City Research Online

Abstract

Patients with communication and swallowing needs during their hospital admissions on stroke units depend on speech and language therapy (SLT) and nursing staff for their care, yet very little is known about how they interact to accomplish that care. This study is the first to direct focused and sustained attention to how these two disciplines share information to meet their common clinical interests in patients with communication and swallowing difficulties.

This ethnographic study was based on three stroke units in one inner city area of the UK. The study explored how the two disciplines engaged with each other as they went about their work on the wards in order to understand what influenced how they interacted, what they talked about, and professional alliances. Qualitative data were collected during 357 hours of fieldwork and included 43 interviews with speech and language therapy and nursing staff and the patient records of 19 patients. Data was primarily interpreted through the lens of symbolic interactionism, with additional support from bioethics, high reliability principles, professional socialisation and humanising care. As part of this study, a systematic review and meta-ethnography was completed and this generated a new conceptualisation that the contingencies of need, capacity, opportunity and quality of relationships underpin communication between therapists and nurses. This conceptualisation was applied to the SLT-nurse relationship through the ethnographic study.

The temporal-spatial context was found to create the conditions through which swallowing information was privileged over communication information, with little interdependence between SLT and nursing roles with patients with stroke-associated communication difficulties. Structured routes for sharing information on the units were less useful to nurses than SLTs, and relationships between SLTs and nurses were hard to build. Despite swallowing having a higher profile on stroke units, the temporal-spatial context introduced ambiguity to swallowing recommendations creating dilemmas for nurses associated with the intermittent presence of SLTs.

Improved sharing by SLTs and nurses of information they hold about how best to meet patients’ needs has the potential to benefit patient care.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RT Nursing
Departments:	Doctoral Theses School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses School of Health & Psychological Sciences > Language & Communication Science

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