This qualitative study explored the effects of trauma as well as coping mechanisms used to deal with post-traumatic stress experienced by ILS paramedics providing emergency care services in the Gauteng Province, South Africa. It also looked at the competencies needed to cope with traumatic stress and promote biopsychosocial well-being. It is argued that it is important to look at this subject from a South African perspective since most of the published research on the sources and effects of trauma on paramedics and other frontline emergency services personnel experience comes from developed countries. It was discovered that there is minimal empirical research from South Africa on similar topics, except for a study in the Cape Town metropole. In addition to that, most published research relied on quantitative data collection methods. Through qualitative case study research this thesis draws on observations and relevant data gathered by way of semi-structured face to face interviews with eleven operational Intermediate Life Support (ILS) paramedics who work in the Gauteng province. Data is gathered on the sources of stress and coping mechanisms currently used by the paramedics. The gathered data was analysed using thematic analysis. The results show that the sources of stress for paramedics include attending gruesome scenes, extreme pressure to save lives and attending a scene where a child or a colleague is involved. It was also observed that the paramedics have a set of coping strategies to manage post-traumatic stress which are both positive and negative coping strategies. In addition to interviews with ILS paramedics from whom data is gathered on their education and training, the results in this thesis gathered insight from a panel of six experts who were engaged through a focus group discussion. These experts have demonstrable expertise in curriculum development, trauma counselling and training. The panel recommended that the training of the paramedics must be more realistic such that the paramedics are better equipped to deal with the challenges they may encounter in the work environment. It was also revealed that those who train paramedics are not well equipped to deliver the health and wellness module. It can be concluded that some paramedics are not well equipped to deal with traumatic events they encounter in the field. The researcher recommends that the health and wellness module be delivered by people who are specifically trained to deal with mental health issues. Insights gathered in this study will help the paramedics, those they help and their families.

At present there are approximately 13,000 registered speech and language therapists, the majority of these are female. The current ratio of male to female professionals in the United Kingdom stands at 3:100. A decade ago, the figure stood at 1.9% (Sheridan 1999), indicating that in recent years, the number of male professionals has been gradually rising, however, this figure remains low in comparison to other professions within the health and education sectors. Previous research has offered explanations for the lack of diversity in the profession (Greenwood et al 2006, McAllister and Neve 2005), citing poor remuneration, employment opportunities and knowledge base of the profession; this has resulted in few men choosing to enter the profession. In addition, it means that male students are likely to find themselves as the sole male in a cohort of students. The minority status that such a position entails is thought to lead to negative consequences, reduced motivation and feelings of isolation (Boyd and Hewlett 2001). This research examined the everyday lived experiences of being a male student speech and language therapist in order to develop an understanding of how they constructed their professional identity and to ascertain whether their gender identity influences this journey. Twelve male speech and language therapy students and early career professionals were interviewed with a semi-structured format through a variety of mediums. The participants shared their stories and experiences of being a speech and language therapy student in both the university and clinical settings. The participants shared their experiences of isolation and of dealing with the assumptions that other professionals made about their position within the speech and language therapy profession and these experiences were reported to have had an effect on both their training and their positioning within the wider profession.

Doctor of Philosophy (PhD) / Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.

Doctor of Philosophy (PhD) / Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.

Introduction: Students with disabilities are underrepresented in post-secondary education, including health professional programs. They experience higher rates of attrition and lower rates of graduation compared to their non-disabled peers. Some research indicates that educators engage in ableist practices preventing students with disabilities from successfully completing these programs. Educators report difficulty meeting the myriad of professional and educational expectations in professional programs. Rehabilitation professions provide a unique opportunity for research given their emphasis on participation and inclusion. Purpose: The purpose of this program of research was to explore the educator perspective in the accommodation of students with disabilities in professional rehabilitation programs. Method: There are three studies that constitute this thesis. The first study is a critical discourse analysis in which the most relevant texts in the accommodation process were examined. The second study is an institutional ethnography informed study, whereby university-based educators were interviewed about their actions in the accommodation process of students with disabilities. The final study is an interpretive description that involved interviews with fieldwork educators who provide disability-related accommodations to students in their work settings. Findings: The texts involved in the accommodation process revealed varied and conflicting discourses and subject positions for educators in rehabilitation programs. University-based educators identified tensions reconciling the focus on students in the post-secondary education context with the focus on clients in the healthcare context, for which they were preparing students. However, fieldwork educators were generally at ease with the accommodation process as they integrated accommodations into the broader goal of learning. Implications: This body of work provides insight into the reasons why educators may struggle with the accommodation process in professional rehabilitation programs. It also identifies potential solutions for educational programs and future directions for research. / Thesis / Doctor of Philosophy (PhD) / Students with disabilities experience difficulty entering and graduating from health professional programs, including rehabilitation. This group of students face challenges in meeting all the requirements for their programs. Through three discrete studies, this thesis explores educators’ perspectives on the accommodation process of students with disabilities. The first study demonstrated that the most relevant documents to the accommodation process require educators to take on conflicting roles. The second study showed that university-based educators struggle with the focus on students at the university, which seemed to be prioritized over the focus on clients in healthcare, the context for which educators prepare students. The final study illustrated that fieldwork educators did not experience these struggles. Rather, they accommodated students as part of the students’ learning journey. These studies help explain why educators may have difficulty with the accommodation process of students with disabilities and offer solutions for educational programs and future research.

Hostage/crisis negotiation has been described as a complex verbal dance between the negotiator and the subject. While one of law enforcement's most effective tools and most significant developments in law enforcement and police psychology over the past several decades, the acceptance of mental health professionals (MHP) on a hostage/crisis negotiation team is ambiguous. This study examined how mental health professionals working with hostage/crisis negotiation teams are perceived, if there is positive small group socialization within teams, whether the outcome of incidents is affected by designation of the MHP as a team member versus a consultant, and whether prior law enforcement experience influences team members' perception of the MHP. A comparative research design was utilized and data were collected from 362 hostage/crisis negotiators using the Hostage/Crisis Negotiation and Mental Health Professional Questionnaire. Independent sample t tests indicated that MHPs designated as team members scored higher on the Small-Group Socialization and Perception scales than those designated as consultants. Results indicated that MHPs with law enforcement experience were perceived more positively than those without. The type of MHP designation showed no significant effect on incident outcome. This study's outcome may produce positive social change in that the results will enhance and promote ideas and cohesion that involves the unity of the MHP and their law enforcement team members in a field that focuses in on preservation of human life in the worst possible conditions, with positive implications for the team, hostages, victims, communities, and even the individual in crisis.

Thesis title: Health Professional-patient communication in relation to weight managementBackground: Global obesity levels have doubled since 1980 and are expected to rise. It is associated with key health risks such as heart disease, some cancers and osteoarthritis and hence has considerable economic consequences for health care resources. Key policy guidelines recommend that all health professionals (HPs) should discuss weight management with their patients making every contact count. However, we know HPs find discussions about weight challenging due to lack of time, training and skills. Knee Osteoarthritis (KO) and obesity are inextricably linked and together with a rise in obesity levels and growing numbers of older citizens rates of KO are set to escalate. As obesity is the key modifiable risk factor for KO, discussions about weight are paramount. This thesis explored this relationship further from the perspectives of patient and HPs, focusing on KO as an exemplar condition where there is scope for improved weight management. Methods: Utilising qualitative methods, three studies were undertaken. Firstly, a systematic review and thematic synthesis was conducted of published literature of physicians' views and experiences of discussing weight management within routine clinical consultations, not specific to KO. Secondly, HPs' experiences of discussing weight in consultations with KO patients through semi-structured interviews were conducted with 26 HPs. Interviews were audio recorded and analysed using TA. A final study recruited 25 overweight/obese patients with KO and investigated their experiences of talking about weight with HPs. Results: Overarching themes were identified across the studies. Firstly, HPs are pessimistic about patients' desire to lose weight and their capacity to help them. Several factors lead physicians and HPs to be reticent to accept responsibility for discussions about weight. Within routine consultations and between HPs and KO patients, weight was viewed as a sensitive topic. Both HPs and patients recognized the difficult cycle of pain, reduced mobility and weight gain. Patients with KO desire patient-centred (PC) care but, despite HPs recognizing its value, they do not receive it. Both physicians and HPs lack communication skills in weight management. Conclusions: The work undertaken in this thesis demonstrates that barriers preventing effective clinical interactions about weight identified in routine consultations still exist, even when two conditions such as KO and obesity are inextricably linked. Although HPs and patients hold similar understanding of these interrelationships and recognise the value of PC discussions, HPs struggle in effective behavior change talk. HPs expressed impatience with the efforts of their patients. To readdress this imbalance all consultations about weight should be PC. Both physicians and HPs were inadequately trained to discuss weight and patients' views supported this. HPs working with overweight patients should be trained in evidence-based behaviour change techniques and PC communication techniques to increase their confidence to support patients in weight management. Finally, health psychologists have the skills to both deliver and guide discussions about weight.

Orientador: Arlete Maria Valente Coimbra / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-07T22:30:19Z (GMT). No. of bitstreams: 1 Teixeira_IlkaNiceiaD'AquinoOliveira_M.pdf: 2857396 bytes, checksum: c9862695fdd22acb97017904bd7b6295 (MD5) Previous issue date: 2006 / Mestrado / Mestre em Gerontologia

Magister Scientiae (Physiotherapy) - MSc(Physio) / Clinical reasoning is the central aim of student health professionals’ education. However, educators still find it challenging to teach, and students still struggle to demonstrate clinical reasoning abilities. Various teaching strategies are used by educators to facilitate the development of clinical reasoning abilities, but it is unclear whether educators utilise robust theories to underpin their teaching strategies. Theories can assist with the conceptualisation, simplification and improvement of information. The aim of this study was to explore the use of theory to inform the teaching strategies which develop clinical reasoning in undergraduate health professional students.

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient' (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; and the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-15 08:39:19.094