Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Design in the Faculty of Informatics and Design at the Cape Peninsula University of Technology, 2012 / Home-Based Health Care (HBHC) is the provision of health services and social assistance to individuals in their homes. It is an indispensable service to communities in need; presently in South Africa, these health care services are provided by local non-profit and non-governmental organizations. It is mainly targeted at poverty-stricken and under resourced communities and is an important aspect of healthcare in South Africa. A lot of communities in South Africa are still under-resourced and live in impoverished conditions. This is reflected in poor living standards characterized by unemployment, uneasy access to basic amenities, unequal distribution of wealth, poor medical facilities in rural communities, etc. The prevalence of the HIV/AIDS endemic has also worsened the situation. However, the South African government has constantly supported initiatives to enhance better healthcare in rural communities. This research presents a case study of caregivers working in Du Noon, an informal settlement in Western Cape, South Africa. Du Noon is overpopulated and home to lots of foreigners who have migrated in search of better living standards thus stretching an already over-burdened community. Naturally, this development supports poor health practices which encourage the spread of diseases within the community. Health facilities do not sufficiently cater for the ever-increasing healthcare demands and as such lots of people depend on NGOs such as SALT (Sharing Abundant Life Together) who through the help of caregivers and community workers have been providing for some of the healthcare needs of the Du Noon community since 2000. Findings reveal that although caregivers in this community have lots of stories to share about their work practices, they do not have a platform to share these stories. This research focuses on identifying processes involved in capturing these stories and moderating them into educative and entertaining visual contents for the purpose of sharing the stories within the community. Using qualitative research methods, empirical and field study provides the needed data as well as understanding of the multi-dynamism of this community. Data analysis is done through interpretive methods for the purpose of understanding the data collected and analysed during the research process. Finally, as a possible research contribution, the research concludes by examining how other technology can enhance the storytelling experience using interaction design methods that enables caregivers participate in the entire design process. Suggestions are also given as to direction for further research within the subject area.

The purpose of this project was to develop an instructional manual on in-service education for Certified Nurses' Aides. It provides examples of classes for staff developers to use when teaching continuing education classes. Topics covered include caring for the elderly, Alzheimer's disease, infection control, adult cardiopulmonary resuscitation, and end of life care.

Dans les milieux de soins, il importe d’assurer la qualité de l’ensemble des services offerts, incluant lors de la fin de vie. À cet effet, un rôle clé des infirmières et infirmiers oeuvrant en centre d’hébergement (CHSLD) est de favoriser l’implication des proches dans les soins de fin de vie, ce qui peut contribuer, entre autres, au soulagement d’une possible souffrance pour eux ou les personnes âgées. Selon Andershed et Ternestedt (2001), l’implication des proches prend plusieurs formes : recevoir de l’information (savoir), être présent (être) et effectuer des tâches ou soins (faire). Cependant, peu d’études sur la fin de vie en CHSLD abordent l’implication des proches dans d’autres contextes que la planification des soins et la prise de décisions. Considérant ce manque de connaissances, le but de l’étude était d’explorer les perceptions de proches, en plus d’infirmières ou d’infirmiers, sur l’implication des proches dans les soins de fin de vie d’une personne âgée vivant en CHSLD. Pour répondre à ce but, une étude de cas qualitative instrumentale a été réalisée. Les données ont été collectées auprès de 4 infirmières ou infirmiers et 3 proches, par l’entremise d’entrevues semi-structurées individuelles, ainsi qu’un journal de bord et la documentation du milieu. L’analyse thématique présente l’étendue de l’implication des proches, les souhaits d’implication des proches et quelques stratégies favorisant cette implication. Ces résultats peuvent servir de pistes d’amélioration dans les pratiques en CHSLD, en plus de sensibiliser les professionnels de la santé aux réalités des proches lors de la fin de vie. / In health care settings, it’s imperative that quality of all services is ensured, including end-of-life (EoL) care. A key role of nurses working in long-term care homes (LTCH) is to promote the involvement of relatives in EoL care to, among others, help relieve a possible suffering of relatives or older adults. Based on Andershed and Ternestedt’s (2001) theory, relatives’ involvement can be described in three categories: their knowledge (to know), their presence (to be) and their participation in tasks or care (to do). However, few studies address relatives’ involvement in LTCH in other aspects than decision-making and care planning. Considering this knowledge gap, we conducted a qualitative case study exploring relatives’ and nurses’ perceptions of relatives’ involvement in this context. Data was collected from a sample of 4 nurses and 3 relatives using individual semi-structured interviews, a reflexive journal and relevant documents from the LTCH. Applying thematic analysis, results showed the scope of relatives’ involvement during the EoL, how relatives wished to be involved, and facilitating strategies to involve relatives in care. These results can guide improvement in LTCH practices and raise awareness in health care professionals of the experience of relatives during the agony phase.

The marginalisation of palliative and pastoral care practices by conventional approaches to care for terminally ill patients, motivated the research curiosity. The significance of terminal patient's spirituality, their language practices and communities of concern are endorsed as being the major contributing factor to meaningful 'living' with terminal illness. Listening to stories has been the qualitative research practice, revealing meaning-making, quest stories. Feminist theology and post-modern ideas and discourses have assisted me, and the participants, in the deconstruction of power, patriarchy and dualism as the primary contributing factors to marginalisation of people due to illness, race, gender, poverty, culture and education. Pastoral care practices and feminist theology have guided us to emphasise the necessity to recognise the God of Grace as an important part to ensuring holistic patient care. Recognising the 'God-Self, respectful narrative and pastoral care practices paved the way to honour sacred spaces and voice stories of terminal illness. / Practical Theology / M.Th (Specialisation Pastoral Therapy)

The hospice volunteer is viewed as an integral member of a multidisciplinary team, with various roles directed at enhancing the quality of life of patients and their families. The purpose of this study is to provide an integrated picture of the hospice volunteer, their role, the human dimensions of this role and the impact this has on their lives as not much has been written in literature about this specific sub-group of hospice workers. The context of the study is a hospice in Gauteng where the researcher works as a volunteer. The ethnographic case study has been chosen as an appropriate research design as it explores the above phenomenon from the volunteers' point of view. The subjects are three volunteers who have been active at the hospice for at least twelve months. Evidence in terms of specific interviews and observations are used to draw conclusions. The interviews are based on a minimal number of open-ended questions. The primary method of analysis is the examination of transcripts from these in-depth interviews. A thematic analysis is carried out in which a detailed description of the emerging themes are given. Four major themes are identified and explored: Description of the role; The experience of being a volunteer; A way of coping; and The influence of the hospice culture. Sub-themes that emerge within each case study vary due to the individual nature of the experience of the role. Themes are explored in light of current theory and findings. This was to note the similarities and differences of this specific sub-group of volunteers compared to others found in the literature reviewed for this study. As there is a scarcity of literature pertaining specifically to hospice volunteers, the study depends mostly on writings pertaining to hospice staff and volunteers in general. A summary and integration of the core findings of the three case studies is given and their similarities and differences are explored. How some of the different themes interlink is also discussed. Although various sub-themes found in the individual case studies are significant to the individual cases, some of them can be incorporated into common themes when looking at the volunteers as a group. The strengths and limitations of the study are discussed as well as recommendations for the hospice organisation and further research. / Psychology / M.A. (Psychology)

This study addresses the effectiveness of communication between the team (doctors, sisters and social workers) and patients at the Breast Cancer Clinic of the Johannesburg Hospital. Tue needs of patients were highlighted, as well as the role of care-giver, both as a group and in their separate disciplines, in attempting to meet these needs. Tue empirical survey was carried out through the use of questionnaires as well as interview schedules. Patients, doctors, nurses and social workers were used as respondents. Results indicated that the majority of patients' needs for information and support were met by the team in general; however, a need for further social work intervention seemed to be apparent. In addition, several barriers were found to inhibit both team-patient and inter-team communication. Tue researcher used the information gathered in this study to make recommendations that will facilitate improved communication in the clinic, with specific reference to the role of the social worker. / Social Work / M.A.(Social Science: Mental Health)

The purpose of this study was to explore first year student nurses’ experiences of encounters with death and dying of a patient during clinical practice so as to make recommendations on increase support for first year student nurses. Qualitative research which was explorative, descriptive and contextual was conducted. Data collection was done using in-depth unstructured interview. Nine participants were interviewed and data was analysed. The findings revealed that lack of knowledge, emotional trauma, low self-esteem and nutritional disorder are the results of dealing with death and dying of patients for first year student nurses. Negative attitudes of clinical professionals, shortage of staff and congested block programme were identified as some aspects worsening the situation. Incidental learning that occurs with negative experience encountered was also identified. The findings show the need for review of curriculum for first year student nurses and the need for change of attitudes of clinical professionals / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore first year student nurses’ experiences of encounters with death and dying of a patient during clinical practice so as to make recommendations on increase support for first year student nurses. Qualitative research which was explorative, descriptive and contextual was conducted. Data collection was done using in-depth unstructured interview. Nine participants were interviewed and data was analysed. The findings revealed that lack of knowledge, emotional trauma, low self-esteem and nutritional disorder are the results of dealing with death and dying of patients for first year student nurses. Negative attitudes of clinical professionals, shortage of staff and congested block programme were identified as some aspects worsening the situation. Incidental learning that occurs with negative experience encountered was also identified. The findings show the need for review of curriculum for first year student nurses and the need for change of attitudes of clinical professionals / Health Studies / M. A. (Health Studies)

This study explored social workers’ perceptions of their role in providing palliative care to patients with life-limiting illnesses in six hospitals across Namibia. A qualitative grounded theory approach was use in which in-depth interviews were conduct with twenty (20) social workers. Several key findings are presented: First, the emerging constructivist grounded theory of social workers’ multi-dimensional roles in providing palliative include identities of advocate, assessor, broker, counsellor, educator, facilitator, patient liaison, mediator, discharge planner and manager of in-country referrals. Second, several participants’ uncertainties of what palliative care entails offered insight that they are in need of palliative care education and training. Third, healthcare professionals do not understand the role of the social workers and therefore social workers receive inadequate support from them. Fourth, there is a lack of in-service training and continuous education in palliative care. Fifth, there are inadequate practice opportunities in palliative care for undergraduate social work students. Finally, the well-being of social workers is another concern with limited debriefing opportunities available. Further research needs to be conducted and policy guidelines established to identify ways to improve the field of palliative care social work. In achieving this, formal education and palliative care practice opportunities for social workers need to be established, providing continuing education and establishing a Centre of Excellence on palliative care provision. This study argues that the social work profession is well positioned to draw upon its values, culture and experiences (particularly from their clients) to get involved in creating a constructivist grounded theory of social workers’ roles in providing palliative care. / Sociology / D. Phil. (Sociology)

The hospice volunteer is viewed as an integral member of a multidisciplinary team, with various roles directed at enhancing the quality of life of patients and their families. The purpose of this study is to provide an integrated picture of the hospice volunteer, their role, the human dimensions of this role and the impact this has on their lives as not much has been written in literature about this specific sub-group of hospice workers. The context of the study is a hospice in Gauteng where the researcher works as a volunteer. The ethnographic case study has been chosen as an appropriate research design as it explores the above phenomenon from the volunteers' point of view. The subjects are three volunteers who have been active at the hospice for at least twelve months. Evidence in terms of specific interviews and observations are used to draw conclusions. The interviews are based on a minimal number of open-ended questions. The primary method of analysis is the examination of transcripts from these in-depth interviews. A thematic analysis is carried out in which a detailed description of the emerging themes are given. Four major themes are identified and explored: Description of the role; The experience of being a volunteer; A way of coping; and The influence of the hospice culture. Sub-themes that emerge within each case study vary due to the individual nature of the experience of the role. Themes are explored in light of current theory and findings. This was to note the similarities and differences of this specific sub-group of volunteers compared to others found in the literature reviewed for this study. As there is a scarcity of literature pertaining specifically to hospice volunteers, the study depends mostly on writings pertaining to hospice staff and volunteers in general. A summary and integration of the core findings of the three case studies is given and their similarities and differences are explored. How some of the different themes interlink is also discussed. Although various sub-themes found in the individual case studies are significant to the individual cases, some of them can be incorporated into common themes when looking at the volunteers as a group. The strengths and limitations of the study are discussed as well as recommendations for the hospice organisation and further research. / Psychology / M.A. (Psychology)