RESUMO
INTRODUCTION: Healthcare practitioners delivering services in rural and underserved areas need timely access to appropriate knowledge to optimise the care they deliver. Novice generalist occupational therapists in South Africa experience this need as they respond to a high demand for hand therapy. Embedded within a study aimed at identifying their support and development needs, this article describes participants' experience of a virtual community of practice. METHODS: A qualitative case study design was employed. Nine occupational therapists participated in a virtual community of practice that met fortnightly for meetings and interacted on WhatsApp. Data were collected through photo elicitation, facilitated reflection, and case discussions. An online survey questionnaire was used to evaluate participants' experience of this virtual community. Thematic analysis was applied to the anonymous responses submitted by participants (n=7). A number of strategies were employed to ensure the trustworthiness of results including prolonged engagement, member checking, peer examination, reflexive reading and writing, triangulation, and a dense description of participants to enable readers to evaluate the transferability of results. RESULTS: Three themes were generated from analysis. The first theme, versatile support, describes participants' experience of being helped and supported, appreciating the immediacy of support, and being able to share resources. A vehicle for learning captures participants' experience of mutual learning, opportunity to reflect, to acquire knowledge and skills, and develop their clinical reasoning. Finally, the community of practice was grounding: learning opportunities were contextually relevant and participants were able to consolidate their professional values and identity. Participants raised the importance of using online platforms that were accessible, recommended a group size of 5-10 members, and proposed 60-90-minute meetings held weekly or fortnightly. CONCLUSION: A virtual community of practice provided both support and professional development opportunities for therapists delivering hand therapy. Careful planning and implementation to upscale this intervention are recommended for rehabilitation personnel delivering care to underserved communities in South Africa. The logistics of virtual communities need to mitigate for connectivity difficulties, and online platforms should enable real-time support. Participant satisfaction and the evaluation of implementation outcomes should be considered in the design of virtual communities of practice.
Assuntos
Terapeutas Ocupacionais , Pesquisa Qualitativa , Humanos , África do Sul , Feminino , Masculino , Terapia Ocupacional/educação , Serviços de Saúde Rural/organização & administração , Adulto , Inquéritos e Questionários , Apoio Social , Interface Usuário-ComputadorRESUMO
BACKGROUND: Older adults living in Residential Aged Care Facilities (RACFs) in South Africa are often exposed to environments that fail to provide adequate occupational opportunities. Practitioners in developing economies are challenged to provide therapeutic services in environments that emphasize occupational deprivation. OBJECTIVES: This study investigated barriers and enablers to implementing recommendations derived from the findings generated by the Residential Environment Impact Scale (REIS). METHOD: A two-phased embedded mixed methodology was employed. Phase 1 was the administration of the REIS. In Phase 2, leadership staff considered factors to implementing findings of the REIS, using the nominal discussion group technique. Data were thematically analyzed. FINDINGS: Findings indicated an organizational culture characterized by top-down management and a medically dominated care approach, constrained by financial and operational concerns. CONCLUSION: Using the REIS to holistically assess, RACFs are an applicable tool that could promote collaborative approaches to enhance organizational culture change, cultivating more occupational opportunities.
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Meio Ambiente , Instituição de Longa Permanência para Idosos , Idoso , Humanos , África do Sul , Meio Social , Prática Clínica Baseada em EvidênciasRESUMO
Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries.
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Traumatismos da Mão , Terapia Ocupacional , Humanos , Terapeutas Ocupacionais , Pesquisa Qualitativa , AprendizagemRESUMO
AIM: Frail and vulnerable adults are divested of meaningful encounters when modernization and urbanization force them to embrace an unconventional residential care environment as a home. The aim of this article is to report on a study of SeSotho elders living in residential care to illustrate how more meaningful and culturally relevant experiences could be facilitated for them. METHODS: A content analysis was done of the individual opinions of 15 collaborators as a secondary scrutiny of information obtained during a nominal group process. MAJOR FINDINGS. Findings revealed that elders were prone to experience loneliness, helplessness, and boredom due to situations dominated by occupational injustice. Co-occupations, training of staff, and environmental adaptations that allow a sense of interdependence could contribute in facilitating occupational justice for elders from a traditional South African indigenous background living in residential care. PRINCIPAL CONCLUSION: Human dignity and respect are upheld within residential care when elders have access to purposeful and meaningful activities of their choice that are culturally appropriate. Occupational therapists should advocate for doing, belonging, and becoming by facilitating meaningful occupational participation that is culturally relevant for their clients.