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2.2.5 ACCESS TO HOME AND COMMUNITY REINTEGRATION AND ENVIRONMENTAL BARRIERS It is the duty ofthe occupational therapist to do community assessment before discharge and reintegration ofthe patient into the community. This helps in discharge preparation of the patient when the occupational therapist knows exactly what the environment or home of the patient looks like. The occupational therapist considers the concept of environmental barriers and environmental support to occupational performance. These are influenced by social, cultural, economic, institutional and architectural elements. According to Trombly (1995:255) community assessment is not done well for all amputees, as a result of which some amputees adapt poorly to the environment or community after discharge. All the amputees whose environment has been assessed should be recorder in hislber file. This include purpose of assessment focus done by qualified occupational therapist, that is, environmental factors involved and addressed, location of the environment assessed, how assessment was carried out, for instance questionnaires or observation, clarity and comprehensiveness of instruction, time taken to do assessment, its usefulness, standardization, that is, literature used to base the assessment on or experts consulted for reassessment, whether the assessment was published and whether the assessment have undergone testing for reliability and validity. This information is very important for the rehabilitation team to assess a successful amputee's rehabilitation on the community level. This also depends on good discharge preparation, and an accessing home, community and workplace (Trombly, 1995:258). 2.2.6 DISCHARGE PLAl\1'."'ING Discharge planning is part of rehabilitation of the amputees whereby amputees are involved in the care, planning andpreparation for their discharge before they are disposed to community rehabilitation services. Thisis the cruciaJ period when the patient has to go home and face the community for the first time after amputation; uncertain and not sure 10
whether adjustment will be successful or not. It is therefore very important to involve the patient and the family in discharge preparation, in order to prepare him physically and psychologically to face this challenge. It is during this period that t1ie rehabilitation team gets time to assess the amputee for readiness to be discharged and reintegrated into the community. It also gives the rehabilitation team the chance to meet the patient's family. During this period the patient is educated together with the family so that the family would be able to support the patient during and after discharge. Involvement offamily members in planning for discharge is an important rehabilitation strategy to ensure continuity ofcare at home, in order to prevent complications like sepsis due to failure to dress the stump wound, contractors due to lack ofexercise, etcetera (Browse, 1998:280). During home trial visits it was found that amputees encountered problems like small houses which caused difficulty for movement of wheelchairs, while some houses had steps but no ramps. The community-based care services for patients were also not available (Siyothula & Kubheka, 2002:12). 2.2.7 ALTERATION OF THE ENVIRONMENT Ifthere are alterations that need to be done liaison with the social services department is essential, as wen as with the Department of Housing ifalterations involve the physical structure ofthe house. It is important that these alterations are done before the amputees are discharged. Social support systems are essential for community rehabilitation like community home based caregivers and ordinary helpers. These helpers assist by taking part in the environmental alteration strategy. Ifthe infrastructure like roads is included in the alterations. strategy, the Department of Transport is also involved to assist with construction or a road to the amputee's house or driveways as well as ramps in the place ofsteps(Ndiovu, 1998:54) 11
Page 2 and 3: TABLE OF CONTENTS PAGE The Titlefor
Page 4 and 5: DEDICATION This dissertation is wri
Page 6: The University of Zululand for prov
Page 9 and 10: 5.1 - 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5
Page 12: CHAPTER3 THEORETICAL FRAMEWORK PAGE
Page 15 and 16: 5.9 SECTIONH: EMPLOYMENT AFTERAMPUT
Page 17 and 18: 6.5.4 6.5.4.1 6.5.42 6.5.4.3 6.5.4.
Page 19 and 20: • 1.1 INTRODUCTION CHAPTER 1 Reha
Page 22 and 23: 1.6.4 Do amputees experience physic
Page 24 and 25: 1.10 CONCLUSION In this chapter an
Page 26 and 27: 2.2.1 GENERAL PHYSICAL REHABILITATI
Page 30 and 31: 2.3 PSYCHOLOGICAL REHABILITATION Ku
Page 33 and 34: Itis the duty ofthe social worker a
Page 35 and 36: 2.5.3 STAFF A(((rUDES An examinatio
Page 37 and 38: the only solution in the study that
Page 39 and 40: small and large groups. and social
Page 41 and 42: esponsibilities in positions they o
Page 43 and 44: what muses do with and for individu
Page 45 and 46: 3.4.8 TIME Time refers to the seque
Page 47 and 48: 3.5.3 MODIFIED CONCEPTUAL FRAMEWORK
Page 49 and 50: image. In this way psychological ad
Page 51 and 52: 4.1 INTRODUcrrON In this chapter th
Page 53 and 54: as it is a useful self-report instr
Page 55: 4.6 VALIDITY Al'o'DRELIABILITY The
Page 59 and 60: caused by accidents. As far as reha
Page 61: more ofthese respondents were from
Page 64 and 65: The members ofthe rehabilitation te
Page 66 and 67: ehabilitation team, to meet other b
Page 68 and 69: Pffi'SICAL CARE This item was inclu
Page 70 and 71: used correctly. Hodkinson, Smith an
Page 72 and 73: time to be visited by old coping am
Page 74 and 75: TABLE 5.14 F1NA.l\(CIAL msroav Fina
Page 76 and 77: 5.5.8 ITEM' 19 RESPONDENTS WHO MANA
Page 78:
they were fit for their old work or
Page 81:
not be effectivelyproductive atwork
Page 84 and 85:
other disabled families there is a
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5.7· SECTIONF:COMMU1'olTfYRElNfEGR
Page 89 and 90:
accessibility of the home, easy mov
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muddy and slippery when it is raini
Page 94:
to their preVIOUS jobs or to be tra
Page 97 and 98:
are community group projects, there
Page 99 and 100:
5.11 SECTION J: REHABILITATION AIDS
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5.11.3 ITEM 45 AVAILABLE COMMUNITY
Page 103 and 104:
Table 528 reveals that amputees exp
Page 106 and 107:
Chapter three described the theoret
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6.5.2 OBJECTIVE TWO To evaluate phy
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• Another (4) 16% were seen by th
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-DISABILITY GRANT The disability gr
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TRANSPORT It is the aim ofcommunity
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• Eleven (11) 44% amputees report
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6.5.3.1 PHYSICAL PROBLEMS SEPTIC ST
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DISCHARGE PREPARATION The fmdings r
Page 122 and 123:
6.5.4.3 DISCHARGE PREPARATION Th'VO
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also be made accessible for the amp
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IS. Mbeki, T.M 1997. White Paper On
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BIBLIOGRAPHY 1. Brink, H. 1996. Fun
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ANNAXUREI LEITER REOUESTING PERMISS
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ANNAXURE2 PERMISSION LEITER FROM DE
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The ChiefMatron King Edward VIIIHos
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'- ANNAXURE 5 -.:') OUESTIONNAIRE F
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Psychologist o Vocational rehabilit
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14. WHO TAUGHT YOU THESE ABOVE ACTI
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17.5 Ifthis financial assistance en
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Other o Ifother, please specify: _
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31. HOME VISIT BY TIIE REHABILITATI
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34.3 Ifno, who does the evaluation
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41.2 Does department of transport p
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