There is minimal research into families where a person who is receiving palliative care has dependent children. In particular, there is a lack of information about the work that palliative care social workers undertake with such families. This study examines the role of the palliative care social worker in safeguarding and promoting the welfare of children of adults receiving specialist palliative care. This is a qualitative study involving the collection of information from a total of 57 palliative care social workers in three ways: focus groups, survey and semi-structured interviews. The analysis demonstrates that palliative care social workers understand the term 'safeguarding children' to mean more than child protection alone. The analysis also focuses on the process of referral, institutional barriers, supports for their work with children, and inter-agency collaboration. An equally important aspect of the analysis, and one generally neglected in psycho-social studies, relates to the socio-economic context of the palliative care social workers' work, including the effects of the immigration status of families on children. In the main, concerns about the present and future care of children come to the attention of palliative care social workers via members of the multidisciplinary team in which they are based. The numbers are reported to be relatively small in contrast to the total number of referrals received. The extent to which support to children is provided varies considerably; some palliative care agencies do not encourage palliative care social workers to work directly with children prior to bereavement and others restrict direct work with children post-bereavement. The main emphasis for all workers, however, is on support to the parents to help them understand their children's needs during the terminal phase of the illness. The well-being of children at this time of emotional stress is included in the palliative care social workers' definition of 'safeguarding children'. In addition, the wide-ranging examination of the palliative care social workers' involvement with the families illustrates the extent of the dedication involved in an under-resourced and little understood area of their work. Whilst palliative care social workers reported receiving basic training on child protection within their agency, with some themselves providing this training, further training on safeguarding children is not always available or known about. The amount and type of professional supervision and support is also varied, particularly in relation to child-care matters; not all have access to supervision from another social work professional. There are a small number of examples given in the study where children are considered to be at risk in some way. Children cared for by lone parents are recognised as being especially vulnerable, particularly if future care plans are not in place before the death of the parent. Also identified as vulnerable are children of parents whose immigration status is in question as their future location may be in doubt, placing children and the surviving parent under additional stress. One of the major difficulties for palliative care social workers is securing support services from local authority children's services. Whilst there are examples of collaboration and co-operation, the findings in this study echo those of others which examine the relationship between adult and children's services. In this study, palliative care social workers speak of frustration and disappointment in the responses they receive, and they are concerned that the needs of children of dying parents are not understood. This study contributes to the debate about the focus of children in care services for adults and how staff may be supported in their task of safeguarding and promoting the welfare of children. This study also adds to the limited existing knowledge about palliative care social work practice.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Purpose of the study. The primary purpose of the study was to evaluate the referral system between CMH ART unit and its feeder sites, and assess the staff perception and patient.s satisfaction about the latter with the intention of improving and shaping it. Research design A non-experimental descriptive type of quantitative research was used in conducting a cross sectional survey to evaluate the referral system between CMH ART unit and its feeder sites. Data was collected through open and closed ended questionnaires handed to the respondents to fill and return back to the researcher. Findings The results revealed lack of management support and supervision of the system; absence of standard operative procedure to follow when down referring patients; insufficient staffing; congested waiting rooms and long waiting hours. Conclusion The down referral process began without the completion of planning with all involved stakeholders because of the pressure to implement the decision to down refer, staff at the feeder clinics although trained on ART care, but not experienced enough to manage the large influx of patients on ART were left alone to manage patients on HAART. Simple measures like communication between facility staff and patient education should be adopted to improve the system. / AFRIKAANSE OPSOMMING: Doel van die studie Die primêre doel van die studie was om die verwysing stelsel tussen die CMH ART eenheid en sy voeder werwe te evalueer, asook om die personeel se persepsie en pasiënte se tevredenheid oor die laasgenoemde te evalueer met die voorneme om dit te verbeter en verwerk. Navorsingsontwerp 'n Nie-eksperimentele beskrywende aard van kwantitatiewe navorsing is gebruik in die uitvoering van' n kruis deursnee-opname om die verwysing stelsel tussen CMH ART eenheid en sy voeder werwe te evalueer Data is ingesamel deur middel van oop en geslote geëindig vraelyste uitgedeel aan die respondente om in te vul en terug te keer na die navorser. Bevindings Die resultate blyk 'n gebrek aan ondersteuning van die bestuur en beheer van die stelsel; die afwesigheid van standaard operatiewe prosedure om te volg wanneer pasiënte af verwys word; „n tekort aan personeel; oorgelaaide wagkamers en lang wag ure. Gevolgtrekking Die af verwysing proses het sonder die voltooiing van die beplanning met alle betrokke belanghebbendes begin as gevolg van die druk om die uitvoering van die besluit om af te verwys te implementeer. Personeel by die voeder klinieke, alhoewel opgelei in ART sorg, maar sonder die nodige onderving om die groot instroming van ART pasiënte te behandel, was alleen gelos om die pasiënte op HAART te behandel. Eenvoudige maatreëls soos die kommunikasie tussen die fasiliteit personeel en die opvoeding van pasiente sal moet goedgekeur word om die stelsel te verbeter.

The objectives of the study were (1) to quantify adherence rate among the study participants in the ART unit and (2) to identify factors that contribute to non-adherence. This cross sectional study was carried out at Nekemete referral clinic. Data was collected using a self-developed structured questionnaire where a total of 338 participants grouped into adherent and non-adherent based on a score derived from an adherence assessment were interviewed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. By using multivariate analysis of variables identified as correlates of adherence, non-adherence was common among those; with age between 18-30 yrs, with no education, who were not married, who had no pipe water supply, those with no electricity in the house, who perceived had no access to assistance from providers, who perceived the health care providers (HCPs) did not keep information confidentially, who had a language barrier with providers, and who were treated with a psychiatric illness. The study concludes that adherence is multi-factorial and varies significantly by individual and care setting. Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Three psychosocial factors were independently associated with poor adherence: the study found that patients perceiving poor access; those perceiving problems in information confidentiality (and possibly experiencing stigmatisation); and having psychiatric morbidity (and possibly with less social support) are more likely to be non-adherent. Furthermore, individuals without electricity and those without piped water supply, implying low income, are at risk for non-adherence / Health Studies / M.A. (Public Health)

Le système de la Cour pénale internationale (CPI), dont la mission est d’assurer la justice internationale, repose sur un lien étroit avec le Conseil de sécurité. Il convient donc de s’interroger sur le rôle du Conseil dans le fonctionnement de la justice pénale internationale. Cette question est fondamentale, car l'intervention d'un organe politique dans l’activité d’un organe judiciaire remet en cause les missions de chacune de ces institutions. L’intrusion du Conseil dans l’activité de la CPI, basée sur sa mission de maintien de la paix, est en fait établie au nom d’un ordre international voulu par le Conseil lui-même. Ce rôle affecte le fonctionnement, l’indépendance et même l’impartialité de la Cour. Les pouvoirs que le Statut de Rome confère au Conseil, lui permettent en effet de saisir la CPI, d’imposer aux Etats de coopérer avec la Cour, de suspendre son activité ou encore de qualifier un acte, de crime d’agression. Cependant, les rapports entre le Conseil et la CPI ne devraient pas être subordonnés, mais entretenus dans le respect mutuel, ainsi une véritable crainte existe concernant le respect du Conseil envers le Statut de Rome. L’étude met en évidence le conflit entre justice et politique et révèle les enjeux actuels en termes de justice pénale internationale. / The international criminal Court system (ICC) whose mission is to ensure international justice, is based on a close relationship with the security Council. So it is proper to wonder about the Council’s role in the functioning of international criminal justice. Such a questionning is fundamental, for the intervention of a political body into the functioning of a judicial body calls into question the missions of both institutions. The Council’s interference in the activity of the ICC, based on its mission of maintaining international peace, is actually carried out on behalf of an international order intended by the Council itself. This role affects the functioning, the independence and even the impartiality of the ICC. The powers the Rome Statute gives to the Council allow it to refer to the ICC, to impose for the States to cooperate with the Court, to suspend its activity or also to qualify an act as a crime of aggression. However the relations between the Council and the ICC should not be subordinated, but maintained in mutual respect. Thus there is a real concern regarding the observance of the Rome Statute by the Council. The study highlights the conflict between justice and politics and reveals the current issues in terms of international criminal justice.

La recevabilité est le cœur de la procédure judiciaire. Elle permet d’étudier la pénalisation de la vie internationale. Elle semble pouvoir rendre compte de la réponse judiciaire à la rancœur internationale au regard des grands faits criminels ; quel qu’en fut le territoire de commission.Cette thèse porte sur la notion de recevabilité devant la Cour pénale internationale. Avec la création de la CPI, la justice pénale internationale prend une dimension nouvelle. La pratique de la Cour est encore récente. L’étude est le prétexte pour examiner le fonctionnement de la Cour pénale internationale. Les Etats ont tenté de limiter la capacité de recevoir de la Cour. Ils l’ont ainsi fondée sur le principe de la complémentarité. Elle supplée l’inaction ou l’action défaillante des Etats, qui ont le devoir de poursuivre les auteurs de crimes internationaux. L’article 17 du Statut de Rome énonce les exceptions permettant de déclarer une affaire recevable devant la CPI. Ainsi, la recevabilité d’une affaire ayant fait l’objet d’une enquête ne sera retenue que s’il est prouvé que les Etats n’ont pas l’intention de mener véritablement à bien les poursuites. Et, que par ailleurs, le seuil de gravité de l’affaire est atteint. Le caractère universel de la compétence de la CPI est battu en brèche par les conditions de recevabilité. On analyse la recevabilité comme une condition de compétence à juste titre, car c’est bien le manquement de l’Etat à assurer l’effectivité des poursuites qui justifie que l’affaire soit déclarée, par la Cour elle-même, recevable. Les conditions requises pour que la Cour puisse agir, force est de constater l’implication du système de recevabilité tant sur l’organisation de la Cour que sur ses rapports avec les Etats. Celles-ci ne sont pas négligeables. De fait, le système de recevabilité est amené à évoluer. Il se caractérise par sa capacité à influencer le droit interne. Ainsi, la décision de recevoir doit amener les Etats à adapter leur droit interne. La viabilité de la Cour, à long terme, dépend du maintien d’une synergie de coopération avec les juridictions nationales, des États parties et d'autres Etats. Le système de recevabilité tend à mettre en évidence des indicateurs émergents dans la pratique de la Cour pénale internationale. C’est notamment le réalignement frappant des rôles des acteurs internationaux et la relation nouvelle qui s’instaure entre les Etats et la Cour. Le système de recevabilité de la Cour tend à éroder le principe de la souveraineté de l'Etat, sans être elle-même balayée par l'opposition catégorique des Etats souverains. / Admissibility is the heart of the judicial process. It studies the criminalization of international life. It seems to account for the judicial response to the international resentment against the great criminal acts, whatever was the territory of commission.This thesis deals with the notion of admissibility before the ICC. With the creation of the ICC, International Criminal Justice is a new dimension. The practice of the Court is still new. The study is an excuse to investigate the operation of the ICC. States have tried to limit the ability to receive from the Court. They did so based on the principle of complementarity. It compensates the action or inaction of failing states, which have a duty to prosecute international crimes. Article 17 RS sets out exceptions to declare a case admissible before the ICC. Thus, the admissibility of a case which is the subject of an investigation will be accepted only, if it is shown that States did not intend genuinely to carry out prosecutions. And that furthermore, the threshold of gravity of a case is reached. The universal nature of the jurisdiction of the ICC is undermined by the conditions of admissibility. Analyzing the admissibility of competence as a condition rightly, for it is the failure of the state to ensure effective prosecution to justify that the case will be declared by the Court itself, admissible. The requirements for the Court to act, it is clear involvement of the system of admissibility as on the organization of the Court that its relationship with the United States. These are not insignificant. In fact, the system will evolve admissibility. It is characterized by its ability to influence the law. Thus, the decision to receive should encourage States to adapt their domestic law. The viability of the Court, in the long run depends on maintaining a synergy of cooperation with national courts of States Parties and other States. The system of admissibility tends to highlight indicators emerging in the practice of the International Criminal Court. This is especially striking realignment of the roles of international actors and the new relationship established between the States and the Court. The system of admissibility of the Court tends to erode the principle of state sovereignty, without itself being swept by the opposition of sovereign states.

Yes / With the aim of targeting high-risk hidden heterosexual young people for Chlamydia trachomatis (CT) testing, an innovative web-based screening strategy using Respondent Driven Sampling (RDS) and home-based CT testing, was developed, piloted and evaluated. Two STI clinic nurses encouraged 37 CT positive heterosexual young people (aged 16-25 years), called index clients, to recruit peers from their social and sexual networks using the web-based screening strategy. Eligible peers (young, living in the study area) could request a home-based CT test and recruit other peers. Twelve (40%) index clients recruited 35 peers. Two of these peers recruited other peers (n = 7). In total, 35 recruited peers were eligible for participation; ten of them (29%) requested a test and eight tested. Seven tested for the first time and one (13%) was positive. Most peers were female friends (80%). Nurses were positive about using the strategy. The screening strategy is feasible for targeting the hidden social network. However, uptake among men and recruitment of sex-partners is low and RDS stopped early. Future studies are needed to explore the sustainability, cost-effectiveness, and impact of strategies that target people at risk who are not effectively reached by regular health care.

Service provision in veterinary oncology in Ontario was examined using a mixed methods approach. First, an interview-based qualitative study explored the service expectations of oncology clients at a tertiary referral centre. Next, a survey-based quantitative study established an understanding of oncology service in primary care practice and investigated the treatment recommendations of practitioners for dogs diagnosed with cancer. The first study, which involved 30 individual and dyadic interviews, identified “uncertainty” (attributable to the unpredictable nature of cancer and its treatment) as an overarching psychological feature of clients’ experience. Consequently, “the communication of information” (both content and process) was the foremost service expectation. For clients, it enabled confidence in the service, the ability to make informed patient care decisions, and preparedness for the potential outcomes of those decisions; it also contributed to creating a humanistic environment, which enhanced client resiliency. Findings suggest that services can support client efforts to manage uncertainty through strategic design and delivery of service, and incorporate intentional communication strategies to support clients’ psychological fortitude in managing the cancer journey. The second study, a vignette-based survey of primary care practitioners across Ontario (N=1071) which investigated veterinarian decision-making in relation to oncology care, determined that 56% of practitioners recommended referral as their first choice of intervention, while 28% recommended palliative care, 13% in-clinic treatment, and 3% euthanasia. Recommendations were associated with patient, client and veterinarian factors. Specifically, referral and treatment were recommended for younger dogs, healthier dogs, and dogs with lymphoma versus osteosarcoma; for strongly bonded clients, and financially secure clients; and by veterinarians who graduated from a North American college, had experience with treating cancer, felt confident in the referral centre, and believed treatment was worthwhile, with variation in relation to practitioner gender and the type of medicine practiced. The human-animal bond appeared to be the primary factor associated with practitioners’ advocacy for quality of medical care for patients. Through a blend of qualitative and quantitative methodologies, this thesis contributes to the evidence upon which best practices may be built so as to enhance the quality of patient and client care in veterinary oncology. / Ontario Veterinary College Pet Trust Fund 049406 and 049854

Students in Technical and Vocational Education and Training Colleges (TVET) in South Africa face a number of challenges including psychological problems. These challenges have a strong bearing on the academic success of the students. The aim of the study was to examine the effectiveness of psychological support services rendered to students at Majuba TVET College. Interviews were recorded verbatim and transcribed. Thematic data analysis was used to analyse the data. The themes used were derived from the research objectives and these were further divided into categories and sub-categories. The study found that the institution does provide psychological support services to the learner. The forms of psychological support include career counselling, pre-counselling, referral system, on-going counselling and peer counselling and mentoring. Improved academic performance, improved student attendance student retention and improved college certification rate are some of the benefits that can be realised from the effective utilisation of psychological support by the students. Various challenges hinder the effective utilisation of these psychological support services including, lack of qualified personnel, being understaffed, poor referral system, conflicting roles of staff, inadequate on-site counselling, low-prioritisation of psychological support by college management and limited access time. The participants highlighted the need for the institution to establish linkages with key stakeholders such as other TVET Colleges so as to have a platform for sharing vital information on psychological support. The participants were of the view that more qualified and registered staff should be hired to bolster the provision of psychological support to students. The referral system should be improved and the participants advocated for the services to be accessible around the clock. College management should show commitment to students’ welfare by prioritising and recognising student psychological support as pivotal to students’ academic success. / Educational Studies / M. Ed. (Adult Education)

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.

Établissant une relation entre un État ou l’une de ses émanations, d’une part, et un investisseur d’autre part, le droit des investissements étrangers se meut au-delà de la distinction droit public/droit privé. Compte tenu du fait qu’il se situe à un point de jonction entre le droit international et le droit interne, le droit des investissements pose d’importantes questions relatives à la loi applicable, ainsi qu’aux juridictions compétentes. Conçu comme un ordre juridique spécifique provenant de l’interaction entre les ordres juridiques international et interne, le droit des investissements engendre de multiples répercussions quant à son interférence avec l’ordre juridique interne. Cette interférence, n’étant soumise à aucune hiérarchie de compétence législative ou juridictionnelle, soulève de sérieuses interrogations : quel serait le droit applicable lorsque les droits interne et international ont vocation à s’appliquer dans un même litige ? Dans le même ordre d’idées, quelle serait la juridiction compétente si les institutions juridictionnelles internationales et internes sont toutes les deux compétentes selon leurs propres règles de rattachement pour trancher le litige ? Les réponses à ces interrogations ne sont pas évidentes et continuent de donner lieu à de vifs débats. La question n’ayant pas été tranchée de façon ferme et définitive, la présente étude proposera d’y apporter des éléments de réponse en démontrant la manifeste prééminence du droit international de fond et de l’arbitrage transnational de nature à permettre d’écarter l’application de la loi locale et d’exclure la compétence des juges internes. Cette prééminence fera enfin l’objet d’un examen approprié. / Establishing a relationship between a State or one of its emanations, on the one hand, and an investor, on the other, international investment law moves beyond the distinction between public law and private law. Given the fact that it resides in-between international law and domestic law, international investment law raises important questions about the governing law and jurisdiction. Conceived as a specific legal order arising from the interaction between the international and the national legal orders, international investment law begets controversy with respect to its interference with the national legal order. This interference, which is not submitted to any hierarchy on the legislative or jurisdictional level, raises serious questions: what would be the applicable law when domestic law and international law are both involved in the same dispute? In a similar manner, what would be the competent court if the international and domestic jurisdictional institutions are both competent according to the rules of their own legal order? The answers to these questions are not obvious and continue to give rise to heated debates. As the issue has not been firmly and definitively resolved, the present study aims to provide an answer by demonstrating the pre-eminence of substantive international law and transnational arbitration to the point of clearly excluding the application of the local law and the competence of domestic judges. This pre-eminence will finally be subject to an in-depth examination.