| Description of the theme:
This role describes the professional knowledge, clinical skills, and professional attitudes required by occupational therapists for service in PHC settings. |
| Knowledge:
Participants agreed that graduates should plan and implement interventions in resource-constrained settings to address the common conditions in PHC centres. KZN-DoH participants expected for interventions to have a preventative and promotive focus instead of the previous bias toward curative intervention programmes. Furthermore, KZN-DoH and established occupational therapists expressed that graduates should be able to plan and implement interventions in different practice settings. Occupational therapy graduates need to understand the different roles required of them in each location at the different levels of care within the public sector, e.g., hospital, clinic, under a tree, or at a home visit. Both the established and novice occupational therapists verbalized the need for knowledge on structural and contextual factors that impact participation in occupation.
Additionally, graduates need to understand the culture of the community that they work in to deliver contextually relevant services. Participants stressed the importance of graduates understanding the impact of health and government policies and procedures on service delivery. The need to understand the effect of health on occupation and its impact on the social determinants of health on the clients’ and their families’ occupation was highlighted in regulatory documents and emphasized by participants. Novice occupational therapists expressed that graduates should have a firm grounding in the profession. They thought it would help graduates build a solid professional identity, i.e., knowing what OT was and their role in the community, clinic, and hospital.
Apply the occupational therapy process within different fields of practice, with all age groups, and indifferent sectors (health, education, welfare, labour and both in the public and private sectors) describing how the role “fits” and is shaped by the context. (SAQA exit level outcomes, P4)
For me, they need to know what type of community is that, what belief systems are there or how do you integrate your western type of knowledge within the community knowledge that is already there but how do you use the skills, the profession in a way that will be integrated into the knowledge that is already existing in that particular community, for me that’s Number 1. (Participant 24, novice occupational therapist)
I think you need to really understand the framework that you fitting into, that you being plugged into. I knew public health, I knew how governments sort of worked but I did not understand the context fully, I did not know, not the chain of command but there’s certain ways that things happen in government and you have to understand that. (Participant 34, novice occupational therapist)
Knowledge about human rights about health and well-being, cultural understandings of health and well-being, social determinants of health and well-being, national health needs, priorities and goals, education and disability systems, and the relevant health, social, disability, and workplace legislation. (WFOT minimum standards (2015), lines 1211-1215)
They need to know how (the) Department of Health works because everything is politically pre-set. You have to know what the government of agriculture is. Other departments, including (the) municipality, they have a section that addresses disability… they need to know what they do. So that we can network. (Participant 5, established occupational therapist) |
| Skills:
There was a consensus that graduates should conduct vocational assessments and rehabilitation and establish mental health programmes and group therapy in the community. Novice occupational therapists focused on basic assessment and intervention skills, while the KZN-DoH participants and the established occupational therapists reported that graduates must acquire skills to offer services relating to interventions in the community, e.g., home visits, support groups, and caregiver training. Both the established occupational therapy and KZN-DoH participants expressed the importance of educating communities about child development, stimulation programmes, and establishing programmes to address primary, secondary, and tertiary disease prevention. Both the established occupational therapists and KZN-DoH participants emphasized that graduates had to ensure the continuity of interventions through home programmes and collaborate with community health workers (CHW). All participants expressed that graduates should be skilled in prescribing appropriate wheelchairs, completing administrative procedures to obtain devices, and conducting wheelchair maintenance.
Established occupational therapy and KZN-DoH participants agreed that graduates need to be critical in their reflections when assessing the effectiveness of interventions. They are advised to learn from their own experiences and that of their peers. In addition, established occupational therapists indicated that graduates should set goals in partnership with their clients rather than impose their views of therapeutic goals. Finally, both the established and novice occupational therapists stressed the need for graduates to understand their role as brand ambassadors. They thought that being a brand ambassador could be strengthened through successful PHC programmes and consistent intervention services in the hospital and the community.
Need to be community orientated department. So, we do our work in the hospital, but we need to ensure that there’s community outreach. And with outreach, we take the service out even to the homesteads [more rural homes]. We visit schools, we visit even the pension pay points at some stage. (Participant 5, established occupational therapist)
You need basic skills. I think whatever the campus prepares you for assessment treatments…that are basic, you have to have that. I think if you do not come out of campus knowing your basic skills, then you are in trouble. (Participant 28, novice occupational therapist)
Then skills, obviously basic splinting skills, basic skills and exposure to making other assistive devices, basic sewing skills for pressure garments, like general rehab skills and vocational assessment and intervention. (Participant 32, novice occupational therapist)
Being able to offer services and empowerment to the patient in their community so I think primary healthcare must happen in the community, it must happen with the patient, where he can access services right there, it must empower the patient to feel like he’s in charge of his health and it must provide knowledge and skills for the person to be able to live healthy lifestyles...so a lot of preventative and promotive activities need to be done in primary healthcare...and screening for existing disability and existing occupational problems so that we can make the community more independent and empower them to be better. (KZN-DoH national manager) |
| Attitudes:
Both the novice and established occupational therapists and KZN-DoH participants had strong opinions about the softer skills needed to enable holistic practice. They listed attributes, including graduates having to be adaptable, resilient, persevering, resourceful, proactive, and demonstrate social accountability and empathy. Furthermore, graduates should be problem solvers who are able to think “out of the box” and prepared to learn from seniors and peers. Novice occupational therapists believed that graduates should have a strong work ethic, especially in the face of challenges and poor work ethic sometimes displayed by healthcare colleagues. Furthermore, graduates must be educated about cultural awareness and recognize their power positions over their clients, families, and the community. Novice occupational therapists stressed the importance of being passionate about their profession and a willingness to exceed expectations. Finally, novice occupational therapists reported that they viewed established occupational therapists as mentors and accessed them for peer support when faced with challenging situations.
…must be adaptable, resilient persevere, be resourceful, proactive, be able to problem-solve and be willing to learn from senior staff and peers. (Participant 10, established occupational therapist)
When you are treating the patients themselves, it’s also your attitude towards the patients…, if you do not have the right attitude, the patient will not allow you to treat them or touch them. so you always have to be very open and friendly. (Participant 20, novice occupational therapist)
Independence and confidence in their abilities. And also not to give up so like problem-solving skills, problem-solve and do not give up. Passionate about what they do. Someone willing to go above and beyond for others, especially in OT. It was so easy just to do nothing and just sit in the office all day because we did not get referrals; I did not do that because I am passionate about OT and helping the community. (Participant 20, novice occupational therapist) |
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