2027//Chronic_diseases_and_occupational_therapy.pdf
10/01/2026 Page 1 of 37
OCT213 – OT AND CHRONIC DISEASES
Foundations in Evidence Based Practice
INTRODUCTION TO ETHICS
Our care for patients should be based on sound judgment (or evidence based practice!!)
o some of this judgement is about having a strong sense of what is right or wrong
o having a strong sense of what we should be doing and shouldn’t be doing as nurses
o having a strong sense of what our priorities ought to be
Nurses frequently have to make difficult decisions for which there is not always a quick, easy or
‘correct’ answer
o e.g. Can Mrs X be discharged yet? Can Mr Y manage his own medications safely?
Nevertheless, nurses still have to be able to explain and account for these decisions and actions
The NMC Code can act as a guide
o This can be seen as a ‘code of ethics’ – a set of important principles to help guide nurses
WHAT IS AN ETHICAL ISSUE?
When you have to judge what is right or wrong
Choosing between options
Deciding whether to do something or do nothing
Should I or shouldn’t I?
Weighing up the potential impact of your decisions or actions
A dilemma – making a difficult choice
ETHICAL ISSUES IN HEALTHCARE
We usually think of the ‘big’ issues
o e.g. definition of life, what is a person, quality of life, prolonging life, ending life, human
rights.
But day to day ethical issues can involve:
o Respecting people
o Treating people with dignity
o Treating people fairly
o Supporting patient’s choices
These ‘principles’ are encompassed in the NMC code
The code is a useful source of ethical principles in health care
4 KEY ETHICAL PRINCIPLES
1. autonomy
2. beneficence
3. non-maleficence
4. justice
AUTONOMY
Respect a person’s right to make their own decisions
Teach people to be able to make their own choices
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OCT213 – OT AND CHRONIC DISEASES
Support people in their individual choices
Do not force or coerce people to do things
‘Informed Consent’ is an important outcome of this principle
BENEFICENCE (TO DO GOOD)
Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-being, improve a
person’s potential, improve quality of life
‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.
Act on behalf of ‘vulnerable’ people to protect their rights
Prevent harm
Create a safe and supportive environment
Help people in crises
NON-MALEFICENCE (TO DO NO HARM)
do not to inflict harm on people
do not cause pain or suffering
do not incapacitate
do not cause offence
do not deprive people
do not kill
BOTH BENEFICENCE AND NON-MALEFICENCE UNDERPIN – EVIDENCE BASED PRACTICE
JUSTICE
Treating people fairly
Not favoring some individuals/groups over others
Acting in a non–discriminatory / non-prejudicial way
Respect for people’s rights
Respect for the law
Distributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health
services, professional time)
o How should we share out healthcare resources?
o How do we share out our time with patients?
o Deciding how to do this raises some difficult questions
Patients should get…..
o an equal share ?
o just enough to meet their needs ?
o what they deserve ?
o what they can pay for ?
4 ETHICAL RULES
▪ Veracity – truth telling, informed consent, respect for autonomy
▪ Privacy – a persons right to remain private, to not disclose information
▪ Confidentiality – only sharing private information on a ‘need to know basis’
▪ Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may
have done
,2027//Chronic_diseases_and_occupational_therapy.pdf
10/01/2026 Page 3 of 37
OCT213 – OT AND CHRONIC DISEASES
ETHICS – 2 BROAD PHILOSOPHICAL THEORIES
▪ 1) consequentialism – taking the consequences of our actions into consideration
▪ 2) deontology – basing our actions on a set of principles or duties
CONSEQUENTIALISM
Actions are right or wrong according to the balance of their good and bad consequences
o the right act is the one that produces the best overall result
Utilitarianism (what action has the greatest utility
o use/benefit/positive outcome) is a type of consequentialism
UTILITARIANISM
most prominent consequence-based theory
based on the principle of utility
actions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue
(e.g. harm)
DEONTOLOGY
Duty or principle based theory
An act is right if it conforms to an overriding moral duty
o For example – do not tell lies, do not kill.
E.g. Christian ethics – The Ten Commandments
o But Christian ethics are not important for some people in the world so moral duties vary
between cultures and societies
A moral duty or principle is one that is:
o laid down by god / supremely rational being
o or is in accordance with reason / rationality
o or would be agreed by all rational beings
The NMC Code of Conduct is a product of Deontological ethics – it guides action based on a set
of principles/duties.
, 2027//Chronic_diseases_and_occupational_therapy.pdf
10/01/2026 Page 4 of 37
OCT213 – OT AND CHRONIC DISEASES
Occupational Therapy and Diabetes
DIABETES
Diabetes mellitus (DM) is a chronic disease in which the pancrease is unable to produce insulin. Or
when cells cease to respond to the insulin that the body has already produces. This results in the
body’s inability to absorb glucose (i.e. Hyperglcemia) into the cells within the body.
HEALTH WARNING: DIABETES ACCERERATING AS SOUTH AFRICA
300 million people worldwide have diabetes.
In sub-Saharan Africa the figure is estimated to be 12.1 million adults, with only 15 percent
having been diagnosed.
According to the International Diabetes Federation (IDF) the estimated number of people
living with diabetes in South Africa is around 1.3 million and the IDF and World Health
Organization predict that numbers will double by 2030.
most at risk are the black communities with rapid lifestyle and cultural changes, and those of
Indian descent
“In South Africa the overall diabetic prevalence is around six percent and is widely predicted,
growing. Among the Indian population it rises to 13 percent,
This sort of integrated approach is being adopted by the current Minister of Health, Dr
Aaron Motsoaledi, in order to make the best use of healthcare resources and better
understand the links between communicable and non-communicable diseases.
Diabetes is an important direct and indirect cause of burden in South Africa. Primary
prevention of the disease through multi-level interventions and improved management at
primary health care level are needed (Bradshaw, D., Pieterse, D., & Norman, R., 2007)
THREE TYPES OF DIABETES
• Type I diabetes occurs when the body does not produce insulin. This form usually occurs in
children and young adults, and requires insulin injections.
• Type II diabetes occurs due to insulin resistance combined with insulin deficiency. This form
is usually associated with older age, obesity, family history, high blood pressure,
hyperlipidemia, and coronary artery disease. Type II can generally be controlled with diet,
exercise, and oral drugs.
• Gestational diabetes is a form of glucose intolerance developed during pregnancy
OT AND DIABETES
Physical,
Cognitive,
Psychosocial, and
Sensory aspects of everyday life activities, including integration of diabetes self-care into
clients’ existing habits and routines
Are clients/patients able to carry out diabetes self-care occupations?
10/01/2026 Page 1 of 37
OCT213 – OT AND CHRONIC DISEASES
Foundations in Evidence Based Practice
INTRODUCTION TO ETHICS
Our care for patients should be based on sound judgment (or evidence based practice!!)
o some of this judgement is about having a strong sense of what is right or wrong
o having a strong sense of what we should be doing and shouldn’t be doing as nurses
o having a strong sense of what our priorities ought to be
Nurses frequently have to make difficult decisions for which there is not always a quick, easy or
‘correct’ answer
o e.g. Can Mrs X be discharged yet? Can Mr Y manage his own medications safely?
Nevertheless, nurses still have to be able to explain and account for these decisions and actions
The NMC Code can act as a guide
o This can be seen as a ‘code of ethics’ – a set of important principles to help guide nurses
WHAT IS AN ETHICAL ISSUE?
When you have to judge what is right or wrong
Choosing between options
Deciding whether to do something or do nothing
Should I or shouldn’t I?
Weighing up the potential impact of your decisions or actions
A dilemma – making a difficult choice
ETHICAL ISSUES IN HEALTHCARE
We usually think of the ‘big’ issues
o e.g. definition of life, what is a person, quality of life, prolonging life, ending life, human
rights.
But day to day ethical issues can involve:
o Respecting people
o Treating people with dignity
o Treating people fairly
o Supporting patient’s choices
These ‘principles’ are encompassed in the NMC code
The code is a useful source of ethical principles in health care
4 KEY ETHICAL PRINCIPLES
1. autonomy
2. beneficence
3. non-maleficence
4. justice
AUTONOMY
Respect a person’s right to make their own decisions
Teach people to be able to make their own choices
,2027//Chronic_diseases_and_occupational_therapy.pdf
10/01/2026 Page 2 of 37
OCT213 – OT AND CHRONIC DISEASES
Support people in their individual choices
Do not force or coerce people to do things
‘Informed Consent’ is an important outcome of this principle
BENEFICENCE (TO DO GOOD)
Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-being, improve a
person’s potential, improve quality of life
‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.
Act on behalf of ‘vulnerable’ people to protect their rights
Prevent harm
Create a safe and supportive environment
Help people in crises
NON-MALEFICENCE (TO DO NO HARM)
do not to inflict harm on people
do not cause pain or suffering
do not incapacitate
do not cause offence
do not deprive people
do not kill
BOTH BENEFICENCE AND NON-MALEFICENCE UNDERPIN – EVIDENCE BASED PRACTICE
JUSTICE
Treating people fairly
Not favoring some individuals/groups over others
Acting in a non–discriminatory / non-prejudicial way
Respect for people’s rights
Respect for the law
Distributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health
services, professional time)
o How should we share out healthcare resources?
o How do we share out our time with patients?
o Deciding how to do this raises some difficult questions
Patients should get…..
o an equal share ?
o just enough to meet their needs ?
o what they deserve ?
o what they can pay for ?
4 ETHICAL RULES
▪ Veracity – truth telling, informed consent, respect for autonomy
▪ Privacy – a persons right to remain private, to not disclose information
▪ Confidentiality – only sharing private information on a ‘need to know basis’
▪ Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may
have done
,2027//Chronic_diseases_and_occupational_therapy.pdf
10/01/2026 Page 3 of 37
OCT213 – OT AND CHRONIC DISEASES
ETHICS – 2 BROAD PHILOSOPHICAL THEORIES
▪ 1) consequentialism – taking the consequences of our actions into consideration
▪ 2) deontology – basing our actions on a set of principles or duties
CONSEQUENTIALISM
Actions are right or wrong according to the balance of their good and bad consequences
o the right act is the one that produces the best overall result
Utilitarianism (what action has the greatest utility
o use/benefit/positive outcome) is a type of consequentialism
UTILITARIANISM
most prominent consequence-based theory
based on the principle of utility
actions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue
(e.g. harm)
DEONTOLOGY
Duty or principle based theory
An act is right if it conforms to an overriding moral duty
o For example – do not tell lies, do not kill.
E.g. Christian ethics – The Ten Commandments
o But Christian ethics are not important for some people in the world so moral duties vary
between cultures and societies
A moral duty or principle is one that is:
o laid down by god / supremely rational being
o or is in accordance with reason / rationality
o or would be agreed by all rational beings
The NMC Code of Conduct is a product of Deontological ethics – it guides action based on a set
of principles/duties.
, 2027//Chronic_diseases_and_occupational_therapy.pdf
10/01/2026 Page 4 of 37
OCT213 – OT AND CHRONIC DISEASES
Occupational Therapy and Diabetes
DIABETES
Diabetes mellitus (DM) is a chronic disease in which the pancrease is unable to produce insulin. Or
when cells cease to respond to the insulin that the body has already produces. This results in the
body’s inability to absorb glucose (i.e. Hyperglcemia) into the cells within the body.
HEALTH WARNING: DIABETES ACCERERATING AS SOUTH AFRICA
300 million people worldwide have diabetes.
In sub-Saharan Africa the figure is estimated to be 12.1 million adults, with only 15 percent
having been diagnosed.
According to the International Diabetes Federation (IDF) the estimated number of people
living with diabetes in South Africa is around 1.3 million and the IDF and World Health
Organization predict that numbers will double by 2030.
most at risk are the black communities with rapid lifestyle and cultural changes, and those of
Indian descent
“In South Africa the overall diabetic prevalence is around six percent and is widely predicted,
growing. Among the Indian population it rises to 13 percent,
This sort of integrated approach is being adopted by the current Minister of Health, Dr
Aaron Motsoaledi, in order to make the best use of healthcare resources and better
understand the links between communicable and non-communicable diseases.
Diabetes is an important direct and indirect cause of burden in South Africa. Primary
prevention of the disease through multi-level interventions and improved management at
primary health care level are needed (Bradshaw, D., Pieterse, D., & Norman, R., 2007)
THREE TYPES OF DIABETES
• Type I diabetes occurs when the body does not produce insulin. This form usually occurs in
children and young adults, and requires insulin injections.
• Type II diabetes occurs due to insulin resistance combined with insulin deficiency. This form
is usually associated with older age, obesity, family history, high blood pressure,
hyperlipidemia, and coronary artery disease. Type II can generally be controlled with diet,
exercise, and oral drugs.
• Gestational diabetes is a form of glucose intolerance developed during pregnancy
OT AND DIABETES
Physical,
Cognitive,
Psychosocial, and
Sensory aspects of everyday life activities, including integration of diabetes self-care into
clients’ existing habits and routines
Are clients/patients able to carry out diabetes self-care occupations?
