The impact of the physical environment on communication for residents of long-term care (LTC) facilities has not been examined in depth. No study currently exists which explores environmental influences on communication within the long-term care setting. Investigation of such facilities is important because of the a large impact environmental features have on the quality of life of residents due to the often restricted nature of daily routines and reduced level of cognitive and/or physical function of residents. A definition of environment is needed in order to create a methodology for assessment and treatment of residents in LTC facilities. This study investigates what factors contribute to a positive communication environment in long-term care facilities and how the physical environment should be assessed. Observational data was obtained for three LTC residents with different types of physical and communicative impairments to determine what environmental factors inhibit or support communication. Barriers and facilitators to communication are identified, and recommendations for assessment of the long-term care environment are made. Contributions from the fields of aphasiology, environmental gerontology, and environmental psychology are described in order to contribute to the understanding of what contributes to a positive communication environment. Study results included support for: participant observation as a component of resident assessment, assessment of multiple environments, the importance considering individual needs during assessment, and assessment of resident perception of environment. Furthermore, this study presents a checklist to be used to guide observational assessments. / text

This thesis is concerned with the experience of aphasia in Khayelitsha, a township on the outskirts of Cape Town characterised by poverty, violence, limited resources and a culture and language that differs from the setting of most speech and language services in South Africa. It is based on three years of intermittent fieldwork that entailed participant observation of the everyday life of five adults living with aphasia and interviews with participants, kin and healthcare workers in various settings. Grounded in sociocultural theory, this thesis has aimed to provide an ethnographic account of cultural frameworks of interpretation of communication impairment following stroke and of the daily reality of life for adults living with aphasia in this setting. An exploration of causal notions in this setting provided interesting commentary on social and cultural processes and how people, caught up in these processes, search for meaning and for cure. Participants entertained plural notions of causation of aphasia and explored numerous therapeutic avenues. The wide variation in causal notions included biomedical causes, social and behavioural determinants, and the influences of supernatural powers, such as witches and ancestors. Similarly participants experienced aphasia through multiple healing systems, including traditional, biomedical and religious therapy options. All however seemed to be ambiguous sources of help. Whilst encounters with the health system presented serious challenges to participants, traditional and religious avenues for help were obscured by a burgeoning and not always ethical open market offering miracle cures. An articulation of the circumstances of this group of adults provided further commentary on the influence of the social context on aphasia. In a context where sociopolitical processes have had a disintegrating effect on social cohesion, questions of support, care and security were of primary concern. Prejudices towards the elderly and women were more acutely felt and vulnerability, isolation, insecurity and fluidity of circumstance emerged as overarching themes. The central argument in this thesis is that the genesis of these experiences can be found in contextual factors in Khayelitsha, such as poverty, inequality, urbanisation and changing cultural paradigms. These emerging themes highlight the disjunctions between the medical alignment of the discipline of speech language therapy in South Africa and the capacity for socially-engaged practice. They also highlight the socio-cultural complexity of the experience of aphasia, specifically the influences of culture and poverty. There is thus theoretical and clinical relevance in using anthropological objectives to explore the world of the adult living with aphasia and the interface between context and service provision. Interventions and healthcare communications that will make a meaningful difference to adults with aphasia in a setting such as Khayelitsha are proposed.

Bakgrund: Människor med funktionsnedsättning rapporterar i högre grad missnöje med omvårdnad och sjukvårdspersonalens förståelse för deras funktionsnedsättning. Många funktionsnedsättningar medför också kommunikationsnedsättningar vilket bidrar till svårigheter i vårdsammanhang. Då kommunikationen inte fungerar mellan patient och sjukvårdspersonal är det svårt att skapa en vårdrelation. Syfte: Syftet med uppsatsen är att beskriva erfarenheter av kommunikationen mellan sjukvårdspersonal och patienter med komplexa kommunikationsbehov [CCN]. Metod: Studien är en litteraturöversikt där vetenskapliga artiklar har granskats. Till resultatet har nio artiklar analyserats och teman har identifierats. Resultat: Fyra teman som är kopplade till svårigheter med att kommunicera med människor med CCN lyfts fram i resultatet. Dessa teman är; kunskapsbrist, tid, anhörigvårdare och vårdrelation. Diskussion: Resultatet diskuteras utifrån syftet med stöd i ytterligare studier. Resultatet kopplas också till Travelbees teori om stegen till en mellanmänsklig relation och hennes syn på kommunikation. / Background: People with disabilities report greater dissatisfaction with care and with the medical staff’s understanding of their disability. Many disabilities also brings communication impairments which contributes to difficulties in health care contexts. When communication fails between the patient and health care professional, it is difficult to create a healthcare relationship. Aim: The aim of this study was to describe the experiences of communication between health care personal and patients with complex communication needs [CCN]. Methods: The study is a literature review where scientific reports have been analyzed. In the result nine articles were analyzed and themes identified. Results: Four themes related to difficulties in communicating with people with CCN are highlighted in the result. These themes are: lack of knowledge, time, carers and care relationship. Discussions: The results are discussed from the purpose of the aim with support in further studies. The result is also linked to Travelbees theory of stages of an interpersonal relationship, and her view of communication.

Introduktion/Bakgrund: Kommunikationen med patienten utgör en vital del i sjuksköterskans arbete och en förutsättning för god omvårdnad. Kommunikation mellan patient och sjuksköterska grundas på sjuksköterskans upplevelse och patientens delaktighet och sjuksköterskor möter patienter med intellektuell funktionsnedsättning i sitt dagliga arbete. Patienter med intellektuell funktionsnedsättning utgör en utsatt patientgrupp på grund av deras nedsatta förmåga att kommunicera och utgör en prioriterad grupp av inspektionen för vård och omsorg. Syfte: Syftet med studien är att belysa sjuksköterskans upplevelser av kommunikation med patienter med intellektuell utvecklingsstörning och svår kommunikationsnedsättning. Metod: Litteraturstudien har genomförts med utgångspunkt i Polit & Becks (2017) nio steg. Litteraturen har sökts efter i databaserna Cinahl och PsycInfo, vilket genererade elva kvalitativa och en kvantitativ artikel. Artiklarna kvalitetsgranskades med Polit & Becks (2017) granskningsmall. Resultat: Analysen av datan resulterade i sex teman. Resultatet visar att sjuksköterskorna upplevde att de behövde en personcentrerad närmande, där kunskaper om patientgruppen och erfarenhet var grundläggande tillsammans med patientkännedom och samarbete med andra. Sjuksköterska upplevde tiden och användningen av kreativa sätt att kommunicera. som viktiga faktorer inom kommunikationen. Sjuksköterskor upplever även frustration, rädsla, tidsbrist och okunskap i kommunikationen. Balansgången mellan dessa upplevelser leder till emotionell trötthet och stress för sjuksköterskan.

This study looks at what happens in informal conversations between three people with learning difficulties (intellectual impairment) and a range of non-disabled partners. It takes a participatory approach using data collected by the participants with learning difficulties who chose their communication partners; these partners included family and staff who were paid to support them. The study uses descriptive statistics to highlight areas where there was apparent asymmetry in the conversations. Conversation Analysis combined with features taken from Systemic Functional Linguistics is then used to look in detail at some of these aspects. Important features identified include turn design, repair, and the use of evaluative language and the contribution of non-verbal aspects in particular eye gaze, gesture and the use of artefacts. The study highlights possible strategies for assessing and supporting more effective and equitable interaction for those with learning difficulties and communication impairment and identifies features that should be considered when training professionals working in the field of learning difficulties.

BACKGROUND: Oral communication impairments (OCIs) are a common childhood problem with often long-term negative outcomes for both the child and society. Despite the growing body of knowledge about the epidemiology of this problem, the shift from traditional treatment approaches to population based approaches to management has been slow. One suggested reason for this is a lack of community based population data on such problems with which to plan services more broadly. AIM: The aim of this thesis is to contribute to the population knowledge of children with OCIs by developing and trialing a data collection method at a community level. LITERATURE REVIEW: One of the major issues in understanding OCIs from a population perspective is the disparate and often incongruent nature of epidemiological data reported in the literature. Five areas of epidemiological research were reviewed in order to critically evaluate the existing evidence base and identify gaps for further research. The five areas reviewed were: Prevalence (Regardless of the methodology used to collect prevalence data, OCIs have been described as a common childhood problem), Life Course (Children with OCIs often have ongoing communication problems and are at risk for poorer life outcomes in social, educational and occupational domains), Comorbidities (OCIs rarely occur in isolation and most children will have other developmental or health issues), Risk factors (There is no one easily definable cause of OCIs, however, genetic and environmental factors appear to increase the risk of OCI in the general population), and Service use (Only around half of children with recognised OCIs will access specialist intervention services).The review concluded that local community data measuring the 'burden', or impact, of the problem, comorbidities and service use in children with and without OCIs would assist in service planning. Therefore a methodology would need to be developed which addressed these issues.A further review of the literature considered this methodology development with specific reference to the issues of study design, sampling and identification of OCIs. The review concluded that a cross-sectional survey design of a community sample could provide the necessary data. Parent and teacher report was suggested as a method for identifying OCIs in surveys, however, a tool needed to be developed and trialed to ensure this method was effective, valid and reliable. PILOT STUDY: A survey tool for parents was designed which included the Child Health Questionnaire (PF - 28), questions relating to socio-demographic features, health and development conditions, service use and specifically developed questions regarding OCIs. The survey methodology was trialed in one school and one childcare centre. The results of the study were reviewed and suggestions made for methodological changes before a community trial was carried out. The reliability and validity of the questions designed to identify OCIs was assessed in a number of ways. Test-retest reliability of parent completed questionnaires proved to be good. Interrater reliability was examined by comparing parent and teacher responses. Parents and teachers agreed on identification of OCI in over 75% of cases for each of the OCIs studied. Criterion validity was assessed by comparing parent report to speech pathologist evaluation in a clinical sample and by comparing parent and teacher report to screening assessments of communication skills in a school sample. Both parents and teachers tended to over-identify children, however, when parent and teacher reports were considered together the validity approached that of the 'gold standard'. Construct validity was assessed by comparing reported OCIs with reports of other developmental conditions known to be commonly comorbid with OCIs. Once again using both parent and teacher report proved to be the most valid method of identifying OCIs using the developed tool. COMMUNITY STUDY: A targeted community survey of 3 to 7 year old children was conducted in a regional centre in Queensland, Australia. Children were sampled through schools and childcare centres. Information letters were distributed to the parents of 898 eligible children. Completed questionnaires were received for 397 children. Teachers completed questionnaires on 375 children which was 42% of the population sampled. Parents and teachers identified OCIs in 16% of the children. However, only 3% of the population were rated by parents or teachers as having severe problems. Over 70% of parents and teachers of children with a reported OCI rated the problem as having an impact on the child's life. Ratings of impact were not related to parent/teacher ratings of severity. Children with OCIs were reported to have significantly more health, developmental and behaviour problems than their peers. Children with OCIs were rated lower by their parents on most aspects of the Child Health Questionnaire (PF-28). In particular, parents reported impacts on their own time and family activities due to the child's problems. No significant differences were found between children with and without reported OCIs on any of the socio-demographic variables studied. Children with reported OCIs used more health and educational services than their peers. Around 60% of children with reported OCIs had seen a speech pathologist, but many parents had also sought advice from a range of other health and educational professionals. Those with two or more OCI conditions were more likely to have seen a professional, however socio-demographic variables did not generally predict service use. Parents reported that the type of service they chose was most commonly influenced by advice from a doctor or teacher. The limitations of this methodology for collecting this type of data are discussed. However despite these limitations data were collected which has major implications for the provision of population based services for children with OCI. CONCLUSION: This thesis has contributed to the understanding of children with OCIs by researching the development of a methodology to study this problem in a defined community sample. The information gained from the literature review and the community study were considered within two models of service provision. The models encompass service delivery from individualised to more population based approaches to the management of OCIs in children. From these models, specific suggestions for the community involved in the study were discussed. This thesis, therefore, provided a survey methodology that is resource efficient in the collection of community data useful in suggesting improved services for children with oral communication impairments.

Children with social communication disorders have been found to exhibit deficits in emotional intelligence, including the ability to identify emotions attributed to facial expressions. The purpose of this thesis was to examine the efficacy of a social communication intervention program designed to increase the accuracy of emotion based word use in three elementary school-aged participants with social communication disorders. The participants took part in a multiple-baseline, 20-session treatment including story enactment, journaling procedures, and supplementary activities. The story enactment portion of the intervention centered on Mercer Mayer's A Boy, A Dog, and A Frog (1967) wordless picture book series. Participants' emotion word productions were analyzed in six categories (happiness, sadness, anger, fear, surprise, and disgust) and valence accuracy was determined for all productions. Results proved variable, but each of the three participants demonstrated improvements in accuracy in at least two emotion categories that were not mastered prior to the onset of the intervention. In addition, two of the three participants increased in valence accuracy of emotion word productions between baseline and follow-up measures. Taken as a whole, the results suggest that this particular intervention program was effective in improving competency in select emotion categories for all three participants. Discussions of individual participant outcomes are included, as well as suggestions for further research.