The strategies and barriers addressed by occupational therapists in the process of successful work-related transitions for clients who have sustained serious hand injuries

Uys, Michelle Elizabeth (2020-03)

Thesis (MOccTher)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT : Introduction. The socio-economic burden of a hand injury in South Africa is substantial. Occupational therapists who facilitate work-related transitions after a hand injury require contextually relevant and robust evidence to inform their clinical practice. Aim. The thesis aimed to understand the strategies employed by occupational therapists to facilitate successful work-related transitions for people with serious hand injuries in both the government and private sectors of South Africa. Methods. A concurrent mixed-methods approach was used. The thesis comprised three phases’ a scoping review, a survey and a collective case design informed by phenomenological principles. The scoping review captured sources published between 2008 and 2018 across fourteen databases. The data was analysed descriptively and was used to inform a survey used in the second phase. The survey made use of a descriptive cross-sectional research design. The questionnaire was piloted. The data were exported from SUsurveys into Microsoft Excel for analysis. Phase three was a collective case design informed by phenomenological principles. Each of the four cases identified through purposive sampling comprised of an occupational therapist and client, amounting to eight participants. Sixteen interviews took place. Data was thematically analysed. Findings. Fifteen studies from 16 countries (14 high- and two upper-middle income) were identified in the scoping review. These revealed four strategies to facilitate work-related transitions and four factors that contributed to their success. No sources were found that detailed the different types of work-related transitions. Three themes emerged in the qualitative study: the acute rehabilitation phase, the pre-occupational phase and the occupational phase. A process model was developed to illustrate the phases through which participants transitioned. The least used strategies were issuing assistive devices for work, a worksite visit, observing a client completing work tasks and implementing a work trial. Financial support and compensation were seen as both an asset and a barrier. Conclusion. The absence of literature from low- and middle-income countries is likely to restrict the evidence-based practice in these countries, as interventions used in high-income countries may not be feasible in these contexts. In clinical practice, an occupation-based approach for work-related transitions is optimal. Collaboration with employers and co-workers enhances service delivery. Clients were positively impacted by the occupational therapists to successfully transition to work. In a country with high levels of unemployment, occupational therapists can contribute to facilitating work-related transitions despite the barriers identified.

AFRIKAANSE OPSOMMING : Inleiding. Die sosio-ekonomiese las van handbeserings in Suid Afrika is groot. Arbeidsterapeute wat werksverwante aanpassings na 'n handbesering wil bewerkstellig, benodig bewysgefundeerde oplossings wat kontekstueel relevant is om hul kliniese praktyk te bevorder.. Doel. Die tesis het ten doel om die strategieë te verstaan wat arbeidsterapeute gebruik om suksesvolle werkverwante aanpassings te fasiliteer vir mense met ernstige handbeserings in die staatsdiens en die privaatsektor van Suid Afrika. Metodes. 'n Gelyktydige benadering van gemengde metodes is gebruik Die tesis bevat drie fases, ‘n oorsig-literatuurstudie, 'n opname en 'n kollektiewe saakontwerp wat deur fenomenologiese beginsels ingelig is. 'n Oorsig-literatuurstudie is gedoen wat bronne tussen 2008 en 2018 in veertien databasisse gepubliseer is bevat. In die opname is gebruik gemaak van 'n beskrywende navorsingsontwerp in deursnee. Die vraelys is geloods. Die data is vanaf SU-opnames na Microsoft Excel uitgevoer vir ontleding. Fase drie was 'n kollektiewe saakontwerp wat deur fenomenologiese beginsels ingelig is. Elkeen van die vier gevalle wat deur middel van doelgerigte steekproefneming geïdentifiseer is, bestaan uit 'n arbeidsterapeut en kliënt, wat agt deelnemers beloop. Sestien onderhoude het plaasgevind. Data is tematies ontleed. Bevindings. Vyftien studies uit 16 lande (14 uit die boonste inkomstegroepe en twee uit die boonste middelsektor) is in die oorsig-literatuurstudie geïdentifiseer. Vier strategieë om werkverwante oorgange te fasiliteer en vier faktore wat tot die sukses daarvan bygedra het, is geïdentifiseer. Geen bronne is gevind oor soorte werkverwante oorgange nie. Drie temas het na vore gekom in die kwalitatiewe studie: die akute rehabilitasiefase, die pre-beroepsfase en die beroepsfase. 'n Prosesmodel is ontwikkel om die fases te illustreer waardeur deelnemers oorgegaan het. Die minste gebruikte strategieë was die uitreiking van hulpmiddels vir werk, 'n besoek aan die werkplek, die waarneming van 'n kliënt wat die werktake voltooi en die uitvoering van 'n werkproef gedoen het. Finansiële ondersteuning en vergoeding word gesien as 'n bate en 'n hindernis. Afsluiting. Die afwesigheid van literatuur uit lande met lae en middelinkomste sal waarskynlik die bewysgefundeerde praktykvoering in hierdie lande beperk, aangesien strategieë wat in lande met hoë inkomste gebruik word, moontlik nie haalbaar sal wees in hierdie kontekste nie. In kliniese praktyk is 'n beroepgebaseerde benadering vir werkverwante oorgange optimaal. Samewerking met werkgewers en medewerkers is 'n wesenlike element wat dienslewering bevorder. Kliënte is positief beïnvloed deur arbeidsterapeute in die suksesvolle oorgang na werk. In 'n land met 'n hoë vlak van werkloosheid, kan arbeidsterapeute bydra daartoe om werkverwante oorgange effektief te vergemaklik, ondanks die talle hindernisse wat geïdentifiseer is.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108175
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