Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room, for example, is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite the numerous studies that have been undertaken in this field, few studies that have investigated the operating room as a clinical learning environment in the South African healthcare system have been published. The aim of this study was to determine students’ perceptions of the operating room as a clinical learning environment in a private hospital context. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Data was collected from nursing students undertaking their training at a private nursing education institution. Ten nursing students participated in an open-ended questionnaire (N=10), and twelve students participated in the focus group discussion (N=12). From the results, four themes emerged, namely, ‘interpersonal factors’, ‘educational factors’, ‘private operating room context’, and ‘recommendations’. This study has highlighted some of the challenges experienced by students in the private sector operating room context. Despite the potential learning opportunities, the key findings reveal negative perceptions of students regarding learning experiences. However, the opinion that the operating room offers an opportunity to gain skills unique to this context, as well as facilitates the integration of theory and practice, was also expressed. Some students reported that the emphasis on profitability and cost to patient, and the lack of a mentoring process in this context posed a constraint to learning. Exploration into the specific preparatory needs of students specific to learning outcomes before operating room placement should be considered. It would also be necessary to improve collaboration between lecturers, mentors and theatre managers so that a structured teaching programme may be developed for students entering the perioperative environment. / AFRIKAANSE OPSOMMING: Studente onderneem hul kliniese plasing in verskeie kliniese omgewings vir die blootstelling aan en aanleer van vaardighede wat verband hou met daardie spesifieke konteks. Die operasiesaal, byvoorbeeld, is ’n kliniese omgewing wat die geleentheid bied om kritiese vaardighede te ontwikkel wat verband hou met die perioperatiewe versorging van die pasiënt. Ten spyte van die talle studies wat in die operasiesaal onderneem was, het slegs ’n paar studies uit ’n Suid-Afrikaanse gesondheidsorg oogpunt, die operasiesaal as ’n kliniese opleidings omgewing ondersoek. Die doel van hierdie studie was om studente se persepsies van die operasiesaal as ’n kliniese omgewing in ’n privaat hospitaal konteks te bepaal. ’n Ondersoekende, verklarende en beskrywende ontwerp wat kwalitatiewe data genereer, is gebruik. Data is ingesamel van verpleegstudente wat hul opleiding by ’n privaat verpleegonderrig instelling ontvang. Tien verpleegstudente (N=10) was genooi om ’n onbepaalde vraelys te voltooi en twaalf student (N=12) het aan die fokusgroep bespreking deelgeneem. Vier temas het na vore gekom, naamlik ‘interpersoonlike faktore’, ‘opvoedkundige faktore’, ‘privaat-operasiesaal konteks’, en ‘aanbevelings’. Hierdie studie het ’n paar van die uitdagings uitgelig wat die studente in ’n privaat sektor operasiesaal ondervind. Ten spyte van die potensiële leergeleenthede teenwoordig in die privaat sektor operasiesaal, toon die belangrikste bevindings egter die negatiewe persepsies van studente jeens hierdie kliniese omgewing. Die opinie is egter ook uitgespreek dat hierdie omgewing ook ’n geleentheid aanbied om unieke vaardighede aan te leer. Dit bied ook ’n geleentheid om teorie en praktiese kundigheid te integreer. Sommige studente rapporteer dat die klem op winsgewendheid en koste vir die pasiënt, asoók die gebrek aan mentorskap in hierdie kliniese omgewing ’n beperking plaas op die leerproses. Die spesifieke voorbereidings behoeftes van studente insake leeruitkomste voordat plasing in die operasiesaal omgewing geskied, moet eers deeglik ondersoek word. Dit is ook nodig om die nodige samewerking tussen dosente, mentors en operasiesaal bestuurders te verbeter sodat ’n gestruktureerde onderrig program ontwikkel kan word vir studente wat die perioperatiewe omgewing betree.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Educators across the health professions are now concerned with the teaching and assessment of professional skills. Caring behaviour is one of the attributes of professionalism in the health sciences professions and in the nursing profession it is regarded as the essence of the profession. The aim of this study is to explore the understandings and experiences of caring behaviours of first- and fourth year nursing students and how they would like to be assessed about their caring behaviours in a curriculum where it is not overtly taught. This will be investigated according to Watson’s carative factors and theoretical framework of caring, while Bloom’s Taxonomy of the affective learning domain will also be consulted. The design of the study is qualitative and explorative. A purposive sample was drawn from first-year nursing students (n=64), and fourth-year nursing students (n=41) at one nursing education institution. The sample of students (n=105) from seven (7) private training hospitals in the Western Cape participated in nine (9) focus group interviews (n=10-15). Data analysis was done by means of a framework analysis approach with a deductive strategy. Research findings from this study are extensively discussed and will be used to inform the undergraduate nursing curricula in South Africa about the profiles of caring nursing students and to make recommendations about the internalisation of caring behaviours, according to the affective learning domain. / AFRIKAANSE OPSOMMING: Opvoeders vanuit die verskeie gesondheidsberoepe, is tans met die leer en assessering van professionele vaardighede gemoeid. Sorgsame gedrag is een kenmerk van professionalisme in die gesondheidsberoepe. In verpleegkunde word sorgsame gedrag as die kern van die beroep beskou. Die doel van hierdie studie is om die begrip en ervarings van eerste- en vierde-jaar verpleegkunde studente rondom sorgsame gedrag te ondersoek. ʼn Verdere doel is om te bepaal hoe hierdie studente graag geassesseer wil word oor hul sorgsame gedrag in ʼn kurrikulum waar hierdie kenmerk nie pertinent geleer word nie. Watson se sorgsaamheidsfaktore en teoretiese raamwerk oor sorgsaamheid, sal gebruik word om die onderwerp na te vors. Bloom se Taksonomie van die affektiewe leergebied sal gesamentlik met Watson gebruik word as teoretiese grondslag vir die navorsing. Die studie-ontwerp is kwalitatief en verkennend. ʼn Doelbewuste seleksie is gedoen om spesifieke eerstejaar verpleegkunde studente (n=64) en vierdejaar verpleegkunde studente (n=41) by die navorsing te betrek. Die geselekteerde studente (n=105) van sewe (7) private opleidingshospitale in die Wes-Kaap, het aan nege (9) fokusgroep onderhoude deelgeneem (n=10-15). Die data-analise is deur middel van ʼn raamwerk-analise benader en ʼn deduktiewe strategie is gebruik. Die resultate van hierdie navorsing word omvattend bespreek en sal gebruik word ten doel voorgraadse verpleegkunde kurrikula in Suid-Afrika te informeer rakende die sorgsaamheidsprofiel van verpleegkunde studente. Aanbevelings, volgens die affektiewe leergebied, word ook gemaak oor hoe sorgsame gedrag geïnternaliseer kan word.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / International college students are becoming a sizable part of the overall college student population in American universities. Studies show that these students come to the United States (U.S) with food habits that could be in variance with the U.S. food safety norms. While food safety in the U.S. is among the safest in the world, foodborne illness has remained a growing concern. Food experts are showing increasing concern about how food habits associated with cultural and ethnic norms are impacting basic food safety practices in the U.S. While minimal research regarding food safety has been conducted with college students in general, no studies have sought to understand food safety practices among international college students. This study investigated self-reported food safety practices of international college students. Specific objectives included: determine international college students’ knowledge regarding basic food safety principles, evaluate international college students’ belief towards food safety, and examine international students’ current food safety practices. The target population was international college students at Kansas State University. An online survey system was used to administer the questionnaires. The respondents were allowed two weeks to complete the questionnaires. To facilitate a higher response rate, two email reminders were sent, the first after one week and another two days prior to the expiration date. SPSS (version 17.0) was used for data analysis. Descriptive statistics were computed to understand the nature of data and provide characteristics of international college students in the study. Independent Samples t-tests were used to examine differences between demographic characteristics. A One-way ANOVA was used to identify differences in food safety knowledge and food handling practices among different ethnic groups regarding food safety. The Pearson correlation coefficient was used to measure association between variables. The majority of the respondents did not answer correctly questions related to cooking foods adequately and keeping foods at safe temperatures. The study suggests that most participants had beliefs that enhanced good safety practices. Respondents rarely practiced using a thermometer to determine correct temperatures of cooked foods or using separate cutting boards when preparing raw and ready-to-eat foods. They also reported using towels that were available to others to dry their hands. No significant differences were found between training and self-reported food safety handling practices.

Although strategic planning has been used successfully in most major business institutions, higher education has been slow to adopt this management technique. Involvement in planning is a critical issue for allied health educational programs, such as physical therapy, which are relatively new to the academic environment. These programs face a continual need to update their curricula and clinical education based on rapid changes in the health care delivery system and the profession. The problem of this study was to determine the extent to which the strategic planning process is currently applied in institutions in the United States which offer accredited physical therapy educational programs. The population of this study was made up of the chief executive officers of the 115 public and independent institutions that offer physical therapy educational programs. Selected experts on strategic planning and chief executive officers were surveyed in two phases using a mailed questionnaire designed to measure the organization, characteristics, and impact of strategic planning in institutions that offer accredited physical therapy educational programs. Seventy-three percent of the chief executive officers responded, and 50.9 percent indicated their involvement with strategic planning by completing the questionnaire. The findings indicate that, although there is general agreement between the experts and the chief executive officers concerning the characteristics of strategic planning, differences exist. Differences were also identified between academic health centers and other types of institutions, between public and independent institutions, and between institutions by type of physical therapy degree offered. It was concluded that, in the opinion of the chief executive officers, strategic planning processes are being practiced in institutions that offer physical therapy programs, that this process is compatible with academic collegiality, that changes are made in policies and programs but not in the mission, that although faculty members including those from physical therapy are involved, the role and the involvement of these individuals is unclear, and that information-gathering and evaluation methods could be refined.

Objectifs: Les patients hospitalisés aux soins intensifs (SI) sont souvent victimes d’erreurs médicales. La nature interprofessionnelle des équipes de SI les rend vulnérables aux erreurs de communication. L’objectif primaire du projet est d’améliorer la communication dans une équipe interprofessionnelle de soins intensifs par une formation en simulation à haute fidélité. Méthodologie Une étude prospective randomisée contrôlée à double insu a été réalisée. Dix équipes de six professionnels de SI ont complété trois scénarios de simulations de réanimation. Le groupe intervention était débreffé sur des aspects de communication alors que le groupe contrôle était débreffé sur des aspects techniques de réanimation. Trois mois plus tard, les équipes réalisaient une quatrième simulation sans débreffage. Les simulations étaient toutes évaluées pour la qualité, l’efficacité de la communication et le partage des informations critiques par quatre évaluateurs. Résultats Pour l’issue primaire, il n’y a pas eu d’amélioration plus grande de la communication dans le groupe intervention en comparaison avec le groupe contrôle. Une amélioration de 16% de l’efficacité des communications a été notée dans les équipes de soins intensifs indépendamment du groupe étudié. Les infirmiers et les inhalothérapeutes ont amélioré significativement l’efficacité de la communication après trois sessions. L’effet observé ne s’est pas maintenu à trois mois. Conclusion Une formation sur simulateur à haute fidélité couplée à un débreffage peut améliorer à court terme l’efficacité des communications dans une équipe interprofessionnelle de SI. / Objective: Patient hospitalized in intensive care units (ICU) are often victims of medical errors. The interprofessional nature of ICU teams makes them particularly vulnerable to communication errors. The primary objective of this project is to improve interprofessional communication in an ICU team using a high fidelity simulation-based training. Method A prospective, double-blind, randomized controlled trial was conducted. Ten teams of six ICU workers completed three simulated scenarios of resuscitation. The intervention group was debriefed on communication skills, whereas the control group was debriefed on technical resuscitation skills. Three months later, teams completed a fourth simulation without debriefing. All simulation sessions were coded for quality, efficacy of communication and team information-sharing by four blinded observers. Results For our primary end-point, improvement in communication in intervention group wasn’t greater than in control group. A 16% increase in communication effectiveness was noted in ICU teams independently of the studied group. Nurses and respiratory therapists significantly increased their communication effectiveness after three sessions. The effect did not last to three months. Conclusion The combination of high-fidelity simulation training and communication-oriented debriefing can produce short-term gains in communication effectiveness of an interprofessional ICU team.

The purpose of this study was to describe the experiences and perceptions of two female obstetrician-gynecologists in their world of academic and clinical medicine. Significant to this dissertation is the complex issue of gender. The theoretical and research perspectives were (1) gender discrimination in the education of girls; (2) feminism in the medical school and the medical workplace; and (3) the literature of caring and connectiveness as it is related to the field of medicine. My prior pilot study and research for my gender issues course I taught in medical school were the deciding factors that initiated this richer dissertation study. The case study approach was used in this ethnographic research, and with my role as participant and a non-participant observer, I conducted multiple observations of participants, wrote field notes and conducted three semi-structured interviews with each participant. I analyzed the data inductively, and then made a cross-case analysis of the variables I found for my study. The findings from this study reveal the importance of family, husbands, and significant others in their continued support of their professional careers. Both participants had positive experiences in their early schooling and supportive mentors in their medical careers. They also agreed that relationships and interactions with patients are the most important aspects of their specialty, and that women doctors "listen more"; however, they believe that the environment plays a role in these differences related to gender. The biggest challenge perceived by the academic physician is the hostility of a system that does not recognize diversity or values of the female doctors who work in the system. She diagnoses this system as unhealthy and inflexible to both male and female physicians. The biggest challenge perceived by the married woman physician revolved around her juggling of family and professional concerns. The significant findings from the theoretical and historical perspectives relative to this study, braided with the insights voiced by the two physicians, strongly suggest a need for curricula and pedagogical restructuring related to feminist knowledge in both our medical institutions and our educational institutions.

No description available.

Introduction: Education of physiotherapists still fails to meet the health and social needs of society. One instrument to steer change in health sciences education is a re-designed curriculum. The overall intent of this study was to develop standards of competencies, teaching and learning strategies, and assessment, for an undergraduate community physiotherapy curriculum in South Africa. The grounding for this research was pragmatism. The Six-step model for curriculum development and the Clinical Prevention and Population Health Curriculum framework guided the research process and main analysis. Methods : A sequential mixed method design was used. First, a two-phase parallel situation analysis was conducted which included a qualitative document analysis of community physiotherapy curricula of the eight physiotherapy university departments in South Africa and a review of health policy documents. The experience of 12 purposively selected physiotherapists who had completed a compulsory community service year was qualitatively explored through interviews within an appreciative inquiry stance. In phase 2, input was gained from physiotherapists, from all ecological levels, on the community physiotherapy curriculum through a Delphi study. Three rounds were used. Round 1 explored the roles of physiotherapy in community health, round 2 quantified consensus in overarching competency domains, and round 3 gathered learning and teaching, and assessment, strategies to gain these competencies. Results : All eight universities had gaps in their community physiotherapy curriculum and were variedly aligned with South African health policies and health profile. Graduates need to be able to provide physiotherapy over the lifespan, to conditions mirroring the quadruple burden of disease, in settings varying from hospitals to homes of clients, with emphasis on health education and promotion within an interprofessional team. They must be prepared for suboptimal practice environments and to utilise the compulsory community service year as a gateway in professional development. Graduates need resilience to cope during the year and awareness about the importance of identifying a mentor in the frequent absence of a profession-specific supervisor. Community physiotherapy needs three core knowledge and skill sets; i.e. clinical physiotherapy, population health and community development. Consensus of 70%+ was gained on competency criteria in the domains of the following professional roles: clinician, professional, communicator and collaborator, scholar, health promoter, public health practitioner, community developer (change agent), and manager/leader. Service-learning was identified as a strategy to develop these roles supported by learning and assessment portfolios. Reflection in different formats – essays, presentations, case analysis, projects such as community wellness programmes, diaries - is a core activity to facilitate learning. A range of complementary strategies were suggested that included direct observation, role-play, and journal clubs. Core to assessment for professional competencies is for the students to be able to give evidence of their own learning (e.g. in a portfolio or oral examination) and to get frequent formative feedback. Conclusion : The physiotherapy profession is important for improving the health status of the South African population. Physiotherapy students should be educated to take on relevant professional roles through the application of appropriate educational standards. The study recommends that the curriculum standards be implemented and evaluated and that the application of complex theory in the further development and implementation of the curriculum be investigated. Lastly, future research in the generic professional domains, such as public health and community development, should be interprofessional in nature. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiology / Unrestricted

Training delivered to medical students and residents in behavioral health is widely acknowledged to be inadequate. While the use of standardized patients is common in medical training and education for physical health conditions via the adherence to clinical protocols for evaluation and treatment, this approach is infrequently used for behavioral health conditions. Used under specific circumstances, standardized patient encounters have long been considered a reliable method of training and assessing trainee performance on addressing physical health conditions, and are even comparable to ratings of directly observed encounters with real patients. This paper discusses common issues and challenges that arise in using standardized patients in behavioral health. Although current evidence of its value is modest and challenges in implementation exist, the use of standardized patients holds promise for medical training and education and as an evaluation tool in behavioral health.

Despite a mandated 1-month rotation in developmental-behavioral pediatrics (DBP), pediatric residents report inadequate training in behavioral health care. As a first step in much needed curriculum development in this area, this study sought to assess learner experiences regarding the management of behavioral health problems during residency. Four focus groups were conducted for residents in years 1-3 of training in 2 residency programs in a northeastern state. Transcripts were analyzed and coded by researchers through qualitative classical content analysis. The exploratory analysis revealed 9 key themes: time requirements, rapport building, resources and referrals for behavioral health, psychiatric medications, diagnosis vs. treatment, working with families, the importance of behavioral health, fears of working with a pediatric population, and training issues. These qualitative data further identify gaps in the behavioral health training of pediatric residents and may inform future innovations in training curricula.