I. C. U. I Hear U? The patient experience of being voiceless in the ICU

Gabrielle Salisbury-baker1

1St George Hospital, South Eastern Sydney Local Health District, Kogarah, Australia

Background: Patients requiring prolonged mechanical ventilation and tracheostomy within the ICU setting regularly experience a period of voicelessness. The psychosocial effects of voicelessness are well documented, with high levels of frustration, anxiety, and depression reported.

Method: A quality improvement project was initiated within an urban, tertiary level hospital to explore the consumer experience of being voiceless in the ICU. Secondary aims were to determine staff communication-training needs, and to guide development of a communication tool that meets the needs of our consumers. A survey or semi-structured interview was completed with ICU staff, and patients who experienced a period of voiceless following intubation and/or tracheostomy.

Results: 15 patients and 32 ICU staff from medical, nursing, and allied health backgrounds completed this survey. 87% of patients indicated communication was inadequate, and 80% did not feel included in care decisions. All emotions described by patients were negative, with common themes of isolation, frustration and fear reported. 66% of ICU staff “frequently” experience difficulty communicating with voiceless patients. Staff reported that patients most want to communicate care needs (e.g. toilet, water, pain), whereas patients most wanted to request information on medical status and management (e.g. “how is my treatment going?”).

Discussion: Voicelessness is a distressing and isolating experience for ICU patients. ICU staff should prioritise the facilitation of successful communication for voiceless patients, and be aware of their need for information on their medical status and management. Results of this survey reveal a discrepancy between what ICU staff and patients feel is important to communicate. For this reason, consumer engagement is essential when developing services and resources that meet the needs of its service users. As a communication tool that encompassed our consumers’ preferences was unable to be located, this tool has been developed for use within our facility.


Biography:

Gabrielle is a senior speech pathologist working in the areas of intensive care and trauma at St George Hospital. She has a special interest in tracheostomy, traumatic brain injury, and alternative and augmentative communication within the critical care setting.

Co-production & consumer co-investigators in Allied Health research – Initial explorations in Gold Coast Health

Dr Kelly Weir1,2, Dr  Shelley  Roberts1,2, Mrs Kylie Gill2, Mrs Zara Howard2,3, Mrs Heidi Townsend4, Mrs Jane  Standen4, Mrs Michelle Drienne4, Professor Sharon Mickan1,2

1Menzies Health Institute Qld & Allied Health Sciences, Griffith University , Gold Coast Campus, Southport, Australia, 2Allied Health Clinical Governance, Education & Research, Gold Coast Health, Southport, Australia, 3Physiotherapy Department, Gold Coast Health, Southport, Australia, 4Consumer Coinvestigator, Gold Coast Health, Southport, Australia

Background/Objectives: Coproduction in research is the inclusion of patient and public involvement to provide a unique ‘insider perspective’ across the research cycle. This aids generation of different ideas and solutions, and value-adds to the health researcher and health service perspectives. Key factors for successful coproduction include early involvement of consumer research partners in the pre-development stage including scientific design, ethics and grant applications; early identification of team strengths/expertise; regular team communication; a flexible and pragmatic approach to research design; shared decision making, responsibility and power sharing; and providing support to each other. Thus, research coproduction may produce higher quality research with greater relevance to patients, potentially increasing effectiveness of interventions, evidence uptake and reducing research wastage. This presentation explores coproduction and the use of consumer coinvestigators in allied health research, and presents initial experiences of coproduction at Gold Coast Health.

Methods: A comprehensive scoping review investigating research coproduction and use of consumer coinvestigators in allied health research in hospital and healthcare settings was undertaken. Variables of interest included coproduction across phases of the research cycle (concept development to publication/dissemination), patient populations, allied health professions, perceived impact on clinical/patient outcomes and research team perspectives of coproduction.

Results: Findings of the scoping review and two case studies will be presented. The first case study describes participation of a consumer co-investigator in a research team investigating the development and implementation of a multi-component exercise and dietary intervention for women who are overweight/obese, and experiencing urinary incontinence. The second case study explores coproduction in research exploring carer and staff perceptions of palliative care services to children within Gold Coast Health.

Conclusion: Consumer coinvestigators and coproduction widens research team perspectives and enhances relevance of allied health research to patient care.


Biography:

Dr Kelly Weir is a Conjoint Principal Research Fellow (Allied Health) at Griffith University & Gold Coast Health, Queensland Australia. She is a certified practicing speech pathologist with over 29 years clinical experience, predominantly in tertiary state-wide paediatric and adult hospitals. Kelly researches in the area of paediatric dysphagia, management of medically fragile infants and children in intensive care and acute care settings; and building research capacity in allied health professionals at Gold Coast Health. Kelly lectures at Griffith University, is an international speaker and has over 56 peer reviewed journal publications.

Young people with complex trauma – keeping them Connected when they “just want to be at the beach”

Ms Kate Headley1, Ms Sophie Phillips1, Ms Kelsey Stalker1

1LINKS Trauma Healing Service, Family And Community Services NSW, Charlestown, Australia

In October 2017 the LINKS Trauma Healing Service commenced a 3 year pilot study offering multidisciplinary trauma treatment for children living in Out Of Home Care (OOHC) in NSW. The service delivers a range of evidence-based trauma interventions combined with allied health services, for children aged 16 and under living in OOHC.

Occupational Therapy and Speech Pathology services have focused on improving quality of life outcomes for young people through consumer-centred goal prioritisation, discipline-specific screening, connecting young people with service providers and strengthening caregiver capacity. Difficulties engaging in education, community activities and social networks have been identified as themes through clinical work.

In late 2018 the team identified the risk of young people disengaging with therapeutic services during the holiday period. This concern coincided with the allied health priorities of increasing engagement in meaningful activities, to promote health, wellbeing and connection with community. An allied health, carer and client-driven initiative enabled young people to participate in a range of leisure activities across the summer including Trauma Sensitive Yoga, Graffiti Art, Soccer, Creative Space, Rugby League and Surf Therapy.

Consumers self-reported therapeutic benefits of engaging in meaningful occupation within a social environment. Activities supported generalisation of skills targeted in psychological therapy, connection with peers and promoted interest in engaging with the external service providers, supporting sustainable relationships.

This presentation will outline the critical and practical considerations for development of a consumer-driven meaningful activities program. The qualitative therapeutic outcomes will be discussed and showcased through feedback provided by young people engaged in the program. The Occupational Therapists and Speech Pathologist will share their reflections of therapeutic benefits, the impact of consumer engagement and future considerations.


Biography:

Kate Headley

Since graduating as a speech pathologist in 2001, Kate has been passionate about working with vulnerable populations. Kate has worked extensively in the disability sector delivering direct therapeutic interventions, clinical supervision, community capacity building projects and student education. Kate’s work across Western NSW has helped her develop her knowledge of the unique challenges faced by allied health providers living in rural and remote communities. Kate is a certified Key Word Sign presenter and a trainer in Inclusive Communication and Behaviour Support. Kate currently works as part of a multidisciplinary team providing trauma treatment to children living in Out of Home Care.

Kelsey Stalker

Kelsey grew up and studied Occupational Therapy in New Zealand. She graduated in 2011 and worked in CAMHS in Auckland for 8 years. During this time Kelsey discovered two areas she is highly passionate about, Dialectical Behaviour Therapy and Outreach work. She is highly motivated to increase access to healthcare for vulnerable populations within a sustainable, community based and culturally appropriate framework. In 2018 she moved to Newcastle NSW, and began working with the LINKS Trauma Healing Service. Here she is relishing the opportunity to combine evidence based practice with Occupational Therapy in the role of Mental Health Clinician.

Sophie Phillips

Sophie’s interest working with disadvantaged communities commenced with university placements in primary health care, mental health rehabilitation and paediatrics. Her career commenced as an occupational therapist in forensic mental health in Melbourne.  She then worked as a family therapist in the areas of child protection and disability. After having three children, she returned to occupational therapy in acute mental health. Her current position as an occupational therapist with the LINKS Trauma Healing Service aligns with her values of family centred practice, community based service delivery and working within a multi-disciplinary framework to improve the wellbeing of young people in out of home care.

Is “Rehab Vision” and effective tool to improve patient knowledge and understanding of inpatient rehabilitation?

Miss Kylie Draper1,2, Professor David Greenfield2, Doctor Indu Nair1

1Sydney Local Health District, , Australia, 2The University of Tasmania, , Australia

BACKGROUND: Inter-hospital transfers facilitate optimal continuity of care however, no standardised education existed within our acute-care and rehabilitation facilities. Patient feedback identified a gap in service delivery indicating a lack of information provided prior to hospital transfer resulting in a negative association to experience and recovery.

METHODS: A quantitative randomised case-controlled study was conducted at a quaternary acute-care hospital for patients identified for inpatient rehabilitation at a secondary facility. “Rehab Vision” was developed by staff with consumer engagement: a seven-minute educational video portraying the rehabilitation hospital. Participants included adult inpatients (18-100years) referred for inpatient rehabilitation. Those with cognitive impairment or inability to comprehend English were excluded. All participants completed a baseline questionnaire evaluating their understanding of the inpatient rehabilitation process. Participants in the treatment group were shown “Rehab Vision” and completed a post-video questionnaire.

RESULTS: Twenty-one patients (10 male; 11 female) (8 treatment; 12 control; 1 did not consent) were eligible to participate. The majority (40%) were admitted from an orthopaedic ward, corresponding with the finding of orthopaedic conditions as the primary diagnosis for 52% of participants. The mean age for all participants was 71years (range 84-27years). Mean age for the treatment group was 73years (range 64-52years). Improvements in patient knowledge and understanding were observed across all questions following the provision of “Rehab Vision”. Furthermore, following the provision of “Rehab Vision” a statistically significant improvement was identified for participant reaction (p=.001) and knowledge of rehabilitation (p=.003), with all patients reporting an overall positive response. Findings confirmed the positive impact of adequate education to utilise patient engagement along with the benefits of standardised communication to improve handover.

CONCLUSION: “Rehab Vision” is an effective tool to improve patient knowledge and understanding of inpatient rehabilitation. As a result, “Rehab Vision” will be implemented as part of standardised care and widely distributed to staff and consumers.

ACKNOWLEDGEMENTS: Sandeep Gupta, Kiel Harvey, Jane Linton, Michael Morris and John Sheehy.


Biography:

Kylie is a speech pathologist currently working at Balmain Hospital within rehabilitation and sub-acute aged care. Kylie also has a variety of clinical experience in acute and outpatient settings. She has additionally been involved in clinical supervision and training of both undergraduate and post graduate speech pathology students. Kylie has completed a Bachelor of Health Sciences (Hearing and Speech) at The University of Sydney and Bachelor of Health Sciences (Speech Pathology) at Charles Sturt University. She was also successful in receiving a Sydney Local Health District Scholarship to complete a Masters of Health Service Management through The University of Tasmania.

Promoting men-inclusive maternity services at Royal Brisbane & Women’s Hospital

Dr Gai Harrison1, Ms Kristy Fitzgerald1

1RBWH, Herston, Australia

Background: There is growing recognition of the importance of men’s inclusion in antenatal care and childbirth to optimise outcomes for maternal and newborn health. However, programs aimed at involving fathers tend to focus on how men can best support their partners rather than addressing their own expectations and needs. Fathers commonly report feeling excluded or marginalised during antenatal appointments and childbirth. This exploratory study, led by social workers, was undertaken to generate data to inform a plan for promoting men-inclusive maternity services at Royal Brisbane and Women’s Hospital.

Method: An environmental audit tool was developed to examine visual depictions of men in maternity services. The audit was administered by two social workers who documented and photographed posters, pamphlets, art work and signage on display. Qualitative analysis was used to elicit the dominant images of men portrayed in this data.

Results: The audit revealed that men are not often visually represented and when they are it is predominantly as supports for their partners or perpetrators of violence (e.g. domestic violence posters).  Visual materials focusing on fathers’ needs and experiences as men were scarce. Signage similarly omitted reference to men.

Discussion: The limited visual depictions of men coupled with their negative portrayal in domestic violence literature may deter men’s attendance at maternity services. Although men were positively portrayed as support persons, these representations may promote the idea that their own needs are secondary to their partners and that they are not entitled to health professionals’ support. Future research will build on these findings by eliciting men’s perceptions of the environment of maternity services and whether they experience a sense of inclusion while attending services. The findings will inform a plan for cultural change to enhance men’s sense of inclusion in maternity services.


Biography:

Kristy has 16 years of social work experience in hospital and health settings and is currently the team leader of the Maternity and Neonatology Social Work Team at the Royal Brisbane and Women’s Hospital. Kristy’s particular interest is in the area of surrogacy, with other research interests including projects to promote men-inclusive maternity services.

The feedback tree: A novel way of engaging staff and consumers to provide feedback on hospital foodservices

Margot Leeson-smith1, Christine Eadeh1, Claire  Dux1, Adrienne  Young1

1Royal Brisbane And Women’s Hospital, Herston, Australia

Australian healthcare standards require that consumers are engaged in evaluating and improving service delivery. In dietetics and foodservices, this is traditionally done using validated satisfaction questionnaires. Informal qualitative feedback often provides rich data that may not be captured in standard questionnaires. This project aimed to trial a novel way of collecting consumer and staff feedback in a large metropolitan hospital. Inpatients and staff from 5 acute wards were invited to provide written feedback or suggestions on pictures of apples. These were placed on The Feedback Tree, which was on each ward for at least one month (January-May 2018). The question “How can we improve our foodservice?” was used to prompt feedback.  Responses were collated separately for patients and staff, and categorised into domains (quality, variety, availability, service). Sixty-one “apples” were placed on the tree (38 patients, 23 staff). Patients mostly provided feedback on food quality (n=16, 67% positive), followed by variety (n=13, all suggestions to improve variety) and service (n=13, 50% positive, negative comments mostly related to menu ordering issues). Staff feedback was primarily related to lack of availability of late/missed meal options (n=7) and variety (n=5), and highlighted the problem of poor communication back to staff about foodservices improvements. The Feedback Tree was a visible and engaging way of obtaining feedback. While it did not unearth new information, it confirmed the importance of current and planned improvement initiatives (vending machine for outside hours meals, expanded snack options) and highlighted the need to improve how we close the feedback loop and communicate changes to consumers and staff (new “you said, we did” foodservices communication strategy for staff).


Biography: 

Margot Leeson-Smith is a Dietitian at the Royal Brisbane and Women’s Hospital / Central West Hospital and Health Service

What mapping perinatal education tells us about the needs of expectant and new parents and the multidisciplinary team that provides this education?

Ms Sheridan Guyatt1,3, Dr Shelley Wilkinson1,2, Associate Professor Michael  Beckmann1,2, Dr  Brianna Fjeldsoe3

1Mater Health, South Brisbane, Australia, 2Mater Research, South Brisbane, Australia, 3University of Queensland, St Lucia, Australia

Background: Perinatal education (PNE) is an expected part of antenatal care. Health care providers (HCP) set PNE content which currently does not influence pregnancy outcomes or align with attendees’ expectations. Mapping PNE allows understanding of what is currently provided for women and their partners, how they use these services, the strengths, gaps, weaknesses and opportunities for change.

Aim: To understand the needs of expectant and new parents by systematically mapping PNE at the Mater Mothers Hospitals (MMH), Brisbane.

Method: Survey of MMH HCP delivering PNE (Aug-Oct 2018) on the content, format and reach (attendance rates).

Analysis: Qualitative analysis including comparing published guidelines with MMH PNE.

Key Findings: There were14 unique PNE offerings delivered by eight different health professionals from a mix of allied health and nursing disciplines with no pharmacy or medical staff involvement. Interdisciplinary co-facilitation, ‘peer teaching’, engaging support people and ‘learning through doing’ were underutilised and education outcomes are not consistently measured.

Attendance was poor with the most popular being the inpatient breastfeeding class (37.4%). Only 19.1% and 17.5% attended the two most popular outpatient session and the remaining 11 PNE sessions attended by less than 5.5% of women. PNE participation rates were concentrated around the last trimester of pregnancy and the inpatient postnatal period compared to women’s known information seeking behaviours in early pregnancy and post discharge. Collectively there is good coverage of the recommended content of PNE but when considered alongside attendance rates there is little attention given to psychological preparation for parenthood.

Discussion: The MMH provides a diverse range of PNE across the perinatal period. Participation and continuity between different PNE is poor. This data provides insight into the need of expectant and new parents and allows for assessment of gaps in current PNE to inform the interdisciplinary co-creation of an evidence based, outcome focussed perinatal education program.


Biography:

Sheridan is a Physiotherapist with over 25 years’ experience working with pregnant and postnatal women in both public and private settings here in Queensland and also in Tasmania. She is currently the Team Leader for the Mothers, Women’s and Pelvic Health Physiotherapy Team at the Mater Mothers Hospital, South Brisbane where over 10 000 babies are born each year. Sheridan is completing a PhD through the Faculty of Medicine, University of Queensland. She is passionate about interdisciplinary practise, effective patient communication and how together we can achieve great outcomes for expectant and new parents.

Developing a New approach for Effective, Systematic, Timely and INteGrated (NESTING) pregnancy, birth and early parenting education program starts with consumer engagement

Ms Sheridan Guyatt1,2, Dr Shelley  Wilkinson1,3, Dr Brianna Fjeldsoe2, Associate Professor Michael  Beckmann1,3

1Mater Health, South Brisbane, Australia, 2University of Queensland, St Lucia, Australia, 3Mater Research, South Brisbane, Australia

Perinatal education (PNE) is an expected part of perinatal care for both expectant parents and health care providers (HCP). Currently, the content of education provided to expectant and new parents is set by HCP, has not been shown to influence pregnancy and childbirth outcomes and is misaligned with the expectations of expectant and new parents.1

Current literature indicates that expectant and new parents want consistent, timely education from a multidisciplinary team delivered throughout the perinatal period.  Expectant and new parents want PNE promoting health and wellness including physical and mental health, emotional, relationship, breastfeeding and parenting skills. Parents value practical skill development, learning from their peers, effective use of digital media and the opportunity to individualise their PNE program. An evidence-practice gap exists.

The educational needs of expectant and new parents and health care providers at the Mater Mothers Hospital were investigated between February and June 2019 with three complementary methodologies.

  1. Survey of women on their educational preferences, knowledge and skills at different points of their perinatal journey.
  2. Interviews with women and their partners to determine the elements required for effective engagement with PNE.
  3. Focus groups of HCP to identify the barriers and enablers to delivering this education.

This research investigates how the evidence-practice gap can be addressed through including consumers to gain a deeper understanding of their content, format and context needs and the gaps identified by HCP in their own skillset to meet these needs. This is formative work in developing the interdisciplinary NESTING PNE program aimed at influencing perinatal outcomes.

Developing an effective PNE requires engagement with expectant and new parents and health care providers to determine their needs. This needs assessment will inform the interdisciplinary co-creation of an evidence based, outcome focussed perinatal education program aimed at influencing perinatal outcomes.

  1. Smith R, Homer C. Literature review on antenatal education – Content and delivery. Sydney: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney; 2017.

Biography:

Sheridan is a Physiotherapist with over 25 years’ experience working with pregnant and postnatal women in both public and private settings here in Queensland and also in Tasmania. She is currently the Team Leader for the Mothers, Women’s and Pelvic Health Physiotherapy Team at the Mater Mothers Hospital, South Brisbane where over 10 000 babies are born each year. Sheridan is completing a PhD through the Faculty of Medicine, University of Queensland. She is passionate about interdisciplinary practise, effective patient communication and how together we can achieve great outcomes for expectant and new parents.

What do consumers of inpatient mental health facilities want to consume? Insights from a food service consultation process

Mrs Amber Thoroughgood, Mrs Cassandra  Knight

1Hunter New England Local health District, Hunter New England, Australia

Background: The provision of foodservices to inpatients in Hunter New England Local health District (HNELHD) Mental Health (MH) facilities is challenging, as these services can be acute, rehabilitation or older persons units, part of an acute hospital or located independently and admissions can be voluntary or involuntary. Consumers of these facilities have a range of nutrition needs from undernourishment and poor appetite, to metabolic syndrome and large appetites. They are generally younger than acute hospital inpatients, and have a higher risk of physical co-morbidities such as heart disease and diabetes1. The NSW ACI Nutrition Standards for Mental Health Inpatient Facilities is used as the baseline for nutrition, but does this compare to what MH consumers want?

Method: A consultation process was completed for each site by the AH Project Officer, which included completing surveys with consumers, carers, HNELHD staff and food service staff. Focus groups were held at some sites, to discuss the topics in the surveys.

Results

Speaking with consumers and staff revealed some interesting insights regarding what is important to them:-

  • Access to healthy food, larger meals and variety
  • Different food on weekends to differentiate from weekdays. E.g. Hot breakfast on weekends
  • Reducing waste
  • limited access to cakes, desserts and hot breakfasts to prevent weight gain
  • A homelike environment for eating, including special events such as BBQ’s
  • Ability to cater for individual diet needs
  • Flexibility to meet individual site needs
  • Yoghurt, Cheese + Biscuits and nuts were the most requested snacks.
  • Access to the same quality of food provided to acute facilities

Discussion

The consultation process was valuable to provide an opportunity for consumers to advocate for what is important to them in regards to nutrition. The results showed  support for the ACI nutrition standards for MH, however also revealed new insights that  are being incorporated in new menus, such as increasing access to healthy foods, limiting less nutritious foods, increasing access to therapeutic diets and providing “weekend specials” to differentiate weekends.

RatcliffeT, Dabin S, Barker P. Physical healthcare for people with serious mental illness. Clin. Governance 2011; 16:20-28


Biography: To be confirmed

Establishing a yoga program in response to patient-reported experience measures within a brain injury rehabilitation unit

Rebecca Seeney1,2, Janelle Griffin1

1Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia, 2The Hopkins Centre, Griffith University, Brisbane, Australia

Background: An acquired brain injury (ABI) is defined as any injury occurring in the brain after birth. Leisure provides an important mechanism by which persons following ABI can access meaningful, goal directed activity. However, ABI impacts on participation in leisure activities both in the short and long term and significantly during hospitalisation. Consideration of leisure participation and relationship to life satisfaction is of relevance to Occupational Therapy because of the role that leisure can plan in the maintenance of health. The aim of this study is to describe the processes involved in establishing a yoga program in an inpatient brain injury rehabilitation unit and to explore patients’ perceived levels of satisfaction with the yoga program.

Method: The yoga program was established following a review of patient satisfaction results with the health delivery in an inpatient rehabilitation unit of a metropolitan hospital. Thirty-one participants were recruited to this mixed methods, pilot experimental study. Quantitative data was collected to evaluate satisfaction with the program and the impact of yoga participation on relaxation and wellbeing of participants. Qualitative data was collected via semi-structured interviews; exploring experiences and perceptions of yoga in providing a meaningful rehabilitation experience.

Results: Participants reported very high levels of satisfaction with the yoga program. They described yoga as an inclusive and adaptable occupation which provided opportunity for increased engagement in meaningful activities and described how the yoga program enhanced their experience of the rehabilitation environment.

Conclusion: This study provides a unique insight into the establishment of a yoga program within a brain injury rehabilitation unit in response to consumer feedback. With appropriate infrastructure, there are many benefits to establishing a yoga program within an inpatient hospital rehabilitation setting. A yoga program may be beneficial in providing opportunity for structured leisure participation in an activity that is meaningful, adaptable and inclusive.


Biography:

Rebecca is an Occupational Therapist within the Brain Injury Rehabilitation Unit at the Princess Alexandra Hospital. She has worked extensively across acute, sub-acute and outpatient rehabilitation services. Rebecca has had a continued interest in research and is now working in a dual clinical and research role, having successfully obtained the Brain Injury Rehabilitation Services Research Practitioner position, a joint position with the PAH Occupational Therapy Department and The Hopkins Centre, (Division of Rehabilitation, MSHHS and Griffith University). The aim of this role is to lead on service development, close-to-practice research initiatives and knowledge translation with an aim to increase patient outcomes and service capacity.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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