This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.

This study investigated the relationship between cognitive development and children’s understanding of the hospital nurse’s role. A group of 35 hospitalized children with chronic conditions and without neurological deficits, aged 4 to 10 years, were given three tasks (i.e., the Nurse’s Role Task, the Balance Beam Task, and the Task of Intrapersonal Understanding), scored for developmental level using Case’s (1992) neo-Piagetian theory of cognitive development as a framework. A full sample of 4—year—olds was not pursued due to the distracting hospital environment which, in combination with the shorter attention span of the 4-year-olds, rendered the interviews extremely difficult to complete. Descriptive results indicated a moderately advanced understanding of the hospital nurse’s role by 8— and lO—year—olds, being on the order of one—third of a substage (i.e., approximately 8 months ahead in development), whereas 4— and 6—year—olds showed an age— appropriate level of understanding of the hospital nurse’s role. Analysis of Variance indicated a statistically significant effect for age on all three tasks (p < .01). Six levels of social—cognitive development in understanding the hospital nurse’s role were found, which were, in successive order: (1) Roles of the nurse as scripted actions (i.e., 4-year-old level), (2) Roles of the nurse as motivated action sequences (i.e., 6—year—old level), (3) Roles of the nurse as planned action sequences (i.e., 8— year—old level), (4) Roles of the nurse as generalized dispositions toward action (i.e., 10—year-old level), (5) Roles of the nurse as demonstrating logically planned decisions towards action (i.e., 12-year—old level), and (6) Roles of the nurse as demonstrating logically planned action sequences (i.e., 14—year—old level). Furthermore, results indicate that a few 6- and 8-year-olds and the majority of l0—year—olds could give an accurate description of the duties of the hospital nurse, that is, 1) nurses are there to help children, 2) nurses have a responsibility for the well-being of their patients, 3) nurses want to improve the physical and emotional health of their patients, 4) nurses also see their own shortcomings in their care for children and have good intentions, and 5) nurses are human and have their own feelings, thoughts, doubts, and ideas. Suggestions for future research have been provided in order to further improve communication between health care professionals and hospitalized children with chronic conditions.

This research examines the treatment of Tuberculosis in South Africa, focussing particularly on the Pietermaritzburg-Msunduzi Council Area in the Natal province. Two alternative measures of TB control are examined, the clinical curative regime and inpatient treatment, that is, the hospitalisation of patients. The samples used are a random selection of patients treated through the Pietermaritzburg Clinic and SANTA Hospital. As this research entails a cost-effectiveness analysis determining the most cost-effective way of treating TB, much of the analysis and conclusions are derived from the costs entailed in the two aforementioned control measures. Cost analysis of the alternative measures of treatment reflects that the clinical outpatient alternative to TB treatment is more cost-effective than the hospitalisation option. A closer examination of the costs reveals the cost savings that can occur if an efficient use of resources is established. Furthermore the results reflect a cost effective drug use by the hospital at R173.65 per patient cured compared to R403.51 per patient cured through the clinic. Analysis of results showed institutional costs as the reason for the cost-ineffectiveness of hospital care. Overall, the clinical measure to the treatment of TB was more cost-effective at R490.34 per patient cured compared to the R7502.66 per person cured through hospitalisation. The sample sizes yielded cure rates of fifty-eight for the clinic and eighty-five percent for the hospital. / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 1999.

Kangaroo Mother Care (KMC) is a fairly new concept to the patients and personnel at the R. K. Khan Hospital. Arising from one of the Governmental initiatives, KMC was introduced to KwaZulu Natal in 2001. The personnel at this hospital were briefly introduced to this alternate method of care for a low birth weight baby, by means of symposia and in-service. Soon after this in-service education, the personnel were requested to implement KMC. This study was undertaken to explore the perceptions of carers for the preparation and experience of KMC and to describe the experiences of the carers who have implemented KMC. Furthermore, this study determined whether carers received support during the implementation of KMC and in so doing to identify the sources of this support. The selection of this particular field of study arose out of the researcher's professional role in educating personnel in the theory and practice of midwifery. The lack of documented evidence to problems that they may have been encountered and management strategies to deal with these prompted this study. The intention was to obtain empirical findings so that personnel would be provided with appropriate and precise information on the subject. A phenomenological approach was used. The sample was obtained from the R. K. Khan Hospital neonatal unit. This is a regional hospital that is located in Chatsworth, Durban. The sample comprised often mothers who were practicing KMC in the post-natal ward, or mothers who were discharged and were still practicing KMC for the past two to four weeks. Data were collected by means of face-to-face interviews. Interviews were conducted using a semistructured interview guide. These interviews provided the researcher with rich, personal and narrative experiences of the carers before and during KMC. The results of this study indicated that KMC was indeed new to most of the mothers and this evoked apprehension, doubt and fear, but once the mothers had tried it and were successful, they felt a sense ofjoy. Nursing personnel formed part of the supportive environment for the mothers practicing KMC. The latter is a prerequisite for the success of KMC. Since KMC is associated with many benefits to the mother, the baby and the institution, for the future it could be incorporated into the midwifery curriculum for student midwives. Recommendations concerning nursing practice, nursing education and nursing research were made at the end of the study including the limitations affecting the study. / Thesis (M.Cur.)-University of Natal, Durban, 2003.

No description available.

The purpose of this Heideggerian phenomenological study was to understand the meaning of the lived experience of seclusion in a psychiatric hospital. Five people with a long standing mental illness who had spent time in a locked seclusion room in a psychiatric hospital were asked to describe their experience in seclusion.Consistent with the method, purposive sampling was used in order to obtain an understanding from those who had lived the experience of seclusion and could articulate their experience. Interviews were audiotaped and the data were transcribed by the researcher. Audiotapes were destroyed when the study was completed. Transcribed data were shared with other researchers who were familiar with Heideggerian phenomenology and hermeneutics for the purpose ofgaining insight into the interpretations. When data were shared, names of participants and other identifying information were removed. Sharing of data for purpose of interpretation is inherent in the Heideggerian method as described by Diekelmann, Allen, and Tanner (1989). Data were analyzed using Diekelmann, Allen, and Tanner's (1989) seven stages. The following patterns emerged constituted pattern- Seclusion, A Paradox Being Powerless yet Hopeful with the supporting themes of 1.) Being Punished, 2) Being Abandoned, and 3) An Opportunity for Reflection and Self Growth. / School of Nursing

The purpose of the study was to examine critical care nurses' perceptions of the usefulness of hospital ethics committees as a coping strategy for resolving ethical dilemmas. The conceptual framework was Lazarus and Folkman's theory of stress, appraisal, and coping (1984).The convenience sample was five critical care nurses from five midwestern hospitals. Confidentiality was maintained by identifying participants as numbers.The research design for the study was an exploratory case study. The research question, nurses perceptions' of the usefulness of hospital ethics committees as a coping strategy to resolve ethical dilemmas, was analyzed using a qualitative methodology. Findings indicated that the nurses did not perceive hospital ethics committees as useful resources in ethical conflicts. Barriers to use of committees included lack of education about the committees, lack of timely intervention by committees in a crisis and risks involved in confronting physicians via committees.Conclusions were that ethics committees were not fulfilling a role as support systems empowering nurses to act as patient advocates in ethical dilemmas. Results can be used to develop strategies to increase the ethics committees' effectiveness in ethical dilemmas. / School of Nursing

This thesis focuses on the cultural construction of cancer experience in a modern clinical context. A French Canadian center, specializing in cancer treatment, was the main source of information for this study. Facts obtained from this setting served for the analysis. The first step in the proposed method, consisted of an ethnographic description of the clinical milieu observed. Next, five additional steps in the analysis indicated the principal elements of this cultural encounter with cancer. These steps included: (1) An analysis of the staff exchange; (2) An analysis of the patient's exchange; (3) An analysis of the documents on Terry Fox and Johnny Rougeau, heroic victims of cancer; (4) An exploration of the patients' lay knowledge on cancer; (5) A life story of a cancerous patient where by the dialectic trends between exchange, knowledge and experience are analysed. / The resultant three hypotheses deal with the emergence of a new exchange on cancer with an emphasis on hope and god morale, the homology of cancer exchanges in the clinical and social spheres, and finally concerning the nature of the layman's knowledge on cancer as making sense out of a troubling experience of liminality and alienation as well as the more open and dynamic character of the layperson's knowledge of cancer.

No description available.

The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.