Three's a crowd: the process of triadic translation in a South African psychiatric institution

Mental health care in South Africa has long been governed by inequalities (Foster & Swartz, 1997). During apartheid, those who did not speak English and Afrikaans could not access mental health services in the same way as those who did (Foster & Swartz, 1997). One main reason for this is the majority of mental health practitioners could not, and were not required to speak languages other than English and Afrikaans (Swartz, 1991). The South African mental health literature suggests that language and communication must be prioritised if there is to be an improvement in mental health care services for those individuals who do not speak English and Afrikaans (Bantjes, 1999; Drennan & Swartz, 1999; Swartz & Drennan, 2000; Swartz & MacGregor, 2002). Drawing on Prasad's (2002) interpretation of Gadamer's critical hermeneutic theory and utilising thematic networks analysis (Attride-Stirling, 2001), this study investigated the process of translated clinical assessment interviews within a psychiatric hospital in the Eastern Cape Province within South Africa. Results of the study revealed that contextual factors, issues concerning linguistic and cultural heritage, clinicians' role expectations regarding translators' role performance, as well as relational dynamics regarding individual levels of control and influence within the translation triad, all impacted on the effectiveness of communication, translation and service provision. These fmdings are supported by literature on the theory and practice of translation that identifies these issues as prominent (Robinson, 2003). Specific recommendations regarding the formalisation of translation practices within the hospital setting, as well as the familiari~ation of clinical practitioners and psychiatric nurses with the intricacies of translation processes are offered

Assessment of a hand exoskeleton on proximal and distal training in virtual environments for robot mediated upper extremity rehabilitation

Stroke is the leading cause of disability in the United States with approximately 800,000 cases per year. This cerebral vascular accident results in neurological impairments that reduce limb function and limit the daily independence of the individual. Evidence suggests that therapeutic interventions with repetitive motor training can aid in functional recovery of the paretic limb. Robotic rehabilitation may present an exercise intervention that can improve training and induce motor plasticity in individuals with stroke. An active (motorized) hand exoskeleton that provides support for wrist flexion/extension, abduction/adduction, pronation/supination, and finger pinch is integrated with a pre-existing 3-Degree of Freedom (DOF) haptic robot (Haptic Master, FCS Moog) to determine the efficacy of increased DOF during proximal and distal training in Upper Extremity (UE) rehabilitation. Subjects are randomly assigned into four groups to evaluate the significance of increased DOF during virtual training: Haptic Master control group (HM), Haptic Master with Gripper (HMG), Haptic Master with Wrist (HMW), and Haptic Master with Gripper and Wrist (HMWG). Each subject group performs a Pick and Place Task in a virtual environment where the distal hand exoskeleton is mapped to the virtual representation of the hand. Subjects are instructed to transport as many virtual cubes as possible to a specified target in the allotted time period of 120s. Three cube sizes are assessed to determine efficacy of the assistive end-effector. An additional virtual task, Mailbox Task, is performed to determine the effect of training and the ability to transfer skills between virtual settings in an unfamiliar environment. The effects of viewing mediums are also investigated to determine the effect of immersion on performance using an Oculus Rift as an HMD compared to conventional projection displays. It is hypothesized that individuals with both proximal and complete distal hand control (HMWG) will see increased benefit during the Pick and Place Task than individuals without the complete distal attachment, as assisted daily living tasks are often accomplished with coordinated arm and hand movement. The purpose of this study is to investigate the additive effect of increased degrees of freedom at the hand through task-specific training of the upper arm in a virtual environment, validate the ability to transfer skills obtained in a virtual environment to an untrained task, and determine the effects of viewing mediums on performance. A feasibility study is conducted in individuals with stroke to determine if the modular gripper can assist pinch movements. These investigations represent a comprehensive investigation to assess the potential benefits of assistive devices in a virtual reality setting to retrain lost function and increase efficacy in motor control in populations with motor impairments

Managing Patient Care: A Substantive Theory of Clinical Decision Making in Home Health Care Nursing

This study investigates the phenomenon of clinical decision making, deriving a grounded substantive theory to explain how home health care nurses make patient care decisions. Despite the continuing shift of health care from acute care settings to the patient\u27s home, little is known about home health care nurses\u27 clinical decision making processes and the factors influencing them. The study employs a field research design using grounded theory based on symbolic interactionism. Data collection at two Visiting Nurse Associations includes participant observation and open-ended interviews of 21 nurses, and document analysis of patients\u27 records and home care nursing practice policies. The study uses the constant comparative technique for data analysis and incorporates measures to enhance its credibility, transferability, dependability, and confirmability. Managing patient care emerged as the basic social process that explains home health care nurses\u27 clinical decision making. This process has three components. First, it embodies the problem solving process with the phases of problem finding and problem management. Problem finding consists of the cognitive processes and decisions of cue searching and inferring patient problems, while problem management consists of planning, intervening, and evaluating. Second, to manage patient care, home care nurses use three styles based on their approach to gathering and evaluating information-- skimming, surveying, and sleuthing. Third, interacting clinical and non-clinical factors influence patient care management: the nurse\u27s education and experience, the patient\u27s health-related attributes, the nurse-patient interaction, and the organizational, legal, and economic factors. With these three components, the emergent theory of managing patient care integrates elements of three cognitive theories--information processing, cognitive continuum, and skills acquisition--thus bridging the traditionally dichotomous rational and phenomenological perspectives underpinning clinical decision making. The emergent theory raises issues critical to the teaching and improvement of clinical decision making among practicing and future home care nurses, in the context of the potential ethical dilemmas implied by the sometimes conflicting factors that influence patient care management. It serves as the springboard for extending the study to other clinical specialties, building a body of substantive theories that would lead to a formal theory of clinical decision making in nursing

Uptake of Best-Practice Recommendations for Management of Acutely Ill Children Admitted in Kenyatta National Hospital: A Longituinal Study Employing Participatory Research in a Complex Environment

The need for improving practice in low-income settings has been demonstrated in recent research assessing the quality of hospital care. Consequently, the Ministry of Health developed clinical practice guidelines and an evidenced-based programme for their dissemination. This thesis explored what factors influence the uptake of the best-practice recommendations in a university teaching hospital. This thesis used a mixed methods research approach that utilized a before and after design and participatory action research. This approach recognizes that health recommendations are compiled for universal use, but that their successful implementation requires particular attention to the individual and complex socio-political contexts of each setting, both at the micro and -macro level, which in this case was the Kenyatta National Hospital (KNH). This thesis is supported by eighteen months of participant observation, based on ethnographic research methodology and action research. Patients' care was largely inconsistent with best-practice recommendations, with nine of the 17 key indicators having performance of below 10% in the pre-intervention period. The intervention had an absolute effect size of over 20% in eight of the 17 key indicators; three of which had an effect size of over 50%. The indicators that required collective efficacy achieved performance of less than 10% in the post-intervention period. The activities during the action research component failed to predict the trend in practitioners' performance, illustrating the difficulty of gaining a holistic understanding of the quantitative results using component parts of the qualitative results as the lens. The notion of professionalism provided an overarching understanding of the implementation process. There were clear gaps between the stated values espoused in the ideal of professionalism and the observed actions of professionals in KNH. Gaps spanned knowledge management, expertise and skills, teamwork, conscientiousness and patient centeredness. I attributed the gaps in professionalism to complexity of professional development

Mindfulness for the Millennial Generation: A Clinician\u27s Handbook for College Counseling Centers

The current generation of college students, the Millennials (Howe & Strauss, 2000, 2007) lead highly pressured and achievement-oriented lives. Along with generational changes, change is occurring on university campuses, especially in terms of mental health demographics. There is an increase in the severity of presenting concerns reported by students as seen at counseling centers (Gallagher, 2008), and more students with existing mental health diagnoses are seeking college admissions (Gallagher, 2009). Changes in the current college student generation and socio-cultural changes underscore the need for an effective stress-reduction program for university students. Mindfulness-based interventions have received attention from researchers and clinicians. The current dissertation modifies the traditional Mindfulness-Based Stress Reduction (Kabat-Zinn, 1990) to propose a new format for facilitating a mindfulness group suited for beginning meditators within the Millennial college student population. In addition to emphasizing flexibility of the group program, the handbook includes information on conducting pre-group screening, debriefing, assessment of members\u27 mindfulness skills, and allied mindfulness practices such as Tai chi and Qigong. Future directions include gathering empirical support for the proposed format and including practices suitable for college students with severe psychological concerns

Math Via Movement: Using Emotional Intelligence in the Math Classroom

The purpose of this curriculum development project was the conception of lesson plans incorporating dance/movement therapy principles in order to augment the instruction of mathematics at a third grade level in a public school while addressing emotional intelligence through social emotional learning. This endeavor was guided by the questions: How does movement affect third grade math students’ abilities to take in and retain information at a public school setting? How can social-emotional interventions change the experience of a third grade student learning mathematics? How can academic counseling informed by body movement and awareness benefit the facilitation of learning mathematics? In order to ensure the functionality of the curriculum, this thesis was mostly a collaboration between the writer and three third grade teachers at a Chicago Public School. Not all of the lesson ideas were actually executed. This process was guided by the Logic Model for program development as presented by the University of Wisconsin. This finished product includes twelve lesson plans which were developed during the school year 2014-2015 and were designed to complement the classroom’s curriculum. These lesson plans were an attempt to incorporate social emotional learning standards from a dance/movement therapy perspective. 128 pages

An investigation into what best practice entails with adolescent survivors of prolonged child abuse

This theoretical study explored the differences between narrative therapy (White, 2007a) and the family contextual model (Gold, 2000) in the treatment of adolescent survivors of prolonged childhood abuse (PCA). The aim of this research was to contribute to defining best practice with this population. Narrative therapy and the family contextual model were selected for this research because they are primarily client directed and trauma responsive as opposed to trauma focused. These were important considerations given the differences between the treatment needs of survivors of long-term childhood trauma, which are inevitably intertwined with development and attachment, and those of single-incident trauma survivors. Content analysis was then conducted within and across bodies of literature on PCA survivorship, Complex Posttraumatic Stress Disorder (which describes difficulties that PCA survivors frequently experience), narrative therapy, and the family contextual model. This analysis found that narrative therapy and the family contextual model each lend different strengths to clinical practice with adolescent PCA survivors and that their differing strengths have the capacity to complement one another. Suggestions for clinicians on how to integrate these two treatment philosophies were therefore proposed in an attempt to offer more comprehensive and effective treatment options for practice with this population, although much further research is needed

Increasing the use of research findings in four allied health professions

The research-practice gap persists in the allied health professions because they perceive or experience barriers to research utilisation. The focus of this work was on overcoming these barriers to increase research utilisation in four allied health professions: nutrition and dietetics, occupational therapy, physiotherapy, and speech and language therapy. There were two aspects to this: the development of an intervention and a critical review of measurement in the field.An action research project, involving interviews, focus groups, a critical review of manuals and a peer review process, identified a seven-step process to enable therapy managers to increase research utilisation. The seven steps of this process were the therapy manager, lead therapist, consultation process, action plan, making it happen, monitoring and evaluating and revising the action plan. This process was used to form the structure of the Turnkey manual. Fortyeight measures of research utilisation were identified for critical review and, with a few exceptions, there was a lack of rigour in the development of these tools. The conceptual framework developed suggested a profile of measures was needed to assess research utilisation. The Bannigan Utilisation of Research Profile is proposed as a basis for further research. As there were no sufficiently robust measures available to evaluate the effectiveness of the Turnkey manual a single case study was used to assess its utility. This identified that the model of manager and lead therapist was viable and that the Turnkey manual, with modification, is a potentially useful intervention.This work has demonstrated that research utilisation is still a nascent subject; there is a lack of definition, interdisciplinary research and coherence in the field. Systems thinking has been explored as a means of researching this complex concept, providing a way forward for interdisciplinary work and perhapsestablishing this emerging subject

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO