According to the Ministry of Health (1996:26), the most common chronic/terminal illnesses were cardiovascular disorders, diabetes, cancer, mental disorders, HIV/AIDS, tuberculosis and asthma. Long term treatment and care and the growing incidence of these conditions necessitated the introduction of home-based care (HBC). Consequently, family care givers play a major role in the provision of care to chronically/terminally ill patients and professional health care providers adopt a supervisory role. This study examined the quality of home care services provided in Botswana. The availability and accessibility of home-based care services and resources have a direct bearing on the quality of home-based care delivery system. The researcher used systems theory was used as the conceptual framework for this study. The study aimed to • determine the accessibility and availability of home-based care services in Molepolole East • investigate what the perspectives and experiences of family care givers, patients and professional health care providers of Botswana home-based care are • determine the roles of professionals health care providers, patients, and family care givers and their relationships in the context of home- based care • identify the needs of chronically/terminally ill patents and family care givers • determine the type of support given to family care givers and patients by professional health care providers and make recommendations for the improvement of home-based care • develop a model to prepare family care givers The research design combined quantitative and qualitative research methods. A sample of convenience was used to obtain information from patients' family care givers and professional health care providers. Interviews and questionnaires were used. A proposed care giving preparedness model is presented to meet needs of the family care givers. The study found that family care givers needs are neither known nor catered for by the professional health care provider. The family care givers were not adequately prepared before adopting the care-giving role. It is recommended that • The proposed preparedness care giving training model is considered for training of patients and family care givers before discharge and during HBC. • Increase patients and family care givers decision-making / Health Studies / D.Litt. et Phil. (Health Studies)

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

The impact of morbidity and mortality on women’s coping strategies has not been explored or documented in South Africa. Therefore, the main objective of this study was to investigate the influence of morbidity and mortality on coping strategies among 10 community vegetable garden clubs representing 79 households in the Maphephetheni uplands, rural KwaZulu-Natal. An innovative mix of qualitative and quantitative methodologies was used to determine the impacts of morbidity and mortality on women’s coping strategies. Qualitative research methodologies included group sustainable livelihoods analyses. Quantitative methodologies included three annual household surveys conducted between 2003 and 2005. The coping strategy index was also used to determine the levels of food insecurity and understand how morbidity and mortality compromised the coping ability of participating households. The coping strategy index has not been previously used in assessing the impact of morbidity and mortality on coping strategies. Chi-Square tests, Pearson correlation, paired-sample t-tests, and frequency and descriptive statistics were applied to analyse data. The study found that the key contribution of women in community gardening and non-farm activities was compromised by the burden of morbidity and mortality that had negative effects on women’s coping strategies. Findings indicated that the frequency of illness among garden club and household members increased between 2003 (21.2% of household members) and 2004 (25%). Similarly, more households (42% of the sample households) experienced a death in 2004 compared to 7.6 percent of households in 2003. As a result, costs associated with health care and funerals were significantly (P = 0.01) lower in 2003 than in 2004. Most garden club and household members relied on subsidised medication to treat illness. Number of households dependent on subsidised medication dropped from 86 percent of households in 2003 to 66.7 percent in 2004. In 2004, households reported purchasing medication in addition to subsidised medication. Caring for the sick and contributions to household chores were significantly (P = 0.01) correlated in 2003 and 2004. This means that increased caring for sick members resulted in increased workloads for women. Caring for the sick and engagement in community garden activities were significantly (P = 0.01) correlated in both 2003 and 2004, suggesting that caring for the sick reduced participation in community gardens. Analysis showed that reduced labour supply due to increased incidences of sickness and deaths, increased health care and funeral costs, reduced household income and increased care-giving minimised women’s ability to cope with adverse situations. Women used erosive coping strategies such as borrowing money, selling assets, limiting portion sizes at meal times and relying on less preferred and less expensive foods to cushion the effects of morbidity and mortality. Application of erosive coping strategies minimises household resilience to future shocks and stresses. Findings showed that farm and non-farm livelihood activities were critical components of rural livelihoods in Maphephetheni because sample households depended on community gardens, home gardens and small-scale non-farm enterprises for food and income to cushion the negative effects of morbidity and mortality. Community gardening contributed less to total monthly household income (4% of total monthly household income) than wages (41%), social grants (40.9%), home gardens (7%), small-scale enterprises (4.2%) and remittances (2.9%). Even though low, the contribution of community gardens to food security cannot be ignored considering the number of households (about 32% of sample households) that depended upon subsistence agriculture for food. Further analysis indicated that community gardens were themselves a coping strategy in the face of morbidity and mortality. Community gardens provided a risk aversion strategy and minimised risk by providing food resources and social and moral support for households facing hardship. Strategies to enhance household asset bases and promote more productive farm and non-farm activities are needed to improve resilience against the effects of morbidity and mortality. Government and non-governmental organisations need to establish a multi-purpose centre where women can learn agricultural and entrepreneurial skills to help households cope more effectively with shocks and stresses. However, such strategies should ensure that tasks allocated to various activities such as community gardening, non-farm activities and household chores such as fuel and water collection should be distributed equally across household members so that women do not carry excessive workloads since increased workloads reduce women’s ability to respond to livelihood insecurity shocks and stresses. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

Chapter 1 describes practical theology as a communicative operational science and stresses how important it is that a hermeneutical and narrative approach compliments it. It is shown that pastoral work must be launched from the church community. The premise is that the Enlightenment paradigm causes a reductionistic, individualistic and denominational approach to pastoral work. A holistic, comprehensive and ecologically orientated approach is proposed. Chapter 2 discusses the need for an ecosystemic approach as a metaparadigrn for practical theology in terms of the move away from the Newtonian view of science and the post-modem critiques of a technocratic society. This is supported by developments in systemic family therapy, constructionism and community psychology. Chapter 3 describes an interrelated ecclesiology as a base theory for practical theology and pastoral work with reference to the church's interrelation with society and the need to include an anthropology as part of an ecclesiology. This interrelationship implies that the serving (diakonia) and caring (koinonia) functions of the church should converge, forming a diaconal pastorate. In chapter 4 the secularised modem world-vie\v and the traditional African world-view, both functioning in South Africa, are employed to shed light upon the importance of the concept community for the church's pastoral work. The term community is broadened to include the idea of networking, emphasisingg that community is more than geographical proximity. Chapter 5 is a quantitative investigation. by means of a questionnaire, of the views (ecosystemic/non-ecosystemic) of pastoral workers regarding the church and of pastoral work. Chapter 6 discusses the implications of a community pastoral work approach. Pastoral work has a serving-caring role, but should also function prophetically, to conscientise. sensitise and empower people. The church as a healing community must become the springboard from which pastoral actions can face the challenge of AIDS (chapter 7). This will require the church to shift its paradigm from the reductionist, individualist approach, presently prevalent in society and church pastoral actions, to an all-encompassing. holistic one. / Philosophy, Practical and Systematic Theology / Th.D. (Practical Theology)

Department of Advanced Nursing Science / MCur

MPM / Oliver Tambo Institute of Governance and Policy Studies / See the attached abstract below

According to the Ministry of Health (1996:26), the most common chronic/terminal illnesses were cardiovascular disorders, diabetes, cancer, mental disorders, HIV/AIDS, tuberculosis and asthma. Long term treatment and care and the growing incidence of these conditions necessitated the introduction of home-based care (HBC). Consequently, family care givers play a major role in the provision of care to chronically/terminally ill patients and professional health care providers adopt a supervisory role. This study examined the quality of home care services provided in Botswana. The availability and accessibility of home-based care services and resources have a direct bearing on the quality of home-based care delivery system. The researcher used systems theory was used as the conceptual framework for this study. The study aimed to • determine the accessibility and availability of home-based care services in Molepolole East • investigate what the perspectives and experiences of family care givers, patients and professional health care providers of Botswana home-based care are • determine the roles of professionals health care providers, patients, and family care givers and their relationships in the context of home- based care • identify the needs of chronically/terminally ill patents and family care givers • determine the type of support given to family care givers and patients by professional health care providers and make recommendations for the improvement of home-based care • develop a model to prepare family care givers The research design combined quantitative and qualitative research methods. A sample of convenience was used to obtain information from patients' family care givers and professional health care providers. Interviews and questionnaires were used. A proposed care giving preparedness model is presented to meet needs of the family care givers. The study found that family care givers needs are neither known nor catered for by the professional health care provider. The family care givers were not adequately prepared before adopting the care-giving role. It is recommended that • The proposed preparedness care giving training model is considered for training of patients and family care givers before discharge and during HBC. • Increase patients and family care givers decision-making / Health Studies / D.Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / Technology dependent children such as those who require a feeding tube, tracheotomy or ventilator are a special group of chronically ill children who require complex care on a daily basis. When these children are hospitalized, the accompanying parent and the nurse caring for the child on the inpatient unit must communicate together about the care of the child. Care for the technology dependent child is optimized when parents and nurses both understand the plan of care for the child. To discover the process of parent-nurse communication that results in mutual understanding of the child’s plan of care, a grounded theory study to explore the perspectives of the parents of previously hospitalized technology dependent children was undertaken. The Theory of Shared Communication emerged from the data and illuminates the parent-nurse communication process. The antecedents of the process are respect for own and others expertise. The communication process consists of six communication behaviors; ask, listen, explain, advocate, verify understanding and negotiate roles. The behaviors are nested within each other and all are not necessarily required for the non-linear process to result in the relational outcome of mutual understanding of the child’s plan of care. An integrative review of the literature regarding the process of communication between parents of hospitalized chronically ill children and their nurses shed light on the components of the process, but no study was found that explicated the entire communication process. A subsequent grounded theory study added the perspectives of the nurses to the original theory. No new components of the process were uncovered, but the nurse’s narratives added significantly to our understanding of the communication process. Additionally, parents of currently hospitalized technology dependent children confirmed the propositions of the Theory of Shared Communication.

The focused of this study is the role of capacity building in Community Home Based Care (CHBC) for HIV/AIDS patients. The study forms part of my Master's in Development Administration programme, undertaken through UNISA. The dissertation was accomplished by studying the TASO community initiative in Sseeta-Nazigo, Mukono District, Uganda. It explores the concept of capacity building and its applicability to CHBC. The primacy data was gathered by conducting Key Infonnant Interviews (KIIs) and Focus Group Discussions (FGD). The secondary data was gathered by reviewing literature to augment the primary data. In addition, data was gathered through observations within the community. The fmdings have identified seven critical components of capacity building: community mobilisation, skills development, Information, Education and Communication (IEC) Voluntary Counselling and Testing (VCT), networking and collaboration, support and supervision, Monitoring and Evaluation (M&E). The study observed that capacity built in the above areas resulted in three outcomes: skills development, improvement in procedures, and institutional development. Informed recommendations were subsequently made related to the seven componentsof capacity building in CHBC / Development Studies / M. A. (Development Studies)

The focused of this study is the role of capacity building in Community Home Based Care (CHBC) for HIV/AIDS patients. The study forms part of my Master's in Development Administration programme, undertaken through UNISA. The dissertation was accomplished by studying the TASO community initiative in Sseeta-Nazigo, Mukono District, Uganda. It explores the concept of capacity building and its applicability to CHBC. The primacy data was gathered by conducting Key Infonnant Interviews (KIIs) and Focus Group Discussions (FGD). The secondary data was gathered by reviewing literature to augment the primary data. In addition, data was gathered through observations within the community. The fmdings have identified seven critical components of capacity building: community mobilisation, skills development, Information, Education and Communication (IEC) Voluntary Counselling and Testing (VCT), networking and collaboration, support and supervision, Monitoring and Evaluation (M&E). The study observed that capacity built in the above areas resulted in three outcomes: skills development, improvement in procedures, and institutional development. Informed recommendations were subsequently made related to the seven componentsof capacity building in CHBC / Development Studies / M. A. (Development Studies)