Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Home-based rehabilitation (HBR) in under-resourced areas in a primary health care context exposes students to the real life situations of clients. The educational experience of HBR, underpinned by the theory of situated learning, promotes experiential and transformative learning. HBR leads not only to academic learning and personal development, but also to an understanding of social accountability and responsibility. Physiotherapy students and their clients frequently have diverse lingual, socio-economic and cultural backgrounds which may hinder the provision of appropriate treatment to clients in their residences. Increased knowledge of HBR in the physiotherapy context could result in an enhanced experience for both student and client. This study sought to explore the perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. Whether the students felt adequately prepared to perform HBR was also explored. A qualitative research design in the interpretivist paradigm was used. An exploratory case study was performed. Semi-structured interviews were conducted with clients (N=7) living in an under-resourced setting who had received HBR from physiotherapy students. Paired interviews were conducted with final year physiotherapy students (N=6) after their HBR placement. The data were subjected to inductive thematic analysis and themes developed. The findings showed that while clients appreciated the students’ services, there were communication barriers and unmet expectations. Students reported difficulty in adapting to the unfamiliar context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency to assist in communication. Earlier facilitated exposure to under-resourced contexts in the early clinical phase was suggested to reduce culture shock. An awareness of home environments in under-resourced areas influenced the students’ interventions in other contexts. To gain maximum benefit from the learning opportunities available through HBR, students require support for client management and client-centred problem solving in an under-resourced setting. Guided reflection should form part of the HBR placement to facilitate the construction of new knowledge, to promote deep transformative learning and to increase the students’ awareness of their role as change agents. Exposure to real life situations in under-resourced settings in the form of HBR provides valuable situated and authentic learning opportunities for physiotherapy students. The experience can be useful in preparing graduates to address the needs of the populations they will serve during community service. / AFRIKAANSE OPSOMMING: Tuisgebaseerde rehabilitasie (TBR) in ondervoorsiende gebiede in die primêre gesondheidsorg-konteks stel studente bloot aan die werklike lewensomstandighede van kliënte. Die opvoedkundige ondervinding van TBR, gerugsteun deur die teorie van gesitueerde leer, bevorder ervarings- en transformasionele leer. TBR lei nie net tot akademiese leer en persoonlike ontwikkeling nie, maar bevorder ook insig in maatskaplike verantwoordbaarheid en verantwoordelikheid. Fisioterapie-studente en hul kliënte het dikwels verskillende taal-, sosio-ekonomiese en kulturele agtergronde wat kan verhinder dat die toepaslike behandeling vir kliënte tuis verskaf word. ’n Toename in kennis van TBR in die fisioterapie-konteks kan lei tot ’n beter ondervinding vir beide die student en die kliënt. Die doel van die studie is om die persepsies van die fisioterapie-studente en hul kliënte met betrekking tot TBR, as deel van die kliniese opleiding in omgewings waar daar beperkte hulpbronne is, na te vors. Daar is ook nagegaan of die studente gevoel het dat hulle genoegsaam voorberei is om die TBR toe te pas. ’n Kwalitatiewe navorsingsontwerp in die interpreterende paradigma is gebruik. ’n Verkennende gevalle-studie is gedoen. Semi-gestruktureerde onderhoude is met die kliënte (N=7) wat in ondervoorsiende omstandighede leef en wat TBR van fisioterapie-studente ontvang het, gevoer. Onderhoude is in pare met fisioterapiestudente in hul finale jaar (N=6) gevoer nadat hulle hul TBR-plasing voltooi het. ’n Induktiewe tematiese analise van die data is gedoen en temas is ontwikkel. Die resultate het getoon dat, alhoewel die kliënte waardering gehad het vir die dienste wat deur die studente gelewer is, daar kommunikasiegapings en onvervulde verwagtinge was. Die studente het gerapporteer dat hulle gesukkel het om aan te pas by die onbekende omgewing met die gevolg dat die intervensies nie genoegsaam kliëntgerig was nie. Hulle het ook aangedui dat daar ’n behoefte is om die nodige taalvaardigheid te ontwikkel om kommunikasie te verbeter. Die kultuurskok wat beleef is, kan moontlik in die vroeë kliniese fase reeds gefasiliteer word deur die studente aan ondervoorsiende kontekste bloot te stel. Die kennis van die tuisomgewings in ondervoorsiende areas het ’n invloed gehad op die studente se intervensies in ander kontekste. Studente benodig ondersteuning in kliëntebestuur en kliëntgesentreerde probleemoplossing in ondervoorsiende omgewings ten einde maksimum voordeel te verkry uit leergeleenthede wat beskikbaar is deur TBR. Begeleide refleksie behoort deel te vorm van die TBR-plasing om die opbou van nuwe kennis te fasilliteer, diepgaande transformatiewe leer te bevorder en die student se bewustheid van hul rol om verandering teweeg te bring, op te skerp. TBR voorsien nie net waardevolle, outentieke leergeleenthede ter plaatse nie, maar gee ook die fisioterapie-studente blootstelling aan die werklike situasies waarin mense hulle in ondervoorsiende omgewings bevind. Hierdie ondervinding kan waardevol wees om graduandi voor te berei om die behoeftes aan te spreek van die bevolkingsgroepe wat hulle tydens hul gemeenskapsdiensjaar sal bedien.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Social Work and Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Urban Planning and Design / Master / Master of Housing Management

Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.

<p>A multi professional team use different professional skills to a specific target. The people in the team complement each other to achieve the best performance possible. Professional identity is a mix between the professional and personal identity. Social identities, like professional identity, is a product of social categorization and social comparison. The purpose of this study was to examine how increased cooperation in cross-disciplinary teams has affected the professional identity of home care staff. The method I used to gather my material were focus groups with home care staff in relation to their workplace. Five focus groups were conducted and formed the basis of the results. I used parts of and got inspired from the hermeneutic approach in the analysis of my empirical findings. The results were interpreted by the social identity theory and the concepts of identity, professional identity and the dual task. The results show that home care staff finds it difficult to describe what their role is in the profession. The team's work has affected the staff to feel stronger in their profession and occupation. They have been able to learn from the other team members and have got a deeper understanding of the other team member’s profession. They also believe that the home care staff group has become more of a united group now that they know more about each other's work, work more equal and have more discussions within the group. Home care staff professional identity has been influenced, as all work within the team goes toward a common explicit goal. This has made stronger professional identity within the group and they can identify themselves more with each other. The teams work towards the common goal has also contributed to that they experience cooperation, understanding and affinity with the other team members. This has broadened their professional identity and they have become part of a new group - the team.</p>