Thesis (M Med (Family Medicine)) -- University of Limpopo,2011.

No description available.

No description available.

No description available.

The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge. / Master of Health Science (Hons)

In today’s hectic society, opportunities to receive pastoral care and to participate in relevant adult or continuing education are greatly valued by organisational employees. For the police community in the English-speaking world, police chaplains have emerged as a group of professionals in police organisations providing specialised pastoral care and associated education to their constituents. As a relatively new community of practitioners, little is known about the emergence of this group in terms of its needs for learning, education and support and processes of acquisition of knowledge and skills. Major purposes of this study were to explicate the learning engaged in by police chaplains to become a professional practitioner and to project the role for future sustainability for all stakeholders. This is the first doctoral thesis to examine the development and practice of police chaplaincy in New South Wales (Australia), New Zealand and the United Kingdom. It was argued that neither police chaplains themselves nor the police communities they serve understand the potential of the role and implications for future learning and performance of that role. Prior to this study, there were no strategies in place to assess consequences of change, to address work-related problems or to determine future training. Consequently, this study explored how police chaplains perform their role so they could better justify the value of their roles for multiple stakeholders and make suitable professional development plans and strategies to improve services, address work-related problems adequately and respond appropriately to social changes. In order to understand and articulate the experiences of police chaplains, a reflective analysis was provided of the work of practising police chaplains in New South Wales, Australia, and a comparative study of police chaplains in New Zealand and the United Kingdom. The qualitative research design was interpretive and used ethnography and autoethnography as methodologies. The researcher is a police chaplain herself and is a current member of this professional group in New South Wales and was for a period of time in New Zealand. Four key objectives guided the inquiry and were addressed in determining an explanatory framework in the literature review and in the findings and discussion chapters. The first objective was to investigate the nature of the professional police chaplain. The findings suggested that police chaplains were male or female, ordained or lay, highly educated and pastoral and have a passion for policing. They are professional in nature from their qualifications as a minister, practising professionalism in their role as minister and chaplain and behaving appropriately as a professional. It was discovered in this study that because police chaplains largely act alone they have developed four distinct ‘walking styles’ of having a presence and performing their role in a police station or other venues. The second objective to explicate the nature of police chaplaincy culture focused on kinship among police chaplains and incorporated notions of community of practice, culture and identity. The findings showed that kinship was a useful explanatory concept for analysing the culture of police chaplaincy. It became evident in the study that learning, belonging, connecting, participating and knowing were essential in the police chaplain’s role in complex and diverse communities of practice and various community and organisational cultures that influenced their identities as a minister, chaplain and pastoral carer. The third objective was to identify the major challenges faced by police chaplains. The findings indicated that police chaplains consistently faced challenges in representing the spiritual to police, managing their time, finding best practices, being credible and understanding others relationally as well as attending critical incidents in their ongoing honorary position. Senior Chaplains played an important role providing the support and training that police chaplains require for their ongoing practice while mentors and/or spouses also provided necessary time to listen to the police chaplain’s challenging day. The fourth objective was to examine the professional development and training of police chaplains. The findings revealed that training offered to the honorary police chaplain was minimal and did not meet the police chaplains’ needs. Strategies including a program of continuing professional education have been suggested to enhance training and development for the future of police chaplaincy. Police chaplains interviewed for this research have given a broad range of perspectives making this exploratory study a significant contribution towards capturing the culture of police chaplaincy for the first time. This exposition of the work of police chaplains contributes to setting future directions for police chaplaincy practice and research enabling a better service for police officers and staff of police services worldwide.

This project investigated the subjective perceptions of family reported by people who have experienced long-term foster care. Foster care involves removal from their biological family of children deemed to be in need of care, and their placement in alternative homes. Foster children may spend varying amounts of time in care, and may have multiple caretakers. The research began with three broad questions: Who do people who have experienced long-term foster care think of as their family? How close do they feel to them? How would they like their family to be? Two exploratory studies were conducted. In Study 1, 43 children in long-term family foster care (CFFC participants) aged between 8 and 15, who had been in care for more than one year, and 42 matched controls, completed the Kvebaek Family Sculpture Technique (KFST). They chose figures to represent family members and placed them on a chess board, using the squares to indicate emotional closeness or distance from each figure. A representation of their �ideal� family was also obtained. Most CFFC participants nominated their foster family as their family, and few changed their ideal representation. In Study 2, 39 adults aged between 19 and 65 (AFCC participants), who had been in either family foster care or cottage homes for at least one year, and a comparison group of 39 matched controls, completed the KFST according to perceptions of family now, as children, and an ideal family. An in-depth, semi structured interview on perceptions of family followed. For the majority of AFCC participants, connections to foster family when they were children had dissipated over time. Nevertheless, about half of the AFCC participants were still strongly and positively attached to one set of foster parents. The major determinant of attachment to foster parents appeared to be a nurturing environment, while a non-nurturing environment was the most prominent feature of failure to attach to foster parents. Visiting by biological parents contributed to continued attachment to them, however, relationships with biological parents were reported as ambivalent, distant, and unsupportive. Foster care participants appeared similar to those in other studies, however, the two samples were small, and may not be representative in terms of ideas about family membership. Caution is necessary in any attempt to generalise from the findings to a wider foster care population. Implications for theory, policy, and clinical applications are discussed, and suggestions made for further research.

In today’s hectic society, opportunities to receive pastoral care and to participate in relevant adult or continuing education are greatly valued by organisational employees. For the police community in the English-speaking world, police chaplains have emerged as a group of professionals in police organisations providing specialised pastoral care and associated education to their constituents. As a relatively new community of practitioners, little is known about the emergence of this group in terms of its needs for learning, education and support and processes of acquisition of knowledge and skills. Major purposes of this study were to explicate the learning engaged in by police chaplains to become a professional practitioner and to project the role for future sustainability for all stakeholders. This is the first doctoral thesis to examine the development and practice of police chaplaincy in New South Wales (Australia), New Zealand and the United Kingdom. It was argued that neither police chaplains themselves nor the police communities they serve understand the potential of the role and implications for future learning and performance of that role. Prior to this study, there were no strategies in place to assess consequences of change, to address work-related problems or to determine future training. Consequently, this study explored how police chaplains perform their role so they could better justify the value of their roles for multiple stakeholders and make suitable professional development plans and strategies to improve services, address work-related problems adequately and respond appropriately to social changes. In order to understand and articulate the experiences of police chaplains, a reflective analysis was provided of the work of practising police chaplains in New South Wales, Australia, and a comparative study of police chaplains in New Zealand and the United Kingdom. The qualitative research design was interpretive and used ethnography and autoethnography as methodologies. The researcher is a police chaplain herself and is a current member of this professional group in New South Wales and was for a period of time in New Zealand. Four key objectives guided the inquiry and were addressed in determining an explanatory framework in the literature review and in the findings and discussion chapters. The first objective was to investigate the nature of the professional police chaplain. The findings suggested that police chaplains were male or female, ordained or lay, highly educated and pastoral and have a passion for policing. They are professional in nature from their qualifications as a minister, practising professionalism in their role as minister and chaplain and behaving appropriately as a professional. It was discovered in this study that because police chaplains largely act alone they have developed four distinct ‘walking styles’ of having a presence and performing their role in a police station or other venues. The second objective to explicate the nature of police chaplaincy culture focused on kinship among police chaplains and incorporated notions of community of practice, culture and identity. The findings showed that kinship was a useful explanatory concept for analysing the culture of police chaplaincy. It became evident in the study that learning, belonging, connecting, participating and knowing were essential in the police chaplain’s role in complex and diverse communities of practice and various community and organisational cultures that influenced their identities as a minister, chaplain and pastoral carer. The third objective was to identify the major challenges faced by police chaplains. The findings indicated that police chaplains consistently faced challenges in representing the spiritual to police, managing their time, finding best practices, being credible and understanding others relationally as well as attending critical incidents in their ongoing honorary position. Senior Chaplains played an important role providing the support and training that police chaplains require for their ongoing practice while mentors and/or spouses also provided necessary time to listen to the police chaplain’s challenging day. The fourth objective was to examine the professional development and training of police chaplains. The findings revealed that training offered to the honorary police chaplain was minimal and did not meet the police chaplains’ needs. Strategies including a program of continuing professional education have been suggested to enhance training and development for the future of police chaplaincy. Police chaplains interviewed for this research have given a broad range of perspectives making this exploratory study a significant contribution towards capturing the culture of police chaplaincy for the first time. This exposition of the work of police chaplains contributes to setting future directions for police chaplaincy practice and research enabling a better service for police officers and staff of police services worldwide.

This research situated antenatal education within a health promotion framework to determine a consumer-based approach to improving antenatal and postnatal education purported to prepare for parenthood. Research, both published and unpublished, criticises current structured educational programs and first time parents are reported to experience high levels of stress and unhappiness. Stage One of this study was a multiple source, multiple methods needs assessment conducted at two large, metropolitan hospitals in Sydney. The aim of the needs assessment was to explore the needs, interests and concerns of first time expectant and new parents, their changing nature during the childbearing year, ascertain learning processes that best suited their needs, and plan effective antenatal education around the results. Repeated in-depth interviews, focus groups, participant observation and surveys were used to collect data from expectant and new parents. Focus groups, surveys and participant observation were used to collect complementary data from educators, midwives and Child and Family Health Nurses who work with expectant and new parents. The third source of data analysed was documentary, that is program outlines and session plans of three comparable hospitals. The needs assessment demonstrated that to effectively prepare women and men for their childbearing experience, a range of strategies, programs and learning activities were required. This resulted in the design of a ‘menu’1 approach to antenatal and postnatal education with an emphasis placed on ‘life as a mum and a dad’, and the ‘world’ of their baby. The results also demonstrated a significant difference existed between the actual learning needs and priorities of expectant and new parents and those perceived to be their needs by the professionals. Expectant and new parents questioned the group facilitation skills of educators and identified methods to improve practice. Three strategies identified by these expectant and new parents as priorities were designed, implemented and an evaluation of each was undertaken in Stage Two of this study. The strategies were: 1. Seven session Having a Baby program for first time parents. 2. Group skills training program for antenatal and postnatal educators. 3. Breastfeeding resource package for antenatal educators. Stage Three of this research was an empirical study. A repeated measures randomised control trial was undertaken to test the effectiveness of the new Having a Baby program. In particular whether women and men who attended this program had improved perceived parenting self-efficacy, knowledge, and decreased worry about the baby eight weeks after birth compared with those who attended the conventional antenatal education program. The new program placed the labour and birth experience as a microcosm of the childbearing experience, and incorporated learning activities designed to enhance the confidence of pregnant women and their partners during their adjustment to parenthood. Perceived parenting self-efficacy2 was the measure by which parenting confidence, and therefore adjustment to parenthood, was measured The randomised control trial demonstrated that the perceived parenting self-efficacy of women and men in the experimental group was higher than those of control group participants at approximately eight weeks after the birth, with the difference being statically significant. The labour and birth outcomes of both groups, and their demographic details, were similar. Evaluation of the group skills training program for antenatal and postnatal educators and the breastfeeding resource package for antenatal educators were undertaken. Data collected from focus groups, interviews and surveys demonstrated the effectiveness of these strategies. The findings of this research question the validity of conventional antenatal classes and confirm the need for training and mentoring of antenatal educators. Effective, high quality antenatal education operating within budget allocation, facilitated by group skills trained educators, can produce superior postnatal outcomes.

Aims : The aims of the study were to describe the experiences of the midwives who were part of the first Australian CenteringPregnancy Pilot Study and to inform the future development of CenteringPregnancy. Background CenteringPregnancy is a model of group antenatal care that has evolved over the past two decades in North America. A pilot study that explored the feasibility of implementing CenteringPregnancy in Australia was undertaken in 2006-2008. I was the research midwife employed to coordinate this study and I explored the experiences of the midwives who were participants as the focus of my Master of Midwifery (Honours) research. Method : An Action Research approach was undertaken to study the implementation of CenteringPregnancy in Australia. This included a qualitative descriptive study to describe and explore the experiences of the midwives who were participants. The study was set in two hospital antenatal clinics and two outreach community health-care centres in southern Sydney. Eight midwives and three research team members formed the Action Research group. Data collected were primarily from focus groups and surveys and were analysed using simple descriptive statistics and thematic content analysis. Findings : CenteringPregnancy enabled midwives to develop relationships with the women in their groups and with their peers in the Action Research group. The group antenatal care model enhanced the development of relationships between midwives and women that were necessary for professional fulfilment and the appreciation of relationship-based care. The use of supportive organisational change, enabled by Action Research methods, facilitated midwives to develop new skills that were appropriate for the group care setting and in line with a strengths-based approach. Issues of low staffing rates, lack of available facilities for groups, time constraints, recruitment difficulties and resistance to change impacted on widespread implementation of CenteringPregnancy. Conclusions : The experience of the midwives who provided CenteringPregnancy care suggests that it is an appropriate model of care for the Australian midwifery context, particularly if organisational support and recruitment strategies and access to appropriate facilities are addressed. The midwives who undertook CenteringPregnancy engaged in a new way of working that enhanced their appreciation of relationship-based care and was positive to their job satisfaction. Implications for practice Effective ways to implement CenteringPregnancy models of care in Australia were identified in this study. These included a system of support for the midwives engaging in facilitating groups for the first time. It is important that organisations also develop other supportive strategies, including the provision of adequate group spaces, effective recruitment plans and positive support systems for change management. In the light of current evidence the development of continuity of care models which enhance the relationship between an individual women and her midwife, it is important to explore the effects of group care on this unique relationship.