D.Cur. (Community Nursing Science) / The purpose of the study was to develop a strategy to assist community nurses facilitate the mobilization of resources for meeting the basic needs of the elderly in the peri-urban and rural communities within the Hhohho region in Swaziland. Qualitative, exploratory, descriptive and contextual research designs were used to explore and describe the basic needs and the resources for meeting the needs of the elderly. In order to achieve the study objectives and be logical, this study was organized into two phases namely: phase one and two. Phase one focused on the first objective namely: to explore and describe the basic needs and resources of the elderly in the peri-urban and rural communities in the Hhohho region in Swaziland. The second phase focused on the second objective namely: to develop and describe the strategy for mobilizing the resources meeting the basic needs of the elderly. Purposive sampling was utilized to select participants who met the inclusion criteria. Data were collected using focus groups and individual indepth face-toface interviews. Tesch method of qualitative data analysis was utilized to identify themes. From the study findings the researcher and the independent coder identified the following themes from the focus groups and individual indepth face-to-face interviews with the elderly and the key informants in the peri-urban and rural communities in the Hhohho region: • Theme 1: Need for resources because of poverty • Theme 2: Need for support because of burden for caring for others • Theme 3: Need for health care because of health challenges • Theme 4: Need for company because of loneliness • Theme 5: Need for protection because of abuse of the elderly persons The study highlighted a lack of resources including food security, housing accommodation, clothing, water supply and basic sanitation, electricity supply and lack of financial resource. The burden of caring for grandchildren who were orphans due to HIV/AIDS related illnesses and others as well as chronic illnesses were also reported...

No description available.

No description available.

No description available.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

This investigation concerns the problem of current health care utilization by aged blacks. Utilizing Andersen's model, the volume and pattern of physician utilization associated with selected predisposing, enabling, and need variables is described for an aged population of 163 interviewed blacks residing in Census Tract 212, Denton, Texas, in 1972. None of the six socio-demographic, economic, or health status variables analyzed, through use of Somers' dyx, allowed substantial reduction .of error in predicting a physician visit in the past year. Representing need, selfrated health status was the best predictor variable. Its proportional reduction in error increased from 17 percent to 30 percent, for those with five to seven years education, and to 23 percent, for those reporting the least income.

published_or_final_version / abstract / toc / Social Work and Social Administration / Master / Master of Philosophy

Bibliography: leaves 217-238 / xix, 238, [82] leaves : ill ; 31 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Depts. of Psychology and Community Medicine, 1992

Introduction: Forty years ago the life saving and life prolonging therapy of dialysis was rationed. It was extremely unlikely that people aged over 50 years would be offered treatment. Today, those aged over 65 years are becoming the fastest growing group of patients on dialysis. Changing population demographics and referral patterns, the opening up of eligibility for dialysis to high risk individuals, refinement and developments in dialysis technology and its ‘success’ in keeping more patients alive for longer periods, along with rising public expectation, are just some of the reasons behind this change in the age profile of those being currently treated for kidney failure. Older people are likely to have multiple co-morbidities and decreased functional status that may complicate their decision-making about dialysis and limit their treatment options. / Enhancing choice and involvement in treatment decision-making to the patient’s satisfaction is a central theme of health care ethics. Current national and international ethical guidelines about the initiation of dialysis recommend shared or joint decision-making and discuss patient ‘benefit’ and patient ‘need’. This project sought to determine how these recommendations, and other ethical issues related to informed consent, possible withdrawal of treatment and quality of life, were embodied in the personal experiences of a group of older people facing dialysis decisions. / Aim: The general aim of this research was to follow the dialysis decision-making process over time amongst a group of people aged 65 years and older. More specifically, this research sought to explore with the participants the following issues: what factors impacted on their dialysis decision-making; how they understood both what was happening to them and the goals of treatment; their preferences for information seeking; how they perceived any future decision-making; how or whether the commencement and experience of dialysis influenced their decision-making; and once treatment had been initiated, how they felt about their initial decisions. / Method: A predominantly longitudinal qualitative study was undertaken. Meetings were conducted prior to the potential initiation of dialysis with 21 participants. These meetings involved a semi-structured interview and the administration of three questionnaires focusing on preferences for decision-making, information seeking and quality of life. Data was also collected from the participants’ health records. For those participants who commenced dialysis a further two meetings were undertaken one month and then six months after treatment was instigated. The qualitative data was analysed thematically using concepts that had either been pre-determined and explored within the interviews or, had emerged from the participants’ stories. / Findings: Findings from this study include: participants not feeling that they had a choice about dialysis; a mismatch between theoretical expectations of informed consent and shared decision-making and the ‘actor centred experiential’ model of decision-making adopted by participants; a need to re-evaluate the balance and relationships between physiological measures of effectiveness emphasised by health professionals, and psychosocial and functional markers valued by participants; and treatment goals not being individually negotiated. / Conclusion: An interest in remaining alive was the driving force behind why participants chose to have dialysis. Other factors impacting on decisions about dialysis were multi-faceted and were based on priorities other than what health professionals consider important. Shared decision-making, as described in the literature, is not unproblematic. However, health professionals need to accept the underlying premises on which shared decision-making is based so that they can find out what expectations patients have of treatment, beyond that of saving life. Such expectations need to be discussed with patients and the various treatment options need to be negotiated in an attempt to achieve patients’ goals. Patients should be encouraged however to be involved in decision-making to the extent to which they desire.

Text in Afrikaans / Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self / Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly. / Health Studies / M.A. (Nursing)