3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Knowledge translation in dysphagia : a South African study.(2014-01-10) Seedat, JaishikaBackground: Knowledge translation models to address existing knowledge gaps in different areas of speech-language pathology practice are providing researchers and clinicians the opportunity to improve efficiency and effectiveness of service delivery. As a developing context, public health care in South Africa can scarce afford the luxury of wasting resources and finances on interventions that are inefficient or without proven benefit given the increasing prevalence of chronic burden of disease such as stroke and traumatic related injury, both of which has dysphagia as a symptom. The outcome of the manner, efficiency and consistency of traditional models of dysphagia management currently being implemented in this context were compared to a pre-existing theoretically proven free water protocol for dysphagia management. Method: The primary aim of the current study was to enable knowledge-to-action translation in dysphagia management by determining the feasibility of using a free water protocol for stroke or traumatic brain injured patients presenting with dysphagia in an acute government hospital setting in Gauteng, South Africa. A mouth care training protocol was developed for nurses as a component of the free water protocol. Nurse perceptions on the training and implementation of mouth care were explored. The quantitative aims investigated if there was a difference between traditional and free water management in terms of a) the occurrence of aspiration pneumonia, b) amount of water intake and c) length of hospitalisation. 139 Nurses and 46 patients with dysphagia were participants. A mixed method design was used. The study was conducted in two phases, phase one comprised the ethnography and the nurse training component. Phase two was quantitative and comprised implementation of the free water protocol by the researcher. Thematic content analysis was used for the qualitative data. Quantitative data was analysed using inferential statistics. Results: The mouth care training protocol for nurses was efficient and effective for the current context. Nurses engaged positively with the study by implementing mouth care successfully when necessary for the dysphagic patients. This combined with consistent daily management of dysphagia with patient involvement, facilitated patient compliance, adequate levels of water intake, with no cases of dehydration, and no incidence of aspiration pneumonia at the end of the intervention period. The comparison group in contrast who received the traditional model of dysphagia management showed longer period of hospitalisation and higher consumption of liquids despite recommendations for liquid restricted diets. There were seven cases of aspiration pneumonia at the end of the intervention period in the comparison group. Conclusions & Implications: Despite no statistically significant differences between the study and comparison groups on the specified outcome measures, clinically significant differences were noted. The method employed in the study seemed to facilitate knowledge translation of the free water protocol to a public hospital context in South Africa. The findings of the study suggested that a collaborative partnership between the speech-language pathologist and nurse was attainable and this seemed to have multifaceted mutual benefits to the patient, institution and the respective professions. Improved monitoring of service provision, implementation of protocols based on contextual evidence, importance of knowledge translation in a developing context and an expanded role of the speech-language pathologist responsive to the needs of the context and patient population were some of the implications that arose from the study.Item An investigation of the support offered by the institution level support team to the foundation phase teachers in a single school in Johannesburg.(2010-09-02) Tebid, Celyne AmbeckSome of the major difficulties encountered in embracing an inclusive education system are, lack of commitment, lack of resources as well as a poor understanding of how to support successful inclusion. The Education White Paper 6 (here after referred to as EWP6) states that, all children can learn, should be supported to learn and assured of equal and equitable education. The implementation of inclusion has been initiated by the EWP 6 (Department of Education, 2001) and is still in the process of developing the necessary education support services. At the school level, an institution level support team (ILST) should serve as a means of supporting learners experiencing learning difficulties. This study examined the perceptions of foundation phase teachers regarding the support they are getting from the ILST as well as finding out whether collaboration between the above mentioned bodies can help in addressing the issue of learner diversity in an inclusive classroom. The investigation was conducted at a school in the Northern suburb of Johannesburg. The foundation phase teachers and some members of the ILST were purposively included as participants. A case study design was chosen since this would allow for in-depth examination of the perceptions of foundation phase teachers regarding the support they are getting from their (ILST). The data collection process included questionnaires, oral follow up interviews, document analysis and observation. The data collected from the above sources has been analyzed according to themes and subthemes that emerged. The findings of the study show that, there is little or no collaboration between the foundation phase teachers and the ILST. It was also evident that the foundation phase teachers collaborate immensely amongst themselves in sharing ideas on how to support learners in their classrooms. Lastly, it was apparent that the support given to the foundation phase teachers was done solely by the learning support educator and not as a team with the other members of the ILST. The ILST on their part did not take time to actually define their roles in terms of how they would be functioning in rendering support to the foundation phase teachers. Based on the findings in this study, recommendations are made as to how to effectively support teachers as well as improve collaboration among all stake holders involved in inclusive practices.Item Evaluating the effectiveness of Harcombe's cognitive approach to literacy instruction in improving literacy learning in a South African university training setting.(2010-06-25T10:16:28Z) McMahon-Panther, GailAlong with various contextual factors, the method of literacy instruction is recognised as one of the main reasons for low levels of literacy learning both locally and internationally. Harcombe’s CATLI process is offered as an alternative literacy methodology, firstly since its constructivist, ecosystemic underpinnings endeavour to address as many contextual issues as is possible, and secondly, because the CATLI process attempts to address some of the gaps in other literacy instructional programmes. The current study aimed to evaluate the CATLI process as a viable alternative to traditional methods of literacy instruction. In addition, the study aimed to evaluate the effectiveness of using the constructivist approach to train university students in the CATLI process. The sample comprised trainee learning support specialists and one parent per learner receiving the CATLI intervention at the community centre at a Johannesburg university in 2007. Quantitative and qualitative data obtained by means of questionnaires and extant records provided evidence that all learners showed improvement in literacy skills as well as general development, ascribing the effectiveness of the process to being underpinned soundly by social constructivism and associated theories. For the same reason, trainees considered their training sufficient.