Interpersonal communication factors in the supervisory relationship that play a role in enhancing occupational therapy students’ clinical reasoning during physical fieldwork education

Learning outcomes for students whose education takes place in the physical field are, among others, knowledge and skills to implement the occupational therapy process. In this process patients’ problems are assessed and recorded, treatment planned, implemented, continuously evaluated, and the progress of each such patient professionally recorded. Since this is a process which requires distinct clinical reasoning skills on the part of the student various factors can influence the development of such skills during their training. Many authors are of the opinion that it is the interpersonal communication between supervisor and student which underpins successful fieldwork education. In this study the purpose therefore was to investigate how the interpersonal communication factors in the supervisory relationship play a role in enhancing occupational therapy students’ clinical reasoning during physical fieldwork education. At the outset a partially mixed, sequential dominant, status-qualitative design was employed. An inter-subjective or interactional epistemological position was adopted in order to generate data from the participants’ subjective experiences, and an interpretive approach was used to understand how occupational therapy students and supervisors perceive the supervisory relationship during the formers’ learning of their clinical reasoning skills. Data was generated from four sources. First of all, from focus groups conducted separately with students and their supervisors on completion of the fieldwork block; secondly from semi-structured one-on-one interviews held with students as well as supervisors on completion of the formers’ fieldwork block; thirdly from students’ Work Habits Reports, and finally by recording the practical exam grades students obtained in the physical field. To analyse the data both qualitative and quantitative research methods were employed. Information obtained from the focus groups and one-on-one interviews were audio-taped and transcribed. After this process, transcribed data was coded and analysed following both a bottom-up and top down approach. The former was carried out by an independent coder and the latter by the researcher herself to determine which interpersonal communication themes and patterns might emerge from the collected data. A clinical psychologist using the Interpersonal Pattern Analysis, a diagnostic instrument, analysed the audio tapes of 14 supervisors who participated in the focus groups and one-on-one interviews. The themes which emerged from the thematic-content analysis and the Interpersonal Pattern Analysis were compared with the grades students obtained for their clinical reasoning skills in the final practical exam in the physical field. The findings of this study indicated that supervisors of students who received high grades solved problems effectively, were predominately linear in their approach, showed only limited empathy, were rigid in their expectations and gave only limited confirmation. In line with these findings supervisors of students who received lower grades were also effective in terms of problem solving skills and also gave limited confirmation, but were circular in their approach, showed partial empathy and were flexible. Finally in respect of the interpersonal approach to human behaviour there is no one role or pattern of interaction that is more effective in all contexts. A style or a pattern that may be highly effective in one kind of relationship may be ineffective in another. What is emerging here though is that a style which is characterised by flexibility and empathy may not necessarily be an effective teaching style, whereas a style characterised by a linear approach and limited empathy did indeed prove to be significantly more effective.Thesis (PhD)--University of Pretoria, 2011.Occupational Therapyunrestricte

The relationship between final year occupational therapy students' values and their levels of achievement

This study set out to investigate the relationship between individual values of final year occupational therapy students at seven universities as well as the eventual performance of each student during the final evaluation. Using a quantitative research method, a total of 154 final year students were assessed in the early part of their final year by means of the Value Scale - a standardised instrument for the multicultural population in South Africa. The final grade each student obtained was reflected by the mean of the grades obtained in all the subjects for that study year. This grade reflected both theoretical knowledge and the practical application of such knowledge. No positive correlations were found between the six second-order value factors and their achievement percentages for the sample as a whole. However, a negative correlation was obtained in terms of autonomous lifestyle and the students’ levels of achievement (r= -0,169; p - 0,036) for the sample as a whole. This result indicates that the higher the students rated independence of action within their work, as well as creativity, diversity, change of activities and risk incurred in projects proposed, the lower their average grades tended to be. In a profession that sets a high value on creativity and independence, it is specifically those students possessing these values who seem to flounder. It is recommended that the autonomy and creativity of occupational therapy students in the clinical field be researched by means of a qualitative method since the declared values by means of self-report measures in quantitative research may not reveal a student’s operational value system.http://www.ajol.info/journal_index.php?jid=153&ab=ajpherd2017-10-31am201

Feedback on students' clinical reasoning skills during fieldwork education

BACKGROUND / AIM : Feedback on clinical reasoning skills during fieldwork education is regarded as vital in occupational therapy students’ professional development. The nature of supervisors’ feedback however, could be confirmative and/or corrective and corrective feedback could be with or without suggestions on how to improve. The aim of the study was to evaluate the impact of supervisors’ feedback on final-year occupational therapy students’ clinical reasoning skills through comparing the nature of feedback with the students’ subsequent clinical reasoning ability. METHOD : A mixed-method approach with a convergent parallel design was used combining the collection and analysis of qualitative and quantitative data. From focus groups and interviews with students, data were collected and analysed qualitatively to determine how the students experienced the feedback they received from their supervisors. By quantitatively comparing the final practical exam grades with the nature of the feedback, their fieldwork End-of-Term grades and average academic performance it became possible to merge the results for comparison and interpretation. RESULTS : Students’ clinical reasoning skills seem to be improved through corrective feedback if accompanied by suggestions on how to improve, irrespective of their average academic performance. Supervisors were inclined to underrate high performing students and overrate lower performing students. CONCLUSIONS : Students who obtained higher grades in the final practical examinations received more corrective feedback with suggestions on how to improve from their supervisors. Confirmative feedback alone may not be sufficient for improving the clinical reasoning skills of students.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1630hb201

Fieldwork education : putting supervisors’ interpersonal communication to the test

Various factors have an impact on the development of the clinical reasoning skills of occupational therapy students during their training. The aim of this study was to investigate how the interpersonal communication skills of the supervisors impact on their students’ ability to learn clinical reasoning skills during their education in the physical field. Thirty final year students at the University of Pretoria and 14 supervisors from six different hospitals formed the study sample. A mixed research design was employed. Data were collected by means of focus groups and one-on-one interviews conducted with fieldwork educators and students on their inter-subjective experience of supervision. It was then analysed by a clinical psychologist using the Interpersonal Pattern Analysis diagnostic instrument, and finally compared with the grades students obtained for their clinical reasoning skills in the final practical exam in the physical field. The findings of this study indicated that the supervisors of students who received good grades, were predominantly linear in their approach, showed limited empathy and confirmation, were rigid in their expectations and solved problems effectively. Supervisors of students who received lower grades were mainly circular in their approach, were flexible and partly empathetic, validated students and also solved problems effectively. Regarding the interpersonal approach to human behaviour there is no one role or pattern of interaction that is more effective in all contexts. A style or a pattern that may be highly effective in one kind of relationship may be ineffective in another. What is emerging here is that a style which is characterised by flexibility and empathy is not necessarily an effective teaching style, whereas one characterised by a linear approach, rigidity and limited empathy may prove to be significantly more effective.This paper is based on the research at the University of Pretoria for the PhD in Occupational Therapy.http://www.otasa.org.za/otasa_journal/index.htmlhttp://repository.up.ac.za/handle/2263/24770am2013ay201

Formulating a return-to-work decision for employees with major depressive disorders : occupational therapists’ experiences

Background: Major depressive disorder (MDD) is worldwide one of the most concerning health problems as it is associated with reduced work productivity and permanent disability. Occupational therapists are often called upon to make a return-to-work decision on employees with MDD in order to facilitate continued employment. Sustaining employment is in alignment with achieving the Millennium Development Goal 1: Eradicating extreme poverty, as it is known that people suffering from mental health disorders are frequently denied employment opportunities leading to reduced financial resources and therefore possible poverty. Aim: This study described occupational therapists’ experiences of formulating a return-towork decision on employees with MDD. It formed part of a larger study. Setting: Occupational therapists working in vocational rehabilitation or mental health in South Africa with a postgraduate qualification in vocational rehabilitation or mental health participated in the study. Method: A qualitative research design was used. Two separate focus groups explored 11 occupational therapists’ experiences of formulating a return-to-work decision on employees with MDD. Ethics clearance number: S34/2007. Results: Seven themes emerged, which were, (1) the biographical profile of the employee, (2) point of view of employer, (3) point of view of employee, (4) point of view of occupational therapist, (5) declaring the employee as temporary incapacitated, (6) declaring the employee as permanently incapacitated and (7) employee’s level of motivation. Conclusion: Occupational therapists ought to have sound knowledge, skill, experience and the ability to collaborate with employees and employers in formulating a return-to-work decision.http://www.phcfm.orgam2016Occupational Therap

The perceptions of adult psychiatric inpatients with major depressive disorder towards occupational therapy activity-based groups

BACKGROUND: Occupational therapists have been using group therapy as their preferred treatment modality in mental healthcare since the origin of the profession. In private mental healthcare units, major depressive disorder (MDD) is the most common psychiatric disease. Occupational therapists use individual and group therapy to treat adult inpatients with MDD. Little is known about the perceptions and experiences of adult inpatients with MDD regarding occupational therapy activity-based groups. AIM: To describe the perceptions and experiences of adult psychiatric inpatients with MDD towards occupational therapy activity-based groups. This article reports on the perceptions of adult psychiatric inpatients with MDD, which formed part of a larger study. SETTING: The study took place at two private general hospitals in Gauteng province, South Africa, each with a psychiatric ward. METHODS: The researcher used a qualitative explorative descriptive design. Accessible participants were selected using convenience sampling. Only consenting participants took part in the study. Data were collected during focus group discussions. Data were thematically analysed. RESULTS: Participants’ perceptions could be placed into one of four themes: (1) experience improved mood, (2) learned coping skills, (3) regained self-esteem and (4) becoming part of the solution to face life challenges. CONCLUSION: Activities that are unique to occupational therapy profession can benefit inpatients with MDD. This supports the profession’s historical beliefs, assumptions and foundations regarding therapeutic use of activities. According to these inpatients, group activities improved their overall mental health.http://www.sajpsychiatry.orgOccupational TherapyPsychiatr

Multiple common comorbidities produce left ventricular diastolic dysfunction associated with coronary microvascular dysfunction, oxidative stress, and myocardial stiffening

Aims More than 50% of patients with heart failure have preserved ejection fraction characterized by diastolic dysfunction. The prevalance of diastolic dysfunction is higher in females and associates with multiple comorbidities such as hypertension (HT), obesity, hypercholesterolemia (HC), and diabetes mellitus (DM). Although its pathophysiology remains incompletely understood, it has been proposed that these comorbidities induce systemic inflammation, coronary microvascular dysfunction, and oxidative stress, leading to myocardial fibrosis, myocyte stiffening and, ultimately, diastolic dysfunction. Here, we tested this hypothesis in a swine model chronically exposed to three common comorbidities. Methods and results DM (induced by streptozotocin), HC (produced by high fat diet), and HT (resulting from renal artery embolization), were produced in 10 female swine, which were followed for 6 months. Eight female healthy swine on normal pig-chow served as controls. The DM + HC + HT group showed hyperglycemia, HC, hypertriglyceridemia, renal dysfunction and HT, which were associated with systemic inflammation. Myocardial superoxide production was markedly increased, due to increased NOX activity and eNOS uncoupling, and associated with reduced NO production, and impaired coronary small artery endothelium-dependent vasodilation. These abnormalities were accompanied by increased myocardial collagen content, reduced capillary/fiber ratio, and elevated passive cardiomyocyte stiffness, resulting in an increased left ventricular end-diastolic stiffness (measured by pressure-volume catheter) and a trend towards a reduced E/A ratio (measured by cardiac MRI), while ejection fraction was maintained. Conclusions The combination of three common comorbidities leads to systemic inflammation, myocardial oxidative stress, and coronary microvascular dysfunction, which associate with myocardial stiffening and LV diastolic dysfunction with preserved ejection fraction

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three genomic nomenclature systems to all sequence data from the World Health Organization European Region available until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation, compare the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2