Browsing by Author "Pienaar, Lunelle"

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    Open Access
    Clinical education in physiotherapy: The experiences of final year students workplace-based learning at the University of Cape Town
    (2022) Timothy, Nastassia; Pienaar, Lunelle; Manie, Shamila
    Clinical education in the profession of Physiotherapy involves the teaching and training of students in real life clinical settings such as hospitals and clinics. The pedagogical support that Physiotherapy students receive in clinical settings is both formal and informal (Dornan, 2012). In the South African context and at the University of Cape Town (UCT), educational and professional support is provided to Physiotherapy students by both academic representatives from the university, clinical educators, and physiotherapy clinicians who are employed by the clinical site in which the clinical education occurs. The phenomenon of clinical education in Physiotherapy is well described in literature emanating from the global North, with fewer studies focused on the learning experiences of students in the South African context. Aligning with the need for curriculum transformation, specifically in this study landscape which is Physiotherapy at UCT, a better understanding of learning on the clinical platform is warranted. This study was conceptualised and conducted through an interpretivist lens and by drawing on the theoretical underpinnings of Lave and Wenger's (1991) Situated Learning Theory (SLT) and Communities of Practice (CoP). Encompassed within SLT is an understanding that learning is not isolated and internal but rather a social process which is dependent on interactions with others and the context in which the learning takes place (Jackson, 2007). Thus this study set out to determine how sociocultural and contextual elements influence learning experiences of final year Physiotherapy students during their clinical placements. This was done by the use of a qualitative, cross-sectional exploratory study design as this was determined to best capture the experiences of students (Austin & Sutton, 2014). Research data was collected by the use of both video diaries and follow-up semi-structured interviews with the six study participants. Discourse Analysis was used to analyse the data, using an analysis framework informed by concepts from both the theoretical framework and the literature review. The study results signify that for this cohort of participants, sociocultural influences, including influences of participation in the clinical site and the interactions and relationships with others, were more important than contextual influences such as the physical learning environment. Unanticipated findings included emotional and mental wellbeing and issues of power related to the physiotherapy clinician. Three main themes emerged from the evaluation of the study findings. Theme one: Student attributes and approach to learning; Theme two: Teacher attributes, skill and power and Theme three: Resources and support at clinical placement site. These themes were able to answer the research question for the study. What has been determined in this research study is that Physiotherapy students bring their own personal and learning attributes to the clinical placement which contribute to their development as a student physiotherapist and their ability to engage actively with learning opportunities. In addition the teacher, either a clinician or clinical educator, must have certain preferable qualities which allows for the development of good relationships between teacher and student, as well as fostering the student's ability to be agentic in maximising learning opportunities. Furthermore the study demonstrated that supported participation in physiotherapy practice allowed participants to learn, thus necessitating that the clinical site possess a culture which is accepting of students and their clinical learning. It is therefore of utmost importance that any limitation to student participation be addressed with urgency at the institution. Appropriate clinical sites must also be considered carefully in relation to the demands of the curriculum, the needs of Physiotherapy as a profession and the institutional culture of the placement.
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    Open Access
    Evaluation of positive expiratory pressure (PEP) devices as an adjunct to cardio-respiratory physiotherapy in patients following open abdominal surgery
    (2015) Jacobs, Rene Catherine; Manie, Shamila; Pienaar, Lunelle
    Purpose: Cardio-respiratory physiotherapy for patients undergoing abdominal surgery has been found to be beneficial in improving lung function post-operatively and in the prevention and treatment of post-operative pulmonary complications (PPCs). The Blow Bottle, a Positive Expiratory Pressure (PEP) therapy device, is commonly used as an adjunct to physiotherapy. The Blow Bottle is low cost and can be easily made by the physiotherapist using readily available materials in the hospital setting. However, evidence to support the use of Blow Bottles in the post-operative management of abdominal surgery is minimal, with few studies reporting significant positive effects especially when compared to conventional cardio-respiratory physiotherapy techniques. Methodology: A randomized control was implemented in a public tertiary institution within the Western Cape. Patients admitted for open abdominal surgery via midline incision were eligible for the trial. Participants were randomly allocated to either the control group (CG) receiving conventional post-operative cardio-respiratory physiotherapy, or the intervention group (IG) who received the additional use of the Blow Bottle. Lung function and the development of post-operative pulmonary complications were the primary outcome s of this study. Lung Function was evaluated by means of spirometry testing and interpretation of Forced Expiratory Volume in 1 second (FEV 1) and Forced Vital Capacity (FVC). The development of post-operative pulmonary complications were diagnosed using the criteria by Mackay et al. (2005) where changes from pre-operative findings of auscultation; temperature, X-ray and sputum are evaluated post-operatively and recorded using the Adapted Abdominal Physiotherapy Outcomes Data Sheet (A-APODS). Results: A total of 19 participants were enrolled in the study, n=11 (CG) and n=8 (IG), predominantly female (n=14) and admitted for cancer related abdominal surgery (n=9). There was a statistically significant (p<0.05) marked reduction in post-operative lung function from baseline across groups, 62% in FEV 1 and 47% in FVC on the first post-operative day. The FEV 1 and FVC were similar across both the control and intervention groups for the first three post-operative days. On auscultation majority of participants had decreased breath sounds on the first post-operative day. However, no one participant developed a PPC across the duration of the study as diagnosed using the criteria by Mackay et al. (2005). Conclusion: Whether the additional use of the Blow Bottle is more beneficial than conventional post-operative cardio-physiotherapy alone is inconclusive due to the incremental drop out of participants from the study and small sample size. In this study there was however a significant reduction in lung function post-operatively. This mandates the need for further research investigating the abdominal surgical field and the use of devices to improve lung function, such as the Blow Bottle, as literature is scant and outdated, and sorely lacking in the resource constraint South African hospital settings.
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    Introduction to the use of the International Classification of Functioning (ICF) in clinical management in undergraduate physiotherapy programme
    (2014-08-20) Jelsma, Jennifer; Pienaar, Lunelle
    Module notes and presentations designed for undergraduate students in the physiotherapy programme. Case studies presented of the use of ICF in the assessment of respiratory, cerebral palsy and orthopaedics patients. One of the most difficult skills that a physiotherapy student has to learn is clinical reasoning. In order to meet the needs of a patient, the student needs to know what the needs are, analyse these needs and the problems that are causing them, choose and apply suitable techniques and then assess whether the intervention has been effective. The International Classification of Functioning (ICF) Framework thus supports comprehensive and holistic assessment that allows meaningful decisions to be made based on the individual's needs.