Scielo RSS <![CDATA[South African Journal of Occupational Therapy]]> vol. 46 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Ethics and clinical education</b>]]> This paper explores the ethical concerns which were identified in a mixed methods study to determine the facilitators and barriers to quality clinical education on the clinical training platform of the University of the Witwatersrand (Wits). Ethical and professional behaviour concerns were extracted and analysed from focus groups and questionnaires that were used to collect data for the study. The ethical and professional behaviour concerns and responsibilities are discussed in terms of the clinical educators in their role as both clinicians and educators. Ethical and professional concerns and responsibilities are also highlighted in respect of students in their role as developing learners and professionals. How students learn ethical and professional behaviour is discussed as well as how a clinical educator should encourage these important clinical competencies which students tend to learn in an overt rather than covert manner. The paper also considers how in a service delivery placement where the focus is on clients' right to care, and the students' right to education may be overlooked and their professional learning compromised. The importance of a sound clinical educator-student relationship is central to professional education and facilitation of reflective practice and clinical reasoning essential for the learning of ethical and professional behaviour. <![CDATA[<b>Occupation-based hand therapy in South Africa: challenges and opportunities</b>]]> Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference, while remaining rooted in an occupational therapy perspective. There are a number of benefits and challenges that have been recognised in hand therapy settings. The use of an occupation-based approach in the field of hand therapy is of interest to all occupational therapists practising in this field. This commentary explores the challenges and opportunities of OBHT as an approach in the assessment and treatment of clients with hand conditions in the South African context. The authors describe OBHT, explore the barriers in practice and propose guidelines for such an approach in our context. Recommendations are made to enhance the understanding and practice of an OBHT approach in everyday hand therapy practice within South Africa. <![CDATA[<b>Sensory processing, praxis and related social participation of 5-12 year old children with Down Syndrome attending educational facilities in Bloemfontein, South Africa</b>]]> BACKGROUND: Down syndrome is one of the most investigated and well discussed syndromes related to intellectual disability, yet little can be found in literature of the impact that sensory processing difficulties or disorders have on the functioning of individuals with Down syndrome. This study investigated the sensory processing, praxis and related social participation of children with Down syndrome with the purpose of contributing to a better understanding thereof and heightening awareness of the importance of including sensory integration therapy as part of intervention. METHODS: The study was conducted by using a cross-sectional, quantitative, descriptive study design. The Sensory Processing Measure (SPM) Home Form was used to collect information regarding the children's sensory processing, praxis and related social participation. The questionnaire was completed by a parent or caregiver of a child with Down syndrome (n=15). RESULTS: The majority of the children with Down syndrome included in the study experienced vulnerabilities in social participation (53.3%) and praxis (80.0%), whereas 100% of the children experienced vulnerabilities in sensory processing. CONCLUSION: The results of this study contribute to the emerging understanding of the sensory processing, praxis and related social participation of children with Down syndrome. The findings may be taken into consideration by occupational therapists delivering services to children with Down syndrome to ensure optimal intervention. It is recommended that further studies on larger samples investigate this topic to corroborate these findings. <![CDATA[<b>Stroke management and functional outcomes of stroke survivors in an urban Western Cape Province setting</b>]]> INTRODUCTION: Long-term disability caused by stroke can be decreased through comprehensive rehabilitation. AIM: This article aims to describe the functional outcomes achieved by stroke survivors in an urban Western Cape Province setting to add to the information on stroke management. METHODS: A descriptive mixed methods study was done. Proportional, stratified random sampling was used to select 53 participants from a population of 267. Quantitative data were collected with the Stroke Impact Scale Version 3.0 and the Modified Barthel Index, and analysed with the Mann-Whitney test. A p value of < 0.05 was deemed statistically significant. Five of the 53 participants were purposively sampled for the qualitative phase of the study. Qualitative data were analysed according to predetermined themes. RESULTS: Seventy-five per cent of participants were managed in a general medical ward. Four were admitted to a specialised inpatient rehabilitation centre. Eighty-three per cent received physiotherapy, 62% received occupational therapy and 57% received both physio-and occupational therapy. Fifty-one per cent experienced communication difficulties, but only 18% received speech therapy. CONCLUSION AND RECOMMENDATIONS: Sufficient inpatient therapy (preferably in a stroke unit /ward) and family education /training should be received before discharge. Occupational therapy, speech therapy, physiotherapy as well as psychological, social work, vision screening and dietetic services should be expanded at both hospital and community level. <![CDATA[<b>A qualitative exploration of the characteristics and practices of interdisciplinary collaboration</b>]]> The Children's Centres in South Australia are examples of settings requiring the effective collaboration of disciplines from diverse backgrounds, such as staff from education, health and welfare. Working together across different professional groups is complex and challenging. Existing literature describing collaboration in early childhood settings focuses on exploring the concept from a single professional perspective, with limited exploration from multiple professional perspectives. The aim of this study was to describe the characteristics and practices of collaboration in well-established Children's Centre teams from multiple professional perspectives. It is anticipated that this description can result in strategies for other teams in similar interdisciplinary settings. A systematic review was conducted summarising the literature on the characteristics and practices of collaboration in Children's Centres, followed by a descriptive qualitative study. Team members from two centres participated in focus groups, thematic analysis was undertaken and findings of both phases were integrated. Characteristics and practices that support constructive teamwork were identified, with the central theme of leadership and the interrelated sub-themes including: development of team cohesiveness; supportive team processes, as well as working within and between government departments. The study contributes to the understanding of the complexity and inter-relatedness of the characteristics and processes involved in collaboration, highlighting the importance of leaders in supporting the collaboration of disciplines from different professional backgrounds. <![CDATA[<b>From paper to practice - academics and practitioners working together in enhancing the use of occupational therapy conceptual models</b>]]> INTRODUCTION: Occupational therapy students are exposed to occupational therapy conceptual models in lectures, and are expected to practice application of these models during clinical fieldwork placements. During fieldwork, they are exposed to practitioners' approaches to the use of occupational therapy conceptual models, and are often confronted with a gap between theory and practice. The objective of this study was to investigate the use of conceptual models by occupational therapy practitioners in the Free State, South Africa, to inform collaborative efforts in the process of reinforcing the link between theory and practice, by enhancing the use of occupational therapy conceptual models. METHODS: A cross sectional study was done in two phases: by means of a questionnaire survey, with practitioners responsible for fieldwork supervision of students; and a workshop survey completed by practitioners attending a workshop on occupational therapy models. RESULTS: Results in the first phase describe the perceptions of 22 supervising practitioners around occupational therapy conceptual models; and their own and students' application thereof in practice. These results were used as the basis to design a workshop on the application of occupational therapy conceptual models. In the second phase, workshop survey questionnaires completed by 20 participants, indicated that they perceived the workshop as enabling with regard to applying new occupational therapy conceptual models with more confidence and competence, and that they felt more confident to supervise students in applying occupational therapy conceptual models during fieldwork. CONCLUSION: This study and its resulting workshop show how collaboration between practitioners and academics can improve the link between theory and practice, benefiting practitioners' professional identity and ultimately impacting on undergraduate training. <![CDATA[<b>The development of an emotional regulation scale for adolescents</b>]]> Emotional regulation is an important skill enabling or disabling the occupational engagement of adolescent clients. Evaluation is a key concept in the occupational therapy process, informing treatment approaches and outcomes. The authors could not identify a scale measuring emotional regulation strategies used by adolescent in the literature. A quantitative, descriptive study was done following a process of scale development. A survey with 78 items was designed which 404 adolescents from a tertiary institution completed. From the results, a provisional scale was developed, measuring emotional regulation strategies used by adolescents. The scale has 39 items, consisting of five emotional regulation strategy categories, named Comfort and Sharing, Antisocial behaviour, Creative Activities, Physical Activities and Eating. A confirmatory factor analysis (CFA) model proved the provisional scale, as well as the items, to be reliable. Further research for the development and the refinement of this scale is recommended. The use of an emotional regulation scale could assist the occupational therapist in understanding the adolescent client's emotional regulation strategies or lack thereof. Emotional regulation skills can either support or hinder a person's wellbeing and are influenced by the emotions experienced, as well as the individual's preference. Key challenges involved in regulating emotions are to choose which emotional regulation strategy to use, when to use it and how to implement it7,8. <![CDATA[<b>Having a child with cancer: African mothers' perspective</b>]]> BACKGROUND: The study was conducted in KwaZulu Natal, South Africa. Six boarder mothers, who lived with their children in the CHOC house while their children received treatment for cancer, were interviewed for the study. Objective of study: The objective was to explore the lived experiences of mothers from rural and peri-urban areas when their children had cancer. Specifically information on occupational balance and disruption, as well as shifting responsibilities, was explored. METHODS: A single focus group followed by individual interviews were conducted. FINDINGS: The findings revealed that some African communities believe that children do not get cancer. There was a lack of factual information around the condition, which perpetuated the stigmatisation of these families. They felt isolated and could not access any community support as a result. Mothers experienced occupational disruption, as well as guilt and self-blame when their children had cancer. RELEVANCE TO CLINICAL PRACTICE: Support and information for mothers hospitalised with sick children should form part of occupational therapy intervention. LIMITATION AND RECOMMENDATIONS FOR FURTHER RESEARCH: These findings are applicable to African mothers from both a peri-urban and rural context in KwaZulu Natal. Further research with mothers across South Africa would be useful to expand on the research findings and would potentially assist in programme development. <![CDATA[<b>The lived experience of drivers with a spinal cord injury: A qualitative inquiry</b>]]> INTRODUCTION: Driving is an instrumental activity of daily living and a facilitator of meaningful participation in society for the majority of the population, including persons with spinal cord injuries. Persons with spinal cord injury may have impaired fitness to drive capabilities. Little is known about perceptions of drivers with spinal cord injury on driving, driver rehabilitation, or return to driving. This study examined the post spinal cord injury driving experiences of drivers and illuminates their rehabilitation and return-to-driving needs within the South African context. METHOD: This phenomenological study explored personal experiences of fourteen drivers with spinal cord injury, recruited through purposive sampling. Face-to-face, semi-structured interviews were audio recorded and transcribed verbatim. The data analysis was an inductive and iterative process. RESULTS/FINDINGS: Six themes represent the study findings: adjusting to physical limitations, safety perceptions and influencing factors, the positive role of driving, contextual features and supports, environmental barriers, and inconsistent provision of rehabilitation services. CONCLUSIONS: The findings indicated that occupational therapists ought to consider incorporating driver rehabilitation services and adopt mediation approaches to advocate for persons with spinal cord injury, who want to drive. Plausible practice and research opportunities are discussed for occupational therapists who are interested in driving and spinal cord injury. <![CDATA[<b>Community Service Occupational Therapists: thriving or just surviving?</b>]]> INTRODUCTION: Community Service was introduced to improve access to health care for all South Africans, yet little is known about the experiences of Community Service occupational therapists. This article describes the characteristics and general experiences of Community Service occupational therapists. METHODS: A national cross-sectional survey was undertaken. Data were collected with an online questionnaire to all occupational therapists completing Community Service in 2013 (n=240). Data were analysed with IBM SPSS Statistics, version 21.0, and responses to open ended questions were post-coded. RESULTS: A 44.3% (n=104) response rate was achieved. Almost half the participants (44.7%) were located rurally with 51.5% working at primary level at least some of the time. Referrals were frequently received for wheelchair related services (61.2%), interventions related to child development (49.5%), disability grant assessments (36.9%) and treatment of adults with neurological conditions (39.8%). While some therapists felt challenged (54.2%) and frustrated (58.3%), many (75.0%) reported satisfaction from interacting with clients. Although the majority perceived the profession to be poorly recognised (63.5%), most were proud to be occupational therapists (66.7%). CONCLUSION: Community Service occupational therapists are playing an important role in improving access to services but Community Service needs to be situated within a broader plan to extend and strengthen services in-line with government policy. <![CDATA[<b>An exploration of burn survivors' experiences of Pressure Garment Therapy at a tertiary hospital in South Africa</b>]]> INTRODUCTION: Pressure garment therapy is used to treat hypertrophic scars, but adherence to this intervention presents challenges. The aim of the paper was to explore the pressure garment therapy experiences of adult burn survivors. METHODS: The experiences of eight purposively sampled participants were explored in a qualitative, phenomenological study. Data were collected by means of semi-structured interviews. Thematic analysis was conducted. RESULTS: Participants described an improvement in the scars, but struggled with adherence to pressure garment therapy. The emotional impact of the burn injury, physical symptoms, the effort of caring for the garments and aesthetic factors created barriers to adherence. Support, inner strength, knowledge, and seeing an improvement facilitated adherence. CONCLUSION: The findings of the study show that participants perceived pressure garment therapy as beneficial, but several complex factors impacted adherence. A bigger choice in material colours, a person-centred approach to burn management, digital photos of scars to catalogue improvement and the establishment of a counselling network are recommended. <![CDATA[<b>Reflections on simulated learning experiences of occupational therapy students in a clinical skills unit at an institution of higher learning</b>]]> BACKGROUND: Global and national changes in healthcare create challenges in providing suitable and quality fieldwork placements for the skills training of undergraduate health professions students. The department of occupational therapy (OT) at a Higher Education Institute (HEI) in South Africa decided in 2013 to incorporate simulated learning experiences as part of the new curriculum for second-year occupational therapy students. Two staff members of the Department of OT trained by an international institution of higher education in the use of simulation during teaching were involved. The aim of this study was to explore and describe the experiences of those students who had benefitted from simulated learning in the Clinical Skills Unit (CSU) to improve on this method of obtaining clinical assessment skills. METHODS: A qualitative methodology was used to describe the reflections of the second-year occupational therapy students of the years 2013 and 2014 (81 students) on the simulated learning of assessment procedures which took place in the CSU RESULTS: Four themes and ten sub-themes were identified from the content analysis of the reflections, namely (i) personal experience (personal emotions, initial stress, confidence) (ii) Teaching and Learning clinical assessment skills (communication, occupational performance components [OPC] and occupational performance activities [OPA]); (iii) professional skills (therapeutic use of self, cooperative learning) and (iv) benefits and challenges of presenting simulated learning experiences (benefits, criticisms). CONCLUSIONS: Occupational therapy students reported a positive experience and satisfaction with learning from the simulated experiences, which succeeded in creating a "safe" learning environment for them and opportunities to hone their clinical assessment skills prior to their first clinical fieldwork placement. Challenges associated with simulated learning experiences (SLE) were found to be: the need for clearer instructions; the number of assessments covered and the provision of a time frame to complete each task. There was consensual agreement in the department that SLE in the CSU will supplement fieldwork placements and contribute to attainment of assessment skills prior to fieldwork placements. It is recommended that current occupational therapy lecturing staff, trained in the use of simulation techniques, develop a manual for the planning of SLE and present training sessions to other staff. The manual may also be of value to other institutions of higher learning in South Africa.