Implementation Barriers and Facilitators for Alternative and Augmentative Communication Use in Intensive Care Units: Comparing Differences Across Physical Therapists and Occupational Therapists
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Communication partners with AAC training are known to increase the ability of a person with aphasia to understand language and participate in everyday social interactions (Genereaux et al., 2004; Hickey, Bourgeois, & Olswang, 2004; Kagan, Black, Duchan, Simmons-Mackie, & Square, 2001; Lyon et al., 1997; Rayner & Marshall, 2003; Rose, Worrall, & McKenna, 2003; Simmons-Mackie, Kearns, & Potechin, 2005). Healthcare providers, when trained in AAC strategies, serve as important communication partners in the acute care setting. Given more effective communication, they increase involvement in treatment planning by individuals with communication impairments (Kagan et al., 2001; Legg, Young, & Byer, 2005; Simmons-Mackie et al., 2007). Previous studies have identified barriers and facilitators to AAC support use in acute care settings for nurses (Baker & Melby, 1999; Bergbom-Engberg & Halajamae, 1993; Hemsley et al., 2001, Leathart, 1994; Simmons-Mackie et al., 2007). While knowledge of nursing-specific is valuable, because nurses spend a substantial amount of time with patients, nurses are one of many healthcare professionals that interact with patients during their stay in the acute care unit. There is little research investigating possible communication barriers between patients and other healthcare staff. The aims of this study were to identify potential barriers that facilitators, physical therapists, and occupational therapists encounter when implementing AAC strategies in an acute care setting and to determine if or how the barriers and facilitators differ by disciplines. Five healthcare providers participated in individual semi-structured interviews. This study identified 18 different barriers and 19 different facilitators. Results indicated that physical and occupational therapy disciplines felt most challenged by using AAC strategies to support individuals with severe communication impairments. Healthcare providers identified their own knowledge of and skill using AAC, the availability of AAC resources, and the patient health status and ability as the most substantial barriers to using AAC supports with patients with severe impairments. Likewise, they identified colleague AAC knowledge and skill as an important facilitator to enhancing their own AAC knowledge and skill. Findings from this study support the need for additional opportunities for training and information sharing between healthcare providers. Both of these recommendations will increase healthcare providers' AAC knowledge and skill, which in turn will help the providers feel more competent and confident implementing communication supports.
Augmentative and alternative communication