Implementing an interprofessional palliative care education program to speech-language therapy and dietetic students.

Palliative care education for allied health professionals has received minimal research attention. This longitudinal study followed the development of an education program for speech-language therapy (SLT) and dietetic (DT) students. The project comprised three stages. In Stage I, consenting SLT and DT graduates (n = 9) were interviewed 6 months after graduation exploring preparedness for working in palliative care. Interviews were transcribed, and topics were extracted through content analysis. In Stage II, a new palliative care curriculum was developed using the extant literature and gaps reported in Stage I. In Stage III, we implemented and evaluated the new curriculum. Students were surveyed before (n = 68) and after (n = 42) the new program and at 6-month post-graduation (n = 15) to capture student-reported changes in knowledge and confidence in palliative care. In Stage I, 10 topics were developed covering knowledge, roles, team, family-focused care, and feelings. In Stage II, a hybrid program was developed including e-learning modules, didactic lectures, and a simulated learning experience. In Stage III, student feedback demonstrated positive shifts in knowledge and confidence ratings from medians 3-6 to 5-8 (1 = none; 10 = excellent) across all domains. Gains in knowledge and confidence were consistently higher at 6-month post-graduation for final survey respondents. Mixed modality interprofessional palliative care education for allied health professionals has merit in improving knowledge, confidence, and perceived preparedness for practice.

Voice Behavior in Healthcare: A Scoping Review of the Study of Voice Behavior in Healthcare Workers.

BACKGROUND: Patient safety and quality care require learning organizations. For organizations to pivot and progress they need a workforce skilled and confident in voicing ideas and errors. Expressing issues related to patient safety and quality improvement can be defined as voice behavior. METHODS: This scoping review aimed to answer two questions: 1) What is the scope of the study of voice behavior in healthcare? 2) How do new graduates in allied health use their voice? The Joanna Briggs guidelines were used to identify 76 articles that were explored using a descriptive and evaluative approach to map the depth and breadth of this topic and identify research gaps. FINDINGS: The review revealed that nursing and medicine feature in voice behavior studies, but few studies focus on allied health. An exploration of the concepts emerging from these studies revealed eight topics: power, risk, tenure, leadership, intervention, self, climate, and strategies. CONCLUSION: Synthesis of the reviewed studies highlights that we know little about allied health new graduates' voice behavior in healthcare. Exploration of voice behaviors with this group will inform education and workplace settings about ways to grow professionals who are confident and competent in speaking up for patient safety and quality improvement.

Educator-student talk during interprofessional simulation-based teaching.

Background: Simulated learning environments are increasingly common in interprofessional education (IPE). While reflection is key to simulated learning, little is known about the nature of these conversations during simulation. The aim of this exploratory paper was to quantify communicative features of conversations during interprofessional simulation scenarios between dietetics students, speech-language therapy students and their educators. Methods: Conversations between students and educators during the pauses between simulated scenario phases were recorded and transcribed. Student and educator utterances were quantitatively analysed for speech acts, question types and elements of IPE (clinical reasoning, roles and responsibilities, client and family centred care, interprofessional collaboration, clinical procedural tasks). Results: Across 1340 utterances from six scenarios, analyses of conversational speech acts and question types highlighted similar patterns of usage between two educators despite different clinical scenarios and professional backgrounds. Educators used a minimally higher proportion of open compared with closed questions, and higher-level problem-solving questions predominated in comparison to simple factual questioning. Educators used more requests for action and attention and students displayed more performative and responsive acts (p<0.05). Students were exposed to all elements of IPE through conversations in all scenarios. Conclusions: Conversations during pauses in immersive simulated scenarios between educators and students enable rich IPE opportunities and higher-level problem-solving. Educators encouraged students to problem solve within and across disciplines with open questions. Educators provided few factual responses to questions themselves rather diverting questions back to the students. This approach to the analysis of conversation can support educators to evaluate their own communication during interprofessional simulations.

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson's Disease, Students and Clinical Educators.

When students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson's Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: "client-centredness"; "who am I/why am I here?"; "understanding interprofessional collaboration and development"; "personal and professional development, awareness of self and others"; "the environment - safety and support". These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of "navigating interprofessional spaces" showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.

Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson's disease: A pilot study.

PURPOSE: Lee Silverman Voice Treatment (LSVT LOUD®) is an effective therapy for phonation in Parkinson's Disease (PD) but little is known about any additional spread of effects to swallowing and cough function. This pilot study examined the effect of LSVT LOUD on pharyngeal swallowing parameters and reflexive cough strength. METHODS: Twenty participants (14 men, 6 women; mean 68years, SD3.5) with PD referred for LSVT LOUD with complaints of voice deterioration were recruited. Mean duration of PD was 6yrs., SD 3. Self-reported Eating Assessment Tool-10 scores ranging from 0 to 25 (normal<3). Prior to LSVT LOUD, 1-week post- and 6-months post-treatment, participants undertook a videofluoroscopic study of swallowing and aerodynamic measures of involuntary cough. RESULTS: All participants completed the LSVT LOUD programme; 3 participants were lost to follow-up at 6-months. All participants made significant gains in average sound pressure level (dB SPL). Aspiration was not observed. Pharyngeal residue (p<0.05) and pharyngeal area at rest reduced (p<0.01) while maximal opening of pharyngoesophageal segment (PES) (p<0.05) and PES opening duration (p<0.05) significantly increased. There was a significant improvement in involuntary cough peak expiratory flow rate and peak expiratory flow rise time. All changes were maintained at 6-months. CONCLUSION: LSVT LOUD demonstrates additional spread effects on pharyngoesophageal deglutitive function and involuntary cough effectiveness in people with mild PD referred with voice complaints. Consequently, LSVT LOUD has potential to provide additional benefits for swallowing safety and efficiency in this patient group.

Simulation-Based Dysphagia Training: Teaching Interprofessional Clinical Reasoning in a Hospital Environment.

This study evaluated hospital readiness and interprofessional clinical reasoning in speech-language pathology and dietetics students following a simulation-based teaching package. Thirty-one students participated in two half-day simulation workshops. The training included orientation to the hospital setting, part-task skill learning and immersive simulated cases. Students completed workshop evaluation forms. They filled in a 10-question survey regarding confidence, knowledge and preparedness for working in a hospital environment before and immediately after the workshops. Students completed written 15-min clinical vignettes at 1 month prior to training, immediately prior to training and immediately after training. A marking rubric was devised to evaluate the responses to the clinical vignettes within a framework of interprofessional education. The simulation workshops were well received by all students. There was a significant increase in students' self-ratings of confidence, preparedness and knowledge following the study day (p < .001). There was a significant increase in student overall scores in clinical vignettes after training with the greatest increase in clinical reasoning (p < .001). Interprofessional simulation-based training has benefits in developing hospital readiness and clinical reasoning in allied health students.

Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting.

Objective: Where swallowing difficulties are chronic or progressive, or a patient is palliative, tube feeding is often not deemed appropriate. Instead, patients continue to eat and drink despite the risks of pneumonia and death. There is currently little evidence to guide clinical practice in this field often termed "risk feeding." This qualitative study investigated staff, patient, and family member perceptions of risk feeding practices in one New Zealand hospital. Method: Twenty-nine staff members and six patients and/or their family were interviewed. Results: Thematic analysis revealed four global themes: supporting practice, communication, complexity of feeding decisions, and patient and family-centered care. Staff described limited education and organizational policy around risk feeding decisions. Communication was considered a major factor in the success. Conclusion: Feeding decisions are complex in the hospital environment. The themes identified in this study provide a foundation for hospital guideline development and implementation.

Cultivating interprofessional practice in New Zealand: an inter-sectorial approach to developing interprofessional education.

The World Health Organization (WHO) challenges health providers to commit to and champion interprofessional education (IPE) and interprofessional collaboration (IPC), arguing that IPE promotes IPC, which in turn improves health outcomes. Providing opportunities for students to engage in IPE, which occurs when current or future practitioners learn from, with, and about one another, ensures that health providers are in line with the WHO imperative of 2010. This paper describes the process of developing and implementing an undergraduate IPE initiative within a large New Zealand district health board, Counties Manukau Health, which provides clinical placements for over 500 students annually. This initiative involved 2 half-day interprofessional workshops attended by 123 students from seven disciplines. The impact of the interprofessional learning on students' perceptions and their confidence in relation to teamwork, communication, and interprofessional interaction were evaluated. Overall, students had a positive view of interprofessional communication and teamwork, and their opinion of relationships with other professionals improved following participation in the workshops.