Effective Communication with Developmental Disability Patients - Research Proposal Example

Communicating Effectively with Patients with Developmental Disabilities: Literature Review Introduction: Good communication plays a pivotal role in the success or otherwise of implementing care plans in people with developmental disabilities. Poor communication between the client, professionals involved, family and other carers, on the contrary, may result in unnecessary stress and the withdrawal of important key individuals from care planning at a later stage (McNaughton et al., 2008, 223-231). Developmental disabilities are characterized by a biologically based abnormal development, a tendency to fixations and preoccupations, and a range of communication abnormalities that may negatively impact social communications of these individuals. Problems with eye contact, facial expression, and other aspects of nonverbal communication are often present. The tone and pitch of the voice may also be different. (Adams et al., 2006, 41-65). Moreover, many of these patients have associated psychiatric disorders, the effective management of which solely depends on development of a partnership between the caregiving nurse and the patient. Any successful partnership between two parties would need communication between the two parties, and an effective communication from the nurse to the patient becomes essential to determine the care needs (Cooray and Bakala, 2005, 355-361).. However, there is a paucity of literature in this area, and therefore evidence base is limited. Despite this limitation, there are quite a few studies highlight the detrimental effects of poor communication in the care outcome of people with developmental abnormalities. To this end, a literature review is conducted, the findings of which have been presented below with a critical analysis as to how it could impact nursing practice in this area. Strategies for Literature Search: For the purpose of the review of literature to support the rationale, need, and continuation of the project, the author conducted an exhaustive literature search. Electronic databases accessed for information included: CINHAL, Medline, Pubmed, and HighWire Press along with the Google Scholar internet search engine. The key words in the search included: Learning disability, intellectual disability, developmental disabilities, pervasive disorders, communication, nursing communication, effective communication, care, effective communication strategies, along and in different combinations. Inclusion criteria for each article reviewed were answers to the following questions: 1. Was the article a valid research article? 2. Did the article’s study include effective communication with patients with developmental disabilities applied to nursing practice? 3. Was the article published within the past 6 years? 4. Did the article have some identification with nursing care strategies applicable to and the care needs of the individuals with developmental disabilities? Each article must answer “yes” to all of these four questions. Based on these criteria, out of about 32 initial articles, only 7 fit the criteria described above. In this critical review article paper, this author intends to present only the very relevant of the article reviews that provide a strong supportive basis for the nursing care delivery needs and the strategies in communication that the nurses can effectively use in practice. The four of them have been chosen from the final seven articles. Allowed to continue, the final presentation will include an exhaustive review of literature, but a conclusion has been derived from the available literature and a critical analysis that can help nursing practice in this area. Review of Literature: For example, the study by Healy and Walsh indicated that staff nurses do not always adopt the requisite and optimal strategies in day-to-day interactions with these individuals, who do not know how to use verbal communication skills and who use typically nonverbal communications. This indicates that either there is a lapse in usage of strategically positioned communication skills on the part of nurses, or they are ill-trained to use appropriate and suitable communication strategies in these patients. It is unfortunate to note in this study that most of the staff nurses failed to adjust their languages to meet the needs of these special service users, and the authors have rightly recommended that the nurses should undergo continuing educations in communications (Healy and Walsh, 2007, 127-141). Following the cue from this study, it would be worthwhile to examine more current evidence from literature about how effective communication strategies on the part of nurses can facilitate care of the individuals with developmental disabilities. Lawthers and colleagues, in their article, "Rethinking quality in the context of persons with disability" present their findings from investigations from the review of the current literature on health services related to the quality of care for persons with disabilities, and if evidence is available, it can be utilized to develop a unique framework to cater the needs of this population during care delivery. The authors include people with developmental disabilities in this group which also include subjects with sensory disorders and people with disorders associated with communication difficulties. In this subgroup of population, word identification and communication needs are very prominent. The authors have reviewed literature and have presented their findings and stated that according to some estimates, at least a quarter of all children with developmental disabilities fail to develop meaningful speech. Speech in these people is often delayed, and those who eventually speak, show a variety of abnormalities both in the form as well as in the content of speech. They are also known to have problems in several forms of nonverbal communications. As a result, these people are often dependent on others for custodial care and decisions about their healthcare. Therefore, the authors argue that "the challenge of the healthcare system is to deliver services to people with disabilities that are appropriate, efficient, effective, and coordinated in such a way that the unique needs of each member" of this group of population are met. The authors treat this issue through a model of quality approach specifically developed for these people. In order to do that, the authors first established the concept of quality and its frameworks and the modes in which these can be implemented in practice. The authors quote the US Institute of Medicine definition of quality of care which is now widely used. That which is significant to this assignment is the "degree to which the health services of individuals increase the likelihood of desired health outcomes and are consistent with the current professional knowledge." The factors which are associated with the quality of individual experience about healthcare are communication, information, respect for patient preferences, shared decision making, and these would indicate the domains of psychosocial aspects of medical care. The authors performed a meta-analytic review of the available literature on a broad base so many studies worldwide can be included that focus on the care quality issues of the people with disability in different categories. This is a very vast study that examines very many different areas of care. The two most important relevant areas that came out through this review are provider knowledge and effective patient provider communication. This review suggests that although the problems and variety of situations are considerably complex, it is unlikely that single provider would be able to possess all knowledge, in most of the cases, patients and their families are frustrated when they perceive their healthcare providers to be lacking expertise about their disabilities. They quote some studies, and they mostly note that care providers did not have information about most recent treatment advances and types of available assistive strategies. The second major area of concern was effective provider-patient communication. There has been a multitude of studies that highlight the significant communication barriers between the providers and the recipients with disabilities. The difficulties in communication have been categorized to be difficulties with basic communications, difficulty understanding the patients issues and problems and therefore increasing the use of testing, difficulty promptly recognising the appearance of a new health problem or probing for the adverse effects of administered medications. Since there is no effective communication, there will be erroneous inferences, and the problem gets more accentuated on the face of the intellectual disabilities of the patients, since the patient has difficulty communicating. For the patient, these can have very adverse clinical consequences. These may be due to misunderstanding between the nurse and the patient leading to poor adherence to treatment regimen and hence suboptimal outcomes of care (Lawthers et al., 2003, 287-299). Impairment of communication is one of the three main symptoms of autistic spectrum disorders. A range of communication abnormalities occur in persons with autism spectrum disorders, ranging from a failure to develop any functional speech in about 30–50 per cent of cases to almost normal but idiosyncratic and pragmatically impaired speech in others. While the degree of impairment varies, problems in the social use of language are present in all cases. This becomes very important in clinical practice. Samuel et al. in their study "An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities" highlight the importance of intensive interaction as an approach that is designed to enhance the deficiency of communication and societal abilities of the people with intellectual disabilities. They had used the principles of caregiver-infant interaction. They evaluated the use of this approach by inexperienced practitioners on four women with profound intellectual disabilities who lived in a supported housing service. This was executed during 5 sessions per week over 20 weeks, and they hypothesized that staff could learn the methods and principles of intensive interaction sufficiently, and they examined the impacts of these interventions on the subjects and also expected that the staff would experience a positive impact on these relationships. The methodology design that was employed was quasi-experimental interrupted time-series multiple-baseline design which was a semi-quantitative design with data being collected through video observations, assessment, schedules, and staff questionnaire interviews. As a result of this, when the data were analyzed, the practitioners did learn how to use mirroring and contingent responding. Moreover, their abilities to look at faces and to become engaged in interaction to lead to joint focus also developed. However, this study had limitations of demonstrating less volume of evidence from the video of interactions in relation to improved quality of relationship. From the implementation point of view, it was difficult to embed practitioner reflection on interactions. This study indicates that if appropriately trained nurses are able to execute intensive interaction as a method of communication (Samuel et al., 2008, 11-26). The goal, when working with nonverbal autistic children, is to facilitate meaningful spontaneous verbalizations across different settings. Voepel-Lewis and colleagues raise an important issue of understanding the physical complaints of these patients, and effective communications are very important and serious issues related to that. The issue becomes further complicated when the patient is a child. Pain assessment remains a very difficult problem in these children. The authors have validated and examined the reliability of a tool named Face, Legs, Activity, Cry, Consolability (FLACC) tool for pain assessment in these subjects, and this study becomes important since similar patients pose problem in practice for the nurses. The subjects of this study were all having development or intellectual disabilities with difficulty in communication. To begin with each participating childs developmental level and ability to self-report pain were assessed. At the same time, the nurse providing care assessed the pain with the FLACC tool, before and after the administration of an analgesic agent. Parents of these children also scored the pain with a visual analogue scale, and the scores were also recorded from the children who could report it of their own. All the observations were recorded through video camera, and utilizing a double-blind strategy the nurses were later allowed to view these videos, and these were the nurses who were unaware about the analgesics and pain scores. This was a quasi-experimental design with analysis of observations. Although the authors accept the limiting role of behavioural cues to suggest physical ailments, this tool was determined to be a valid tool in clinical practice to assess pain complaints when the patients cannot verbalize pain (Voepel-Lewis et al., 2002, 1224-1229). Implications to Nursing: Autistic people have unique ways of communicating and interacting that are rooted in their unique ways of thinking and experiencing the world. Those communicating with autistic people have to change the way they themselves communicate in order to help a person understand and communicate. The interaction style that the caregiver uses with each particular person depends on their perceptual and communication profile (Hanser and Erickson, 2007, 268-278). However, this literature review indicates that nurses knowledge on the specific defects and special ways to communicate are poor, and those often act as barriers for effective care. Further studies have indicated that if appropriate training is provided, nurses are able to understand, communicate, and can even build trust and relationship with people with developmental disabilities. Moreover, in another study, there are tools available that can assess nonverbalised physical complaints with considerable validity and reliability. Therefore, it is worthwhile to conclude that nurses academic curriculum must include teaching about communication strategies and the science of it in order for them to be able to practice in this area (Broussard, 2007, 322-328). Conclusion: As medicine and nursing science are improving, more and more patients of developmental disability may need to be cared for by nurses even in the emergency setting (Bradley and Lofchy, 2005, 45-57) or medical surgical wards, and such a framework of training and implementation could be mandatory for all nurses to complete for facilitating standard and quality care. This literature review is rudimentary and studies and less in this area, so this can be extended to a full-fledged research covering details of practice and the science of communication. References Adams, C., Lloyd, J., Aldred, C., and Baxendale, J., (2006). Exploring the effects of communication intervention for developmental pragmatic language impairments: a signal-generation study. International Journal of Language and Communication Disorder.;41(1):41-65. Broussard, L., (2007). Empowerment in School Nursing Practice: A Grounded Theory Approach. The Journal of School Nursing; 23: 322 - 328. Bradley, E. and Lofchy, J., (2005). Learning disability in the accident and emergency department. Advanced Psychiatric Treatment; 11: 45 - 57. Cooray, SE and Bakala, A., (2005). Anxiety disorders in people with learning disabilities. Advanced Psychiatric Treatment]; 11: 355 - 361. Hanser, GA and Erickson, KA., (2007). Integrated Word Identification and Communication Instruction for Students With Complex Communication Needs: Preliminary Results. Focus on Autism and Other Developmental Disabilities; 22: 268 - 278. Healy, D. and Walsh, NP., (2007). Communication among nurses and adults with severe and profound intellectual disabilities: Predicted and observed strategies. Journal of Intellectual Disability; 11: 127 - 141. Lawthers, AG., Pransky, GS., Peterson, LE., and Himmelstein, JH., (2003). Rethinking quality in the context of persons with disability. International Journal of Quality in Health Care, Aug 2003; 15: 287 - 299. Samuel J, Nind M, Volans A, and Scriven I., (2008). An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities. Journal of Intellectual Disability; 12(2):111-26. Voepel-Lewis, T., Merkel, S., Tait, AR., Trzcinka, A., and Malviya, S., (2002).The Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Observational Tool as a Measure of Pain in Children with Cognitive Impairment. Anesthesia Analgesia.; 95: 1224 - 1229. McNaughton, D., Hamlin, D., McCarthy, J., Head-Reeves, D., and Schreiner, M., (2008). Learning to Listen: Teaching an Active Listening Strategy to Preservice Education Professionals. Topics in Early Childhood Special Education; 27: 223 - 231. Read More