Factors influencing speech pathology practice in dysphagia after stroke: A qualitative focus group study.

Autor: Choy J; Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.; HammondCare Braeside Hospital, Prairiewood, New South Wales, Australia.; Speech Pathology Department, Royal Rehab, Putney, New South Wales, Australia., Pourkazemi F; Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia., Bogaardt H; Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.; School of Allied Health Science and Practice, University of Adelaide, Adelaide, South Australia, Australia., Anderson C; HammondCare Braeside Hospital, Prairiewood, New South Wales, Australia.; Nepean Hospital, Kingswood, New South Wales, Australia., Chai SY; HammondCare Braeside Hospital, Prairiewood, New South Wales, Australia., Pebdani RN; Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.; Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: International journal of language & communication disorders [Int J Lang Commun Disord] 2024 Jul-Aug; Vol. 59 (4), pp. 1599-1611. Date of Electronic Publication: 2024 Feb 19.
DOI: 10.1111/1460-6984.13017
Abstrakt: Background: Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician-specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke.
Aim: To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke.
Methods & Procedures: We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi-structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method.
Outcomes & Results: Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'.
Conclusions & Implications: Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke.
What This Paper Adds: What is already known on this subject Dysphagia rehabilitation can improve swallowing after a stroke. However, dysphagia rehabilitation is characterised by variability in clinical practice. Clinician-specific and workplace factors influence clinical practice and may contribute to variability in dysphagia rehabilitation. What this study adds Professional relationships influence speech pathologists' clinical practice, including relationships between senior and junior clinicians, between inpatient and community settings and with peers and multidisciplinary teams. Workplace norms and hierarchies, poor continuity of care between settings and competing priorities from other disciplines can hinder dysphagia rehabilitation. However, collaborative learning, positive workplace cultures and respectful transdisciplinary care can improve the quality and consistency of clinical practice. What are the clinical implications of this work? Flattening hierarchies in the workplace can foster a safe learning space. Further, questioning workplace norms and seeking out peer learning within and across settings can build clinical skills and confidence. Developing positive workplace cultures that support continuous development may be key for empowering speech pathologists to provide high-quality and consistent dysphagia rehabilitation.
(© 2024 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)
Databáze: MEDLINE
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