Speech Language Pathologists’ Development of Practice for Managing Burn Injuries in South Africa.

Abstract

Background and Aims: This study analyses how speech-language pathologists (SLPs) have constructed knowledge and practice for burn injury management despite a lack of clinical guidelines and undergraduate training through their experiences of practice. The research project addresses a gap in understanding how clinical practices evolves when evidence-based guidelines are not available. I have selected the example of burn injury management because of its prevalence in South Africa and it is an emerging field of clinical practice for SLPs. Methods: The study involved a qualitative exploratory design with a metacognitive reflective approach. Participants included 11 SLPs from across the country. Data collection was conducted through online interviews and SLPs experiences were analysed via thematic analysis. Results: The following themes emerged: The complexities and challenges of working with patients with burn injuries influences the development of clinical practice in burn injury management, clinical practice develops through interactions between dynamic SLP teams and the multi-disciplinary team (MDT), clinical practice develops through the application of cognitive phenomena and generic SLP knowledge, the development of clinical practice for burn injury management is context-dependent, individual SLP’s psychological and personality factors influence the development of clinical practice in burn injury management. 6 Conclusion: In the absence of explicit clinical guidelines and undergraduate training the development of clinical practice and the creation of knowledge in burn injury management is multifactorial and seems to rely on a set of extrinsic and intrinsic factors. A proposed model is presented to explain practice development and knowledge creation in this field. In the context of the South African healthcare system, healthcare practitioners who work in teams possess and apply certain cognitive skills to daily practice. Those SLPs whose personalities appear to align with practice development and knowledge creation essentially take on the challenge of risk and complexity when treating patients with burn injuries, in their pursuit of comprehensive service delivery. As the field of burn injury management evolves, SLPs and other healthcare practitioners need to cultivate intrinsic factors (their individual personality traits and cognitive processes) and commit to ongoing learning and professional development, to provide the best possible care for their patients. Implications: This research provides insight into the generation of knowledge and clinical practice in a resource-poor context and in a field with limited guidelines or training. The findings have implications for the future research, supporting structures, training and development of healthcare practitioners to encompass care for conditions not explicitly taught in the curriculum.