The paper will delve into the professional experiences of therapists in treating and rehabilitating patients suffering from hand injury in Saudi Arabia. The graph below shows that surgeons prefer working with close association with therapists. This means that therapists today treat and rehabilitate a large number of patients. This exposes the hand injury treatment therapists before a large variety experiences. These experiences occupational hand therapists face would form the base of the research.
Figure 1. Graph showing surgeons working with therapists
(Source: ifsht.org 2017)
Azam, Hassan and Farooq (2016), opine that occupational therapists today experience a variety of challenges and opportunities while treating the patients suffering from hand injuries. The aim of the research is to study the experiences and the factors related to them with the health sector of Saudi Arabia in the backdrop. Pathak, Rathore and Dharani (2016) supports the view and opine that the hand therapists during the course of serving injured patients come under the influence of market conditions like government policies and social outlook in Saudi Arabia regarding treatment of injuries. Ellegala et al. (2014), point that increasing complexity in types of injuries and their treatment pose serious professional challenges before therapists. Moreover, in order to understand these challenges therapists experience, it is important to understand the anatomy of human hand and the causes of injuries. Hence, research will aim to delve into the market conditions, the anatomical and injury aspects of the human hand and the various challenges and opportunities experience due to these factors.
The research would be based on quantitative method of collecting data. The sample would consists of interviews taken by ten qualified occupational therapists having at least a year experience of working with Mohammed bin Abdul-Aziz hospital and Prince sultan military medical city in Riyadh, Saudi Arabia. The second method to collect data would consist of qualitative data collection method of collecting data from secondary sources like articles, books and official websites of reputed organisations like Saudi Occupational Therapy Association (saudiota.org 2017).
The research would reveal the various experiences occupational therapists treating and rehabilitating patients with hand injury encounter during the course of their profession. The experiences would consist of both positive experiences or opportunities and challenges these professionals face. The research will also help in pointing out these opportunities and challenges have on the career development of the occupational therapists treating hand injuries in Saudi Arabia.
The profession of occupational therapists consist of providing wellness services to the ailing, sick and injured people. The aim of the occupational therapists is to assess the ailment of the patients and intervene into the problem. They assist the ailing people to develop, rejuvenate and maintain the meaning physiological activities.
Hoffman et al. (2014), state that occupational therapists are components of allied health profession. They often help people, especially children and aged suffering from burns, injuries and other ailments to regain their normal strength and viability. The occupational therapists work in close association with variety of other paramedical professionals like speech therapists, audiology, nursing and medicine. Pergolotti et al. (2015), adds to this increasing importance of the occupational therapists and state that this important they play to ensure recovery and wellness of patients from a variety of illness have made them get associated with multinational hospitals and nursing homes. Chutkan (2013) further points out that, occupational therapists today provide patients, doctors and carers with consultation to deal with complication ailments and post surgery recovery. This has led to great career development of the occupational therapists especially the ones working in association with multispecialty hospitals. Clarke et al (2016), further points out that development on medical science and improvement in treatment methods have enabled the therapists treat a wide variety of ailments. This once again has led to increase in their demands and their career development.
O’Halloran, Worrall and Hickson (2015), contradict this bright professional development of the occupational therapists. They state that the success of the service of occupational therapists does not depend on the knowledge and experience of the therapists alone. The awareness patients have about their health and their resultant cooperation with the therapists play important role in deciding the success of the service of the therapists. Tang et al. (2016) points out that the professional therapists face challenge while treating patients due to acute lack of health awareness among them. They mention that often the patients hire services of the therapists only when their injuries like hand injuries reach critical stage. Situations like these pose challenge before the therapists to cure such patients.
Chib, van Velthoven and Car (2015), presents a very significant professional challenge which occupational therapists face while treating injuries like hand injuries. Their views contradict the views of Clarke et al (2016) which state that technological and medical developments enable the therapists treat wider range of injuries. They in fact point that occupational therapy of injuries like, hand injuries are dependent on technological and expensive medical treatments. These expensive treatments are largely confined to the multispecialty hospitals like Prince Mohammed bin Abdul-Aziz hospital, Riyadh (pmah.med.sa 2017). This dependence on technology prevents the therapists from spreading their operations into towns and villages where there are demands for their services. Bloom et al. (2015) support this view and state that this concentration of occupational therapists in the technology intensive hospitals creates huge competition for career development. Tjis view of Bloom et al. is supported by the figure below showing ratio of number of hand therapists to total population in several countries. The figure shows that in Saudi Arabia has more therapists compared to many other countries in the world. The health sector in Saudi Arabia is dominated by the government hospital and healthcare systems. This leaves very little opportunities for development of private health care system, which can employ the increasing number of trained professional hand injury therapists. Stanley et al. (2015), state that this intense competition and limited scope for professional development create intense competition among the therapists. These senior and established therapists often oust the new therapists, which affect the flow of human resource to this sector, which impedes the growth and innovation in the paramedical sector. This analysis shows that occupational therapists treating critical injuries like hand injuries experience both opportunities and challenges in the course of treating patients in multispecialty hospitals.
Figure 2. Figure showing ratio between hand injury and occupational therapists ratio in various countries including Saudi Arabia
(Source: ifsht.org 2017)
The following is the anatomy structure of a human hand, which would aid the researchers to under the reasons of the injuries the occupational therapists treat:
Human hand is prehensile organ having generally five fingers adapted for grasping and catching things. The bone structure of the hand starts with eight carpal bones arranged in two rows and they have very restricted movements among themselves. The small bones forming the carpel are scaphoid, lunate, triquetrum and pisifom bones. The upper row or the distal row consists of trapezium, trapezoid, capitates and hamate bones (healthxchange.sg 2017). The carpel gives rise to four metacarpal bones, which then give way to four phalanxes. Each phalange is made consist of three phalanxes bones namely, proximal phalanges, intermediate phalanges and distal phalanges. The thumb only has proximal and distal phalanges. The doctors and anatomists often consider the ulna and radius as part of the human hand anatomy because they aid supination and pronation (rotation about the forearm axis). The joints or articulations of the human hand which aid in movement are interphalangeal articulations or hinge joints, metacarpophalangeal joints which the finger digits meet the palm, intercarpal articulation where the palm meets the human wrist and the wrists which continues into the forearm (Gupta, Gupta and Tyagi 2017).
Figure 3. Figure showing bone structure of a human hand
(ncbi.nlm.nih.gov 2017)
The muscles in a human hand can be divided into extrinsic and intrinsic muscle groups. The extrinsic muscle group consist of flexors and extensors, which help, in the bending and stretching of the fingers respectively. The intrinsic muscle group consists of thenar muscle in the thumb, the hypothenar in the little finger, lumbrical muscles and the interrosseous muscles (Klar 2016).
A human hand has radial, median and ulnar nerves. The radial nerves are present in the dorsal side of the ring finger, index middle and continue to the proximal interphalangeal joints. The nerve passes very close to the skin. The median nerves are present on the palm side of the hand and branches to enter the fingers. The ulnar nerves are present at both the palm and dorsal side of the hand. The radial and the ulnar artery are the main arteries supplying blood to the hand. They branch into brachial artery to reach every section of the human hand. A superficial network of veins carries blood away from the hand (medlineplus.gov 2017).
A human hand is covered by tough hairless skin tightly attached to the bones and tissues of the hand. The skin of the fingers has papillary ridges, which helps grasping of things by increasing friction.
The experience of the occupational therapists in rehabilitation of patients with hand injuries depend a lot on market scenario. The section below would delve into how macroeconomic factors like political intervention and socioeconomic structure of Saudi Arabia influence the experiences of the hand injury therapists.
Newberry (2015), states that macroeconomic factors have deep impact on the professional experience of professionals including occupational therapists. Alraga (2017), states that in Saudi Arabia, the health system is largely under the control of the government. The government of Saudi Arabia provides free access to the people, which allow people to get treatment. However, the article remains silent about the quality of treatment the patients get free of cost. The article also states that the Ministry of Health monitors the treatment methods, planning and functioning of the private health care systems. The private health care system also includes the therapists who treat and rehabilitate a variety of patients including the ones suffering from hand injury. Adeyemi et al. (2014) point out that the study of the anatomy of the human hand conducted above clearly shows that the hand conducts a variety of functions like holding things and lifting heavy things. This shows that these activities often expose the intricate structure of the hand consisting of bones, muscles, nerves, blood vessels and skin to injury. Choi, Yuan and Borchardt (2016) further adds to this view of Adeyemi et al. and state that hand is also subject to work related musculoskeletal disorder. Treatment and rehabilitation of patients suffering from these injuries require minor to serious attention from therapists and doctors. Coats and Shewan (2016) state that successful rehabilitation of patients suffering from injuries like hand injuries require continuous innovation in the field of medical science. Innovation in medical science requires more liberal market environment and more involvement of the private sector medical bodies. Morganti and Li (2015) clearly mention that this restriction on private medical bodies like hospitals and research laboratories restricts innovation. As a result, the therapists dealing with hand injuries are not able to provide appropriate modern treatment to deal with diverse hand injuries. This restricts the experience of both the therapists and the patients. Thus, it would not be a overstatement to mention that the government controlled medical environment of Saudi Arabia restricts the occupational therapists from rehabiliting their patients. This restricts them from experiencing positive customer satisfaction and career growth as discussed above.
The Ministry of Health, Government of Saudi Arabia takes several helath initiatives to increase awareness about health in the Saudi society (moh.gov.sa 2017). The shortage of professionals due to lack of sufficient private initiative, limited financial resources, ever-changing patterns of diseases and lack of national healthcare information system contributes to further health ignorance system in the Saudi society. Dobrzykowski, Callaway and Vonderembse (2015) point out that benefiting the patients and creating customer satisfaction is very important towards creating positive experiences of occupational therapists. They also point that they level of awareness and knowledge patients has directly impact their attitude towards health care services. Itri (2015) points out that due to lack of innovation and strict control of government the medical sector in Saudi Arabia lacks the innovation necessary to treat wide range of injuries. The people in the country as a result show low degree of cooperation and awareness towards medical practioners. Yang and Ramanan (2013) state that the anatomic study of the hand shows that it consists of muscles, nerves, bones and blood vessels. This complex engineering of the hand designed to perform variety of activities. This makes the hand prone to major and minor injuries which need prompt medical and therapists attention. They often do not cooperate with therapists, which create negative and often experience negative service experience (Willemse et al. 2016). The therapists on the other hand experiences low level of job satisfaction.
Ramos-Grille et al. (2015) in their work unfold a very important aspect of professional experience of the therapists dealing with patients having hand injuries. They state that patients suffering from injuries and illness tend to exhibit aggression and withdrawal symptoms towards treatments. Karino et al. (2016) point out that patients suffering from injuries may show resistance towards certain medicine and treatment methods. These complicated medical conditions vary from patient to patient. These cases pose challenges before the therapists to cure and rehabilitate such patients. This explanation shows that therapists today face challenges during their course of treating patients with hand injuries owing to the complex physical and behavioural responses of the patients.
The following are the main and subordinate question whose answer the research would seek to reply:
The main aims and objectives of the research will be:
The research would be based on the following hypothesis:
H0: The Suadi government have very strong control over the health sector of the nation and does not allow strong participation of private health organisations.
H1: This strict intervention of government impedes innovation in various areas of medical science like treatment of hand injury
H2: The people of Saudi Arabia have low awareness about health conditions and injury.
The study design is appropriate because it allows the researcher to delve into the experiences occupational therapists experience while treating and rehabilitating patients suffering from hand injuries. The outcome first introduces the occupation of the therapists to the readers to outline their profession and their experiences. Then the structure introduces the anatomy of a human hand, which helps the readers understand the types of injuries the hand is liable to be received (Chutkan 2013). Then the researcher went on to study the impact the macroeconomic environment has on the professional experiences of the therapists. This approach would allow the readers to understand the topic in an orderly fashion. Thus, it can be justified that the approach of the research proposal is appropriate.
The method used to gain information consists of inclusion and exclusion criteria. The criteria considered to conduct the interview were age, profession, employer and lifestyle. The potential sample size would consist of ten occupational therapists. The researcher would choose the sample namely, the occupational therapists employed with Mohammed bin Abdul-Aziz Hospital and Prince sultan Military Medical City, Riyadh, Saudi Arabia. The interviewees should be employed with any of these two medical institutions for at least a year. The interview should include working relationships the therapists have with the co-workers and patients (O’Halloran, Worrall and Hickson 2015). The researcher should ask the occupational therapists questions involving the hand injury rehabilitation, which would reveal the opportunities and challenges they experience. They researcher should also interrogate the therapists on their educational backgrounds and the challenges they face while gaining expertise in treating patients. The researcher would ask questions on the professional boundaries and limitations of the profession of occupational therapists. He would also ask the therapists questions pertaining to their collaboration with other medical professionals like doctors and surgeons (Tang et al. 2016).
The researcher would use data of qualitative and quantitative nature. The sources of qualitative data would be secondary sources like official websites, books, articles and journals. He should ensure that the data he collects from these secondary sources are reliable, authentic and valid.
The researcher should collect quantitative information from primary sources like interviews, conversations and survey. The chosen form of primary sources of data is interview of occupational therapists employed with Mohammed bin Abdul-Aziz Hospital and Prince Sultan Military Medical City in Riyadh (psmmc.med.sa 2017). The sample size of collection of primary data would be ten. The occupational therapists should have experience of working as therapists treating and rehabilitating patients suffering from hand injuries for at least a year.
The researcher should analyse the data collection from the interview of ten occupational therapists statistically. He should first analyse the responses of the occupational therapists using software applications like SPSS and NVivo. Then he should present the findings in form of bar charts and pie charts to aid easy analysis. The researcher should then use the findings while explaining the experiences the occupational therapists encounter while treating patients suffering from hand injuries. The researcher would also consider ethical issues dealt with in the next section.
The researcher would face limitations like constraint of time and budget while conducting the researcher. Inadequacy of time and the requirement to present the research within the stipulated time prevents the researchers from conducting detailed research. Moreover, the experience of the professional therapists in treating and rehabilitating patients with hand injuries is a new area of research. This inadequacy of data often requires the researcher take long time to collect relevant information. Large amount of data on experience of therapists of other countries, hand anatomy and injury are available on the internet (Chen et al. 2014). This would require the researcher to scrutinise and judge the reliability and authenticity of the information before incorporating in the research paper. However, time and budget constraint would limit the researcher from conducting detailed research on the topic. The researcher would succeed in conducting the research in more detail of more time is allowed.
There are certain ethical issues faced by the therapists of hand injuries and if the dilemmas are not be recognised at the earliest stage, that can lead towards serious offence and the researchers may get punishment for that. It is also important to describe all the necessary data relating to the data protection in a brief manner (Cridland et al. 2015).
Certain guidelines should be followed up by the researchers during their work regarding data protection Act and should be abstained from doing certain things. Data Protection Act was enacted with an intention to give protection to the personal data that are stored in a computerised form or in theoretical form. It is the legal rights of the individuals to keep their data secured and Data Protection Act gives them the opportunity (parliament.uk 2017). There are eight principles so that the information can be handled legally. The term personal data denotes certain specific data by which an individual can be identified. Ethical dilemmas can be cropped up if the researcher will use or disclose any facts without obtaining the permission from that person. Personal data can be classified as name and address or email address. It should be the duty of the researchers to maintain all the provisions lawfully to avoid any unwanted clashes.
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