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Managing ongoing swallow safety through information-sharing: an ethnography of speech and language therapists and nurses at work on stroke units

Barnard, R. A. ORCID: 0000-0003-4319-9550, Cruice, M. ORCID: 0000-0001-7344-2262 & Jones, J. (2022). Managing ongoing swallow safety through information-sharing: an ethnography of speech and language therapists and nurses at work on stroke units. International Journal of Language and Communication Disorders,

Abstract

Aims To generate new understanding for how speech and language therapists and nurses share information for ongoing management of swallow safety on stroke units.

Design: Ethnographic methodology, involving 40 weeks of fieldwork on three stroke wards in England between 2015 and 2017.

Methods: Fieldwork observation (357h) and interviews with 43 members of speech and language therapy (SLT) and nursing staff. Observational and interview data were analysed iteratively using techniques from the constant comparative method to create a thematically organised explanation.

Results: An explanation for how disciplinary differences in time and space influenced how SLT and nursing staff shared information for ongoing management of swallow safety, based around three themes: (1) SLTs and nurses were aligned in concern for swallow safety across all information sharing routes, however (2) ambiguity was introduced by the need for the information contained in swallowing recommendations to travel across time, creating dilemmas for nurses. Patients could improve or deteriorate after recommendations were made and nurses had competing demands on their time. Ambiguity had consequences for (3) critical incident reporting and relationships. SLTs experienced dilemmas over how to act when recommendations were not followed.

Conclusion: This study provides new understanding for patient safety dilemmas associated with the enactment and oversight of swallowing recommendations in context, on stroke wards. Findings can support SLTs and nurses to explore together how information for ongoing dysphagia management can be safely implemented within ward realities and kept up to date. This could include considering nursing capacity to act when SLTs are not there, mealtime staffing, and SLT seven-day working. Together they can review their understanding of risk and preferred local and formal routes for learning from it.

Publication Type: Article
Additional Information: This is the peer reviewed version of the following article: Barnard, R. A. , Cruice, M. & Jones, J. (2022). Managing ongoing swallow safety through information-sharing: an ethnography of speech and language therapists and nurses at work on stroke units. International Journal of Language and Communication Disorders, which is to be published in final form at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1460-6984. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Subjects: P Language and Literature > P Philology. Linguistics
R Medicine > RC Internal medicine
Departments: School of Health Sciences > Language & Communication Science
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