confidence in knowledge and ability to suggest suitable supportive strategies pre- and post-lecture/workshop and 15 students were video recorded when interacting with a simulated patient pre- and post-workshop. RESULT: The results show no change in attitude in either student group, but both groups rated their confidence in knowledge as higher post-lecture/workshop. The students' ability to suggest supportive strategies post training was significantly higher only in the workshop group. Comparing post training results regarding knowledge and ability to suggest supportive strategies between the groups, higher ratings were found for the workshop group. The analysis of video recordings indicated that the students also used new supportive strategies and used strategies more frequently after the workshop. CONCLUSION: An interactive workshop can improve medical students' knowledge and skills in communicating with people with acquired communication disorders.

Teaching medical students about communication in speech-language disorders: Effects of a lecture and a workshop.

PURPOSE: This study aims to explore the effects of an interactive workshop involving speech-language pathology students on medical students' knowledge about communication in relation to speech-language disorders. METHOD: Fifty-nine medical students received a lecture about speech-language disorders. Twenty-six of them also participated in a workshop on communication with patients with speech-language disorders. All students completed a 12-item questionnaire exploring knowledge and attitudes towards communication before and after the lecture or the workshop. The results from the two groups' self-ratings of confidence in knowledge were compared with expert-ratings of their ability to choose suitable communicative strategies. RESULT: Both the lecture and the workshop increased the students' confidence in knowledge about speech-language disorders and how to support communication. Only the workshop group also displayed a statistically significant increase in expert-rated ability and changed their attitude regarding responsibility for the communication in cases of speech-language disorders. There were no statistically significant correlations between the student's own confidence ratings and the experts' ratings of ability. CONCLUSION: Increased confidence in knowledge from learning is not always reflected in actual knowledge in how to communicate. However, an interactive workshop proved to increase medical students' expert-rated ability and attitudes related to communication in cases of speech-language disorders.

Communicative barriers and resources in nursing homes from the enrolled nurses' perspective: A qualitative interview study.

BACKGROUND AND OBJECTIVES: Managing communicative disability is a pervasive issue in long-term care facilities. The aim of this study was to explore how enrolled nurses experience their everyday interactions with residents in nursing homes, particularly focusing on interactions with residents with communicative disability. DESIGN: A qualitative exploratory design including content analysis was used. PARTICIPANTS AND SETTING: Eight individuals working at six nursing homes in western Sweden were interviewed. METHOD: The interviews were semi-structured with questions about the participants' experiences in communicating with residents, feelings associated with interactions involving residents with communicative disability, meaning ascribed to interactions, and factors influencing interactions. The interviews were analysed using content analysis. RESULTS: A dynamic interplay between interpersonal relations, daily interactions and the managing of communicative disability was revealed. The enrolled nurses had good knowledge of supportive strategies and an awareness of the importance of the development of personal relationships with residents in order to facilitate interaction. However, factors in the environment presented barriers to communication. CONCLUSIONS/IMPLICATIONS: The organisation and physical environment of nursing homes prevent the enrolled nurses from taking full advantage of the communicative resources they have in interaction with residents with communicative disability, hence affecting staff-resident relationships and the delivery of person-centred care.

Communication partner training of enrolled nurses working in nursing homes with people with communication disorders caused by stroke or Parkinson's disease.

PURPOSE: To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. METHOD: Five dyads consisting of a person with stroke-induced aphasia (n = 4) or Parkinson's disease (PD) (n = 1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. RESULTS: Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. CONCLUSIONS: The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training. IMPLICATIONS FOR REHABILITATION: Communication partner training can improve the communicative environment of people with communication disorders. For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker. An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders. The training also positively affected the perceived functional communication of the persons with communication disorders.

Training conversation partners of persons with communication disorders related to Parkinson's disease--a protocol and a pilot study.

This paper reports on the adaptation of a training programme for conversation partners of persons with Parkinson's disease, and a protocol for assessment of possible changes in conversational interaction as a result of intervention. We present data from an explorative multiple case study with three individuals with Parkinson's disease and their spouses. Repeated analysis of natural conversational interaction and measures of the participants' perception of communication as well as measures of different cognitive abilities were obtained. The results show that the communication in all three dyads was affected by both speech and language problems and that the conversation training model and the assessment protocol may work well after minor adjustments. Influence of different aspects of cognition on communication is discussed.