M.Sc. (Occupational Therapy), Faculty of Health Sciences, University of the Witwatersrand, 2009 / This qualitative study explores the perceptions of parents/caregivers of the efficacy of a student based occupational therapy service with children with autistic spectrum disorders (ASD). Key informant interviews were conducted with ten randomly selected parents/caregivers of children with ASD receiving occupational therapy from final year students of the University of the Witwatersrand. Data analysis generated six themes: Understanding of Occupational Therapy; Limitations of students as therapists; Lack of partnership; Inadequate structure of the program; Inefficacy of the service and, Desperate need of help. The study showed that the student based occupational therapy service was not effective because students were not in a position to provide a comprehensive treatment programme for the children. The findings highlight the need for the provision of a full time occupational therapy service at the CDC. A follow up study to explore experiences of students in the management of ASD is recommended.

Unplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated with unplanned hospital admissions in older adults under treatment for cancer. A conceptual framework based on the literature and this researcher's clinical experienced guided this study. The purpose of this study was to explore the factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions of older adults with cancer. A convenience sample of 129 dyads of older adults with cancer and their family caregivers were approached and enrolled in the adult oncology outpatient infusion centers and inpatient units within a community cancer center in central Florida. Patient demographic and clinical data were obtained through a retrospective medical record review. Family caregiver demographic and side effect knowledge data was collected prospectively during interviews with family caregivers using a newly developed tool, Nurse Assessment of Family Caregiver Knowledge and Action Tool (NAFCKAT). The NAFCKAT contains 11 items to determine baseline knowledge about side effects and plan for managing side effects. A fever subsection consists of 4 knowledge and 2 action questions and a dehydration subsection consists of 2 knowledge and 2 action questions. Preliminary research was conducted to determine reliability and validity of the NAFCKAT. Excellent inter-reliability was found for the tool and preliminary support for validity was determined for the fever subscale. Descriptive statistics and logistic regression analyses were used to evaluate data collected from patient medical records and NAFCKAT scores. Study findings revealed that unplanned hospital admissions were more likely to occur when older adults had the presence of impaired function prior to treatment initiation and/or experienced side effects of infection /fever and vomiting/diarrhea during treatment. The presence of impaired function and family caregiver support (knowledge and availability) did not moderate the relationship between side effects and unplanned hospital admissions. Findings suggest that the presence of impaired function and side effects of infection and fever, and vomiting and diarrhea, predict unplanned hospital admissions in older adults during the active cancer treatment phase. Nurses should advocate for and conduct targeted assessments to identify the presence of functional impairments prior to cancer treatment initiation. In addition, nurses should actively monitor for the presence of cancer treatment-related side effects during the treatment phase of the cancer trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to support older adults and their family caregivers during cancer treatment and reduce the risk for unplanned hospital admissions.

In South Africa today only one in every three children lives with both of their biological parents. Most children not living with biological parents live with a grandparent. Vulnerable children are those whose basic needs for food, shelter, safety, protection, and education are not met or are insufficiently met. Many children who are orphaned are vulnerable, but vulnerability is not limited to orphans only. Children who live with their grandparents can be called vulnerable children as they suffer the loss of parental contact through death, illness, abandonment or migrant labour. Care-givers of vulnerable children face numerous challenges in their daily lives. Although the care of grandchildren by grandmothers is not unusual or new, the traditional network of financial and emotional support for this care-giving task has gradually fallen away over the years as parents are deceased, or too ill to work or have abandoned their children. This has left care-givers, many of whom are elderly and themselves vulnerable, with less resources and more financial and care-giving responsibility. Care-givers and the children for whom they care live in a wider context of poverty, unemployment, the HIV pandemic and crime in South Africa. Care-givers are at risk of burn-out due to the intensity of the challenges they face. Increasing resilience of care-givers serves to increase the positive outcomes for the vulnerable children in their care. The goal of this study was to explore whether participation in awareness-based Gestalt group work sessions would enhance the resilience of care-givers of vulnerable children. In the context of applied research, a mixed methods approach was used, specifically an embedded mixed methods approach. The study measured respondents‟ resilience before and after the implementation of a series of eight Gestalt group work sessions. A quasi-experimental research design, the comparison group pre-test-post-test design, was used for the quantitative part of the study and a case study design for the qualitative part. Quantitative data were collected through a structured interview using a pre-determined interview schedule based on theoretical constructs of resilience. Qualitative data were collected through semi-structured interviews, observations and field notes. The respondents were 19 care-givers of vulnerable children from a semi-rural area in KwaZulu-Natal. They were selected through snowball sampling and were assigned into comparison and experimental groups through a simple random sampling method. The experimental group participated in the Gestalt group work sessions whilst the comparison group did not. Although the quantitative results showed no significant difference in the pre- and post-test results, the qualitative results confirmed that experimental group members experienced a positive effect upon their resilience through participating in the Gestalt group work. Conclusions drawn from the qualitative findings indicated that respondents had a high level of resilience present in their lives before the research began. The awareness-based Gestalt group work sessions had a positive impact upon aspects related to the resilience of care-givers of vulnerable children. / Dissertation (MSW)--University of Pretoria, 2013. / gm2014 / Social Work and Criminology / unrestricted

The diploma thesis discusses the issue of kinship foster care, its specifics, strengths and weaknesses. It examines the views of grandparents, aunties, uncles and other relatives on their role in foster care and the children's life. The theoretical part is focused on basic topics in foster care, views on foster care and the development of children living in foster care. The practical part of the thesis is focused on semi-structured interviews with care givers which should tell us facts about their views of foster care, why children are placed in their family, practical problems and help which they need. There are also casuistries of foster care families.

A recent Report Card on Physical Activity and Health in South African Children and Youth 2010 states that at least four major factors place young children at risk: tobacco use, poor diet, lack of physical activity and facing weight challenges, this then including being overweight, underweight, obese or stunted for one’s age. One of the areas for action and intervention mentioned in the report card is training of teachers. The aim of this study was to increase knowledge, skill and competence in school teachers (care givers) when dealing with underweight in school children. A training program (train-the-trainer) was designed by the researcher. Under nutrition (underweight) is implicated in more than half of all child deaths worldwide. 25.33% of respondents in this study showed signs of underweight highlighting the importance of such training in schools. Using the above statistical data the research embarked on the development, implementation and evaluation of a training program for care givers on underweight prevalence in children in South African schools. The intervention research model of Thomas and Rothman was used in the design and development of the training program. A descriptive design with a quasi-experiment one group pre-test-post test was used in this study. A non parametric statistical test was utilized as data was measured on an ordinal scale (Wilcoxon signed rank test). The care giver training program was implemented over nine weeks consisting of one and a half hour sessions held once weekly. All Foundation Phase teachers were involved in the training (18 Care Givers). The program was implemented with grade one learners at a traditional primary school in Pretoria with a mixed demography and age groups varying between 6 and 8 years of age. Hundred and fifty learners participated in the pre and post test wherein a non probability sampling method was used. The study found that the training program for care givers had a statistically significant effect on underweight prevalence in young children. FMEA profiling in this study confirmed that enhancing care giver knowledge, skill and competence contributes significantly to the changes experienced in children’s underweight status. BMI levels changed significantly. The percentage underweight children dropped from 25.33% to 15, 33% over time. It is recommended that this intervention program be implemented and facilitated by teachers (care givers) forming part of a multi-disciplinary education approach in many South African schools. AFRIKAANS : ‘n Onlangse verslag getiteld “Report Card on Physical Activity and Health in South African Children and Youth 2010” dui aan dat daar ten minste vier hooffaktore is wat jong kinders se gesondheid aan gesondheidsrisiko’s blootstel. Die faktore sluit in rook, ongesonde eetstyl en dieet, gebrekkige deelname aan fisieke aktiwiteit en gewigsuitdagings. Gewigsuitdagings waarvoor Suid Afrikaanse jeug te staan kom sluit in oorgewigvoorkoms, ondergewigvoorkoms, obesiteit en of groeibeperking (stunting). Een van die areas wat in die verslag as voorkoming vir hierdie gewigsuitdagings voorgestel word is opleiding aan opvoeders. Die doel van die studie was dan om kennis, vaardigheid en bekwaamheidsvlakke in onderwysers te verbeter wanneer hulle met ondergewig kinders in hulle sorg werk te bewerkstellig d.m.v ‘n indiensopleidingsprogram (Train-the–trainer). Tans dra ondergewigvoorkoms by tot meer as die helfte van alle sterftes onder kinders wêrelwyd. In hierdie studie is bevind dat soveel as 25.33% van die kinders in die studie tekens van ondergewig getoon het. Dit beklemtoon die belangrikheid van ‘n opleidingsprogram aan die opvoeders van hierdie kinders. Statistiese data soos hier bo genoem is deur die navorser aangewend in die ontwikkeling, implementering en evaluering van die opleidingsprogram aan opvoeders van ondergewig kinders in die skool. Die intervensie navorsingsmodel van Thomas and Rothman is gebruik in die ontwerp en ontwikkeling van die opleidingsprogram. ‘n Beskrywende ontwerp met kwasi-eksperimente, een groep voortoets-natoets is in die studie gebruik. Nie parametriese statistiese toetsing is aangewend en data is gemeet aan die hand van ‘n ordinale skaal (Wilcoxon signed rank toets). Die opleidingsprogram aan opvoeders is oor ‘n tydperk van nege weke geïmplimenteer. Elke opleidingsessie was een en ‘n half uur lank en een maal per week aangebied. Alle grondsalgfase opvoeders was in die opleiding betrokke (n=18). Die program is getoets op graad een leerders wat skoolgaan in ‘n tradisionele laerskool in Pretoria met ‘n gemengde demografie en ouderdomsgroepe het gewissel tussen ses en agt jaar oud. Een honderd en vyftig leerders het aan die voor en natoetsing deelgeneem en ‘n nie waarskynlike metode van insluiting is gebruik. Die studie het bevind dat die opleidingsprogram aan opvoeders van ondergewig kinders in die skool ‘n beduidende invloed gehad het op die voorkoms van ondergewig. FMEA profiele gedoen in die studie het bevestig dat die verbetering van opvoeder kennis, vaardigheid en bekwaamheidsvlakke beduidend bygedra het tot die verandering in die ondergewig status van die kinders. LMI tellings het gedaal vanaf 25, 33% tot slegs 15, 33% oor verloop van tyd. Die navorser is van mening dat hierdie voorkomingsprogram in werking gestel behoort te word en deur opvoeders in die skool gefasiliteer word; om sodoende deel te word van ‘n multi-dissiplinêre onderwysbenadering in Suid Afrikaanse skole. / Dissertation (MA)--University of Pretoria, 2013. / Biokinetics, Sport and Leisure Sciences / unrestricted

Magister Artium (Social Work) - MA(SW) / This thesis explores the personal, social and environmental factors of caregivers from the Groblershoop community to determine whether these factors influence the caregiver’s ability to provide care to children from birth to six years. Using the Human Capabilities Approach and the Ethics of Care Perspective, this study seeks to examine the resources that are available for caring in Groblershoop. It also explores how the factors above (personal, social and environmental) play a role in how the resources are used by caregivers to increase the well-being of children under six years. The Human Capabilities Perspective purports that caregiving resources are not an end in itself. The resources are only as valuable as they are able to improve the functioning of the caregivers to provide care and assist in ensuring the well-being of the care receivers, namely the children. The Ethics of Care Perspective is used to examine the consequences of inadequate care by the State, community and caregivers themselves.This study was conducted among caregivers from the community of Groblershoop, which is 150km from the main town of Upington in the Northern Cape Province. The town is rural in nature and unemployment, poverty and social ills such as substance abuse and teenage pregnancies are rife. Work is largely seasonal in nature and is found mainly on the surrounding grape and cattle farms. This study is qualitative in nature and used a purposive sampling method. Ten caregivers were selected using the criteria that they must reside in the community of Groblershoop and must be the primary caregiver to children from birth to six years of age, to participate in the semi-structured interviews. Seven other caregivers were also selected using the same criteria above to participate in a focus group interview using participatory action learning techniques. Participant Observation was conducted in the homes of three caregivers that participated in the individual interviews. Additionally, seven individual interviews were conducted with service providers that provide services to the community of Groblershoop.The main findings of the study reflect that the personal, social and environmental factors do influence the caregiver’s ability to provide care to children from birth to six years among a small group of caregivers from the Groblershoop community. The personal factors explored in the study included the age, gender, health status, substance usage, educational level and income of the caregiver. Ill health was found to be a key factor which posed a challenge to caregivers in terms of being able to provide care to children. The World Health Organisation’s five key elements of care was used to provide a framework for assessing adequate caregiving. These factors were sustenance, stimulation, support, structure and surveillance. Factors such as educational levels were closely linked to income levels. The higher the educational level the better the income for the caregiver. The Child Support Grant was a major source of income for the majority of caregivers. Low levels of income also meant that the caregivers were unable to provide adequate nutrition to children.The social factors focused on in this study was public policies which make provision for care resources, parenting practice, support systems, and the gender practices of caregivers. The consequences of inadequate care were examined through focusing on the children and the associated developmental delays experienced by them. The study found that while good public policies exists not enough resources were available to enable these policies to increase the well-being of people at community level. The lack of resources available for caring in the Groblershoop community impacted on parenting practices of caregivers. Caregivers in this study, due to the lack of resources as well as other factors such as limited knowledge of child care, resulted in care being considered inadequate using the World Health Organisation’s five elements of care. Gender practices among the caregivers are based on the stereotypical gender roles which sanction the ideology of patriarchy. Women are the primary caregivers and the biological fathers were absent from the caring process. The environmental factors that were explored in this study were the climate, the physical home environment and the neighbourhood condition. Due to the excessive summer heat and the harsh cold of winter, physical activity and movement in the community is severely hampered. During summer, families sleep outside as the housing structures are built in a way that retains the heat and is freezing in the winter. Dwellings are small and typically compromises of a big room sub-divided by the family themselves. No ablution facilities are available inside dwellings and some homes still make use of chemical toilets and pit latrines.Crime and violence is closely linked to the alcohol usage at the local shebeens. These factors impact on caregiving as the environment with the lack of facilities and the harsh climate lends itself to fostering of illnesses amongst children.The study concludes that the personal, social and environmental factors significantly influence the caregiver’s ability to provide care to children from birth to six years in Groblershoop. To assist the development of children, it is essential that the above factors are considered as they influence the ability of the caregiver to use resources to achieve wellbeing. The findings of this study provides a good argument for an integrated coordinated approach to service delivery which takes into account the distinct challenges of rural communities, with regards to their distance from urban centres and the current lack of infrastructure within these communities. The study highlights the importance of focusing on how resources can effectively improve the quality of life of caregivers in communities as opposed to just making resources available and ensuring uptake. As this study demonstrates through the Human Capabilities lens, that resources alone do not result in people being able to live the lives they value. Ensuring that they are able to convert the resources into wellbeing should be the focus of how the State evaluates the effectiveness of programmes. November 2009

Bakgrund: Det finns ett ökat behov av närstående, som vårdar den palliativa patienten i hemmet. Antalet vårdplatser inom slutenvården har minskat och andelen äldre ökar i befolkningen. Det palliativa teamet är av betydelse som stöd till närstående i hemmet i vården av den palliativa patienten. Syfte: Att kartlägga närståendes beskrivning av det stöd de fått från palliativa teamet under den tid de vårdade den palliativa patienten i hemmet och vilka förslag till förbättringar anger närstående, som skulle kunna stärka stödet från det palliativa teamet.Metod: En kvantitativ och kvalitativ registerstudie. Data hämtades från Svenska palliativregistrets (SPR) närståendeenkät, bearbetad av SPRs registerhållare och översänts till författaren i Microsoft Exelfil. Deskriptiv analys med frekvensberäkningar, procent samt medelvärde, standardavvikelse och variationsvidd. Kvalitativ data med närståendes kommentarer analyserades med summativ innehållsanalys. Nyckelord räknades och därefter genererades fem koder. Samtliga närståendes kommentarer i citat har redovisats med följande fem koder; informationsbehov, kommunikation och dialog, stödinsatser, närståendes ansvar och anpassad vårdnivå. Resultat: Majoriteten av närstående var nöjda med stödet de fått från palliativa teamet och med information om efterlevandesamtalet, var de skulle vända sig i en akutsituation, närståendepenningdagar, vem som är den patientansvarige läkaren under den palliativa patientens sista dagar i livet och hur få tag på denne vid behov och förväntat dödsfall. De förslag på förbättringar som närstående redovisade var; förbättringar om ett ökat informationsbehov, bättre kommunikation och dialog, stödinsatser, närståendes ansvar och vårdnivå för den palliativa patienten. Konklusion: Majoriteten av närstående var nöjda med det stöd de fått från palliativa teamet under tiden de vårdade den palliativa patienten i hemmet. De förslag på förbättringar, som närstående angav omfattade behov för ökad information, bättre kommunikation, stödbehov och anpassad vårdnivå för den palliativa patienten. / Background: There is an increased need for caregivers to provide in home care for the palliative patient. The number of hospital beds have decreased and the proportion of elderly in the population is expected to increase. The palliative team has an important role in providing support for the palliative patient and their caregivers during in home care. Purpose: Compilation of caregivers’ perception of the support from the palliative team during in home care for the palliative patient and their suggestions for improvements in support from the palliative team.Method: A quantitative and qualitative registry study. Data received from the Swedish Palliative Registry caregiver survey, summarized by the registry technician, was sent via a Microsoft Word file to the author. Descriptive analysis by calculations of frequency, percent, standard deviation and variation width. In the qualitative section all suggestions from caregivers’ were analyzed with summative content analysis. Keywords counted and divided into five codes; information needs, communication and dialogue, support interventions and level of care for the palliative patient. Result: A majority of the caregivers’ were satisfied the support received from the palliative team and information received regarding the follow-up interview after the passing of the palliative patient, knowledge of who was the primary care physician during the palliative patient’s last week of life and how to contact him/her, where to turn in an acute situation and the expected death of the palliative patient. Caregivers’ suggestions for an improvement in support included needs for increased information, better communication and dialogue, actions for support and level of care for the palliative patient. Conclusion: A majority of the caregivers were satisfied with the support received from the palliative team during the time they cared for the palliative patient at home. Caregivers’ suggestions included needs for increased information, better communication and dialogue, actions for support and level of care for the palliative patient.

<p>Att vårda en närstående person med demens innebär en stor börda för anhörigvårdaren vilket kan resultera i psykisk ohälsa. Stöd är en viktig del för att minska bördan. Syftet med studien var att ur ett omvårdnadsperspektiv belysa anhörigas upplevelse av psykosocial börda och psykosocialt stöd vid vård av en person med demens i hemmet. Studien var en systematisk litteraturstudie som baserades på 15 vetenskapliga artiklar. I resultatet framkom att anhöriga som vårdar en person med demens upplevde en psykisk och fysisk börda. Den tyngsta psykiska bördan uppgavs vara brist på egen tid och att känna sig isolerad från omvärlden. Anhörigvårdarens individuella uppfattning om sig själv och förhållandet till personen med demens påverkade bördan. Informellt socialt stöd visade sig viktigt och minskade risken för depression. Det framkom att socialt stöd och stödgrupper var betydelsefullt för den anhörige. De anhöriga kände att de inte fick det stöd som behövdes från hälso- och sjukvårdpersonal. Därför behövs mer kunskap hos formella vårdgivare för att kunna möta behovet av stöd för anhöriga till en person med demens. Ökad kunskap och förståelse om psykosocial börda ger sjuksköterskan större förutsättningar att kunna ge anhörigvårdaren ett adekvat stöd. Ytterligare forskning krävs för att utvärdera sjuksköterskans roll som psykosocialt stöd.</p>

Att vårda en närstående person med demens innebär en stor börda för anhörigvårdaren vilket kan resultera i psykisk ohälsa. Stöd är en viktig del för att minska bördan. Syftet med studien var att ur ett omvårdnadsperspektiv belysa anhörigas upplevelse av psykosocial börda och psykosocialt stöd vid vård av en person med demens i hemmet. Studien var en systematisk litteraturstudie som baserades på 15 vetenskapliga artiklar. I resultatet framkom att anhöriga som vårdar en person med demens upplevde en psykisk och fysisk börda. Den tyngsta psykiska bördan uppgavs vara brist på egen tid och att känna sig isolerad från omvärlden. Anhörigvårdarens individuella uppfattning om sig själv och förhållandet till personen med demens påverkade bördan. Informellt socialt stöd visade sig viktigt och minskade risken för depression. Det framkom att socialt stöd och stödgrupper var betydelsefullt för den anhörige. De anhöriga kände att de inte fick det stöd som behövdes från hälso- och sjukvårdpersonal. Därför behövs mer kunskap hos formella vårdgivare för att kunna möta behovet av stöd för anhöriga till en person med demens. Ökad kunskap och förståelse om psykosocial börda ger sjuksköterskan större förutsättningar att kunna ge anhörigvårdaren ett adekvat stöd. Ytterligare forskning krävs för att utvärdera sjuksköterskans roll som psykosocialt stöd.

Syftet med denna studie har varit att undersöka och jämföra hur fyra professionella inom olika människovårdande yrkesgrupper uppfattar sina möjligheter att uppmärksamma och hjälpa barn som upplever föräldrars konflikter med anledning av separation. Studien har genomförts med hjälp av en kvalitativ metod genom att intervjua en: skolkurator, skolpsykolog, samordnare och familjerättssekreterare. De teoretiska utgångspunkter vi använt oss av är professionsteori med begreppen jurisdiktion och handlingsutrymme samt nyinstitutionell teori inbegripande begreppet organisatoriskt fält. Utifrån dessa teorier och begrepp har vi undersökt och jämfört hur en skolkurator, en skolpsykolog, en samordnare och en familjerättssekreterare enskilt och i jämförelse med varandra beskriver sitt arbeta, om problematiken framkommer i yrkesgruppernas arbete samt hur de arbetar i möten med barn. Alla informanter beskriver att barn kan må dåligt av föräldrars konflikt med anledning av separation. I vissa fall, och i olika utsträckning kan detta komma till uttryck i mötet med de professionella i studien. De uttryck hos barnen som lyfts fram i studien är dåligt mående, beteendeproblem, koncentrationssvårigheter och försämrade skolprestationer. Representanterna från de olika professionerna har olika förutsättningar att hjälpa dessa barn beroende på deras olika utgångspunkter och arbetsuppgifter / The purpose of this qualitative study is to examine and compare how professionals in four groups in Human Services perceive their possibilities to see, understand and help children who experience parental conflicts due to separation. A qualitative method has been used, where the selection of participants was made through appropriate sampling. The theoretical basis applied involves professional theory with the concepts jurisdiction and scope for action, as well as new institutional theory including the concept organizational field. Based on these theories and concepts we have examined and compared how the professionals from four occuapational groups; school counselor, school psychologist, coordinator and secretary of family law, individually and in comparison with each other, describe their work with this type of problems and how they act in meetings with children. The results show that the professionals have the experience that children may feel bad about the conflict between their parents in connection with separation. In some cases, and to a varying extent, this may be expressed in meetings with the professional groups in the study. The reactions of the children highlighted in the study are bad mood, behavioral problems, difficulty to concentrate and deteriorating school performance. The professionals from the different professional groups, depending on their jurisdiction and scope for action, have different abilities to help the children showing these reactions.