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Article Excerpt
It has been argued that speech-language pathologists working in the acute hospital setting could enhance patient health care and patient satisfaction with health care if they supported patients with communication difficulties and health care staff to communicate in optimal ways during everyday hospital communication activities. In order to do this however, speech-language pathologists need a reliable and valid measure of a patient's ability to communicate in everyday hospital situations. This article is the first article in a two-part series that describes the development of a new measure of communication activity for the acute hospital setting called the Inpatient Functional Communication Interview (IFCI; O'Halloran, Worrall, Toffolo, Code, & Hickson, 2004). This first article investigated whether two measures of communication activity, the Functional Communication Profile (FCP; Sarno, 1969) and the Inpatient Functional Communication Interview-Research Version (IFCI-RV; Toffolo, Code, & McCooey, 1995), were representative of the communication situations that actually occur during staff-patient interactions in the acute hospital setting. Direct observation of staff-patient interactions indicated that neither the items on the FCP nor the IFCI-RV captured the range and type of communication activities that actually occurred.
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The role of speech-language pathology in the acute hospital setting was recently evaluated in terms of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF; WHO, 2001; McCooey-O'Halloran, Worrall, and Hickson, 2004). That paper argued that if speech-language pathologists shifted their role toward facilitating optimal staff-patient communication in everyday hospital situations, then they may be able to enhance the overall quality of patient health care and improve patient satisfaction with health care. However, before speech-language pathologists can begin to work in this way they need a valid and reliable measure of patients' ability to communicate in everyday hospital situations.
A valid functional communication measure, or using the terminology of the ICF (WHO, 2001) a measure of communication activity, in the acute hospital setting would consist of items that reflected the real life communication that occurs in the acute hospital setting. Although several assessments of communication activity already exist, such as the ASHA Functional Assessment of Communication Skills for adults (ASHA FACS; Frattali, Thompson, Holland, Wohl, & Ferketic, 1995) and the Communication Activities of Daily Living 2 (CADL-2; Holland, Frattali, & Fromm, 1998), these measures have been designed for use with people living in the community. That is, the items on these measures reflect the everyday communication activities of people living in the community. The communication activities that occur in the acute hospital setting have not been identified. Therefore it is not clear if the items on any existing communication activity measures actually reflect the real life communication activities that occur in the acute hospital setting and therefore whether any of these currently available communication measures are suitable for use in the acute hospital setting.
Two existing communication measures with items that may reflect the communication activities that occur in the hospital setting are the Functional Communication Profile (FCP; Sarno, 1969) and the Inpatient Functional Communication Interview-Research Version (IFCI-RV; Toffolo, Code, & McCooey, 1995). The FCP (Sarno, 1969) was the first measure developed to describe the ability of a person with aphasia to communicate in activities of everyday life. The 45 items on the FCP are grouped into five sections (movement, speaking, understanding, reading, and other) and include activities such as greeting, recognition of your own name, understanding TV and movies, and reading the newspaper. The full list of 45 FCP items is shown in Table 1.
The IFCI-RV (Toffolo et al., 1995) is a measure of communication ability in everyday activities in the hospital setting. It was developed in a similar way to the Communicative Effectiveness Index (CETI; Lomas, Pickard, Bester, Elbard, Finlayson, & Zoghaib, 1989). Initially, hospital inpatient and staff groups were interviewed using the Nominal Group Technique (NGT; Delbecq, Van de Ven, & Gustafon, 1975) in order to identify everyday hospital communication situations. This process yielded 82 hospital communication situations. Each communication situation was then reviewed by three speech-language pathologists. Only those situations that met the following criteria were included in the final list of IFCI-RV items. Each communication situation had to be:
* A communication situation
* Different from the other communication situations listed, and
* Directly observable in an inpatient hospital setting.
Following this process, 25 hospital situations remained, and these formed the basis of the IFCI-RV (Table 2).
This research sought to investigate whether the items on the FCP (Sarno, 1969) and/or the items on the IFCI-RV (Toffolo et al., 1995) were representative of the communication activities that occur in the acute hospital setting. Specifically we wanted to determine whether the individual items on the FCP and IFCI-RV were actually observed during everyday staff-patient interactions in the acute hospital setting. If the items on the FCP and/or IFCI-RV were observed during actual staff-patient interactions in hospital then speech-language pathologists could be confident that the FCP and/or IFCI-RV were valid communication activity measures for the acute hospital setting.
METHOD
Participants
Eleven inpatients receiving acute medical care at The Geelong Hospital, Australia, participated in this research. Eight of the participants were recruited through referrals made to the Speech-Language Pathology Department, and a further three participants were recruited through medical...
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