72 F I S I O T E R A P I E SEPTEMBER 1980 E x p erim ental group C ontrol group Class / f f - r ( f - r y Cf - f f f 0 23 15,5 7,5 56,25 3,63 1 - 2 5 11,5 - 6 , 5 42,25 3,68 3 + 2 3 - 1 1 0,33 0 8 15,5 - 7 , 5 56,25 3,63 1 - 2 18 11,5 6,5 42,25 3,68 3 + 4 3 1 1 0,33 ef = 60 e/1 60 15,28 / = actual freq u en cy o f re-adm ittance f = theoretical frequency of re-adm ittance x ' = 15,28 (acquired chi-square). D egrees of freedom = 2. C ritical 5% level = 5,991. 1 % level = 9,210. from unnecessary psychological and physical trau m a during recu rren t periods of hospitalisation and the fam ily will be spared unnecessary expense. E very physiotherapist should th erefore m otivate th e p a re n t of such a child to becom e a m em ber o f th e team . References 1. Burgess, J. (1965). T h e m anagem ent o f sick children in hospital from th e physiotherapist p oint o f view. P hysiother., 51. 183 -186. 2. G oldin, C. J. (1965). T h e physical therapist as p aren t Fig. 3 counsellor: an em erging role. Phys. Ther., 45, 6 7 § T 682. ? - 3. H obson, E. P. G . (1961). Physical therapy in relation to th e disabled p atient and the hom e. P hysiother., 47, 133- 135. 4. Porter, A. L. (1967). Physiotherapy in the treatm en t o f b ro n ch io litis and bro n ch o p n eu m o n ia in babies and young children. P hysiother., 53. 333 - 335. 5. R eynolds, R . J. S. (1975). P aed iatric physiotherapy in th e past 25 years. Physiother., 61, 106 - 108. 6. Shepherd, R . (1974). Physiotherapy in Paediatrics. A lden and M ow bray. O xford. T R E A T M E N T N O T E : SHORTWAVE DIATHERMY (S.W.D.) IN THE TREATMENT OF UNRESOLVED PNEUMONIA S. H. M. B L A C K W O O D , M .C.S.P., Dip. T.P.* OPSOM M ING D it is gevind dat p n eum onie in die konsolidasie stadium e ffe k tie f behandel kan word m e t kortgolfdiaterm ie om sodoende resolusie aan te help. Som m ige chroniese borskwale, byvoorbeeld asma en em fiseem , vind ook hierby baat. 'n D eur-en-deur aanw ending word gebruik en asem halingsoefeninge m o et altyd daarm ee saam ge- doen word. How m any physiotherapists know the fru stratio n of treating a p neum onia w hich refuses to resolve. In spite o f chem otherapy, postural drainage, percussion, shaking and vibrations, rib-springing, breathing exercises and the p a tie n t’s ow n activity, back come the chest ra d io ­ graphs still show ing th a t resolution has no t occurred. M any years ago, w hen all efforts to clear up a p neum onia in a p atien t who was herself a d octor had failed, it was decided to try shortw ave diatherm y. T he p atien t was in term itten tly febrile and chronically unwell. T h e resistant p atch of inflam m ation was situated in the a n terio r segm ent of the right lower lobe. A pplication was through-and-through this area w ith a large m alleable electrode placed posteriorly and a m edium glass electrode placed anterio rly with close spacing. Initially fo u r m ild therm ic treatm en ts o f fifteen m inutes d u ratio n were given tw ice a day fo r tw o days. T he patient was sent for chest radiographs which show ed a m arked red u ctio n in th e size o f the inflam m atory patch. A fu rth er six treatm en ts were given in exactly the sam e, way fo r th e next th ree days. A t th e com pletion of tW course th e chest radiographs were clear and the patiA*.' was feeling well. As a consequence, over the years SW D has been used routinely by m e and now in m y practice for unresolved pneum onia. A pplication has alw ays been as described, the electrom agnetic field being directed as n early as possible through the area o f inflam m ation. I t has been found, however, th a t one daily tre a tm e n t of tw enty m inutes’ d u ratio n is equally effective. A m axim um of six to eight treatm ents should be given. I f there is no change in the size of the pulm onary opacity, then som e o ther lesion is present, possibly sinister, and th e p atien t should be referred for fu rth er investigation. C heck radiographs should be carried out after th ree o r four treatm ents an d if th ere is seen to be an increase in the size of th e opacity th en treatm en t should be stopped im m ediately. As a fu rth e r consequence SW D was tried fo r som e o th er chronic resp irato ry disorders and found to be useful in th e treatm en t o f em physem a, asthm a and chronic bronchitis. I t is N O T used, how ever, in the * P rivate P ractice, W estville, N atal. R eceived 16 Ju ly 1980. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) SEPTEMBER 1980 P H Y S I O T H E R A P Y 73 presence of infection. A pplication is again through-and- through the chest wall w ith a large m alleable electrode placed posteriorly in the upper thoracic region and a medium m alleable electrode placed anteriorly over the sternum and p ectoral region. D osage is m ild therm ic for fifteen to tw enty m inutes. SWD applied thro u g h the chest unequivocally gives the p atien t a sense of w ell-being — perhaps on the cleus ex m achina principle. It m ay be th a t the effect is to relieve bronchospasm , n o t only to induce m ore gene­ ral relaxation, and it m ay be th a t m ucus is rendered less viscid; th e attrib u te of SW D of effecting vaso­ d ilatatio n m ay serve a purpose when used across the lungs o r it m ay serve only to increase th e v entilation: perfusion inequality. T his m ight prove an interesting field fo r research. T h ere should be no need to stress th a t o th er proce­ dures, such as vibrations and breathing exercises, should always accom pany the treatm en ts by shortw ave diatherm y. THE CRITICAL INCIDENT TECHNIQUE IN PHYSIOTHERAPY EDUCATION JO H L Y N E C. B E E N H A K K E R , B.Sc. (Physio) R e p o rt o f a pilot study undertaken to determ ine the behaviour o f an effective physiotherapist. The critical incident technique was used to collect data fr o m 30 practising physiotherapists and 300 separate incidents o f effective and in effective behaviour were identified. On the basis o f this study, the desirability o f objectively identifying curriculum content in physiotherapy educa­ tion has been established. O ne o f the problem s facing p h y sio th erap y educators today is w hat should be tau g h t and w h at should be deleted from the ra p id ly expanding un d erg rad u ate c u rri­ culum. W e m ust establish w hether the present syllabus is meeting the needs o f th e society in w hich the physio­ therapist w ill p ractice and ensure th a t th e needs o f the students are also being met. O f the m any studies th a t have been done by the various professions, one o f the m ost p rom ising m ethods o f determ ining cu rricu lu m content ap p ears to be the critical incident technique. By incident is m ean t a u n it o f observable hum an activity w hich is sufficiently com plete in itself to allow inferences to be m ade ab o u t the person p erfo rm in g the act. A critical incident is one w hich leaves th e reader little doubt regarding its effectiveness o r ineffectiveness. \ T h e critical incident technique was evolved by Ijflanagan (1954) and he has used it as a basis fo r studies in m any varied fields. Jensen (1960) and B arham (1963) have applied th e technique to different aspects o f N ursing and a large study in O rth o p aed ic tra in in g was described by M iller (1968). In these studies, practitioners in th e various professions w ere asked to describe a situation, record w h at action w as taken by the person observed and w h at the result o f the action was. Once the incidents had been collected, it was possible to identify the key actions o f the profession being studied. A p ilo t study was carried o u t by the Physiotherapy D epartm ent o f th e U n iv ersity o f the W itw atersrand to determ ine w hether the critical incident technique w ould be a practicable m ethod o f establishing w h at behaviours characterise an effective physiotherapist. METHOD Six physiotherapy colleagues w ere chosen to carry out the study and each was asked to ap p ro ach five senior physiotherapists representing hospital and private practitioners, as well as those fro m special institutions Senior L ecturer, A cting H ead, S ub-D epartm ent o f P hysiotherapy, U n iv ersity o f the W itw atersrand. Received 11 Ja n u a ry 1980. (W itw atersrand) D .P.E. (W itw atersrand)* Opsomming Verslag van 'n voorlopige studie wat onderneem is om die gedrag van ’n doeltreffende fisioterapeut vas te stel. Die kritiese insident tegniek is gebruik om data van 30 praktiserende fisioterapeute te versam el en 300 aparte insidente van doeltreffende en ondoeltreffende gedrag is ge'identifiseer. Op grond van hierdie studie is die w enslikheid van objektiew e identifisering van kurriku- lum inhoud in fisioterapie-onderrig vasgesteh and training centres. T here were eight physiotherapists from private practice, five from cerebral palsy schools and institutions, th irteen in h o sp ital em ploy and four at train in g centres, w ho took p a rt in th e study. These 30 physiotherapists w ere given 10 form s each in w hich to rep o rt incidents w hich they considered to have had a positive o r negative outcom e, as regards effectiveness. T o ensure th e collection o f a full spectrum o f behaviours in the cognitive, psychom otor an d affective dom ain, the areas suggested fo r collection o f th e incidents w ere:— # Interpersonal relationship w ith th e patient, his fam ily o r o th e r m em bers o f th e health team . # Intellectual — use o f problem solving and other skills in the assessm ent o f th e p a tie n t o r situation as well as th e plan n in g o f a treatm en t program m e. 9 Technical — m ethods o f carrying ou t the assess­ m ent o r treatm en t program m e. O f the 300 form s given o u t, 180 w ere retu rn ed in tim e fo r the study w hich was lim ited to an in itial six week period. As several o f the form s h ad m ore than one rep o rted incident, 300 exam ples w ere collected w hich fell under two o r m ore of the m ain areas. Each incident was extracted fro m the fo rm and recorded on a sep arate card. T h e first analysis o f the data was done in June, 1979, w hen 194 incidents w ere identified. In July, a fu rth e r 106 incidents w ere categorised an d o f these only one was fo u n d to be a new b eh av io u r (T able I). E ach m ain a rea w as subdivided according to the incidents, and as new behaviours w ere received, new sub-areas w ere form ed, e.g. A -I-R elatio n sh ip w ith p a ­ tien t (a) Listens to p atien t, (b) E xplains to p atien t, (c) G ain s p a tie n t’s co-operation etc. ANALYSIS OF D A T A T h e valid ity o f the in terp re tatio n and classification o f the incidents was checked by subm itting a random sam ple o f th e cards to two o f th e co-workers. These w orkers then sorted out the cards u n d er the various areas and it was found th a t there was a ninety-five p e r cent agreem ent in th e ir classification as com pared R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )