A narrative analysis of a speech pathologist’s work with Indigenous Australians with acquired communication disorders

Abstract

Individual, detailed narratives are useful in exposing the challenges and clinical reasoning behind culturally sensitive practice. Implications for Rehabilitation Speech pathologists (SPs) can learn from hearing the clinical stories of colleagues with experience of providing rehabilitation in culturally diverse contexts, as well as from ongoing training in culturally competent and safe practices. Such stories help bridge understanding from the general to the particular. SPs working with Indigenous Australians with acquired communication disorders post-stroke and brain injury may find it helpful to consider how the themes, drawn from an interview with the clinician in this study - flexibility, awareness of cultural context, person-centredness, being practical and working ethically - might apply to their practice. Narratives may be helpful in staff training and form an important part of the SP evidence base.

Using Qualitative Methodologies in Speech-Language Pathology: An Example From Serving Students With Hearing Loss

“…Ethnographies involve looking at what people do (behaviors), what they say (language), discrepancies or tensions between what they say they do and what they really do, and what they make and use (artifacts). Ethnographic strategies have been employed by SLPs to enable them to better understand clients from culturally linguistically diverse backgrounds so they are able to provide more acceptable services (e.g., Crago, 1990;Hersh et al, 2015;Hwa-Froelich & Westby, 2003;Rodriguez & Olswang, 2003); to understand the lived experiences of persons with communication disabilities and their families (e.g., de Wolfe, 2014;McIlroy & Storbeck, 2011;Simmons-Mackie et al, 1999); or to investigate the culture of intervention programs (e.g., Brorson, 2005;Ng et al, 2015;Westby & Ford, 1993). Traditional ethnographies involve three components: in-depth interviews of persons, on-site observations, and review of artifacts (e.g., materials used in the context).…”

Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians

“…Our pilot study (Armstrong et al, 2012;Armstrong et al, 2015), interviewing 13 Aboriginal people and their families, found little awareness of communication problems or relevant services following stroke in an urban Aboriginal community, with none of the 13 people reporting ongoing speech therapy after leaving hospital. Reports of predominantly non-Aboriginal speech pathologists' concerns and difficulties in bridging the cultural and linguistic gaps with their Aboriginal clients (Hersh et al, 2015a(Hersh et al, , 2015b) mirror those of other health professionals dealing with patients facing a range of different conditions and disorders (National Stroke Foundation, 2004;Shahid, Bessarab, Howat, & Thompson, 2009;Shahid et al, 2011;Taylor et al, 2009). However, when communication is the focus of a service, treatment must involve functional and relevant language, and incorporate culturally appropriate practices in order to be effective.…”

“…Given the above, and the importance of communication for individual, family, and community functioning, it is significant that few Aboriginal Australians receive ongoing communication rehabilitation services and there is virtually no published research in the area. Exceptions include recent articles by our research team (Armstrong, Hersh, Hayward, Fraser, & Brown, 2012; Armstrong et al, 2015; Hersh, Armstrong, & Bourke, 2015a; Hersh, Armstrong, Panak, & Coombes, 2015b) and another reference to one case scenario involving a Yolngu man with global aphasia who spoke limited English and experienced great difficulties in hospital in terms of management and discharge (Faux et al, 2009). A similar situation exists in terms of Indigenous peoples internationally.…”