Abstract
Background: Discharging clients with long-term aphasia from therapy services constitutes a challenging dilemma for practising clinicians for a multitude of reasons. Although discharge was raised and discussed as a contentious issue in the field of aphasiology ten years ago, it remains an aspect of practice which is complex and underexplored. We are only a little more enlightened now than then on how to address this issue in relation to professional education and practice.
Aims: This paper draws on a single case study of a man with aphasia, his wife, and treating clinician, taken from a substantial research study, to highlight awareness of how communication, choice and differing perceptions of goals of therapy influence the experience of the discharge process. The case serves as the context for addressing a gap in the university curriculum around teaching about discharge practice in the context of long-term aphasia.
Methods & Procedures: This paper describes how university and practice educators could include discharge issues in students' learning by teaching discharge in context, addressing it in formal university lessons as well as through work-based learning opportunities in clinical placements, and by scaffolding learning using graduated learning outcomes over the different stages of the students' programme.
Main contribution: This paper provides practical suggestions to guide the inclusion of discharge in teaching about communication disorders generally, and specifically in relation to long-term aphasia. Discharge needs to be appreciated within the context of the entire intervention process, with good practice modelled in both university and workplace settings. We propose that it is learned in association with stages of decision-making, duty of care, documentation, goal setting, continuous therapy evaluation, clinical reasoning, professional communication with clients, ethical behaviour, and evidence-based practice.
Conclusions & Implications: Bringing discharge practice from the realm of implicit knowledge to one that can be examined and discussed in an explicit manner should help reduce anxieties about discharge for new clinicians, help to clarify and improve the discharge approaches used by clinicians and lead to better discharge experiences for clients.
Acknowledgements
The authors would like acknowledge the following people with whom they have had open and to helpful discussions about discharge in practice and education: Professor Linda Worrall (University of Queensland), Associate Professor Annette Braunack-Mayer (University of Adelaide), Tom Penman (Principal Therapist, Neurological Pathway, Lambeth Primary Care Trust, London, UK), Dr Emma Fitzpatrick (City University Clinical Tutor and Independent Practitioner), and Dr Sue McAllister (University of Sydney). Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Notes
1. Through the course of this research, the first author spoke to many speech pathologists and teachers about their training experiences at conferences around Australia and the UK. Discharge issues were reported as only briefly mentioned, if covered at all. Discharge has rarely been addressed within continuing education or professional development programmes.