The aim of this study was to develop a Gestalt play therapy based hospital preparation program for children undergoing the surgical procedures of grommet insertion, or grommet insertion and adenoidectomy, at Tygerberg Hospital. Literature was reviewed according to relevant topics, namely otitis media in children, Gestalt play therapy, theories of child development, and children's experience of illness and hospitalisation. Semi-structured interviews were conducted with four subject groups and the data obtained was qualitatively analysed. Research findings were discussed and integrated with reference to the literature. This information was applied in the development of the proposed program. The aim, underlying principles, objectives and components of the program were discussed and guidelines for implementation were provided. The program was implemented and evaluated in a single subject pilot study, which yielded a positive response. Recommendations for both practical implementation in a therapeutic context and further study in a research context were made. OPSOMMING Die doel van hierdie studie was om `n Gestalt spelterapie-gebaseerde hospitaalvoorbereidingsprogram te ontwikkel vir kinders wat die chirurgiese prosedures van ventilasiebuis-plasing of ventilasiebuis-plasing en adenoïdektomie by Tygerberg-hospitaal ondergaan. `n Literatuurstudie is uitgevoer rakende relevante onderwerpe; naamlik, otitis media in kinders, Gestalt spelterapie, kinderontwikkelingsteorieë, en kinders se ervaring van siekte en hospitalisasie. Semi-gestruktureerde onderhoude is met vier subjekgroepe uitgevoer en die data wat verkry is, is kwalitatief geanaliseer. Navorsingsbevindinge is bespreek en geïntegreer met verwysing na die literatuur. Hierdie inligting is toegepas in die ontwikkeling van die voorgestelde program. Die doel, onderliggende beginsels, doelstellings en komponente van die program is bespreek en riglyne vir die implementering daarvan is verskaf. Die program is geïmplimenteer en geëvalueer in `n enkelsubjek loodsstudie, waar `n positiewe respons verkry is. Aanbevelings vir beide praktiese implementering in `n terapeutiese konteks en verdere studie binne navorsingskonteks is gemaak. / Social Work / M.Diac.

During the researcher's work with looked after children for the past four years, it became clear that adolescent placements were much more likely to break down than others. Although there is some literature about foster placement breakdowns, the researcher did not really get an answer as to the causes of adolescent placement breakdowns. This study therefore explores causal factors of adolescent placement breakdowns as seen by foster carers, adolescents and professionals. It is evident from this study that there are no easy answers. Although the adolescent, as much as any other child, craves to belong, to be listened to and be respected, it seems that it is not always possible for foster carers to put this into practice, given the challenging behaviour that adolescents often display. Recommendations are based on relevant literature and the empirical study, in the hope that it might be useful to those with an interest in this field. / Social Work / M.Diac. (Play Therapy)

The researcher wanted to explore the experiences of children who removal by a social worker either to an institution or to foster homes. The researcher wanted to find out if the behaviour of absconding could be explained by using systems theory, contructivism, cybernetics and person- centered theory. The researcher hypothesized that children abscond from alternative care as a means of communicating with the social worker involved as well as any other person significant in their lives. The study wanted to explore how these children perceived their involvement in the decision making process of their removal. The researcher only interviewed children who had absconded from the alternative care placements. The study found that all the children interviewed perceived that they were not involved in any way in the process of removal. They all saw their removal as a form of punishment for something they did wrong, but they did not get an opportunity to discuss with their parents or significant others. They also perceived their absconding as an effort to rectify the situation. A lot of anger and suspicion towards social workers was encountered during the study. In terms of the theories mentioned above, these perceptions are the children’s own reality, which might differ from the realities as created or perceived by social workers. It is hypothesized that social workers who use the Child Care Act 74/83 and its regulations in the removal of children, do it to protect the children from risky situations as their job responsibility requires. This study indicates that the children did not experience removal as protection. Instead of children feeling protected in the alternative care, they felt blamed, judged and unhappy about their removal and excluded from the process. The researcher made a few suggestions that could be considered when social workers removing children to alternative care. It is recommended that social workers involve the children and their parents or significant others in the entire process of deciding the future of any children in their (parents’) care. However, if removal is deemed necessary, just telling or informing children that they will be removed for their own safety is not enough. Children might not perceive the situation as dangerous. Instead, they might see the social worker as posing a danger to them and their families and thus try to shut the social worker and what s/he says out of their minds. Findings safe ways to involve children and families in the decisions about their future may require of social workers to revive their academically acquired knowledge in this respect. / Social Work / M.A. (Social Sciences (Mental Health))

Social Work / D.Phil. (Social Work)

A description of the developmental characteristics of adolescents and the effect of deafness, on the cognitive emotional and social development of the Deaf adolescent boy is given. At a stage, when the parents influence is crucial in any child's upbringing, the Deaf child, mainly because of his/her need for special educational services is placed in a school hostel at an early age. The aim of the investigation was two-fold: • Firstly, from thl! literature study, to analyze and describe the educational distress of the Deaf adolescent boy residing in the school hostel. Secondly, to conduct an empirical survey consisting of structured questionnaires in order to ascertain the kind of support rendered to the Deaf adolescent boy in the hostel. From the literature study and the empirical survey a training/educational programme was designed to promote the educational skills of hostel parents at schools for Deaf adolescent boys. / Inclusive Education / M.Ed.(Orthopedagogics)

Text in Afrikaans / In die studie word die ontwikkelingspad van 'n Newtoniaanse benadering na 'n ekosistemiese benadering in die denke van die navorser en lewering van pleegsorgdienste deur die maatskaplike werker/navorser, beskryf. In die beskrywing is gefokus op drie beginsels elk van die Newtoniaanse - en die ekosistemiese benaderings. Die gekose beginsels is met 'n gevallestudie geillustreer. Aan die ha d van die beginsels van die ekosistemiese benadering word 'n konsepsuele raamwerk gebied waardeur die outonomie van mense en sisteme in stand gehou en gebruik kan word. Volgens tweede orde kubernetika, is die studie die konstruksie van die navorser. Pleegsorg is 'n komplekse alternatiewe versorgingsposisie vir 'n kind en die lewering van begeleidingsdienste stel besondere eise aan die professionele persone betrokke. Hierdie studie suggereer dat pleegsorgdienste wat aan die hand van die ekosistemiese benadering gelewer word, 'n konstruksie van gedeelde verantwoordelikheid tussen al die betrokke partye voorstel. / Social Work / M. A. (Social Science: Mental Health)

Introdução:O comprometimento de determinados grupos musculares e alterações sensório motoras são algumas das características apresentadas por crianças com paralisia cerebral, fazendo-se necessária a utilização de andadores e estabilizadores para auxiliar no ortostatismo e na marcha desses pacientes. Atualmente, existem equipamentos que favorecem estes aspectos, porém o custo ainda é bastante alto, tornando-os inacessíveis a uma grande parcela da população. Com o intuito de se apresentar uma alternativa de qualidade e custo reduzido, desenvolveu-se na UTFPR um andador/ estabilizador baseado no protocolo PediaSuit™, confeccionado em PVC. O suporte é dado através de elastômeros fixados a um cinto, permitindo assim uma marcha mais próxima do natural. Objetivo: Avaliar a marcha e a postura de crianças com Paralisia Cerebral a partir do uso de uma Unidade Terapêutica Domiciliar de baixo custo e baixa mecanização. Método: Foram realizados testes visando analisar a resistência mecânica do material utilizado e ensaios com o protótipo construído. O PVC mostrou ser um material com alta resistência nos testes de flexão e impacto. A massa máxima suportada pelo andador no teste realizado foi de aproximadamente 226 kg. Após a avaliação do equipamento, três crianças foram filmadas utilizando o andador em PVC e um andador comum. Aspectos da marcha e da postura foram avaliados por trinta fisioterapeutas através desses vídeos.Resultados: O andador em PVC apresentou melhores resultados em relação a todos os aspectos da marcha avaliados, promovendo uma deambulação mais próxima do normal. Em relação à resistência mecânica, os ensaios mostram que o PVC Ø32mm é um material adequado para a confecção de equipamentos de tecnologia assistiva, por ser capaz de suportar cargas elevadas sem se romper. A utilização desse material também proporcionou uma redução significativa no custo final do equipamento / Introduction: The involvement of certain muscle groups and sensorimotor deficits are some of the characteristics displayed by children with cerebral palsy, making necessary the use of stabilizers and gait trainers to assist posture and gait of those patients. There are assistive technology devices that promote these aspects, but the cost is still quite high, making them inaccessible to most people. In order to present an alternative with lower cost, a PVC stabilizer/ gait trainer based on PediaSuit™ protocol was developed at UTFPR and Vitória Research Center. The support is provided by elastomers fixed to a belt, thereby allowing a more natural gait pattern. Objective: To evaluate the gait and posture of children with cerebral palsy during the use of a low cost/ low mechanization Therapy Unit Homecare. Method: Some tests were carried out to determine the strength of the prototype and the material itself. PVC proved to be a material with high strength in bending and impact tests. The maximum mass supported by the walker in the test conducted was approximately 226 kg. After evaluating the equipment, images of three children using a reguar gait trainer and the PVC home care unit were taken. Aspects of gait and posture were analysed by thirty physiotherapists through these videos. Results: The PVC home care unit showed better results in regarding all aspects of gait evaluated by promoting closer to normal gait. The mechanical strength tests show that PVC Ø32mm is a suitable material for fabrication of assistive technology equipment, to be able to withstand high loads without breaking. The use of this material also provided a significant reduction in the final cost of the product.

Esta pesquisa resulta do estudo realizado com professores do Atendimento Pedagógico Domiciliar na cidade de Curitiba - PR e suas concepções quanto a utilização de jogos didáticos no ensino e aprendizagem de conceitos científicos das disciplinas de Ciências e Biologia, Física, Matemática e Química. Apresenta os conceitos de Educação Inclusiva e Especial ressaltando o conceito de Atendimento Pedagógico Hospitalar e Domiciliar. Ainda destaca a estratégia da utilização dos jogos didáticos como fator de contribuição para o desenvolvimento de habilidades cognitivas e da autoestima seriamente comprometida em função da doença do aluno atendido por esse programa da Secretaria de Educação do Estado do Paraná. Os jogos foram selecionados na internet sendo que já haviam sido testados e com resultados já registrados. A produção foi artesanal. Para o levantamento de dados foram utilizadas perguntas semiestruturadas por meio de questionário e posterior entrevista com os professores do APD. A metodologia utilizada para a análise de dados foi a de estudo de caso com enfoque qualitativo. Segundo os professores entrevistados, os jogos didáticos confirmaram ser excelente estratégia de ensino e aprendizagem enriquecendo as aulas e proporcionando aos alunos a oportunidade de aquisição do conhecimento de forma leve e divertida. / This research is the result of a study conducted with teachers Pedagogical Household Care in Curitiba - PR and conceptions about the use of educational games in teaching and learning of scientific disciplines of science and biology, physics, mathematics and chemistry concepts. Introduces the concepts of Inclusive Education and Special highlighting the concept of Hospital and Home Teaching Service. Also highlights the strategy of using educational games as a contributing factor for the development of cognitive skills and self-esteem seriously compromised because of the student served by this program the Department of Education of the State of Paraná disease. The games were selected on the internet of which had already been tested and results have already registered. The production was handmade. Semi- structured questions were used by a questionnaire and subsequent interviews with the teachers of the DPA for data collection. The methodology used for the data analysis was a case study with qualitative approach. . According to the interviewed teachers, educational games confirmed to be excellent strategy for teaching and learning enriching classes and giving students the opportunity to acquire the knowledge of light and fun way. / 5000

Introdução:O comprometimento de determinados grupos musculares e alterações sensório motoras são algumas das características apresentadas por crianças com paralisia cerebral, fazendo-se necessária a utilização de andadores e estabilizadores para auxiliar no ortostatismo e na marcha desses pacientes. Atualmente, existem equipamentos que favorecem estes aspectos, porém o custo ainda é bastante alto, tornando-os inacessíveis a uma grande parcela da população. Com o intuito de se apresentar uma alternativa de qualidade e custo reduzido, desenvolveu-se na UTFPR um andador/ estabilizador baseado no protocolo PediaSuit™, confeccionado em PVC. O suporte é dado através de elastômeros fixados a um cinto, permitindo assim uma marcha mais próxima do natural. Objetivo: Avaliar a marcha e a postura de crianças com Paralisia Cerebral a partir do uso de uma Unidade Terapêutica Domiciliar de baixo custo e baixa mecanização. Método: Foram realizados testes visando analisar a resistência mecânica do material utilizado e ensaios com o protótipo construído. O PVC mostrou ser um material com alta resistência nos testes de flexão e impacto. A massa máxima suportada pelo andador no teste realizado foi de aproximadamente 226 kg. Após a avaliação do equipamento, três crianças foram filmadas utilizando o andador em PVC e um andador comum. Aspectos da marcha e da postura foram avaliados por trinta fisioterapeutas através desses vídeos.Resultados: O andador em PVC apresentou melhores resultados em relação a todos os aspectos da marcha avaliados, promovendo uma deambulação mais próxima do normal. Em relação à resistência mecânica, os ensaios mostram que o PVC Ø32mm é um material adequado para a confecção de equipamentos de tecnologia assistiva, por ser capaz de suportar cargas elevadas sem se romper. A utilização desse material também proporcionou uma redução significativa no custo final do equipamento / Introduction: The involvement of certain muscle groups and sensorimotor deficits are some of the characteristics displayed by children with cerebral palsy, making necessary the use of stabilizers and gait trainers to assist posture and gait of those patients. There are assistive technology devices that promote these aspects, but the cost is still quite high, making them inaccessible to most people. In order to present an alternative with lower cost, a PVC stabilizer/ gait trainer based on PediaSuit™ protocol was developed at UTFPR and Vitória Research Center. The support is provided by elastomers fixed to a belt, thereby allowing a more natural gait pattern. Objective: To evaluate the gait and posture of children with cerebral palsy during the use of a low cost/ low mechanization Therapy Unit Homecare. Method: Some tests were carried out to determine the strength of the prototype and the material itself. PVC proved to be a material with high strength in bending and impact tests. The maximum mass supported by the walker in the test conducted was approximately 226 kg. After evaluating the equipment, images of three children using a reguar gait trainer and the PVC home care unit were taken. Aspects of gait and posture were analysed by thirty physiotherapists through these videos. Results: The PVC home care unit showed better results in regarding all aspects of gait evaluated by promoting closer to normal gait. The mechanical strength tests show that PVC Ø32mm is a suitable material for fabrication of assistive technology equipment, to be able to withstand high loads without breaking. The use of this material also provided a significant reduction in the final cost of the product.

Introduction<p>Dans le monde, presque 10,6 millions d’enfants meurent chaque année avant d’avoir atteint leur cinquième anniversaire. En dépit de l’existence théorique d’interventions curatives efficaces, on constate que la mortalité intrahospitalière peut demeurer très élevée dans les services de pédiatrie de nombreux pays à faible revenu notamment en Afrique. Pour améliorer la prise en charge des enfants dans ces hôpitaux et par conséquent la survie des enfants, il est nécessaire avant tout de faire le constat de la situation et de la reconnaître, d’en analyser les causes, de s’attaquer aux déterminants vulnérables et de se doter d’outils d’évaluation de la qualité de soins dans les hôpitaux. En tant que pédiatre oeuvrant à l’HPG, j’ai constaté que la mortalité intrahospitalière était élevée. Fruit d’une démarche personnelle, ce travail avait pour objectif global la réduction de cette mortalité.<p>Pour y arriver, les objectifs spécifiques étaient les suivants :<p>1) Décrire et évaluer la qualité des soins intrahospitaliers chez les enfants à l’HPG.<p>2)Préciser la mortalité intrahospitalière globale ainsi que les mortalités spécifiques.<p>3)Etudier l’importance des facteurs associés à la surmortalité des enfants à l’Hôpital Provincial de Goma.<p>4)Construire un modèle de prédiction de la mortalité globale intrahospitalière ainsi qu’un score pronostique adapté au contexte.<p>5)Mettre en place un programme de formation et de supervision du personnel médical et paramédical.<p>6)Etudier l’impact de ce programme sur la mortalité intrahospitalière. <p><p>Méthodologie<p>Les analyses ont porté sur les données des études qui se sont déroulés dans le service de pédiatrie de l’hôpital provincial de Goma (HPG), il s’agit des études suivantes: une étude descriptive d’observation d’évaluation de la qualité des soins intrahospitaliers des enfants en décembre 2004 (étude qualitative utilisant la méthode de Nolan), une étude de cohorte prospective intrahospitalière portant sur les indicateurs prédictifs de la mortalité (du 1er avril 2003 au 31 mars 2004) (« avant ») ,suivi d’une intervention dont l’impact avait été évalué de nouveau par une étude de cohorte prospective intrahospitalière (du 1er janvier 2005 au 31 décembre 2005) (« après ») (étude d’intervention quasi-expérimentale). <p><p>Résultats<p>Les résultats du travail étaient les suivants :<p>A) -Les facteurs qui augmentent le risque de décès étaient la référence tardive et la sévérité de la maladie à l’admission. <p>-Les facteurs limitant la qualité de la prise en charge et qui contribuaient probablement au mauvais pronostic étaient :<p>1)A l’admission, le triage n’était pas toujours correctement fait, les soins d’urgences étaient retardés l’après-midi et la nuit et 12% des admissions étaient différés. Il n’y avait pas de grille d’évaluation initiale, ni des guides pratiques de l’OMS, ni les guides standardisés de prise en charge, ni de kit d’urgence.<p>2)En hospitalisation, il y avait une insuffisance en nombre du staff (surtout l’après-midi et la nuit), le monitoring de base et les soins infirmiers étaient insuffisants surtout la nuit, les cliniciens notaient les signes cliniques, mais ne les documentaient pas toujours, le délai pour avoir le diagnostic était trop long et l’indisponibilité des médicaments prescrits.<p>-Le staff du service avait des connaissances théoriques et pratiques insuffisantes et une motivation insuffisante<p>B)-Durant la première étude de cohorte, une mortalité globale de 15,9% et des mortalités spécifiques anormalement élevées ont été observés. Les enfants les plus à risque de décès avaient, à l’admission, les caractéristiques suivantes :un âge < 1 an, un périmètre brachial < 115 mm ou un retard de croissance pondérale (-3< Z-PPA ≤ -2 et Z-PPA ≤ -3), une altération de la conscience, une raideur de la nuque, un tirage intercostal et une infection.<p>C)-Ces premières données avaient permis de construire le modèle Goma1 basé essentiellement sur les indicateurs suivants :l’âge,le périmètre brachial, l’état de conscience et le type d’infection. Grâce au score pronostique, il était destiné à la sélection à l’admission des enfants à risque élevé de décès pour une admission en soins intensifs et à la standardisation de la mortalité en vue de l’évaluation de la qualité de prise en charge. <p>D)-Une intervention a été menée, en décembre 2004 portant essentiellement sur la formation et la supervision du personnel de santé œuvrant à l’HPG. Grâce à une évaluation avant-après, on a pu déterminer l’impact probable de cette intervention :la mortalité globale a diminué de 15,9% (avant l’intervention) à 4,6% (après l’intervention) et restait toujours plus basse après l’intervention et après ajustement à l’aide du modèle. <p><p>Conclusions<p>La mortalité pédiatrique intrahospitalière est généralement beaucoup trop élevée et c’était le cas à l’HPG.<p>Notre démarche après ce constat et l’évaluation de la qualité des soins donnés aux enfants sur base d’un questionnaire qualitatif a été d’intervenir sur un des points mis en exergue par cette évaluation (formation et supervision du personnel insuffisante) et d’évaluer l’impact de ce programme sur la mortalité globale.<p>Les résultats ont suggéré un impact positif de ce programme (mortalité globale de 15,9% avant l’intervention et de 4,6% après l’intervention).<p>Si de nombreuses critiques liées à la méthodologie (évaluation uniquement qualitative, étude quasi-expérimentale avant-après, intervention limitée, etc) doivent être épinglées et limitent la portée de ce travail, la démarche entreprise a cependant permis de mobiliser le personnel de santé œuvrant dans des conditions difficiles, autour d’un projet commun et améliorer ainsi la prise en charge des enfants hospitalisés à l’HPG. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished