This study explored community-based Palliative Care nurses’ experiences of their work. The aim of this study was to explore the positive aspects of working in palliative care, as well as the challenges that community-based nurses experience in their work. The coping strategies that are employed by these nurses to deal with the difficulties of their work were understood, and the participants provided recommendations to their organisations to improve their working experiences. The research was conducted in two research settings, St Luke’s Combined Hospices and Tygerberg Hospice, which are both non-profit organisations providing Palliative Care in the community. Permission was gained to conduct research by the St Luke’s Combined Hospices Research Ethics Committee, and the Palliative Care Manager at Tygerberg Hospice. A qualitative research design was used to conduct this study, and purposive sampling was used to select the sample. Fourteen nurses were interviewed using a semi-structured interview schedule, and a digital recorder was used so that interviews could be recorded accurately. Qualitative data analysis was used to arrange the data into themes, categories and subcategories. Findings from the study indicate that there is a great sense of satisfaction from working in Palliative Care and positive aspects include feelings of honour and privilege, making a difference, appreciation from patients and families, life lessons learnt, having a role in the community and working in a team. The perceived challenges were emotional challenges such as persistent rumination about work, feelings of helplessness and dealing with challenging families. Organisational challenges pertained to demanding workloads and a lack of organisational support. Personal challenges were seen as having a negative impact on the physical health and family lives of participants. Lastly, environmental challenges included issues around safety and driving to communities. Coping strategies were the support from family and friends, avoidance coping and self-care as well as group support and debriefing and support from colleagues. Lastly, recommendations include an open-door policy within the organisation, improved training and education, a better understanding of community Palliative Care, improved interaction with staff and staff reward and recognition.

Includes abstract. / Includes bibliographical references (leaves 64-69). / This study explored Cotlands Hospice staff's perceptions of challenges and stressors which they experience in the workplace, in caring for HIV infants. This aim of this study was to highlight some of the key struggles that healthcare workers are faced with in the HIV workplace in caring for HIV positive infants. The study also explored the participants' current coping strategies used to cope with stressors from within the workplace and supportive resources available to aid the participants were identified. Lastly unmet needs identified by participants were explored and discussed.

Includes bibliographical references (leaves 70-75). / The research investigated the perceptions of the challenges faced by grandmothers caring for AIDS orphans in Khayelitsha, a township on the outskirts of Cape Town. The aim of this study was to make a contribution to an understanding of the challenges faced by grandmothers who are performing a surrogate parent role. The research focused on the grandmothers? perceptions of the types of challenges they faced in caring for AIDS orphans as well as their perceptions of the causes of these challenges. Lastly the research aimed to investigate the strategies employed by the grandmothers in dealing with these challenges and to ascertain whether or not grandmothers are aware of existing resources that are available to assist them with their challenges.

Includes abstract. / Includes bibliographical references (leaves 82-86). / In this study the researcher aims to explore the child right violations and psychosocial risks experienced by children orphaned primarily as a result of HIV/AIDS in Lesotho. Lesotho ranks in at number three in the world of countries most ravaged by the HIV/AIDS pandemic. Of its 2.2million citizens, 17% are orphans, and half of them have been orphaned as a result of HIV/AIDS (United Nations Program on HIV/AIDS, 2004) (UNAIDS). According to the Non-Governmental Coalition on the Rights of the child, (2000), the number of orphans in Lesotho continues to increase on daily basis resulting in the country being under enormous strain and these vulnerable children at increased risk. The research design used in this study is the qualitative research design and research was conducted using face to face in depth interviews. A semi structured interview schedule was constructed and the researcher also used a tape recorder. Purposive sampling technique was used to obtain a sample size of 12 adolescent orphans at a High School in Maseru Lesotho. Data analysis is done according to Tesche’s steps of interview analysis, in which the main themes and categories are drawn from the interviews and discussed. The main findings were that most of the orphans who participated in the study had a poor quality of life but maintained a positive outlook in terms of the future. Most of the orphans were living in child headed households that had no electricity. There was no evidence of physical abuse amongst the respondents. In terms of psycho social risks, most orphans did not suffer from depression or severe anxiety. A small percentage of orphans did experience suicidal ideation in response to the death of their parents and their current circumstances. The main conclusions were that orphans in Lesotho are experiencing child right violations especially poor quality of life and that orphans in this study did not experience severe psycho social risks. From these findings, it is recommended that there is a need for more non-profit organizations that address the child right violations and psycho social risks experienced by orphans in Lesotho as well as a need for awareness campaigns on the plight of orphans to be generated. It is also recommended that the Lesotho government continue to fund the education costs of orphans as well as offer transportation to school.

This research investigated an issue that has implications for early breastfeeding cessation and impaired mother-child bonding. It focused on child abuse survivors' perceptions and reactions surrounding breastfeeding and bonding, the necessity of trust before disclosing abuse, and the transition to self-efficacy. It also provided recommendations for health professionals' practice.

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld. / Thesis (PhD)--University of South Australia, 2009