The purpose of this study was to explore the challenges parents of children with mental health disabilities and disorders in Namibia face when attempting to access mental healthcare resources. The study used a qualitative exploratory approach. Purposive sampling was used to include parents, caregivers and relatives of children with metal health disabilities and disorders. The sample also included key informants. Data was collected through focus group discussions with the participants and individual interviews with the key informants. Overall, a total of 41 people provided information for this study. Thematic data analysis was used to assess the data. The results suggest that parents/caregivers and relatives of children with mental health disabilities and disorders do experience barriers accessing mental health care. The challenges go beyond commonly-reported problems in the literature such as stigma and discrimination and include basic challenges such as a lack of transportation to healthcare services and a lack of acceptance of the mental health disorders by the parents. The study offers recommendations for how service provision can be improved and how parents of children with mental health challenges can have better access to services.

The aim of the present thesis is to evaluate the effects of an Intensified Primary Health Care (IPHC) intervention on GPs' and home care nurses' possibilities to monitor and support cancer patients, and on cancer patients utilisation of medical services. A further aim is to identify determinants of cancer patients' utilisation of such services. A total of 485 patients newly diagnosed with breast, colorectal, gastric or prostate cancer were randomised to the intervention or to a control group. The follow-up period was 24 months for all patients. Patients randomised to the IPHC were referred to the home care nurse. The home care nurse and the GP received copies of the medical record each time the patient was discharged from hospital after a period of in-patient care, or had visited a specialist out-patient clinic. In addition to this, recurrent education and supervision in cancer care were arranged. The IPHC resulted in a marked increase of home care nurse follow-up contacts. The majority of control patients (74%) reported no such contacts, while 89% of IPHC patients reported this. High age (=80 yr) was the strongest predictor within the IPHC group for reporting a continuing home care nurse contact. Furthermore, the IPHC increased GPs' knowledge about patients' disease and treatments, and appeared to facilitate their possibilities to support the patients. The IPHC reduced the utilisation of specialist care among elderly cancer patients. The number of days of hospitalisation for older patients (=70 yr) randomised to the IPHC were 393 less than for older control patients during the 3 first months after inclusion. Regression analyses defined diagnosis, extensive treatment, comorbidity, low functional status, pain and socio-economic factors as predictors of a high utilisation of medical services.

Sammanfattning Inledning: Allt mer av distriktssköterskans omvårdnadsarbete går mot att vårda människor i livets slut. Döendet för med sig existentiella tankar som kan orsaka ångest hos patienter och deras närstående. Bakgrund: Palliativ vård förebygger och lindrar lidande genom tidig upptäckt, noggrann analys och behandling av smärta och andra fysiska, psykosociala och existentiella problem. Den innefattar även stöd till närstående under och efter vårdtiden. Syftet med studien var att undersöka hur distriktssköterskor upplever ångest i livets slutskede, hos döende patienter, deras närstående och sig själva, med fokus på orsaker Metod: Studien har en kvalitativ design där fyra fokusgruppsintervjuer har genomförts med sammanlagt 20 distriktssköterskor. Kvalitativ innehållsanalys användes för att analysera datamaterialet. Resultat: Sjuksköterskorna beskrev att brist på trygghet och tillit skapade ångest för patienter och deras närstående. Känslor av otillräcklighet gav ångest hos sjuksköterskorna. Mötet med döden väckte existentiella tankar och utlöste ångest hos patienter, deras närstående och sjuksköterskorna. Kontinuitet och tillgänglighet var viktiga för att ge trygghet. Sjuksköterskorna ansåg att bästa sättet att bearbeta och hantera svåra situationer var att samtala med kollegor och stödja varandra. Konklusion: Studien visar att tid och trygghet är centralt för att lindra ångest hos patienter, närstående och distriktssköterskor i palliativ vård. Palliativ vård är utmanade, kräver mod och kreativitet. Nyckelord: Palliativ vård, hemsjukvård, distriktssköterskor, ångest / Introduction: Today, community health nurses work increasingly more with the provision of end-of-life care. Dying and the existential dimension may cause anxiety in patients and their family. Background: Palliative care prevents and relieves suffering through early detection, careful analysis and treatment of pain and other physical, psychosocial and existential problems. It also includes support for the family during and after the period of care. Aim: The purpose of this study was to examine how community health nurses experienced anxiety during the last phase of a patient’s life. The nurses' experience of anxiety in dying patients, their families and in the nurses themselves was examined with a focus on the causes and attitudes. Design and method: The study used a qualitative design where four focus group interviews were conducted with 20 community health nurses. The data was analyzed using qualitative content analysis. Results: Nurses felt that lack of safeness and confidence created anxiety in patients and their families. Feelings of inadequacy created anxiety among nurses. According to the nurses encounter with death brought on existential thoughts and created anxiety among patients, their families and the nurses themselves. Continuity and accessibility were important to provide safeness. The nurses felt that the best way to process and handle difficult situations was through discussion with colleagues and by giving each other support. Conclusion: This study shows that according to nurses’ experiences, time and safeness are central to relieve anxiety in patients, family members and community health nurses in palliative care. Palliative care is challenging, demands courage and creativity.

Syftet var att undersöka hur sjuksköterskor, inom hemsjukvården, uppfattar sin egen kompetens och sitt behov av stöd i relation till sina arbetsuppgifter. Metoden är en enkätstudie. Enkäten förmedlades via e-post. Urvalet utgjordes av 131 sjuksköterskor inom hemsjukvården i en större stad i Mellansverige, varav 15 av sjuksköterskorna deltog i studien. Resultatet visar att den egenuppfattade kompetensen hos deltagarna var hög och majoriteten av de sjuksköterskor som medverkade känner sig trygga i att arbeta självständigt och att utföra sitt uppdrag som sjuksköterska inom hemsjukvården. Stödet från sjuksköterskekollegor anses som viktigt, dock önskas mer tid eller möjlighet att diskutera patienters vårdproblem. Att ha en bra arbetsrelation med sin läkare upplevs som mycket viktigt hos deltagarna. Majoriteten önskade ett mer omfattande samarbete med läkaren. Slutsatsen är att sjuksköterskorna inom studien uppfattade sin egen kompetens som bra och samtliga känner sig bekväma med att jobba självständigt. Att ha bra arbetsrelationer med kollegor och läkare är mycket viktigt för studiedeltagarna däremot anser några deltagare att de inte alltid kan räkna med sina sjuksköterskekollegor i svåra situationer. Majoriteten av sjuksköterskorna önskade ett mer omfattande samarbete med läkaren. Urvalet i studien var litet och bortfallet var stort, därför behövs en mer omfattande studie inom området. / Aim: The purpose of this study was to describe registered nurses (RNs) perceptions of their competence within the municipal elderly care and their need of support in relation to their job assignment. Method: A questionnaire survey. The questionnaire was delivered electronically as an email. The sample consist of 131 RNs within the municipal elderly care in a large city in the middle of Sweden. 15 of the RNs engaged in the study. Results: The RNs perceive their competence as high and the majority feel secure to perform their job assignment. The support from their nurse colleagues is considered important, however more time and opportunities to discuss care issues is desirable. A good labour relation with the physician is considered important among the respondents. The majority wishes a better physician-nurse teamwork. Conclusion: The RNs perceive their competence as good and the majority feel secure to perform their job assignment independent. A good labour relation with the colleagues and physician is considered important. However some RNs doesn’t believe that they can count on their colleagues in difficult situations. The majority of the RNs desires increased teamwork with the physician. Future interventions are needed with larger sample and a lesser falling off.

Purpose: Our aim is to get an insight on how home care workers experience, handle and looks upon their work. We also want to form an opinion of how home care workers experience the relationship to the clients they meet. Questions: How does home care workers experience their daily work with their clients? Home care workers daily meet many different sorts of clients with different needs, how do they handle this? What kind of support does home care workers get in their work? Method: A qualitative design with semistructured interviews. Conclusion: The most central conclusion from all of our interviews were: that home care service workers has a very stressful and demanding occupation, that the work has a low status, that the personnel has a big responsibility for the wellbeing of other people and that they often find their work satisfying and fun. To have someone to talk to and exchange ideas with was also mentioned by the informants as a vital part of feeling support in their work. From the Antonovskys theory, a sense of coherence, and Goffmans views of the society, we also find that the larger part of our informants feel a high sense of coherence and that when they have to adjust to their different caretakers they play different roles.

Thesis (Ph. D.)--University of California, San Diego, 2004. / Vita. Includes bibliographical references (leaves 263-283).

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Social Work / Master / Master of Social Sciences

published_or_final_version / Social Work / Master / Master of Philosophy

Infection control practices are a critical element in home-based care for people living with HIV/AIDS. It involves principles and procedures used to minimize the risk of spreading infections in home-based care. Infection control practices help to prevent morbidity, mortality rates and improve health for the volunteer caregivers and the patients. However, most previous studies on home-based care have focused on burdens of care, perceptions of rewards, quality of care and challenges faced by caregivers. Therefore, it is not clear how and to what extent infection control practices are carried out in home-based care. The purpose of this study is to explore the experiences of home-based care coordinators and volunteer caregivers regarding infection control practices in home-based care. Qualitative interviews were conducted with ten home-based care coordinators/project managers and ten focus group discussions were conducted with volunteer caregivers. An interview guide and a focus group schedule with open ended questions were used. Volunteer caregivers in home-based care organizations were faced with practical challenges regarding infection control practices that posed a threat to their work and health. The received insufficient infection control material resources such as gloves, masks and sanitizers. They also mentioned to have received poor quality gloves that easily broke, poor quality aprons that were not tight; easily blown by the wind and also thin masks that could not filter the bad odour. Other challenges that they faced included, insufficient water supply; insufficient knowledge on infection control and lack of cooperation from some patients and some family members regarding the use of protective clothing especially gloves and masks. Most volunteer caregivers were ridiculed by some family, community members and friends. Sometimes they could not access some patient due to HIV related stigma and discrimination. However, volunteers developed various strategies of dealing with these challenges such as replacing the torn gloves with plastics, carrying 2.5 litres of water, educating patients and family members about the importance of wearing gloves and practicing infection control. These findings require the government, NGOs, funders and donors to form a forum with volunteer caregivers to discuss the supply of materials. They need to establish a central administration that will be responsible for allocating adequate and quality materials for infection control practices. This central administration should also be responsible for supervising HBCOs including monitoring and evaluating infection control practices. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.