University of Nottingham, Nottingham, UK.
National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, UK.
BMC Med. 2019 Mar 4;17(1):54. doi: 10.1186/s12916-019-1286-9.
Managing hearing communication for residents living with hearing loss and dementia in long-term care settings is challenging. This paper explores how care can be effective in optimising hearing communication for residents living with dementia. We argue that the underlying notion of permission or authorisation allows care staff to do what they know will be effective in providing person-centred care that enhances hearing communication. The paper also indicates that this notion of permission can usefully be applied to other areas of care home practice.
To address hearing-related communication in care homes, we conducted a realist synthesis (RS). As a theory-driven approach to reviewing literature, it also uses expert opinion to understand complex health situations. Using RS, we developed a theory surrounding the management of hearing-related communication in care homes. Applying formal processes to the literature search and data extraction, the analysis uncovered relevant mechanisms and contexts to help confirm, refute or refine our understanding of how hearing communication could be improved.
Forty-three papers were selected for the realist synthesis. The documents were analysed to construct five context-mechanism-outcome configurations (CMOCs). The CMOCs represent possible care interventions to optimise hearing-related communication in care homes for person living with dementia and hearing loss (PLWDHL). They include leadership promoting positive regard and empathy through person-centred care, communication training for staff, 'knowing the person' and relationship building for responsive awareness of residents' hearing needs, maintaining and monitoring hearing communication through care planning, and managing noise in the care home environment.
Leadership that provides appropriate training and resources is likely to enhance knowledge and skills, leading to staff feeling able and equipped to respond to the hearing-related communication needs of PLWDHL. Collaboration with local hearing services is likely to raise awareness of hearing loss among care home staff. Importantly, care staff require a sense of permission from leadership, to work with knowledge and autonomy in the interest of residents living with dementia and hearing loss.
在长期护理环境中，管理听力受损和患有痴呆症的居民的听力沟通具有挑战性。本文探讨了如何通过优化听力沟通来为患有痴呆症的居民提供有效的护理。我们认为，许可或授权的基本概念允许护理人员采取他们认为有效的措施，提供以患者为中心的护理，增强听力沟通。本文还表明，这种许可概念可以在其他养老院实践领域中得到有益的应用。
为了解决养老院中的听力相关沟通问题，我们进行了一项实际主义综合研究（RS）。作为一种基于理论的文献综述方法，它还利用专家意见来理解复杂的健康状况。通过 RS，我们围绕养老院中与听力相关的沟通管理制定了一个理论。通过正式的文献检索和数据提取过程，分析揭示了相关的机制和背景，以帮助确认、反驳或完善我们对如何改善听力沟通的理解。
共有 43 篇论文被选入实际主义综合研究。对这些文献进行了分析，构建了五个情境-机制-结果配置（CMOC）。这些 CMOC 代表了在养老院中为听力受损和患有痴呆症的患者优化与听力相关的沟通的可能护理干预措施。它们包括通过以患者为中心的护理促进积极关注和同理心的领导力、为员工提供沟通培训、“了解患者”并建立关系以对患者的听力需求做出响应性意识、通过护理计划维护和监测听力沟通，以及在养老院环境中管理噪音。
提供适当培训和资源的领导力很可能会增强知识和技能，使员工感到有能力和装备来满足听力受损和患有痴呆症的患者的听力沟通需求。与当地听力服务机构合作，很可能会提高养老院工作人员对听力损失的认识。重要的是，护理人员需要从领导层获得工作的许可，以便在为患有痴呆症和听力损失的居民的利益的情况下，运用知识和自主权。
