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Biomedical subjects

L Krefting

Publications and source records attributed to L Krefting.

13 recordsLinked to original sources
PubMed1995

Professional expertise of occupational therapists in community practice: results of an Ontario survey.

This paper presents findings of a study, The Community Practice Project, that examined the situation of occupational therapists practising in community based settings in the province of Ontario, Canada in 1992. In addition to providing a profile of the typical community based therapist, the study considered issues relating to: the principal roles in places of employment; specific job skills and areas of professional expertise utilized in the community; and how well occupational therapists; formal training prepared them for their community oriented roles and tasks. Results indicate that great opportunities exist and job satisfaction is high in community settings. Nonetheless, therapists feel inadequately prepared for the new role of consultant and its concomitant skills in a field that has re-oriented itself toward the client and is increasingly focused on health promotion and disability prevention.

Attitude of Health Personnel↗
PubMed1994

Stability of functional outcomes following transitional living programme participation: 3-year follow-up.

The functional status and perceived problems of 21 persons with severe brain injury were reported at admission, and at 1 and 3 years post-discharge from a community-based post-acute rehabilitation programme. Functional status was measured by participation in productive activity, financial support, place of residence and level of supervision required. Improvements observed at 1-year follow-up remained stable or had improved at 3-year follow-up. Loneliness and depression, while not reported at admission, increased over time to become the two problems reported most frequently at 3-year follow-up.

Activities of Daily Living↗
PubMed1994

Native Canadians relocating for renal dialysis. Psychosocial and cultural issues.

OBJECTIVE: To examine the effects of relocation from remote Native communities for dialysis treatment and explore the receptiveness of patients, caregivers, and their communities to establishing a local satellite dialysis unit. Second, to examine the methodological issues inherent in a qualitative, cross-cultural study. DESIGN: Qualitative descriptive survey using semistructured interviews. SETTING: The Moose Factory Zone (MFZ), situated along the west coast of James Bay in northern Ontario, is one of four geographically defined areas of responsibility within Ontario through which the federal government provides health care services to Native Canadians. PARTICIPANTS: Twenty-four Native residents of MFZ selected by volunteer and nominative sampling techniques. Patients with end-stage or prefailure renal disease, informal caregivers and supporters, professional caregivers, and community spokespersons were included in the study population. MAIN OUTCOME MEASURES: Identification of issues important in planning dialysis services for Native patients in remote communities in the MFZ. RESULTS: Informal caregivers and both categories of patients supported in principle a proposed satellite dialysis unit at Moose Factory General Hospital. Their criticisms of the present system necessitating relocation to urban centres included inadequate social support, inconvenience and expense, and family separation. Professional caregivers generally supported establishing a local dialysis unit but had concerns regarding staff training and continuity of care. Community spokespersons also supported the proposed unit but only if quality of care could be ensured. CONCLUSIONS: Relocation for dialysis treatment disrupts social support patterns and creates psychosocial problems. Although the psychosocial advantages of providing dialysis treatment services close to home are readily apparent, other considerations, such as cost, equipment, and expertise, and training of health care personnel, make the provision of tertiary level care more difficult in isolated areas. Additional study is required to determine the impact of methodological issues inherent in qualitative cross-cultural studies such as this.

Adolescent↗
PubMed1993

Incorporation of ethnographic methods in occupational therapy assessment.

Many constructs of interest to occupational therapists can only be studied through qualitative methods. Such constructs include meaning of activity or the illness experience and the context in which these occur. The purpose of this paper is to describe how ethnographic methods used in research can be generalized and applied to clinical practice. Ethnography is compared with other qualitative research approaches and a model clinical ethnographic assessment process is described.

Activities of Daily Living↗
PubMed1993

Community-based rehabilitation cadres: their motivation for volunteerism.

Volunteer workers, or cadres, are critical to the successful implementation of community-based rehabilitation (CBR) programmes. To date, relatively little research has examined the importance of motivation in health volunteers in general, and especially CBR workers. This paper reports the major findings of a field study in rural Indonesia. A multimethod design within a broad qualitative research framework which focused on the personal experiences of CBR volunteers was utilized. Descriptive data were obtained from written questionnaires, focus groups and key informant interviews. Research findings indicated that volunteer cadres perform considerable duties and face numerous difficulties in the course of their CBR activities. Incentives also play an important role in determining the motivation and ultimate performance of volunteer cadres. Developing an understanding of what it is like to be a volunteer CBR cadre has important implications for rehabilitationists interested in developing and sustaining CBR programmes and is clearly critical to any evaluation of CBR.

Adult↗
PubMed1992

Cognitive failure in patients with terminal cancer: a prospective study.

In a prospective open study, 61 consecutive patients with terminal cancer admitted to the hospital underwent cognitive assessment using the Mini-Mental State Questionnaire three times a week between admission and discharge or death. Mini-Mental State Questionnaire score upon admission was 28 +/- 1.5 in patients who were discharged (N = 14), and 25 +/- 3 in patients who died in the hospital (N = 47, P less than 0.01). The forty-seven patients who died in the hospital presented a total of 66 episodes of cognitive failure (CF) that were defined as a score of less than 24 or a drop of greater than 30% in the score on the Mini-Mental State Questionnaire. Of these 47 patients, 39 (83%) presented CF an average of 16 days before death. Upon detection of CF, a complete medical examination, laboratory evaluation, computerized tomography of the brain if indicated by abnormal findings on medical examination, and a complete medication review were performed. The cause of CF could not be established in 37 (56%) cases. Drugs, sepsis, and brain metastasis were the most frequently detected causes and were present in 6, 4, and 4 cases, respectively. In addition, 22 episodes (33%) of CF improved (10 episodes spontaneously and 12 episodes as a result of treatment). Our findings suggest that CF is extremely prevalent during the last weeks of life and, consequently, informed consent for therapeutic or research procedures or resuscitation may be impossible to obtain reliably at that stage.

Aged↗
PubMed1992

"Doing battle": a metaphorical analysis of diabetes mellitus among Navajo people.

Effective communication with patients and their family members forms the foundation of a therapeutic relationship. This is particularly important when the occupational therapist, other health professionals, and the patient are from different cultural backgrounds. This paper describes one aspect of the findings of a ethnographic study of chronic diabetes among the Navajo people (referred to here as Dine'). It focuses on the dominant metaphorical images that were used by the informants to describe their illness experiences. The data suggest that diabetes can be considered a metaphor for larger social changes in the life-style and traditions (e.g., away from sheepherding as a means of basic subsistence to obtaining urban-centered employment) of native Americans and their effects on the Dine'. Implications of our findings include the importance of metaphorical communication for perceptions of compliance, powerlessness, and patient and therapist satisfaction with the therapeutic relationship.

Arizona↗
PubMed1991

Activity and post-polio fatigue.

Fatigue was studied in 12 subjects with post-polio sequelae (PPS). Results of the Fatigue Severity Scale (FSS) demonstrated a mean score of 4.8 +/- 1.6 (non-disabled scores = 2.3 +/- 0.7). The Human Activity Profile (HAP) was not sensitive enough to measure fatigue. Fifty percent of subjects scored below the first percentile based on age and sex matched norms. The Activity Record (ACTRE) results revealed that subjects spent 5% of their time resting and 1% in planning or preparation activities. Fatigue peaked in the late morning or early afternoon and was relieved by rest periods. Use of energy conservation and work simplification skills along with frequent rest periods was suggested as a possible method for managing PPS fatigue.

Activities of Daily Living↗
PubMed1991

Rigor in qualitative research: the assessment of trustworthiness.

Despite a growing interest in qualitative research in occupational therapy, little attention has been placed on establishing its rigor. This article presents one model that can be used for the assessment of trustworthiness or merit of qualitative inquiry. Guba's (1981) model describes four general criteria for evaluation of research and then defines each from both a quantitative and a qualitative perspective. Several strategies for the achievement of rigor in qualitative research useful for both researchers and consumers of research are described.

Health Services Research↗
PubMed1991

Leisure activities after a stroke: an ethnographic approach.

Ethnography is a qualitative research design that has relevance for clinical research in occupational therapy. The ethnographic approach is illustrated in the present paper through a description of how it could be used to investigate the effectiveness of an occupational therapy leisure intervention with stroke survivors. This paper contrasts ethnography with a randomized clinical trial design addressing the same question. Background information about ethnography, its relationship to other qualitative approaches, and its relevance to occupational therapy is addressed. Additionally, specific aspects of the research process are described, including triangulation of data-gathering strategies, sampling, and analysis. The limitations of ethnography are then described. The paper concludes with some examples of ethnographic work with persons with disabilities.

Cerebrovascular Disorders↗
PubMed1990

Double bind and disability: the case of traumatic head injury.

This paper presents ethnographic data to support the double bind model of communication most recently described by Alexander. Using traumatic head injury as an example, an interactive view of paradoxical communication was taken focusing on the disabled, the family, and service providers. A brief discussion of head injury in the U.S. is followed by a delineation of the principles of the model. A number of specific binds are described based on perceptions of caregiving, private and public performance of the head injured, the invisibility of the disability, and economic disincentives to employment of the disabled. The paper expands the model based on the disability experience including illustrations of split binds, contextual communication and biological aspects of double bind.

Adolescent↗
PubMedDate not supplied

Measuring long-term outcome after traumatic brain injury.

We report the results of the first stage of development of an instrument to measure long-term functional outcome after traumatic brain injury. The instrument focuses on both the person with a disability and the impact on the family caregiver. We illustrate the early stages of instrument development, focusing on one approach to standardized reviewer feedback to evaluate content validity. The results of the pilot testing are discussed in terms of: purpose, instrument construction, and clinical utility. While the complete details of the instrument are not presented, example items are used as illustration. A number of methodological issues in instrument development in rehabilitation are described including the logistics of reviewer feedback, the use of family caregivers in instrument development and the reliability of self-report in brain-injured population.

Activities of Daily Living↗