This thesis explores home-based care volunteer (HBCV) identity and how it is shaped by context in rural KwaZulu-Natal, South Africa. The literature on home-based care in Africa is dominated by the "burden of care narrative" which is supported by the themes of "women as caregivers", "poverty" and "stigma". The literature presents government and stakeholder collaboration as the general solution to alleviating the burden of care on women caregivers. A wider scope for research within the themes is necessary to discover alternative solutions to the problem of the burden of care. This study ventured to expand the scope of current research by exploring the area of HIV and AIDS home-based care volunteer (HBCV) identity and participation in care and support. Fifteen HBCVs were interviewed about their work and personal life stories and interviewed reflexively using narrative interviewing. Findings indicate that the women's stories were dominated by narratives of gender, poverty and sociopolitical factors (social field narratives). Meta-narratives influencing the women's lives were stories of communal motherhood, aspirations to service-oriented work and religious beliefs and commitment. The women's personal life stories revealed that they saw themselves as distinctively caring. Connections between the different aspects of identity and context revealed that the women made sense of their community participation through their personal identities as strong and loving mothers and the association with the group identity of community mothering. Home-based-care volunteerism was explored as a form of agency in response to a lack of recognition, support and acknowledgement for AIDS caregivers and their patients. Researcher reflexivity through autoethnography and poetry contributed to achieving depth in the study and to the understanding that HBCVs strive for space recognition, acknowledgement and validation for their work. In a resource strained context a balance must be found between material compensation and respect and recognition which can be effective in sustaining community initiated volunteerism. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

Introduction. The use of Highly Active Antiretroviral Therapy (HAART) has shown to reduce the morbidity and mortality and prolongs survival, improving quality of life restoring and preserving immunologic function, maximizing antiretroviral activity and durably suppressing viral load and further preventing vertical HIV transmission. However, their use in Critical Care Units CCU is still controversial as there are still no set standards for how HAART should be applied in these settings (Anderson, 2009). This study was aimed at exploring the perceptions of critical care nurses towards their educational preparedness in managing HIV/AIDS patients admitted to CCU in KwaZulu-Natal. Methodology. Quantitative descriptive research design was used and data collection included a structured questionnaire and open ended questions. Results. The findings of this study indicate that of the critical care nurses who were sampled for this study and had undergone training in HIV/AIDS management, 45% and 25% respectively perceived that they were not educationally prepared to provide services for people living with HIV/AIDS admitted to CCUs. Almost all N=50 (94%) critical care nurses reported that HIV/AIDS management should be incorporated into the critical care nursing programme. Their universal perception N=42 (75%) is that this will improve the standards of nursing care in the critical care field. Over and above lack of training and updated information reported by the respondents, they are still challenged by factors such as advanced level of HIV disease, confidentiality about the disease, knowledge about a HIV/AIDS treatment regimen and emotional challenges. However, there are guiding policies within critical care settings for nurses to utilise in the management of HIV/AIDS and in the care of people who have already been infected. Conclusion and recommendations. In conclusion, more research with a larger scale sample is required to provide appropriate generalisation of the findings of the study. Alternatively a qualitative research study which may provide richer data on the lived experiences of the critical care nurses regarding care of people living with HIV/AIDS is suggested. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Aim: The aim of this study was to investigate the educational shortcomings as evident in the literature reviewed with the intention of developing intervention/s thus contributing to practice, management, research and education. Background: Literature identifies many limitations in psychosocial support to families of patients in ICU. Little is known about the continued educational support the ICU nurses receive, formally and informally, to empower them to provide psychosocial support to the families of ICU patients. Methodology: The mixed method (concurrent triangulation design), was adopted using the survey for both the quantitative and qualitative approach. In-depth interviews, conversations, participative observation and the review of documents were used to collect data. Collection of data occurred simultaneously. A research instrument and guide were used to obtain quantitative and qualitative data respectively. Setting: Purposive sampling was used for the selection of hospitals within which the chosen ICUs were located and the educational institutions which provided the formal education and training to ICU nurses who worked in these hospitals. Participants: The qualitative arm involved interviews with a purposively selected sample of critical care nurses. Saturation was reached after nine interviews. A sample size of 34 (n=34) was used in the quantitative arm of the study. Convenience sample was used. Data Analysis: A mixed method approach was adopted. The study applied a thematic analysis according to the qualitative analysis described by Creswell 2007. Descriptive statistics were used to summarize data and findings were presented in tables and graphs. The SPSS version 15.0 and STATA statistical package calculate non – parametric tests between selected study variables. Findings: The main themes derived from the qualitative analysis and confirmed by the statistical data demonstrated the manner in which continued education preparation was inadequate, the lack of specific clinical accompaniment, the lack of direction in terms of the philosophy of the units, ICU nurses being left on their own to obtain educational preparation. The results indicated that the lack of continued informal education at the unit and hospital level influenced the ICU nurses’ lack of implementation of psychosocial support to families of ICU patients. Statistical results and qualitative themes were converged and integrated during data analysis. Jamerson et al.’s (1996) model of family experience was used to contextualise the findings. Recommendations: Recommendations arising from the study were made for improvements in nursing practice, nursing management, nursing education and future nursing research. A practice checklist was formulated and expert opinion was sought using the Nominal Group Technique. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Introduction: Malnutrition is a health issue directly and indirectly contributing towards high rates of morbidity and mortality globally, particularly in developing countries. South Africa (SA) is faced with a double burden of diseases with a high prevalence of both under and over nutrition. The high prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) in SA worsens undernutrition. HIV/AIDS increases nutrient requirements and inadequate food intake results in malnutrition. Nutrition support through food supplementation is important to combat the high prevalence of malnutrition in sub-Saharan African countries including South Africa. Thus, a groundnut-soya based supplementary paste, Sibusiso, has been produced. However, its nutritional composition and acceptability have not been studied. Objectives: (i) To determine the nutritional composition and physical properties of a ready-to-use supplement, Sibusiso, (ii) To determine the sensory acceptability of Sibusiso among healthy subjects; and sensory acceptability and perceptions of Sibusiso by subjects treated for HIV and HIV/TB. Materials and methods: The nutritional composition, colour and texture of Sibusiso and a commercial peanut butter (control) were analysed following standard procedures. A cross-sectional consumer acceptability test was done using a 5-point facial hedonic scale (healthy control group, n = 68; HIV, n = 88 and HIV-TB co-infection treated, n = 51). A total of six focus group discussion sessions (HIV subjects = 4 sessions and HIV/TB co-infected subjects = 2 sessions) were also conducted. Results and discussions: The protein content of Sibusiso (16 g/100 g) was almost half that of the commercial peanut butter (control), (25 g/100 g). However, Sibusiso contained 1.4 times more ash (4 g/100 g) and almost twice as much carbohydrate (40 g/100 g) compared to the commercial peanut butter (22 g/100 g). The fat (40 g/100 g) and energy (2 624 kJ/ 100 g) content of Sibusiso was not substantially different from that of the commercial peanut butter which was 43 g/100 g and 2 852 kJ/100 g, respectively. The lysine content of Sibusiso (58 mg/g) was about 1.7 times higher than that of the commercial peanut butter. The methionine (11 mg/g) and histidine (35 mg/g) content of Sibusiso was almost twice that of the commercial peanut butter, respectively. The nutrient content of Sibusiso was either similar or slightly more than that of other ready-to-use supplements such as Plumpy’nut®. Sibusiso met the FAO/WHO/UNU recommendations for essential amino acids. The consumption of 50 g of Sibusiso per day may provide approximately 35% of the Estimated Energy Requirements (EER) and 30% of the Recommended Dietary Allowance (RDA) for protein for adults. Sibusiso was brown in colour, similar to the commercial peanut butter. Its textural attributes were found similar to that of the commercial peanut butter but harder and stickier. The acceptability of Sibusiso was significantly associated (p ≤ 0.05) with the health status of consumers. Overall, Sibusiso was liked by 94% of HIV and HIV/TB individuals (mean score: 4) compared to 85% for the healthy group (control). More than 90% of the HIV/TB and HIV treated individuals liked the taste compared to the control group (86%, mean score: 4). The colour and mouthful were rated 'good' by more than 80% of the HIV and HIV/TB group, mean score: 3, with only 68% among the healthy group, mean score: 4.1. Conclusion: Sibusiso is a good source of nutrients and was found to be acceptable to HIV and HIV/TB treated consumers. It may be effective in alleviating disease-related malnutrition among vulnerable individuals such as those infected by HIV and HIV/TB. / Thesis (M.Sc.Hum.Nut.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.