published_or_final_version / Architecture / Master / Master of Architecture

The overall aim of this licentiate thesis was to describe encounters in hospital care from the perspectives of nurses and patients. It focuses specifically on nurses’ views of shortcomings in patient-care encounters in one hospital (I) and the meanings of participation in hospital care as narrated by patients (II). Three focus group discussions with 15 registered nurses were conducted, and data were analyzed using thematic content analysis (I). Narrative interviews were conducted with 15 patients in hospital care, and the interviews were analyzed with a phenomenological hermeneutic interpretation (II). This licentiate thesis shows that a shared understanding is considered as central for both the nurses and the patients in the hospital-care encounter. The nurses demonstrate the need to understand, to create space, and also to be available for vulnerable patients. The patients describe the need to be understood and to understand their own situations. This thesis suggests that positive encounters in hospital care imply that nurses need to take responsibility for creating a mutual dialogue where the patient experiences himself or herself as a co-creator in a trustful context. When nurses acknowledge and confirm the vulnerability of their patients, it becomes possible to support them to participate in an active manner. A well-functioning team, as well as a coherent environment, is, in this thesis, understood as a precondition for positive hospitalcare encounters.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Unnoticed deterioration in the clinical condition of children in ward areas can lead to near or actual cardiopulmonary arrest. Children suffering from a cardiac arrest in hospital often display abnormal physiological parameters hours prior to this event occurring (i.e., within a 24 hour period). Prevention of cardiopulmonary arrest in the wards lies in the ability of nursing and medical staff to be able to identify these abnormal physiological parameters, i.e., early signs of deterioration, and to intervene prior to this event. This study aimed to identify nurses’ experiences with regards to current knowledge, clinical practice and training in the recognition of clinical deterioration in children. It could then be determined whether a formal guideline on the early recognition of clinical deterioration in children would be perceived as being beneficial by the respondents in this study. The research question that guided this study was “what are the perceptions and experiences of registered professional nurses working in paediatric wards with regards to their recognition of unexpected clinical deterioration in children?” An exploratory descriptive study, utilising a qualitative approach was applied. The target population consisted of all registered professional nurses working in paediatric wards in academic hospitals in the Western Cape, South Africa. Ethical approval was obtained. Informed written consent was obtained from the participants. The purposive sampling method was used to select the participants (n=17) who met the criteria. Five focus group interviews were conducted to collect the data, using an interview guide. The planned methodology with its instrumentation and procedures was verified through a pilot study that was conducted on the first focus group interview. The steps of the research process included transcribing the collected data verbatim from the audio recordings and the field notes, and then analysing the data by summarising and packaging the data, identifying themes and trends in the data and verifying and drawing conclusions. The analysis themes identified were based on Donabedian’s conceptual framework, comprising Structure (the environment in which the care takes place), Process (method by which the care takes place), and Quality Assurance (the planned, organised evaluation of the patient care which has been rendered). The findings showed that the increased level of severity of illness of children nursed in paediatric wards, as well as staff shortages, gaps in training on resuscitation and clinical deterioration, limited ICU beds and staff, lack of adequate monitoring and emergency equipment in the wards, and inexperienced staff are all factors that were identified that increase the risk of staff not being able to detect clinical deterioration in children nursed in paediatric wards. Teamwork among nursing staff and other medical professionals, as well as parental involvement in the care of the children, assisted staff in being able to detect clinical deterioration. Most participants were unfamiliar with ‘early warning systems’ and reported that there are no paediatric ‘early warning scores’ (PEWS) in place. They believed such a system would be beneficial; however they had concerns regarding the time it would take to score a patient, the training involved, and the ease of use of such a tool and system. Recommendations for addressing non-recognition of clinical deterioration by nurses in paediatric wards such as appropriate knowledge and skill updating, were put forward in the study. / AFRIKAANSE OPSOMMING: ‘n Kliniese verswakking by kinders wie in pediatriese sale verpleeg word, wat nie betyds waargeneem word nie, kan dit lei tot ‘n amperse of werklike kardio-pulmonale arres. Kardio-pulmonale arres in kinders word dikwels voorafgegaan deur ‘n verandering in die fisiologiese parameters (so vroeg as 24-uur voor die arres). Die voorkoming van saalverwante kardio-pulmonale arres berus op die vermoeë van verpleeg- en mediese personeel om die abnormale fisiologiese tekens so vroeg as moontlik waar te neem en daadwerklik op te tree voordat die arres plaasvind. Die doel van hierdie studie was om die ondervindige van verpleegkundiges te identifiseer met betrekking tot die bestaande protokolle, opleiding en hulpbronne wat beskikbaar is vir die waarneming van die kliniese agteruitgang in kinders. ‘n Bepaling sal gevolglik gemaak kan word of die studie-respondente ‘n amptelike riglyn rakende die vroegtydige waarneming van kliniese agteruitgang in kinders voordelig sou vind al dan nie. Die rigtinggewende navorsingvraag vir die studie was “wat is die sieninge en ondervings van geregistreerde verpleegkundiges in pediatriese sale rakende die herkening van onverwagte kliniese agteruitgang in kinders?” ‘n Verkennende, beskrywende navorsingsmetodologie, met ‘n kwalitatiewe aanslag, is gebruik. Die teikenpopulasie het bestaan uit alle geregistreerde professionale verpleegkundiges, werksaam in die pediatriese sale van die akademiese hospitale in die Wes Kaap, Suid-Afrika. Etiese toestemming, asook ingeligte, skriftelike toestemming is vooraf verkry van elke deelnemer. ‘n Doelbewuste steekproefnemings metode is gebruik om die studie deelnemers, wat aan die navorsingskriteria voldoen het, te kies. Vyf fokusgroep onderhoude is gevoer om data in te samel en ‘n onderhoudsgids is gebruik vir dié onderhoude. Om die navorsingmetodologie, instrumentasie and prosedures te bevestig, is ‘n voortoets tydens die eerste fokusgroep onderhoud gedoen. Die stappe van die navorsingproses is gevolg om die ingesamelde data, bestaande uit klankopnames en veldnotas, woord-vir-woord oor te skryf. Die data is hierna ontleed deur middel van opsomming en samevoeging, terwyl temas en neigings geïdentifiseer is en afleidings geverifieër en gefinaliseer is. Die geïdentifiseerde ontledingstemas is basseer op Donabedian se konsepsuele raamwerk, bestaande uit Struktuur (die versorgingsomgewing), Proses (die versorgingsmetodes) en Kwaliteitsversekering (die doelbewuste en beplande evaluering van gelewerde verpleegsorg). Die navorsingsbevindinge het daarop gedui dat verskeie faktore ‘n rol speel in die risiko-toename wat verband hou met personeel wat nie die kliniese agteruitgang in kinders wat in pediatriese sale verpleeg word, waarneem nie. Die faktore sluit in: die kinders se graad van siekte, personeeltekorte, opleidings tekortkominge ten opsigte van resussitasie- en die identifikasie van kliniese agteruitgang by kinders, tekorte aan genoegsame moniterings- en noodtoerusting in die sale, en onervare personeel. Die waarneming van kliniese agteruitgang is wel bevorder deur spanwerk onder verpleegkundiges en ander mediese personeel, asook ouers wat betrokke was by die versorging van hulle kinders. Die meerderheid van die navorsingdeelnemers was nie vertroud met ‘vroeë waarskuwingsstelsel’ nie, en het aangedui dat geen ‘pediatriese vroeë waarskuwingsstelsels’ beskikbaar is nie. Alhoewel hulle van mening was dat so ‘n stelsel voordelig kon wees, het hulle bedenkinge gehad oor die tyd wat dit in beslag sou neem om die dokumentasie te voltooi, die opleiding wat hulle sou moes ontvang, en wat die moeilikheidsgraad van so ‘n stelsel sou wees. Die voortvloeiende aanbevelings van hierdie studie, wat die nie-herkenning van kliniese agteruitgang deur verpleegkundiges in pediatriese sale aanspreek, sluit in toepaslike kennis- en vaardigheids opdatering.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Pneumonia is the greatest single cause of mortality in children less than five years of age throughout the world causing more deaths than those due to AIDS, malaria and tuberculosis combined. Approximately 50% of all childhood pneumonia deaths occur in sub-Saharan Africa. Children in developing countries being treated for pneumonia frequently have one or more comorbid conditions which increases their risk of dying. The proper management of the child with severe or very severe pneumonia is essential to reduce case fatality. Standard case management (SCM) of pneumonia, has been shown to be an effective intervention to reduce deaths from pneumonia, but what is lacking is a means of delivering it in low-resource/high burden countries. A major barrier to wide application of this intervention in low-income countries is weak health-care systems with insufficient human and financial resources for implementing SCM to a sufficient number of children at a level of quality and coverage that would result in a significant impact. The objective of this dissertation is to address this issue by investigating ways of improving delivery of standard case management of pneumonia in district hospitals throughout Malawi, a high HIV-prevalent country which would result in a decrease in the in-hospital case fatality rates (CFR) from pneumonia in children less than five years of age. We reviewed the evidence base for SCM. Then we evaluated the development and implementation of a national Child Lung Health Programme (CLHP) to deliver SCM of severe and very severe pneumonia and a programme to provide uninterrupted oxygen supply in all paediatric wards at District Hospitals throughout Malawi. We demonstrated that it was feasible to implement and maintain both programmes country-wide. Thirdly we evaluated the trend in case fatality rates in infants and young children (0 to 59 months of age) hospitalized and treated for severe and very severe pneumonia over the course of the implementation of the CLHP. The findings from this study showed that in the majority (64%) of cases, who were aged 2-59 months with severe pneumonia there was a significant effect of the intervention that was sustained over time whereas in the same age group children treated for very severe pneumonia there was no interventional benefit. No benefit was observed for neonates. Fourthly we investigated factors associated with poor outcome reported in the previous study, in a subset of this cohort to determine the individual factors including demographics of the study population, recognised co-morbidities and clinical management that were associated with inpatient death. This study identified a number of factors associated with poor pneumonia-related outcomes in young infants and children with very severe pneumonia. They included co-morbidities of malaria, malnutrition, severe anaemia and HIV infection. The study found that the majority of reported comorbid conditions were based on clinical signs alone indicating a need for more accurate diagnosis and improved management of these comorbidities that may lead to improved outcomes. Other identified factors included a number of potentially modifiable aspects of care where adjustments to the implementation of SCM are indicated. These included enhancing correct classification of the severity of the disease, the use of correct antibiotics according to standard case management, more extensive availability and use of oxygen together with oximetry to guide its use,. Finally recommendations were made to address the identified reasons for poor outcomes and suggested future research. / AFRIKAANSE OPSOMMING: Pneumonie is die grootste enkele oorsaak van sterftes by kinders jonger as 5 jaar in die wêreld en veroorsaak meer kindersterftes as die menslike immuungebrekvirus (MIV), malaria en tuberkulose saam. Ongeveer 50% van kindersteftes van pneumonie kom in sub-Sahara-Afrika voor. Kinders in ontwikkilende lande, wie vir pneumonie behandel word, het dikwels een of meer bydraende toestande wat die doodsrisiko verhoog. Kinders wie ernstige of baie ernstige pneumonie onderlede het moet korrek behandel word om sterfte te voorkom. Die standaard protokolle om kinderpneumonie korrek te behandel het getoon om effektief te wees om die sterftesyfers te verlaag. In lae inkomste lande bestaan die strategieë nie om die protokolle aan te wend nie. ‘n Groot struikelblok in die aanwending van die pneumonie behandelingsprotokolle in lae-inkomste lande is die swak gesondheidsorgsisteme met onvoldoende menslike en finansiële hulpbronne. Die tekorte gee aanleiding tot die beperkte implementering van pneumonie protokolle wat die omvang en kwaliteit van die pneumonie protokolle beperk en daarom impakteer die protokolle nie op die kindersterftesyfer nie. Die doel van die verhandeling is om hierdie probleem aan te spreek deur navorsing hoe om die pneumonie protokolle landwyd in alle distrikhospitale in Malawi, ‘n land met ‘n hoë MIV prevalensie, aan te wend om sodoende die kindersterftesyfer (kinders jonger as 5 jaar) as gevolg van pneumonie te verlaag. Ons het die getuienis van die pneumonie protokolle ondersoek. Hierna is ‘n nasionale Kinderlong Gesondheidsprogram ontwikkel en landwyd geïmplementeer. Volgens die program is kinders met ernstige en baie ernstige pneumonie volgens Wêreldgesondheidsorganisasie (WGO) protokolle behandel. Ononderbroke suurstoftoevoer in alle pediatriesesale in distrikshospitale in Malawi veskaf. Die navorsing het getoon dat die implementering en instandhouding van pneumonie behandelingsprotokolle is landwyd moontlik. Verder het ons die tendens ondersoek of die kindersterftesyfer in babas en jong kinders (0 tot 59 maande) wat in die hospital opgeneem en behandel is vir ernstige en baie ernstige pneumonie tydens die implementering van pneumonie protokolle verminder het. Die bevindinge van hierdie verhandeling wys dat in die meerderheid (64%) van die kinders tussen 2 en 59 maande met ernstige pneumonie, en met die toepassing van die pneumonie protokolle, statistiesbetekenvol die sterfte syfer verlaag het. Die protokolle vir die behandeling van baie erstige pneumonie het nie dieselfde wenslike effek gehad nie. In neonate (jonger as 2 maande) was daar ook geen verlaging in die sterftesyfer nie. Laastens het ons die redes vir die swak uitkomste ondersoek in ‘n substudie en veral klem gelê op bydraende siektes en kliniesesorg tekorte geassosieer met pneumonie sterftes. Die studie het ‘n aantal faktore geïdentifiseer wat bygedra het tot die sterftesyfer in kinders met baie ernstige pneumonie en in neonate. Die geïdentifiseerde bydraende faktore het malaria, wanvoeding, erge anemie en MIV-infeksie ingesluit. Voorkomende maatreëls moet vir die geïdentifiseerde faktore ingestel word. Aanpassings in die pneumonie protokolle is voorgestel. Ten slotte word aanbevelings gemaak om die geïdentifiseerde redes vir swak uitkomste aan te spreek en verdere navorsingidees word aanbeveel.

published_or_final_version / Social Work / Master / Master of Social Work

The purpose of this study was to describe the meaning of caring from the perspective of community-dwelling individuals 65 years and older, who claim a Polish American ethnic identity. As background and preparation for the study the researcher spent 2 years in the Polish American community from which the key informants were chosen, explored the concept of caring cross culturally in the Human Relations Area Files, and spent a summer in Poland--the country of origin for the second generation sample. These experiences revealed that the care expectations by one group of people who are elderly and identify themselves as Polish American are unknown. Interviews were used to collect data from 7 informants. Participation, observation and written resources within the ethnic community supplemented the interview process. Tape recorded interviews were transcribed; field notes were compiled. All written data were analyzed, organized into categories and validated by the informants. Ten categories represented the Polish American elder's view of caring: kinds of Polish symbols, kinds of greeting, kinds of acknowledgment, kinds of caring, places for Polish people to meet, reasons for joining the Arizona Polish Club, reasons for going to the Arizona Polish Club, reasons for giving acknowledgment, care expectations: characteristics of a caring nurse, and ways to express caring. A primitive view of a 3-staged model was developed for generating universal conceptualizations of care from the Polish American elder's view of caring. Relationships among the categories were inferred from the data by the researcher and discussed as themes. Themes included: Arizona Polish Club as a caring place, being with my own kind, togetherness, neighboring, get moving in the morning, being there, taking time out, and having heart. The themes were discussed in relation to the research questions and the concept of caring that guided the study. This study revealed some of the characteristics, attributes, and conditions of caring that will be useful in expanding nursing's definition of caring, devising psychometric instruments to measure caring, and developing a cross cultural, cross age taxonomy of caring. Recommendations for nursing included care and research strategies with elders and suggestions for future study.

No description available.

No description available.

No description available.

Problemas relacionados a medicamentos (PRMs) compreendem erros de medicação (EMs) e reações adversas a medicamentos (RAMs). Este estudo teve por objetivo analisar, classificar, quantificar e intervir nos PRMs ocorridos em pacientes idosos internados. Este estudo prospectivo descritivo de uma série de casos clínicos abrangeu 28 pacientes e 100 prescrições aleatórias a eles destinadas. A identificação dos PRMs se deu por métodos de farmacovigilância ativa e as intervenções farmacêuticas (IFs) foram realizadas diretamente junto à equipe médica. Medicamentos de uso potencialmente inapropriado para idosos foram utilizados por 21,4% dos pacientes; 19% das prescrições possuíam rasuras. Foram encontrados 924 PRMs, sendo 920 EMs e 4 possíveis RAMs, sendo uma delas confirmada. A maioria dos EMs foi classificada como sem prejuízo ao paciente. Foram realizadas 143 IFs em 73 prescrições de 92,9% dos pacientes, sendo a maioria (77,6%) acatada pela equipe médica. Apesar das limitações, demonstrou-se a importância do farmacêutico na investigação, prevenção e solução de PRMs. / Drug related problems (DRPs) include medication errors (MEs) and adverse drug reactions (ADRs). The objective of this study was to analyze, classify, quantify and intervene in DRPs occurred in hospitalized elderly patients. This prospective descriptive study of a case series included 28 patients and 100 random prescriptions to them addressed. The identification of DRPs was carry out by methods of active pharmacovigilance and the pharmaceutical interventions (PIs) were performed directly with the medical staff. Drugs potentially inappropriate for the elderly were used by 21.4% of the patients; 19% of the prescriptions had rasures. There were 924 DRPs, with 920 MEs and 4 possible ADRs 4, one of which confirmed. The majority of MEs was classified as \"without harm to the patient\". Were carried out 143 PIs on 73 prescriptions of 92.9% of the patients, being the majority (77.6%) fully embraced by the medical staff. Despite the limitations, it was possible to demonstrate the pharmacist importance in research, prevention and resolution of DRPs.