Colman Centre for Specialist Rehabilitation Services, Norwich, UK.
Int J Lang Commun Disord. 2021 Jan;56(1):205-214. doi: 10.1111/1460-6984.12578. Epub 2020 Oct 10.
Surgical and respirator masks are worn to reduce the risk of droplet and airborne transmission of viral respiratory disease. As a result of the novel coronavirus (COVID-19) pandemic, mask wearing has been designated mandatory for healthcare professionals working in UK hospitals for the foreseeable future. It is thus timely to consider the long-term implications of mask wearing on communication within healthcare settings, from both a patient and a clinician perspective.
The primary objective is to identify research evidence that corresponds to the mask-wearing experiences of healthcare professionals working on the ground. By drawing together a summary of the literature illustrating the potential challenges associated with mask wearing, it is possible to make an application to various clinical cohorts and to formulate a set of preliminary, evidence-based support strategies. The paper additionally explores the role for the Speech and Language Therapist (SLT) in supporting communication in the context of mask wearing.
METHODS & PROCEDURES: Through a scoping review of the relevant literature, this paper reflects holistically on the prospective challenges associated with mask wearing across a variety of healthcare settings and patient populations. The subsequent conclusions have been used to inform the proposed clinical guidelines for safe and effective practice.
OUTCOMES & RESULTS: There is a current research gap with regards to mask wearing in non-medical and non-clinical healthcare workers, and the impact this may have on both a professional and a personal basis. In the absence of preliminary data, the development of associated communication support strategies is hindered. This paper draws upon a variety of clinically conceivable issues faced by healthcare professionals, outlines important practical and ethical considerations, and proposes evidence-based solutions to some of the challenges identified. Future research is required to gather evidence with regards to actual clinical experiences of mask wearing to substantiate hypotheses.
CONCLUSIONS & IMPLICATIONS: Although undoubtedly essential in protecting the health of staff and patients, there are numerous logistical, physiological, psychological, social and economic complications associated with the wearing of masks. The ability of healthcare staff to successfully communicate with patients and with colleagues is jeopardized, which may adversely affect the efficiency, effectiveness, equitability and, most notably, safety of therapeutic intervention. The SLT has a distinct role in facilitating communication in order to safeguard the provision, accessibility and efficacy of services. What this paper adds What is already known on the subject Existing research explores the impact of mask wearing on medical doctors, surgeons and dentists, and upon the corresponding patient cohorts. Little is known about how mask wearing may affect Allied Health Professionals and their ability to deliver therapeutic interventions safely and effectively. With mandatory face covering potentially a long-term requirement for UK healthcare staff, it is both timely and relevant to consider the consequences of mask wearing on communication across acute and community settings. What this paper adds to existing knowledge This paper identifies a range of prospective key issues associated with mask wearing across a variety of clinical and non-clinical populations, with application specifically to vulnerable patient cohorts. Through evidence synthesis, this paper provides a summary of fundamental issues supported by relevant literature, and draws upon these in order to propose a preliminary set of evidence-based clinical guidelines setting out potential solutions to the challenges faced. This review additionally assists in quantifying the role of the SLT within these extraordinary circumstances, with the aim of prompting unified practice, building upon professional guidance and increasing skill recognition. What are the potential or actual clinical implications of this work? In addition to their role in facilitating the development of individualised communication strategies for patients, SLTs should actively seek to provide widely accessible multidisciplinary education opportunities focusing on supporting communication; with specific reference to mask wearing and the associated communicative challenges. At a commissioning and managerial level, leaders within healthcare should acknowledge mask wearing as just one of the complexities associated with frontline working in the context of the COVID-19 pandemic, and aim to support their workforce by delivering resources and protocols which maximize and promote staff safety, efficiency, resilience and well-being in concurrence with positive patient outcomes.
外科口罩和呼吸面罩的使用旨在降低病毒呼吸道疾病飞沫和空气传播的风险。由于新型冠状病毒（COVID-19）大流行，在可预见的未来，佩戴口罩被指定为英国医院医护人员的强制性要求。因此，及时考虑口罩佩戴对医疗环境中患者和临床医生之间的沟通的长期影响是及时的。
主要目的是确定与在实地工作的医护人员口罩佩戴体验相对应的研究证据。通过总结说明与口罩佩戴相关的潜在挑战的文献综述，我们可以将其应用于各种临床队列，并制定一套初步的、基于证据的支持策略。本文还探讨了言语治疗师（SLT）在支持口罩佩戴背景下的沟通中的作用。
通过对相关文献的范围审查，本文全面回顾了各种医疗保健环境和患者群体中与口罩佩戴相关的预期挑战。随后的结论被用来为安全有效的实践提供拟议的临床指南。
在非医疗和非临床医护人员佩戴口罩方面存在当前的研究空白，这可能对专业和个人都产生影响。在缺乏初步数据的情况下，相关沟通支持策略的制定受到阻碍。本文借鉴了医护人员面临的各种临床设想问题，概述了重要的实际和伦理考虑，并针对确定的一些挑战提出了基于证据的解决方案。需要进一步的研究来收集关于实际临床口罩佩戴经验的证据，以验证假设。
虽然口罩在保护医护人员和患者的健康方面无疑是必不可少的，但佩戴口罩存在许多后勤、生理、心理、社会和经济方面的并发症。医护人员与患者和同事成功沟通的能力受到威胁，这可能会对治疗干预的效率、效果、公平性，以及最显著的安全性产生不利影响。言语治疗师在促进沟通以保障服务的提供、可及性和效果方面具有独特的作用。
现有研究探讨了口罩佩戴对医生、外科医生和牙医以及相应的患者群体的影响。
对口罩佩戴如何影响医疗保健专业人员及其安全有效地提供治疗干预的能力知之甚少。
对于英国医护人员来说，强制性佩戴口罩可能是长期的要求，因此考虑口罩佩戴对急性和社区环境中的沟通的影响是及时和相关的。
本文确定了各种临床和非临床人群中与口罩佩戴相关的一系列预期关键问题，特别适用于脆弱的患者群体。
通过证据综合，本文总结了支持文献中的基本问题，并利用这些问题提出了一套初步的基于证据的临床指南，提出了应对所面临挑战的潜在解决方案。
本综述还有助于量化 SLT 在这些特殊情况下的作用，旨在促进统一实践，建立在专业指导基础上并提高技能认可度。
除了为患者制定个性化沟通策略外，言语治疗师还应积极寻求提供广泛的多学科教育机会，重点是支持口罩佩戴和相关沟通挑战。
在委托和管理层面，医疗保健领域的领导者应认识到口罩佩戴只是 COVID-19 大流行背景下一线工作人员面临的诸多复杂性之一，并通过提供资源和协议来支持他们的员工，这些资源和协议应最大限度地提高和促进员工的安全性、效率、弹性和幸福感，同时实现积极的患者结果。
