Browsing by Author "Ernstzen, Dawn Verna"

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    The development of a contextualised evidence-based clinical practice guideline for the primary health care of chronic musculoskeletal pain in the Western Cape
    (Stellenbosch : Stellenbosch University, 2017-03) Ernstzen, Dawn Verna; Louw, Q. A.; Hillier, S. L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Chronic musculoskeletal pain (CMSP) is a global healthcare concern, and is a major cause of disability and morbidity in sub-Saharan Africa. The implementation of high-quality, evidence-based clinical practice guidelines can enable quality healthcare for CMSP. Clinical guidelines for CMSP developed in developed nations may not be appropriate in developing countries with resource-constrained environments, due to differences in socio-cultural, societal and policy contexts. The contextualisation of clinical guidelines may be an option to provide guidance in resource-constrained environments. Aim: The overall aim of the research project was to develop a contextualised evidence-based, multimodal clinical practice guideline for the primary health care of chronic musculoskeletal pain in adults in the Western Cape Province of South Africa (SA). Method: The research was conducted in three parts: Part 1 comprised two qualitative descriptive studies to explore contextual factors that play a role in the health care of CMSP in three community centres. Three community health centres were strategically selected to represent a rural, a semi-urban and an urban-township setting. Study one used semi-structured interviews with patients to discover patients’ perspectives of CMSP and its healthcare management. In study two, semi-structured interviews were conducted with a diverse group of healthcare practitioners’ to explore their perspectives on the contextual barriers and facilitators regarding the healthcare of CMSP. Interviews were recorded, transcribed and analysed using inductive content analysis. Part 2 entailed study three, a systematic review conducted to identify current, high-quality clinical guidelines on the primary health care of CMSP. Guidelines that met the inclusion criteria were assessed using the Appraisal of Guidelines Research and Evaluation, Version II. Evidence-based recommendations were extracted from high-quality guidelines and synthesised for the contextualisation process. Part 3 of the project entailed the validation and contextualisation of the clinical recommendations. In study four, a multi-disciplinary panel of experts validated the clinical recommendations for the South African context using a modified Delphi approach. The panel developed context points relevant to the recommendations during a consensus meeting. In study five, potential end-users reviewed the applicability and acceptability of the contextualised clinical practice guidelines through a survey. Results: Twenty patients with CMSP and 21 practitioners participated in Part one. The findings indicated that CMSP influenced patients in multiple ways. Participants largely agreed on the context factors that influence CMSP care, namely the personal characteristics of the patient and practitioner, the social and environmental circumstances within which the patient lives, the healthcare interventions received and healthcare system factors. These contextual factors formed the foundation of the relevant facilitators and barriers to CMSP care in the context investigated. Twelve clinical guidelines on the primary healthcare management of CMSP were identified through the systematic review. Six of these clinical guidelines were of high quality, and 156 recommendations were extracted from them. The recommendations were synthesised using a structured process. The end-result was a core set of 43 multimodal evidence-based, clinical recommendations. Seventeen multi-disciplinary panel members validated the recommendations for the South African context, nominated an extra recommendation and positioned the recommendations within the context of application for primary healthcare. The contextualized guideline was reviewed by a diverse group of 18 end-users who confirmed the clinical guideline to be largely applicable and acceptable for the intended context. Conclusion: The end-product of the project was a contextualised, evidence-based and multimodal clinical guideline for the primary healthcare of CMSP in the Western Cape province of South Africa. The findings indicate that modifications in practice patterns, healthcare system organization and governance will contribute to the successful implementation of the guideline. A inter-/multi-disciplinary approach, with the outcome of the patient as self-manager within a supportive environment, is underscored. Further research avenues include the development of a multilevel implementation plan and a pragmatic trial to investigate the feasibility of the contextualised clinical guideline in the South African context.
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    Evaluation of clinical sites used for training undergraduate physiotherapy students : factors that may impact on learning
    (Health & Medical Publishing Group, 2014-10) Williams, L. G.; Ernstzen, Dawn Verna; Statham, Susan B.; Hanekom, S. D.
    Background. Clinical education forms an integral part of the training of undergraduate healthcare students. Clinical learning and education can be influenced by a number of factors. Objectives. To evaluate clinical service sites used to train undergraduate physiotherapy students at Stellenbosch University, in terms of: (i) the suit­ability of the site as a training facility; and (ii) the range of clinical problems students encounter at these clinical service sites. Methods. A descriptive study was conducted. Data were gathered through structured clinical site visits, staff interviews and student record sheets documenting the number and type of patients students encountered at the clinical service sites. Results. Seven of the nine clinical sites used for training were evaluated. Close proximity to the Faculty was an identified strength of three of the sites. There were opportunities for the expansion of multidisciplinary services and group treatment classes. There were safety concerns at most of the sites visited. The number of qualified physiotherapists was low and there was also a lack of basic equipment needed for patient management at more than half of the clinical sites. Students’ exposure to the various fields of physiotherapy varied greatly at the tertiary service settings versus primary healthcare settings. On average students saw only two patients per day during a 5-hour clinical day. Conclusion. The suitability of healthcare service sites for training undergraduate students should be carefully evaluated prior to commencing training at these sites. The development of good clinical training sites for undergraduate healthcare students requires the availability of adequate resources such as equipment, an adequate complement of clinical staff and effective measures to ensure student and patient safety.
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    Home-based rehabilitation : physiotherapy student and client perspectives
    (Health & Medical Publishing Group, 2016-05) Parris, Dianne; Van Schalkwyk, Susan Camille; Ernstzen, Dawn Verna
    ENGLISH SUMMARY : Background. Home-based rehabilitation (HBR) in under-resourced areas in a primary healthcare (PHC) context exposes students to the real-life situations of their clients. There is a scarcity of literature on student and client experiences of HBR in the physiotherapy context. Increased knowledge of HBR could result in an enhanced experience for both student and client. This study sought to discover the perceptions of final-year physiotherapy students and their clients relating to their experiences of HBR during a PHC placement in a resource-constrained setting. Objectives. To explore the experiences and perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. To discover the barriers to and facilitators of effective HBR. Methods. An exploratory case study was performed. A qualitative phenomenological research design in the interpretivist paradigm was used. Semistructured 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. Results. Clients appreciated the students’ services; however, data revealed communication barriers and unmet expectations. Students reported struggling to adapt to the context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency and earlier exposure to such contexts. Conclusion. Exposure to real-life situations in under-resourced settings in 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 serve during community service.
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    Learning experiences of physiotherapy students during primary healthcare clinical placements
    (Health & Medical Publishing Group, 2014-10) Ernstzen, Dawn Verna; Statham, Susan B.; Hanekom, S. D.
    Background. Primary healthcare (PHC) is necessary to address the health needs of communities. It creates the opportunity for the attainment of curricular outcomes through community-based education. Appropriate learning opportunities are needed to enable students to develop the necessary skills to attain these outcomes. Objectives. To describe the learning opportunities occurring during physiotherapy PHC placements and to explore the role the learning environment and learning opportunities played in attaining the outcomes for the placements. Methods. A descriptive case study was conducted using different strategies for data collection and analysis. Participants completed a record sheet to indicate time spent on different activities. Observational site evaluations, individual interviews with site representatives and focus-group discussions with students were conducted to explore their perceptions about PHC clinical placements. Results. The results indicated that the participants valued PHC placements as powerful learning environments. However, students did not have the opportunity to engage satisfactorily in activities that foster the principles of PHC. Participants acknowledged that several resource constraints existed in this context; however, they identified several potential valuable learning opportunities. Students suggested curriculum-specific strategies needed to prepare them for PHC, and recognised the need for healthcare services in the communities they served. Conclusion. While the PHC learning environment was rich and authentic, learning opportunities need to be optimised to enable students to fully reach the outcomes for the placements. Learning opportunities need to be crafted to foster collaborative learning, interdisciplinary learning, community engagement and empowerment.
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    Physiotherapy students’ perceptions about the learning opportunities included in an introductory clinical module
    (Health & Medical Publishing Group, 2014-10) Ernstzen, Dawn Verna; Statham, Susan B.; Hanekom, S. D.
    Background. Clinical education forms a core component of physiotherapy training. However, the transition from the classroom to clinical learning environments can be challenging. An introductory clinical placement with appropriate learning opportunities is therefore important to ensure that learning outcomes are reached. Objectives. To determine second-year physiotherapy students’ perceptions about the learning opportunities provided in an introductory clinical module and to determine their perception about the attainment of the learning outcomes. Methods. A descriptive case study was undertaken, using mixed methodology. All 39 second-year physiotherapy students were invited to participate. Data were collected using a self-developed questionnaire which focused on the outcomes of the module and the perceived value of the learning opportunities. A focus group discussion was conducted with a random subset (n=15) of the population. Results. The response rate to the questionnaire was 79% (n=31). Peer learning by observing senior students, demonstrations by clinical lecturers and the assessment of specific skills were perceived by students to be particularly useful. However, several learning opportunities did not contribute effectively to learning. Participants highlighted a transitional process between classroom and clinical environments during which they became aware and could respond mentally to the demands of a clinical placement. Conclusions. The clinical education introductory module provided valuable opportunities, where students learnt productively in a non-threatening learning environment. Junior students linked theoretical and practical concepts to clinical implementation. Peer mentoring and progressive mastering were valuable learning strategies. Reflection and students’ emotional adjustment to clinical practice are topics for further investigation.
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    Roles and attributes of physiotherapy clinical educators : is there agreement between educators and students?
    (Health & Medical Publishing Group, 2013-10-28) Ernstzen, Dawn Verna
    Objectives. To determine which roles and attributes of clinical educators are perceived as important in creating a clinical learning environment that is conducive to learning, and if there were differences between the perceptions of undergraduate physiotherapy students and clinical educators. Design. A cross-sectional survey in the form of a purpose-built questionnaire was conducted among physiotherapy students and clinical educators. Setting. The study was performed at the Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. Participants. All enrolled undergraduate physiotherapy students (n=80) with clinical experience, and all clinical educators (n=37) involved in the delivery of clinical education were invited to participate. Results. The educator roles that strongly influence the clinical learning environment were found to be those of technique demonstrator, mentor, assessor, knowledge provider and facilitator of learning. Educators’ and students’ views about the role of the educator as role model, reflector, knowledge provider and technique demonstrator differed. Participants agreed that the attributes of the clinical educator that are conducive to learning are approachability, recognising student abilities, and good communication skills. Conclusion. The clinical educator is pivotal in the success of the physiotherapy clinical education programme. The study found similarities and differences about the role perceptions of educators and students. The differences might influence the learning experience, and it is recommended that expectations be clarified at the start of the clinical education programme.