A Metasynthesis of Patient-Provider Communication in Hospital for Patients with Severe Communication Disabilities: Informing New Translational Research

Figures & data

Figure 1. Search strategies and number of papers.

Table I. Summary of Type of Design, Method, Age-group and Type of Condition, Focus, and Participants in Included Studies.

Paper	Design	Method	Age-group and type of condition	Focus	Participants
Balandin et al. (2001)	Qualitative	Semi-structured interviews	Adults with acquired conditions	Experiences communicating in hospital	10 adults with acquired severe communication disabilities
Hemsley et al. (2001)	Qualitative	Semi-structured interviews	Adults with acquired or lifelong conditions	Experiences nursing the patient with severe communication disabilities	20 nurses working on a range of hospital wards (not intensive care units)
Buzio et al. (2002)	Quantitative	Survey	Adults with lifelong conditions	Experiences of care and communication and care in hospital	31 adults with cerebral palsy, including 23 with communication impairments (beyond hearing/vision impairment)
Hemsley & Balandin (2004)	Qualitative	Narrative inquiry	Adults with lifelong conditions	Experiences and needs of the older parents providing support to adults with communication disability	Six parents of five adults with cerebral palsy and severe communication disabilities
Balandin et al. (2007)	Qualitative	Semi-structured interviews	Adults with lifelong conditions	Experiences communicating in hospital	10 adults with cerebral palsy and severe communication disabilities
Hemsley et al. (2007a)	Qualitative	Narrative inquiry	Adults with lifelong conditions	Experiences and needs supporting adult son or daughter with communication disability in hospital	Eight parents of seven adults with cerebral palsy and severe communication disabilities
Bartlett et al. (2008)	Quantitative	Medical record chart review	Populations with communication problems of any kind or severity	Safety in hospital and risk for adverse events in patients with communication disabilities	2355 medical records for adults aged over 18 from 20 general hospitals
Hemsley et al. (2008a)	Qualitative	Focus groups	Adults with lifelong conditions	Views on support needs of family caregivers of adults with communication disabilities in hospital.	Six family carers (five parents and one sibling) of adults with cerebral palsy and severe communication disabilities.
Hemsley et al. (2008b)	Qualitative	Focus groups	Adults with lifelong conditions	Views on roles and needs of family carers of adults with communication disabilities in hospital	Six staff members (three disability service, three hospital setting) who had supported adults with severe communication disabilities in hospital.
Hemsley et al. (2008c)	Qualitative	Focus groups	Adults with lifelong conditions	Experiences of patients with communication disabilities in hospital; and views on roles of carers and what would improve experience	Six adults with cerebral palsy and severe communication disabilities
Gordon et al. (2009)	Qualitative	Observations, conversational analysis	Adults with acquired or lifelong conditions	Observations of communicative interactions of nursing staff and patients with aphasia or dysarthria in hospital	Five adult hospital patients with aphasia or dysarthria, and their nurse interactants
Hemsley et al. (2011a)	Qualitative	Narrative inquiry	Adults with lifelong conditions	Views on communication needs in hospital	15 adults with lifelong disabilities, 15 paid carers, 15 hospital nurses who had worked with patients with severe communication disabilities
Hemsley et al. (2011b)	Qualitative	Narrative inquiry	Adults with lifelong conditions	Views on the roles of paid carers in hospital supporting adults with lifelong communication disability	15 adults with lifelong disabilities, 15 paid carers, 15 hospital nurses who had worked with patients with severe communication disabilities
Hemsley et al. (2012)	Qualitative	Narrative inquiry	Adults with lifelong disabilities	Expressed concepts of time in stories about communication in hospital	15 hospital nurses who had worked with patients with severe communication disabilities
O’Halloran et al. (2011)	Qualitative	Observations	Adults with acquired conditions	Environmental factors affecting patients’ abilities to communicate in healthcare interactions on acute stroke wards	65 adults on a stroke ward with a range of communication impairments
Hemsley et al. (2013a)	Qualitative	Focus group	Children with lifelong conditions	Views and experiences of communicating in hospital	10 parents and 7 children with cerebral palsy and severe communication disabilities
Hemsley et al. (2013b)	Qualitative	Narrative inquiry	Adults with acquired conditions	Experiences of adverse events of patients with aphasia in hospital	10 spouses and/or adults with aphasia as main or co-informants to the interviews
Hemsley et al. (2014)	Qualitative	Focus groups	Children with lifelong conditions	Views and experiences on communication with children with cerebral palsy in hospital	49 participants included hospital nurses and allied health in hospital or disability services who had worked with or supported people with severe communication disabilities

Table II. Summary of Content Themes.

Paper	Develop services, systems and policies	Devote more time to communication	Ensure access to communication tools: Nurse call system	Ensure access to communication tools: Communication aids	Access personally held written health information	Collaborate effectively with carers, spouses, or parents	Increase the communicative competence of hospital staff
Balandin et al. (2001)	X	X	X	X		X	X
Hemsley et al. (2001)	X	X		X			X
Hemsley & Balandin (2004)	X	X	X	X	X	X	X
Balandin et al. (2007)		X	X	X	X		X
Hemsley et al. (2007a)	X			X		X	X
Hemsley et al. (2008a)	X	X			X	X	X
Hemsley et al. (2008b)	X			X		X	X
Hemsley et al. (2008c)	X	X	X	X	X	X	X
Gordon et al. (2009)	X						X
Hemsley et al. (2011a)			X	X			X
Hemsley et al. (2011b)	X				X	X	X
Hemsley et al. (2012)	X	X		X		X	X
O’Halloran et al. (2011)	X	X	X	X		X	X
Hemsley et al. (2013a)	X	X	X	X		X	X
Hemsley et al. (2013b)	X	X	X	X		X	X
Hemsley et al. (2014)		X	X	X		X	X

Note. X indicates a theme present in the included study.

Table III. A Summary of the Priorities for Further Research.

Priorities for further investigation	Authors
Research on the communicative environment of hospital wards	O’Halloran et al. (2011)
Social research on health systems, policies, and processes of care for patients with communication disabilities	Bartlett et al. (2008); Hemsley & Balandin (2004); Gordon et al. (2009); Hemsley et al. (2011b, 2012, 2014); O’Halloran et al., 2011
Patient safety research that includes patients with communication disabilities	Bartlett et al. (2008); Hemsley et al., (2013b)
Investigation of communicative interactions in hospital with patients with communication disabilities (including observations, interviews)	Balandin et al. (2007); Bartlett et al., (2008); Gordon et al. (2009); Hemsley et al. (2013b)
Evaluation of communication interventions in hospital settings.	Balandin et al. (2007); Gordon et al. (2009); Hemsley & Balandin (2004); Hemsley et al. (2001, 2007, 2008a, 2008b, 2011a, 2011b, 2013a, 2013b, 2014)
Investigation of the impact of implementing the strategies to improve hospital care and reduce the risk of adverse events	Bartlett et al. (2008); Hemsley & Balandin (2004); O’Halloran et al., (2011)
Hospital communication experiences, patient safety, and patient outcomes, discharge planning, and costs of care (including comparison to other patient groups)	Bartlett et al. (2008); Gordon et al. (2009); Hemsley et al. (2004, 2007, 2008, 2011a, 2013a, 2013b, 2014); O’Halloran et al. (2011)
Investigation of experiences of younger children with communication disabilities in hospital, and at transition to adult hospital services	Hemsley et al. (2013a, 2014)
Communication of health information by people with severe communication disabilities in hospital	Hemsley et al. (2011a, 2013a)
Ethnographic and observational research methodologies	Gordon et al. (2009); Hemsley et al., (2014, 2013b); O’Halloran et al., (2011)
Research with larger and more homogenous groups	Balandin et al. (2007); Gordon et al., (2009)
Investigation of caregiver mastery, and ways to improve the transfer of knowledge and expertise from the family carer to nursing staff	Hemsley & Balandin (2004); Hemsley et al. (2008a, 2008b, 2013b)
Investigation of the occupational health and safety research issues arising for family carers or community-based paid carers providing care and support in hospital	Hemsley et al. (2008a, 2011b)
Investigation of the impact of providing supports to family caregivers in hospital and the role of siblings in the care of adults with lifelong communication disabilities	Hemsley et al. (2008a)

Balandin, S., Hemsley, B., Sigafoos, J., Green, V., Forbes, R., Taylor, C., & Parmenter, T. (2001). Communicating with nurses: The experiences of 10 Individuals with an acquired severe communication impairment. Brain Impairment, 2, 109–118.

 Google Scholar

Hemsley, B., Sigafoos, J., Balandin, S., Forbes, R., Taylor, C., Green, V. A., & Parmenter, T. (2001). Nursing the patient with severe communication impairment. Journal of Advanced Nursing, 35, 827–835. doi: 10.1046/j.1365-2648.2001.01920.x

 PubMed Web of Science ®Google Scholar

Buzio, A., Morgan, J., & Mount, D. (2002). The exepriences of adults with cerebral palsy during periods of hospitalisation. Australian Journal of Advanced Nursing, 19, 8–14.

 PubMedGoogle Scholar

Hemsley, B., & Balandin, S. (2004). Without AAC: The stories of unpaid carers of adults with cerebral palsy and complex communication needs in hospital. Augmentative and Alternative Communication, 20, 243–258.

 Google Scholar

Balandin, S., Hemsley, B., Sigafoos, J., & Green, V. (2007). Communicating with nurses: The experiences of 10 adults with cerebral palsy and complex communication needs. Applied Nursing Research, 20, 56–62. doi: 10.1016/j.apnr.2006.03.001 p.61

 PubMed Web of Science ®Google Scholar

Hemsley, B., Balandin, S., & Togher, L. (2007a). Narrative analysis of the hospital experience for older parents of people who cannot speak. Journal of Aging Studies, 21, 239–254. doi: 10.1016/j.jaging.2006.12.001

 Web of Science ®Google Scholar

Bartlett, G., Blais, R., Tamblyn, R., Clermont, R. J., & MacGibbon, B. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association Journal, 178, 1555–1562. doi: 10.1503/cmaj.070690 p.1559

 PubMed Web of Science ®Google Scholar

Hemsley, B., Balandin, S., & Togher, L. (2008a). Family caregivers discuss roles and needs in supporting adults with cerebral palsy and complex communication needs in the hospital setting. Journal of Developmental and Physical Disabilities, 20, 257–274. doi: 10.1007/s10882-007-9095-z

 Web of Science ®Google Scholar

Hemsley, B., Balandin, S., & Togher, L. (2008b). Professionals’ views on the roles and needs of family carers of adults with cerebral palsy and complex communication needs in hospital. Journal of Intellectual & Developmental Disability, 33, 127–136. doi: 10.1080/13668250802082898

 PubMed Web of Science ®Google Scholar

Hemsley, B., Balandin, S., & Togher, L. (2008c). ‘We need to be the centrepiece’: Adults with cerebral palsy and complex communication needs discuss the roles and needs of family carers in hospital. Disability and Rehabilitation, 30, 1759–1771. doi: 10.1080/09638280701645474 p.1765

 PubMed Web of Science ®Google Scholar

Gordon, C., Ellis-Hill, C., & Ashburn, A. (2009). The use of conversational analysis: Nurse-patient interaction in communication disability after stroke. Journal of Advanced Nursing, 65, 544–553. doi: 10.1111/j.1365-2648.2008.04917.x p.552

 PubMed Web of Science ®Google Scholar

Hemsley, B., Balandin, S., & Worrall, L. (2011a). The “Big 5” and beyond: Nurses, paid carers, and adults with developmental disability discuss communication needs in hospital. Applied Nursing Research, 24, e51–58. doi: 10.1016/j.apnr.2010.09.001

 PubMedGoogle Scholar

Hemsley, B., Balandin, S., & Worrall, L. (2011b). Nursing the patient with developmental disability in hospital: Roles of paid carers. Qualitative Health Research, 21, 1632–1642. doi: 10.1177/1049732311415289

 PubMed Web of Science ®Google Scholar

Hemsley, B., Balandin, S., & Worrall, L. (2012). Nursing the patient with complex communication needs: Time as a barrier and a facilitator to successful communication in hospital. Journal of Advanced Nursing, 68, 116–126. doi: 10.1111/j.1365-2648.2011.05722.x pp.121, 116

 PubMed Web of Science ®Google Scholar

O’Halloran, R., Worrall, L., & Hickson, L. (2011). Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: An observational study. International Journal of Language & Communication Disorders, 46, 30–47. doi: 10.3109/1368282100 3660380 p. 38

 PubMed Web of Science ®Google Scholar

Hemsley, B., Kuek, M., Bastock, K., Scarinci, N., & Davidson, B. (2013a). Parents and children with cerebral palsy discuss communication needs in hospital. Developmental Neurorehabilitation, 16, 363–374.

 PubMed Web of Science ®Google Scholar

Hemsley, B., Werninck, M., & Worrall, L. (2013b). “That really shouldn't have happened”: People with aphasia and their spouses narrate adverse events in hospital. Aphasiology, 27, 706–722. doi: 10.1080/02687038.2012.748181

 Web of Science ®Google Scholar

Hemsley, B., Lee, S., Munro, K., Seedat, N., Bastock, K., & Davidson, B. (2014). Views of allied health and nursing staff on communication with children with cerebral palsy and complex communication needs in hospital. Developmental Neurorehabilitation, 17, 156–66. doi:10.3109/17518423.2012.741149

 PubMed Web of Science ®Google Scholar