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Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

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    The perceptions and experiences of Chiropractic Master’s students on practicing evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal
    (2023) Tayob, Tasmiya; Varatharajullu, Desiree
    Evidence-based practice (EBP) integrates the best available research evidence in conjunction with clinical expertise with the consideration of patient values. A well-trained clinician should pose clinically relevant questions and access the clinically relevant literature to find, appraise, and use the best valuable evidence in routine clinical care. Patients who receive evidence-based therapy have better outcomes in comparison to patients who do not. Globally, EBP is accepted as a basis of healthcare professional education, which was initially used in medicine, but now extends to allied health professions. In order to achieve the best patient outcomes, healthcare professions should effectively incorporate adequate knowledge, skills and attitudes towards EBP into education programmes. The implementation of EBP is regarded as a key competence for the improvement of healthcare quality. Numerous professions have implemented EBP, such as nursing, physiotherapy, occupational therapy, social care, pharmacy, physical therapy, dietetics, podiatry, radiography, orthotics, speech and hearing therapy, psychology and chiropractic. Evidence-based practice has had an increasing impact on chiropractic education and its implementation in chiropractic care. The importance of EBP is essential as its implementation is a requirement at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Students are required to use EBP when managing and treating patients during their clinical practicum and, thus, it is essential that students are knowledgeable in EBP and know how to use it adequately. Aim of the study The aim of this study was determine the perceptions and experiences of registered Chiropractic Master’s students on the implementation of evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal, South Africa. Methodology This study utilised a qualitative, exploratory and descriptive design. Purposive sampling was used, interviewing 14 Chiropractic Master’s students who have been clinically active for more than four months at a chiropractic teaching clinic in KwaZulu-Natal. Their perceptions and experiences with regard to the implementation of EBP were obtained through semi-structured interviews, which consisted of three key questions, encouraged by relevant probes. The data collected were stored electronically and then transcribed verbatim. Thereafter, the transcripts were coded and analysed by the researcher in order to identify themes along with relevant subthemes. The coded data were then interpreted by the researcher using the previously identified themes and sub-themes. Results There were four main themes identified in this study, namely perceptions and necessity regarding the roles of EBP; undergraduate education and its role in the implementation of EBP; the importance of clinical experience in the implementation of EBP; and the implementation of EBP. Overall, students had a positive perception with regard to EBP with some students reporting limitations to its practice, along with positive perceptions. The students believed that the chiropractic training at the DUT CDC provided a solid foundation but a lack of training in multiple aspects was found. These aspects are discussed comprehensively, including the insufficient training in theoretical and clinical aspects, as well as for pre-clinical preparation. In addition, limitations and barriers were identified, as well as measures of improvement in order to enhance the implementation of EBP were suggested. Conclusion In South Africa, this study is the first to explore the perceptions and experiences of Chiropractic Master’s students on the practice of EBP at a teaching clinic in KwaZulu Natal. The perceptions and experiences were based on various aspects, such as knowledge, application, skills, proficiency, confidence, support structures, training and challenges. Although Chiropractic Master’s students had positive perceptions regarding the implementation of EBP and found the chiropractic training at the DUT to have provided a solid foundation, there were suggested methods of improvement for the chiropractic curriculum to enhance the implementation of EBP. A lack of undergraduate training regarding EBP was one of the key factors that students found to have hindered a more efficient practice of an evidence-based approach. Therefore, it is recommended that the findings of this study be of aid to the Durban University of Technology Chiropractic Department to enhance the quality of the chiropractic curriculum by re-evaluating the context in which the concept of an evidence-based approach was set out in order to encourage EBP by students and consider a different, more coherent method of implementation.
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    Perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini municipality
    (2019-09-05) Frederick, Tarryn Miranda; Varatharajullu, Desiree; Sibiya, Nokuthula
    Chiropractic is the most frequently utilised complementary and alternative medicine therapy by children and adolescents worldwide. Evidence suggests that childhood health and lifestyle can impact on the health and quality of life in adulthood. The chiropractic care of paediatric patients should therefore be considered as a viable, conservative approach to the holistic management of children. The chiropractic management of paediatric patients is still however surrounded by controversy, from the public and other healthcare professions, largely due to the lack of scientific research in this field. With the adoption of evidence-based practice, it is imperative that the chiropractic profession remain dynamic, continually exploring, questioning and researching the elements that contribute towards effective chiropractic paediatric treatment and management. This study endeavours to provide a new viewpoint from the perspective of new graduate chiropractors on their confidence and competence with regards to paediatric patient management, which are aspects, regarded by multiple studies, as vital elements of successful patient management in the healthcare sector. The findings of this research can provide a greater understanding of the methods which can be implemented in order to foster knowledge, skill and overall confidence during tertiary education, with respect to the field of chiropractic paediatric training. Aim of the study The aim of the study was to assess the perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini Municipality. Methodology A qualitative, explorative, descriptive research design was utilised for this study. A purposive sample of 10 new graduate chiropractors in the eThekwini Municipality were interviewed. Their perceptions with regards to their paediatric patient management were obtained through semi-structured interviews. Eight key questions, relating to chiropractic paediatric patient management and paediatric educational training, were used to encourage the discussion. The data collected were stored electronically and then transcribed. The transcripts were then coded and analysed by the researcher to identify categories and subcategories. Interpretation of the coded data thereafter occurred, utilising the themes and sub-themes previously identified by the researcher. Results Four main themes were identified in the study, namely self-perception of confidence, knowledge and skill in paediatric patient management; exposure and training received in the chiropractic course; challenges encountered in paediatric patient management; and further enhancement of paediatric patient management. Participants expressed a lack of confidence and competence with regards to their management of the paediatric population. A strong correlation was exhibited between their perceived lack of skill in paediatric treatment and management and increased referral rates for this patient category. Participants stated that their lack of exposure to paediatric patients during the chiropractic paediatric curriculum in the course, negatively impacted on their diagnostic and orthopaedic assessment skills, as well as their ability to facilitate treatment to this age group. Participants identified areas of enhancement in the chiropractic paediatric component of the chiropractic programme. A variety of obstacles encountered by new graduate chiropractors were discussed, including parental satisfaction and influence on paediatric treatment; communication and time management skills; uncooperative patients and lack of competence and confidence with regards to paediatric patient management. Methods to improve paediatric assessment and treatment were then highlighted and discussed further. Conclusion This study is the first in South Africa to assess the perceptions of new graduate chiropractors in their management of paediatric patients. These perceptions were based on a variety of factors such as self-perceived competence, self- confidence, professional education and continued professional development, as well as practitioner experience. While new graduate chiropractors acknowledged the beneficial aspects of the chiropractic paediatric component of the chiropractic programme, they provided constructive feedback and recommendations for further enhancement of the chiropractic paediatric curriculum in the chiropractic course. The lack of exposure to paediatric patients prior to private practice was highlighted as a key factor that negatively impacted on new graduate chiropractors’ confidence to assess, treat and manage this patient population. Therefore, it is recommended that the findings of this research be utilised by the Durban University of Technology’s Chiropractic Department in order to enhance the quality of their chiropractic paediatric curriculum.
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    Clinical instructor's experiences of clinical education at a chiropractic teaching clinic in KwaZulu-Natal
    (2018) Vogl, Enya Elizabeth; Orton, Penelope Margaret
    INTRODUCTION: This dissertation provides insight into the status of the clinical instructor’s experience of clinical education at a chiropractic teaching clinic in KwaZulu-Natal and aims to equip the profession to understand better how clinical instructors perceive their role in the clinical education of chiropractic students. AIMS AND OBJECTIVES: The primary objective of this study was to explore and describe the experiences of the clinical instructors at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC) as perceived by themselves. This study contributes to knowledge of the clinical education experience of clinical instructors at the DUT CDC. This information can assist the institution to better equip the clinical instructors for clinical learning, thus improving the educational experience of the students, and accomplishing the departmental and institutional vision and mission. RESEARCH DESIGN: This study was conducted within a constructivist paradigm using a qualitative, exploratory, descriptive design to explore the experiences of clinical instructors at the DUT CDC with regards to the clinical education setting. The constructivist paradigm as an epistemological position takes the view that knowledge of how things are is a product of how we come to understand them. This design concentrates on understanding and exploring meaning and the way people make meaning rather than proving a theory. RESEARCH METHODOLOGY: Semi-structured interviews were conducted with chiropractic clinical instructors so as to explore their clinical education experience within the DUT CDC, until saturation was met. A total of 14 interviews were conducted and analysed. The data was transcribed and coded by the researcher as well as the research supervisor. Content was analysed using the Graneheim and Lundman (2004) framework. RESULTS: The research question was answered and three primary themes that encompassed the experience of the chiropractic clinical instructors were identified. These were: clinical instruction and the role of the clinical instructor; interpersonal relationships in the clinical education setting; and the clinical education environment experience.
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    An analysis of the Somatology programme offered at South African Universities of Technology to determine whether it meets the needs of industry
    (2015-03-11) Rammanhor, Kiveshni; Bhagwan, Raisuyah
    The beginning of the 20th century presented the Somatology profession with unprecedented challenges of acquiring a scientific base and achieving professionalisation. It is in this milieu that a few research studies were previously undertaken with regard to Somatology education however, none particularly focused in relation to areas that are preparing graduates for industry. The current study was a national study that explored the existing National Diploma offering through the lens of students, educators and members of the Durban University of Technology’s Advisory Board. In particular, it focused on developing broad guidelines to guide academics on what further content was required to be integrated into the current Somatology education. A triangulated approach using both quantitative and qualitative methods was used to guide the operationalisation of the research process. Five Universities of Technology participated in the study, viz. Cape Peninsula University of Technology, Central University of Technology, Durban University of Technology, Tshwane University of Technology and the University of Johannesburg. Third year and B.Tech students were surveyed with regard to the current Somatology Programme and what further aspects needed to be integrated into it to better prepare graduates for industry. In addition, in-depth interviews were also held with ten academics, two from each University of Technology, to examine what they thought needed to be included in education to strengthen the current programme. The same was done through a focus group discussion with members of the Durban University of Technology Advisory Board. A programme analysis of current content being taught at the five Universities was also undertaken. The results reflected that although most of the samples were satisfied with the current educational programme, they still believed that gaps existed and that graduates were still not adequately prepared for industry. It was found that both students and educators saw the need for more therapies to be included in the training. Both educators and the Advisory Board sample also saw the need for a stronger emphasis to be placed on practical skill development. The Advisory Board sample also strongly articulated for training to occur in an industry context as opposed to the University based experiential setting. Using data from these multiple samples, a set of guidelines was developed and presented. These guidelines were based on what further therapies needed to be integrated into education. The Duke Integrative Medicines Wheel of Health was adopted as the theoretical framework of the study. It was also utilised to identify specific areas that needed to be interwoven into education to further strengthen graduates’ preparedness for industry.