Abstract
International students graduating from speech-language pathology university courses must achieve the same minimum competency standards as domestic students. This study aimed to collect ...descriptive information about the number, origin, and placement performance of international students as well as perceptions of the performance of international students on placement. University Clinical Education Coordinators (CECs), who manage clinical placements in eight undergraduate and six graduate entry programs across the 10 participating universities in Australia and New Zealand completed a survey about 3455 international and domestic speech-language pathology students. Survey responses were analysed quantitatively and qualitatively with non-parametric statistics and thematic analysis. Results indicated that international students came from a variety of countries, but with a regional focus on the countries of Central and Southern Asia. Although domestic students were noted to experience significantly less placement failure, fewer supplementary placements, and reduced additional placement support than international students, the effect size of these relationships was consistently small and therefore weak. CECs rated international students as more frequently experiencing difficulties with communication competencies on placement. However, CECs qualitative comments revealed that culturally and linguistically diverse (CALD) students may experience more difficulties with speech-language pathology competency development than international students. Students' CALD status should be included in future investigations of factors influencing speech-language pathology competency development.
Service-based caring sectors like disability are increasingly being operated via market logic, including shifts towards personalised funding. These shifts must be brought to life in/through people ...already located in relation to ideas and values that underpin historical policies. Our manuscript examines how identities are re/shaped in relation to marketised policy change and explores how identity change unfolds (or not) during periods of transition: situated within the transition to the National Disability Insurance Scheme executed in Australia as a major disability funding reform. Our qualitative dataset involves interview and focus group data collected with service recipients/carers (
= 28), providers/managers (
= 17) and advocates (
= 2) during shift from government- to personally-controlled funding of allied health services for people with disability in Australia (2017-2020). We used layered sociological inference to develop and interrogate processes of tension and identity change amidst lived experience(s) of policy change. Our analysis elucidates how various identities were encouraged, desired, resisted and constrained in relation to the policy transition. We bring together sub-themes from analysis of recipient/carer data (getting value-for-money; critiquing service quality; and experiencing system shortfalls) and manager/provider data (learning to transact; the call to care; and structural frictions in/and identity transitions) to interpret that recipients/carers are
and that managers/providers are
In both cases 'hearts' and 'minds' are perceived to be diametrically opposed and symbolic in/against processes of marketisation. We synthesise our data into an illustrative framework that facilitates understanding of how this perception of opposed 'hearts' and 'minds' seems to constrain the identity transitions encouraged by personalised funding, and explore ways in which desired identities might be supported amidst marketising policy transition.
OBJECTIVESLittle is known about how cognitive and behavioural decline in MND is managed clinically. This review aimed to summarise clinical management approaches of cognitive and behavioural decline ...in MND reported in peer-reviewed and grey literature.METHODSA scoping review was conducted across Embase, Medline, Psychinfo and Emcare in October 2022. Grey literature was also searched across Google Scholar and Google in October 2022.RESULTSA total of N = 26 studies and 8 documents were included. Thematic analysis revealed six key areas of clinical management: i. Assessment, ii. Education, iii. Advance Care Planning, iv. Adaptation of Care Plan, v. Communication and vi. Carer Support.CONCLUSIONSThe literature on management of cognitive and behavioural decline in MND is sparse. Most peer-reviewed literature consists of expert commentary and there is a lack of primary data to guide practitioners and families on how to manage cognitive and behavioural change in MND.PRACTICE IMPLICATIONSDetermining as early as practicable the presence of cognitive and behavioural changes in pwMND will enable practitioners to make adaptations to communication, provide education and supported decision-making for forward planning. This will enable individualised care, planned in partnership with families with MND, which incorporates personal needs and wishes.
Background
Therapeutic relationships are fundamental in aphasia rehabilitation, influencing patient experience and outcomes. While we have good understandings of the components of therapeutic ...relationships, there has been little exploration of how and why therapists construct and enact relationships as they do. Sociological theories may help develop nuanced understanding of the values, assumptions and structures that influence practice, and may facilitate critical reflexivity on practice.
Aims
To explore the potential for theoretical approaches from outside speech–language therapy to enable a deeper understanding of the nature and enactment of therapeutic relationships in aphasia rehabilitation.
Methods & Procedures
An explanatory single case study of one speech–language therapist–patient dyad in an in‐patient stroke rehabilitation setting. Data included observations of five interactions, two interviews with the client and three interviews with the speech–language therapist. Analysis was guided by analytical pluralism that applied aspects of three sociological theories to guide data analysis and make visible the contextual factors that surround, shape and permeate the enactment of therapeutic relationships.
Outcomes & Results
The analysis of this dyad made visible individual, interactional and broader structural features that illustrate the dynamic processes that practitioners and patients undertake to enact therapeutic relationships. Clinical practice could be viewed as a performance with each person continually negotiating how they convey different impressions to others, which shapes what work is valued and foregrounded. The patient and therapist took up or were placed in different positions within the interactions, each with associated expectations and rights, which influenced what types of relationships could, or were likely to, develop. Organizational, rehabilitation and individual practitioner structures assigned rules and boundaries that shaped how the therapist developed and enacted the therapeutic relationship. Whilst the therapist had some agency in her work and could resist the different influencing factors, such resistance was constrained because these structures had become highly internalized and routinized and was not always visible to the therapist.
Conclusions & Implications
While therapists commonly value therapeutic relationships, social and structural factors consciously and unconsciously influence their ability to prioritize relational work. Sociological theories can provide new lenses on our practice that can assist therapists to be critically reflexive about practice, and to enact changes to how they work to enhance therapeutic relationships with clients.
What this paper adds
What is already known on the subject
Therapeutic relationships are critical in aphasia rehabilitation. We have a good
understanding of the different components of therapeutic relationships and how relationships are perceived by patients and practitioners.
What this paper adds to existing knowledge
This study is novel in its use of sociological lenses to explore contexts and complexities inherent in building and maintaining therapeutic relationships. These are often invisible to the practitioner but can have a significant impact on how relational work is enacted and what forms of relationship are possible.
What are the potential or actual clinical implications of this work?
This study will support clinicians to critically reflect on how they enact therapeutic relationships and may enhance awareness of the often‐hidden factors which influence the ways in which they work.
Purpose: The sociocultural and historical context and membership of the speech-language pathology (SLP) profession underpins our norms of practice and our discourses. This context also informs and ...defines the ways that we practice today, including who we legitimise to enter our profession and why. In this paper, we used theory as a tool to critically explore how this socioculturally constituted knowledge and practice influences how students experience learning in SLP practice placements.
Method: We used the theory of Legitimate Peripheral Participation (1991) as a conceptual framework to interpret qualitative data from two separate programs of research that had explored the phenomena of student learning in SLP practice placements.
Result: The analysis cast light on how our understanding and expectations of SLP students' learning and competency development in placements is recursive and strongly legitimised in our profession. Students adjust to accommodate the professional knowledges, practices and expectations they encounter in their placements. This facilitates the perpetuation of practices proffered by the majority culture.
Conclusion: The use of theory allowed us to explore the phenomena of student learning in placements in a new light, which unmasked new understandings of the longstanding challenge to increase diversity in the SLP community.
Abstract Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority ...or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners’ identity, practices and participation in their health professional communities.
Purpose: Feminism is a theoretical position that allows researchers to explore, identify and potentially address issues that negatively impact on women, including on their health and health care. It ...has been used for many years in health care professions such as nursing.
Method: In this paper, we argue that feminist research could underpin innovation in our professional practice as speech-language pathologists. We present research from within and outside of speech pathology that supports this position, and describe how feminism as an epistemology can guide qualitative research and discuss how other health care professions have used this framework to ask questions across broad areas.
Conclusion: A feminist lens enables critique of ourselves and our profession to help us to understand how being female-dominated interacts with being portrayed, understood or conceptualised as feminine, and the consequences of this for professional practice. Feminism could also support us to better understand and support our clients, who may experience their disability, health and lives in ways that vary because of gendered experiences, expectations, or limitations.
Background
Professional placements are critical elements of speech–language pathology qualifying programmes that can be complex learning environments for international students. Students are ...supported by placement educators who facilitate their developing skills and competencies for professional practice in these placements. However, strategies that facilitate international students’ learning in placements have not been identified.
Aims
To identify strategies that are reported by speech–language pathology international students and placement educators to facilitate positive learning experiences and competency development in practice placements.
Methods & Procedures
This study used an exploratory research design to gather data from four focus groups with international students and five focus groups with placement educators. Thematic analysis was used to identify strategies, and these were interpreted using two theories of learning.
Outcomes & Results
Four themes were identified that described international students’ placement experiences and learning. For each theme, strategies were identified that placement educators can practically and responsively implement with international students to enable positive placement learning experiences.
Conclusions & Implications
These strategies support international students to manage acculturative adjustments for the cultural and learning requirements of placements that may facilitate their successful participation, and provide structure to reduce their cognitive load. However, strategies to develop communication skills for practice were less feasible. Through fostering positive placement experiences, these strategies may also facilitate opportunities for educators and international students to share intercultural skills and knowledge that may be transferable to practice.
Purpose: Impaired swallowing is a serious symptom of amyotrophic lateral sclerosis (ALS) impacting on health and wellbeing. Little is known about how cognitive impairment in amyotrophic lateral ...sclerosis impacts on oropharyngeal swallowing. A scoping review was undertaken to explore how cognitive impairment impacts on a person living with ALS's (plwALS) ability to understand and manage oropharyngeal swallowing function.
Method: Subject headings and keywords were searched across MEDLINE, SCOPUS, CINAHL, PsychINFO, Emcare and Google Scholar in May 2019. Articles containing information on amyotrophic lateral sclerosis and cognition and swallowing were reviewed. A secondary search was conducted in July 2020 with broadened search terms.
Result: The primary search identified 1055 articles, and 47 were included for full-text review. Of these, no articles directly met the inclusion criteria of both cognitive impairment and swallowing. The secondary search with broadened terms identified an additional 762 studies, and 9 were included for full-text review, but none met the inclusion criteria. Consequently, thematic analysis was completed on articles from the full-text review to identify themes that related to both cognition and swallowing. The themes identified were: (i) early specialised multidisciplinary management of ALS achieves better outcomes; (ii) cognitive impairment impacts on management; and (iii) impaired swallowing occurs in nearly all people living with ALS and is a serious symptom of the disease.
Conclusion: The interaction between cognitive impairment and oropharyngeal swallowing function in ALS has not been investigated. This is important, as cognitive impairment impacts insight and decision-making and may have implications for oropharyngeal swallowing management.
To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making.
A scoping review was performed to identify ...academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick's hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis.
A total of 33 articles were identified (
= 7 for supported decision making and
= 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (
= 14), dementia or neurocognitive disorders (
= 6), cognitive disability (
= 5), mixed populations (
= 1), and those receiving end-of-life care (
= 7). In their design, most programs sought specific changes in practice (behaviour)
experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour.
Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design.
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