Clinical reasoning and the occupational therapy curriculum

Several reasoning styles are used by occupational therapists when they evaluate clients' problems. This study investigated the influence of the occupational therapy curriculum in Hong Kong on therapists' clinical reasoning styles. Two groups of therapists with different clinical experience were recruited. Through interviews with the therapists after identifying clients' problems using the Canadian Occupational Performance Measure, their clinical reasoning styles were explored. The local occupational therapy curriculum was analysed to isolate the components that influence clinical reasoning. Results showed that more experienced therapists use conditional reasoning that considers clients' needs in their future lives whereas junior therapists use procedural reasoning that focuses on clients' disabilities. The analysis of the occupational therapy curriculum indicated that it prepared the students with an equal emphasis on theoretical and clinical subjects and fieldwork practice. The present curriculum was useful in providing educational preparation for novice therapists. However, the period of fieldwork practice can be lengthened to allow adequate maturation of clinical reasoning skills. Problem‐based learning can be incorporated to facilitate students' problem‐solving and self‐directed learning skills. Copyright © 2000 Whurr Publishers Ltd.     

Adaptive Equipment Design and Fabrication

Occupational therapists can play a unique role in helping disabled persons procure adaptive equipment for those special problems of daily living. Treatment using only the devices listed in various catalogues does not always provide effective solutions. Sometimes only a particular item designed and fabricated specially to solve a functional problems brings the solution needed. Yet not all occupational therapists can or should engage in designing and making assistive equipment. This paper will explore the process of problem solving used by one occupational therapist/designer as he makes adaptive equipment. Seven distinct parts of the process will be discussed as a guide for other occupational therapists who may wish to increase their skill in this area of professional activity.     

Hospice and palliative care: A Delphi survey of occupational therapists' roles and training needs

This paper describes the use of the Delphi survey method to identify the roles and training needs of occupational therapists working in the field of hospice and palliative care in Australia. The study was conducted in 1993 using a purposive sample of 47 occupational therapists. The survey consisted of three consecutive questionnaires and five in-depth interviews. The results indicated that there is a role for occupational therapy in this new and expanding field, and that occupational therapists need to promote a higher profile for their profession and their skills through research, education and presentations to maximize this role. The study also highlighted the importance of continuing education for occupational therapists working in this field.     

浅析医院医疗器械维修中存在的问题及维修管理对策

医院医疗器械是对机体通过直接或间接接触,完成进行疾病诊断和治疗的仪器和器具,也包括计算机软件。使用医疗器械可以完成样本检查,帮助诊断治疗提供重要信息。随着各城市医院规模扩大,医疗器械普及面和应用范围也越来越广泛。医院日常使用的医疗器械较多,面对这些器械,如何处理器械常见的问题,开展规范的维修管理对策,对于保证医疗器械正常使用具有重要的作用。医疗水平和工作效率的提升对医疗器械的管理带来一定限制,提升医疗器械维修水平同时,也要加强医疗器械的日常维修、保养等管理工作,只有充分重视日常管理工作,对维护制度不断完善,加强维修人员培养,才能不断持续提升医院医疗器械的维修水平,满足医疗技术操作的要求。本文对医院医疗器械维修中存在的问题进行分析,以此对管理对策不断完善,从而提升医院医疗器械维修的管理水平,仅供借鉴。     

Occupational therapists’ decision-making in the management of clients with upper limb hypertonicity

This study applied social judgement theory to the exploration of factors influencing occupational therapists’ decision-making when they manage upper limb hypertonicity in clients with cerebral palsy. To achieve this goal, both objective and stated policies were investigated. This quantitative study drew information from a literature review and a survey with experienced occupational therapists to identify 12 factors that could influence decision-making. Based on these 12 factors 110 case vignettes of individuals with cerebral palsy and upper limb hypertonicity were generated. Intervention decisions were elicited from 18 experienced occupational therapists for each of the 110 case vignettes. Therapists were also asked to rank the factors in order of perceived importance. Occupational therapists generally used severity of spasticity, wrist and finger posture, and client and family background information to guide their clinical intervention choices. Hhowever, therapists demonstrated poor insight into the nature of their decision-making processes. This was highlighted in the disparity between their stated and objective policies. These findings have implications for both the professional development of therapists and the training of students.     

Continuing professional development for occupational therapy emergency department services

Aim: To explore continuing professional development (CPD) resources and needs of Australian emergency department occupational therapists. Method: Australian websites and occupational therapy newsletters were searched to identify CPD resources/opportunities. Occupational therapists with recent clinical experience in Australian emergency departments were surveyed on strengths, weaknesses, opportunities and threats to their service, research information needs, supervision/mentor arrangements and quality assurance activity. Results: No Australian CPD opportunities were identified; 1.3% of the 2008 OT AUSTRALIA conference topics were emergency department specific. Forty‐one Australian hospitals employed a total of 51 occupational therapists of whom 30 responded. Half were supervised by occupational therapists; 20 had occupational therapy mentors; 23 perceived that they were very independent; seven did quality assurance projects; 25 had unmet research needs; 27 thought their service was effective; and service strengths, weaknesses, opportunities and threats to service could be identified by most occupational therapists. Conclusion: Australian occupational therapists in emergency departments need specialised CPD opportunities. The information needs and strengths, weaknesses, opportunities and threats provide a CPD topic planning guide.     

The Framework of Occupational Gradation (FOG) to Treat Upper Extremity Impairments in Persons With Central Nervous System Impairments

Occupational therapists providing treatment of persons with central nervous system (CNS) impairments now embrace a motor control approach based on principles of strength training and practice of meaningful occupations. This paper describes the Framework of Occupational Gradation (FOG), which was developed to assist occupational therapists to systematically challenge upper extremity function by manipulating the degrees of freedom of active motion in a person's extremity. Clients may be able to perform occupations under several or all levels within the framework. However, the person, task, or object properties and the environment can also be manipulated by the occupational therapist to optimize or challenge a person's performance at each level. Application of the FOG is presented through case studies.     

Occupational therapists' decision-making in the management of clients with upper limb hypertonicity

This study applied social judgement theory to the exploration of factors influencing occupational therapists' decision-making when they manage upper limb hypertonicity in clients with cerebral palsy. To achieve this goal, both objective and stated policies were investigated. This quantitative study drew information from a literature review and a survey with experienced occupational therapists to identify 12 factors that could influence decision-making. Based on these 12 factors 110 case vignettes of individuals with cerebral palsy and upper limb hypertonicity were generated. Intervention decisions were elicited from 18 experienced occupational therapists for each of the 110 case vignettes. Therapists were also asked to rank the factors in order of perceived importance. Occupational therapists generally used severity of spasticity, wrist and finger posture, and client and family background information to guide their clinical intervention choices. However, therapists demonstrated poor insight into the nature of their decision-making processes. This was highlighted in the disparity between their stated and objective policies. These findings have implications for both the professional development of therapists and the training of students.     

Shoulder Pain in the Patient with Hemiplegia

Shoulder pain in the affected upper extremity of patients with hemiplegia is of fundamental concern to occupational therapists who are working for increased independence of patients. The author interviewed several other occupational therapists, reviewed recent literature and completed a survey of charts of 30 patients. The literature and the therapists' responses indicated a higher frequency of pain than the author anticipated. The chart review was completed (1) to determine objectively the frequency of shoulder pain or subluxation in patients with hemiplegia, and (2) to ascertain the use of the upper extremity and the performance of functional activities of those patients who had shoulder pain or subluxation. Although the number in the sample of charts was too small to yield more than an indication of problems, 3 group patterns emerged based on the differences in functional use of the upper extremity. These 3 patterns of function were compared with findings in the literature. Further study is suggested to assess pain and its responses to occupational therapy, during both the acute and chronic phases of care. The goal of research would be to better predict which patients would develop shoulder pain, thereby helping to prevent long-term complications.     

新型医疗设备管理方法设想

为解决部分医院医疗设备供不应求、部分医院医疗设备使用率不高这一矛盾,本文提出了一种新型医疗设备管理方法。该方法通过引进专业管理团队和系统平台,可以在不增加资金投入的情况下,改善医疗设备使用不均、缩短病人等待检查时间,从而提高医院的整体服务质量,并在一定程度上缓解医患矛盾。     

供应室护士职业防护现状的调查分析

目的探讨供应室护士职业防护的现状及其防护措施。方法对186名3所综合医院供应室的护士进行问卷调查。采用SPSS13．0进行统计分析。结果护士对职业防护的认识水平不高。护士锐器损伤比例最高，占43．5％；其次为听力减退，占10．8％；高温烫伤和皮肤过敏分别为5．9％和3．8％。锐器损伤后的处理措施存在诸多问题。结论供应室护士职业防护意识不强，职业危害对其健康有较大影响。应加强职业安全教育及培训，提高自我防护意识，保障职业安全。     

Assessment of the Hemiparetic Upper Extremity

The Functional Test gives an accurate and immediate assessment of upper extremity capabilities for performance of functional activities. It has been used primarily with patients who have a residual hemiparetic upper extremity following a stroke. This seventeen task test is arranged in seven levels and can be administered in approximately thirty minutes. It is completely portable and can be used practically in many different treatment settings. The information obtained will allow therapists to set realistic functional goals and design effective programs for the patient's use of the involved upper extremity. The early research on this instrument implies that this test may be used as an alternative to some of the traditional objective and time consuming test measures that are currently used by occupational therapists.     

Caring for children with physical disability in Kenya: potential links between caregiving and carers' physical health

Background The health of a carer is a key factor which can affect the well‐being of the child with disabilities for whom they care. In low‐income countries, many carers of children with disabilities contend with poverty, limited public services and lack assistive devices. In these situations caregiving may require more physical work than in high‐income countries and so carry greater risk of physical injury or health problems. There is some evidence that poverty and limited access to health care and equipment may affect the physical health of those who care for children with disabilities. This study seeks to understand this relationship more clearly. Methods A mixed methods study design was used to identify the potential physical health effects of caring for a child with moderate‐severe motor impairments in Kilifi, Kenya. Qualitative data from in‐depth interviews were thematically analysed and triangulated with data collected during structured physiotherapy assessment. Results Carers commonly reported chronic spinal pain of moderate to severe intensity, which affected essential activities. However, carers differed in how they perceived their physical health to be affected by caregiving, also reporting positive benefits or denying detrimental effects. Carers focussed on support in two key areas; the provision of simple equipment and support for their children to physically access and attend school. Conclusions Carers of children with moderate‐severe motor impairments live with their own physical health challenges. While routine assessments lead to diagnosis of simple musculoskeletal pain syndromes, the overall health status and situation of carers may be more complex. As a consequence, the role of rehabilitation therapists may need to be expanded to effectively evaluate and support carers' health needs. The provision of equipment to improve their child's mobility, respite care or transport to enable school attendance is likely to be helpful to carers and children alike.     

浅谈医疗设备维修与质量控制的结合与应用

随着社会的快速发展与民众生活水平的提升,人们更加注重自身的健康问题,对医院各方面的要求开始逐年增加,其中医疗设备很大程度上决定着医院能否开展相关的医疗活动。很多医院为满足各类患者的需求,开始大规模引进各种高精密、高适应性的新型医疗设备,以此来降低临床诊断与治疗中的误差率,但是医疗设备经过长期的使用后不可避免的会出现指数偏差或者失灵等状况,这为医院的相关医疗活动带来了一定的安全隐患,基于此,文章就设备维修与质量控制简述、医疗设备质量控制指标、医疗设备维修与质量控制的结合与应用措施展开分析与论述。     

北京市宠物医院X射线机使用及防护情况调查

目的 了解北京地区宠物医院X射线诊断设备的使用情况及防护管理水平。方法 对北京市13个辖区中共计292家宠物医院进行了实地调查,填写调查记录表;并对其中35家医院的机房外辐射水平进行了现场检测。结果 X射线诊断设备使用率为49.66%;职业病危害申报率6.90%,场所年度监测率25.52%,参加辐射安全与防护培训率22.07%,个人剂量监测率22.76%,职业健康检查率16.55%,上述要求全部满足的宠物医院仅2.07%;35家接受辐射防护水平现场检测的医院中防护合格率为34.29%。结论 北京市宠物医院中X射线诊断设备的使用率相对较高,但辐射防护工作尚存在明显不足,应引起相关单位的重视,加强管理。     

Occupational Therapy and Rehabilitation Engineering

Occupational therapists in clinical settings are often challenged with difficult problems in the selection, application and modification of complex mechanical, electrical or structural aids for persons with severe disability who wish to improve their levels of independence. At the Rehabilitation Institute of Chicago, solutions to such situations are facilitated by interaction between the occupational therapist and the rehabilitation engineer. In this paper, following the identification of the population served and their specialized needs, the working relationship between the occupational therapist and rehabilitation engineer will be discussed through presentation of two case studies. Various commercially available equipment will be considered along with modifications possible, and finally, customer design solutions will be given for some problems. Given the growing store of resources for assisting clients who have special needs, many creative systems can be developed in therapists and engineers combine their respective knowledge and skills in problem solving.     

中医医院医疗设备的配置与管理特点

由于中西医诊断、治疗方式不同,导致中医医院在病人结构上也和西医医院有所不同。这些不同对医院的医疗设备的配置和管理都有重要影响。作者试图通过对中西医院不同点的对比和分析,揭示出现代中医医院医疗设备配置。