BACKGROUND: Patients receiving haemodialysis (HD) treatment experience a significant symptom burden and their needs are multifaceted. In HD unit, patients receive treatment in a diverse cultural and open ward setting. However, patients‟ experiences of receiving HD treatment in an open ward setting are not known. OBJECTIVES: The central aim of this study was to explore and describe the experiences of patients receiving HD treatment in an open setting environment at an academic hospital in Johannesburg. DESIGN: A qualitative, exploratory and descriptive study was conducted at a public, tertiary level academic hospital in Johannesburg after obtaining ethical approval from Wits University and relevant authorities. SETTING: The research setting for this study was an adult Chronic Renal Dialysis Unit. POPULATION: Sixteen adult (age 18 and above) patients receiving chronic HD treatment were recruited purposively in this study. INTERVENTIONS: An in-depth semi-structured interview was conducted either before or after receiving HD treatment, which was audio-recorded, transcribed then analysed by using Giorgi Phenomenological method. FINDINGS: A mood enhancer appeared a major theme as participants positively valued the open setting environment for their overall and psychological well-being. Participants expressed by being with others and sharing experiences, a sense of community likened to a family developed. Common to all participants‟ language was the use of the “we” in relation to being in the open setting environment. This expression of the “we” by participants was interpreted as a community concept. The use of “we” associated with the concept of community described as a space to which every patient receiving HD belonged. They described their experiences in a collective manner. This was evident in repetitive reference to their common space, being together, sharing experiences, and finding identity from one another, being understood and a sense of being protected with personal relations that extend beyond 10 years for some. This open space contributed to shaping their perception of body image and illness. The nurse‟s role in timeously providing HD care was appreciated by many. However, being exposed to multiple situations of chronic illness and treatment a sense of fear developed. Any negative event experienced, watched, observed, or heard in the HD unit triggered fear in the patients. Two common fears were of HD complications and the constant threat of death. Complications such as clotting, muscle cramps and collapsing because of hypotension as well as watching somebody dying on the machine were all reported in this study and so psychological counselling was felt to be very important. CONCLUSION The recommendations proposed in this study hopefully will assist HD staff to intervene and make adjustments to support patients‟ holistic needs. Further studies into patients receiving HD in open settings and mixed-gender space are required for diversity of experiences and knowledge from different settings. Keywords: Haemodialysis, hospital environment, open setting, patient experiences

p. 1-68 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-10T21:09:11Z No. of bitstreams: 1 DissertacaoAdriana Aquino.pdf: 512112 bytes, checksum: e66844469c0d5fbd2d4cad1162b090c3 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-04-11T19:18:15Z (GMT) No. of bitstreams: 1 DissertacaoAdriana Aquino.pdf: 512112 bytes, checksum: e66844469c0d5fbd2d4cad1162b090c3 (MD5) / Made available in DSpace on 2013-04-11T19:18:15Z (GMT). No. of bitstreams: 1 DissertacaoAdriana Aquino.pdf: 512112 bytes, checksum: e66844469c0d5fbd2d4cad1162b090c3 (MD5) Previous issue date: 2007 / Introdução: Uma parcela dos casos com tuberculose apresenta falência ao tratamento especifico, necessitando de condutas terapêuticas mais agressivas para alcançar a cura. Em 2005, foram identificados no Brasil 208 casos em tratamento com esquema III. A análise da coorte de casos novos e de retratamento demonstrou que 1% dos casos apresentou falência aos esquemas de tratamento de 1ª linha. Objetivo: Mensurar a magnitude do sub-registro da falência de tratamento antituberculose, identificar seus possíveis fatores preditores e estudar suas implicações para o desfecho dos casos. Metodologia: Estudo descritivo exploratório, pela análise do banco de dados de tuberculose do Sinan no período de 2000 a 2005. Por meio da conjunção de variáveis denominadas “condições marcadoras” e do resultado do pareamento probabilístico do Sinan com o banco de tuberculose multirresistente (SITBMR), foram identificados prováveis registros de falência não reconhecida, subdivididos em quatro categorias mutuamente exclusivas, de maior para menor rigor de classificação. Resultados: No período de 2000 a 2005 foram identificados 1.552 registros de falência reconhecida. A utilização do conjunto de variáveis previamente definidas permitiu a identificação de mais 9.299 prováveis registros de falência. Isso representou uma proporção de subnotificação de 85,7%. Entre os registros de falência, há predomínio de casos com recorrentes retornos ao sistema, notificados como reingresso após abandono ou recidivas após cura, associados com Aids, e com prescrição de esquemas terapêuticos inadequados ao tipo de entrada. A partir da análise multivariada, algumas dessas características também foram identificadas como possíveis fatores preditores de falência e para o seu não reconhecimento. Os registros de falência em relação aos registros de não falência apresentaram maior proporção de registros com desfecho desfavorável (RP=2,68) com alta proporção de abandonos (32,9%) e TBMR (11,9%). Entre os registros de falência não reconhecida a ocorrência de abandonos foi mais freqüente (RP=1,27). Conclusões: Há deficiências na forma como os registros dos casos de falência de tratamento antituberculose são notificados no sistema de informação oficial. Os dados atualmente divulgados pelo Programa Nacional de Controle da Tuberculose (PNCT) precisam ser revistos. Especial atenção precisa ser dada aos casos em falência para aumentar as chances de cura e evitar a evolução para multirresistência. / Salvador

Appendum consists of last two leaves. / Copies of author's previously published articles inserted. / Bibliography: leaves 241-283. / xviii, 284 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / The studies described were designed to identify and address (through the application of relatively novel and potentially useful adjunctive therapeutic strategies) some of the determinants of sub-optimal therapeutic response in intermediate coronary syndrome and chronic congestive heart failure; especially when targeted towards those patients who fail to gain the maximal benefit from pre-existing modalities of pharmacological treatment. / Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 1999