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Seit Einführung der Modellklausel im Jahr 2009 befindet sich die Logopädie als Gesundheitsfachberuf im Prozess der Akademisierung und Professionalisierung (Klotz, 2018). Dabei wird ein Wandel der einstigen Heilhilfsberufe zu Professionen angestrebt, „die in einem gesellschaftlich relevanten Problemfeld wissenschaftlich begründbare Leistungen erbringen“ (Klotz, 2018, S. 4). Wesentlicher Bestandteil einer solchen Professionalisierung ist eine akademische Ausbildung sowie wissenschaftlich fundiertes Spezialwissen.
Neben Aspekten der Weiterentwicklung der Ausbildung wurde schon 2012
der Auf- und Ausbau von Forschung als bedeutsame Herausforderung benannt (Gesundheitsforschungsrat, 2012). Dabei hob der Wissenschaftsrat (2012) die Sonderrolle der Logopädieforschung innerhalb der Therapiewissenschaft heraus, da enge Bezüge zu den traditionell universitären Disziplinen wie den Sprachwissenschaften oder der Neurolinguistik bestünden und damit bereits eine breite Forschungsbasis vorhanden sei. Auf der anderen Seite besteht für die Disziplinentwicklung der Logopädie/ Sprachtherapie die Herausforderung, dass dieser unterschiedliche Berufsgruppen wie LogopädInnen, SprachheilpädagogInnen, klinische LinguistInnen, PatholinguistInnen und weitere Berufsgruppen angehören.
Obwohl in der Praxis die gleichen Störungsbilder behandelt werden, ist
das Selbstverständnis nicht identisch: während in der Sprachheilpädagogik
die (sonder)pädagogische Ausrichtung wesentlich ist, ist die Logopädie
eher medizinisch orientiert und die klinische Linguistik sprachwissenschaftlich ausgerichtet. Grohnfeldt (2018) fordert dementsprechend eine weiterführende Diskussion zur Wissenschaftlichkeit in der Logopädie/ Sprachtherapie mit der Betonung einer eigenen, gemeinsamen Identitätsentwicklung.
Die HerausgerInnen dieses Tagungsbandes widmen sich seit 2019 dieser
Thematik und haben einen Diskurs zum forschungsmethodischen Grundverständnis in der Logopädie/Sprachtherapie angestoßen (Kohler, 2019 und 2021; Kohler et al. 2020a&b, 2021, 2022). Hintergrund ist die seit Jahren zunehmende Forderung nach evidenzbasiertem Arbeiten in der Logopädie/ Sprachtherapie. Dabei wird eine unreflektierte Übertragung der Ansprüche an Wirksamkeitsnachweise, wie sie im medizinischen Bereich vorzufinden sind, für die Logopädie/Sprachtherapie kritisch gesehen. Der sprachtherapeutische Alltag zeichnet sich nämlich durch stark individualisierte, komplexe Interventionen über einen längeren Zeitraum aus.
Zahlreiche Einflussfaktoren innerhalb und außerhalb der Therapie spielen für den Therapieerfolg eine bedeutsame Rolle und sollten somit in Wirksamkeitsstudien mit einfließen können. Stark kontrollierte Studien, wie sie in der Medizin als Goldstandard gelten, können nur bedingt Aussagen darüber bieten, wie wirksam eine Intervention im klinischen Alltag tatsächlich ist.
Für einen breiten Diskurs über die forschungsmethodische Ausrichtung
der Logopädie/Sprachtherapie initiierten die HerausgeberInnen 2022 ein
von der VW-Stiftung gefördertes, dreitägiges Symposium zum Thema
„Einzelfallorientierte Forschung in Sprachtherapie/Logopädie“. Ziel war es einerseits die bereits bestehende Expertise der 30 Teilnehmenden in diesem Forschungsfeld zusammenzuführen, methodische Bedarfe aufzudecken und ein gemeinsames Methodenverständnis für eine Evidenzbasierung in Logopädie/Sprachtherapie zu entwickeln. Das vorliegende Herausgabewerk spiegelt das Geschehen dieses Symposiums wider und versteht sich als Auftakt zu einem kontinuierlichen Diskurs. Der Wissenschaftsrat betonte 2023 erneut die Relevanz der Weiterentwicklung der Gesundheitsfachberufe als wissenschaftliche Disziplin (WR, S. 5-6) und konstatierte: «Wichtig für die Disziplinbildung sind insbesondere gemeinsame Forschungs- und Lehrgegenstände, Erkenntnisperspektiven sowie Methoden und Qualitätsstandards. In sozialer Hinsicht besteht eine Disziplin
aus einer Gemeinschaft von Expertinnen und Experten, die ihre Forschung auf das Gebiet der Disziplin konzentrieren und deren disziplinspezifische Kommunikation über Publikationen, Fachtagungen und Fachzeitschriften erfolgt.» (WR, S. 49). Damit sollte das Ziel verfolgt werden, eine eigenständige Disziplin der „Gesundheitsfachberufe“ und damit inbegriffen
der Logopädie/Sprachtherapie neben der Medizin und anderen Fächern
zu etablieren, um derer zu stärken. Zudem wurde die Logopädie im
Mai 2023 in das Portal «Kleine Fächer» des Bundesministeriums für Bildung und Forschung (BMBF) aufgenommen. Auch damit wird das Ziel verfolgt, die Logopädie/Sprachtherapie in der Hochschullandschaft sichtbarer zu machen.
From Surviving to Living (on): A Grounded Theory Study on Coping in People with Pancreatic Cancer
(2023)
IntroductionAssessment of challenging behaviors in dementia is important for intervention selection. Here, we describe the technical and experimental setup and the feasibility of long-term multidimensional behavior assessment of people with dementia living in nursing homes.MethodsWe conducted 4 weeks of multimodal sensor assessment together with real-time observation of 17 residents with moderate to very severe dementia in two nursing care units. Nursing staff received extensive training on device handling and measurement procedures. Behavior of a subsample of eight participants was further recorded by videotaping during 4 weeks during day hours. Sensors were mounted on the participants' wrist and ankle and measured motion, rotation, as well as surrounding loudness level, light level, and air pressure.ResultsParticipants were in moderate to severe stages of dementia. Almost 100% of participants exhibited relevant levels of challenging behaviors. Automated quality control detected 155 potential issues. But only 11% of the recordings have been influenced by noncompliance of the participants. Qualitative debriefing of staff members suggested that implementation of the technology and observation platform in the routine procedures of the nursing home units was feasible and identified a range of user- and hardware-related implementation and handling challenges.DiscussionOur results indicate that high-quality behavior data from real-world environments can be made available for the development of intelligent assistive systems and that the problem of noncompliance seems to be manageable. Currently, we train machine-learning algorithms to detect episodes of challenging behaviors in the recorded sensor data.
Despite the enormous number of assistive technologies (ATs) in dementia care, the management of challenging behavior (CB) of persons with dementia (PwD) by informal caregivers in home care is widely disregarded. The first-line strategy to manage CB is to support the understanding of the underlying causes of CB to formulate individualized nonpharmacological interventions. App- and sensor-based approaches combining multimodal sensors (actimetry and other modalities) and caregiver information are innovative ways to support the understanding of CB for family caregivers. The main aim of this study is to describe the design of a feasibility study consisting of an outcome and a process evaluation of a newly developed app- and sensor-based intervention to manage CB of PwD for family caregivers at home. In this feasibility study, we perform an outcome and a process evaluation with a pre-post descriptive design over an 8-week intervention period. The Medical Research Council framework guides the design of this feasibility study. The data on 20 dyads (primary caregiver and PwD) are gathered through standardized questionnaires, protocols, and log files as well as semistructured qualitative interviews. The outcome measures (neuropsychiatric inventory and Cohen-Mansfield agitation inventory) are analyzed by using descriptive statistics and statistical tests relevant to the individual assessments (eg, chi-square test and Wilcoxon signed-rank test). For the analysis of the process data, the Unified Theory of Acceptance and Use of Technology is used. Log files are analyzed by using descriptive statistics, protocols are analyzed by using documentary analysis, and semistructured interviews are analyzed deductively using content analysis. The newly developed app- and sensor-based AT has been developed and was evaluated until July in 2018. The recruitment of dyads started in September 2017 and was concluded in March 2018. The data collection was completed at the end of July 2018. This study presents the protocol of the first feasibility study to encompass an outcome and process evaluation to assess a complex app- and sensor-based AT combining multimodal actimetry sensors for informal caregivers to manage CB. The feasibility study will provide in-depth information about the study procedure and on how to optimize the design of the intervention and its delivery. DERR1-10.2196/11630
Background: Currently, to the best of our knowledge, no findings exist concerning the needs of professionals in specialized pediatric palliative care (PPC) regarding electronic health records (EHRs). Several studies have highlighted benefits concerning the use of EHRs in pediatrics. However, usability is strongly affected by the degree of adaptivity to the context of application. The aim of this study is to examine the needs of professionals concerning an EHR in the specialized PPC inpatient and outpatient settings. Methods: A qualitative research design was chosen to address the complex aspects of user demands. Focus group interviews and semi-structured one-on-one interviews were conducted with PPC professionals. N = 23 participants from inpatient and N = 11 participants from outpatient settings of specialized PPC representing various professions took part in the study. Results: The findings could be grouped into four categories: (1) attitude towards the current methods of documentation, (2) attitude towards electronic documentation in general, (3) general requirements for an EHR, and (4) content requirements for an EHR. Conclusions: Professionals in specialized PPC expect and experience many benefits of using electronic documentation. Their requirements for an EHR for inpatient and outpatient settings of PPC are largely consistent with EHRs for pediatrics. However, individual specifications and adaptations are necessary for this particular setting.
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants’ desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC.
Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.