Speech-language therapists’ negotiation of communication during clinical engagement.
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Date
2018
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Abstract
Globally, speech-language therapists share similar practice issues with other healthcare professionals with regard to responding to the changing healthcare landscape and the changing nature of practice. In the profession, the speech-language therapist uses his or her communication to facilitate the improvement of his or her client’s impaired communication. The therapist further seeks to enhance communication in the delivery of care. Therefore, communication is the core skill that is central to the work of a speech-language therapist. The temporary lens of the study focussed on facilitating an understanding of competences, a discussion on communication as a core and soft skill in the profession, communicative competence in academe and the world of work, as well as theories on communication and competency development. My study explored the participants’ experiences of negotiating their communication during clinical engagement. An interpretivist paradigm informed the choice of a case study research methodology. Semi-structured interviews and observations of the participants in practice were conducted. As the speech-language therapists recollected encounters of using communication in their interventions with their clients and their families, their stories were tinged with relived emotions and with reflections on particular events or people. Thus, narrative analysis was conducted to represent and analyse the data. The production of the narratives constituted the first level of analysis. The participants were invited to go through the narratives, and to provide suggestions to reflect their stories better. Although there were unique characteristics to each participant’s story, similar nuances resonated through the data set. The data was analysed through a grounded and inductive approach. In the second level of analysis, using cross-case comparison, six factors influencing communication were identified in the eight narratives. Through thematic analysis, the following themes were identified: productive remembering of educational experience, problematising clinical engagement, undervaluing of speech-language therapy, searching for certainty, and moving to comfort. Further to this, antithetical cases (as the atypical cases) were used to validate the initial findings. The thesis of this study was named: The diamond framework: Curriculum of resilience to deal with matters of the ‘cut’, the ‘carat’, the ‘colour’ and the ‘clarity’ to explore the notion of negotiating communication in clinical practice. Referring to the evaluation of a diamond, these four constructs were considered a metaphor to develop the thesis framework:
The ‘cut’ is representative of the ‘professional-self’: the outward portrayal and usually the first aspect noticeable to others.
The ‘carat’ refers to the ‘context of practice’: the pragmatic space within which the practitioner operates in a social setting.
The ‘colour’ refers to the ‘affective factors’ of the professional self, which refer to unique characteristics of the individual in his or her personal practice.
The ‘clarity’ refers to the elements of the personal self, which refers to inner qualities, such as the ability to refract and displace light and engage agentic resources to shine.
This study found that the professional, the contextual, the personal and the affective selves co-influence the negotiation of communication strategies. While looking to the reconceptualisation of the curriculum to inculcate the personal and affective selves of future students in the professional education for specific contextual spaces, there has to be cognisance of the strong hegemonic forces of the profession that are still dominant. Therefore, the ethos of the professional education of speech-language
therapists needs to revisit these ideals and practices of both the profession and the higher education institutions engaged in developing and regulating future professionals.
Key words: communication, speech-language therapy, graduate competence, narrative analysis, professional education
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.