From Static Risk Lists to Dynamic Nursing Action for Subsyndromal Delirium.

The problem of translating research findings into effective practice is a long‐recognised issue in the science of intervention (Douglas and Burshnic ; McCurtin and Clifford ; Thome et al. ). Studies have focused on the factors that interfere with the transition and influence the judgement of clinicians. In this paper, we are interested in a vital precursor, that of differences in how a problem or process is conceptualised and how these may impact on the practices of assessment and intervention. Of the two dimensions of communication, understanding has always been recognised as more challenging to assess than observable expressive behaviours (Bloom ; Sperber and Wilson ). The domain of understanding encompasses all relevant aspects of language (e.g. vocabulary, grammar and linguistic pragmatics) represented by spoken, manual and visual symbols, as well as contextual pragmatics, which includes the ability to interpret embodied communication and environmental cues (Van Dijk ). Ferstl () argues that ‘language serves communication, and communication … is situated in linguistic and social contexts’ (p. 37). Put plainly, communication does not happen in a void; the influences between setting and language use are bidirectional. One complication is that different views about an individual's level of understanding—potentially at variance with that of the speech and language therapist (SLT)—may be espoused by others, including fellow professionals (e.g. nursing staff, teachers) family members and carers, (Grove et al. ; Smith et al. ). Contrasting assessment findings may be attributable to different perspectives offered by functional communication in the setting (e.g. home, classroom, day centre) as compared to standardised testing which eliminates contextual cues. Given the interaction between language and context, it is not surprising that assessing a person's understanding is far from straightforward. To start with, the terminology deployed by SLTs and other colleagues can be confusing. Terms such as , and are used interchangeably. But are these terms synonymous? Or do the semantics differ in subtle ways? One website on bilingualism in childhood claims that ‘Receptive Language is the term used to describe everything a person understands’ (Bilingual Kidspot: ) a position which is emphatically rejected by Wallach and Ocampo (). These authors maintain that the term ‘receptive language’ fails to take account of the reality that comprehension is constructed in context, and suggest SLTs instead use ‘spoken/witten language comprehension’.