Thesis (M.A.)--Acadia University, 1998. / Includes bibliographical references. Also available on the Internet via the World Wide Web.

Thesis (M.A.)--Acadia University, 1998. / Includes bibliographical references. Also available on the Internet via the World Wide Web.

Thesis (M.S.)--University of Nevada, Reno, 2008. / "May 2008." Includes bibliographical references (leaves 30-33). Online version available on the World Wide Web.

Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2008. / Includes bibliographical references (leaves 59-67). Also available online.

This collection of work represents an interest in education in palliative care over the last ten years. These papers are written either by myself or in collaboration with colleagues in Britain and New Zealand. During those years the way in which palliative care is taught and learned has changed and continues to change. The overview of the work submitted here describes the rationale behind the development of new approaches to the teaching and learning of care at the end of life. In many ways this collection represents a personal journey - one that involves investigation, growth, research and evaluation. By publishing these papers and promoting discussion in this area of education I have made an original contribution to the changing way in which doctors are taught and learn to care for people who are dying and into our understanding of the nature of learning to care for those people. The papers are listed here in chronological order. Throughout the text of the overview they are referenced along with other relevant papers but appear in the reference list in bold. I declare that I am the author of the papers contained in thesis unless otherwise stated. All references documented have been consulted in the writing of these papers. References appear in the texts in the form required for each individual journal. The papers have all been published in peer reviewed journals. MacLeod, R.D., Nash, A.: 1991 : Teaching palliative care in General Practice - a survey of education needs and preferences. Journal of Palliative Care 7: 4, 9-12. (reference 6) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A.: 1992 : "Taking the lid off1 -observations of the process of palliative care education for General Practitioners. Postgraduate Education for General Practice 3, 28-3 (reference 9) (RDM 60% - AN 40%) James, C., and MacLeod, R.D.: 1993 : The problematic nature of education in palliative care. Journal of Palliative Care 9:4, 5-10 (reference 10) (RDM60%-CRJ-40%) MacLeod, R.D.: 1993 : Education in palliative medicine : a review. Journal of Cancer Education 8: 4, 309-312 (reference 11) MacLeod, R.D., Nash, A.: 1994 : Multidisciplinary palliative care education. Journal of Interprofessional Care 8:3.283-288 (reference 12) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A. and Charny, M.: 1994 : Evaluating education in palliative medicine. European Journal of Cancer Care 3: 163-168 (reference 14) (RDM 60% - AN 30% - MC 10%) MacLeod, R.D.: 1997 : Teaching holism in palliative care and hospice. American Journal of Hospice & Palliative Care 14:1, 12-16 (reference 36) MacLeod, R.D., James, C.R.: 1997 : Improving the effectiveness of palliative care education. Palliative Medicine 11:5, 375-380 (reference 38) (RDM 60% - CRJ 40%) MacLeod, R.D., Robertson, G.: 1999: Teaching about living and dying. Education for Health 12:2,185-192 (reference 65) (RDM 80% - GR 20%) MacLeod, R.D.: 2000 : Learning to care: a medical perspective. Palliative Medicine 14:3, 209-216 (reference 66) MacLeod, R.D.: 2001 : On reflection: how doctors learn to care for people who are dying. Social Science & Medicine 52,1719-1727 (reference 67).

The outcome of 121 children who underwent palliative cardiac surgery at the Red Cross War Memorial Children's Hospital over a 5 year period, 1980 1984, was retrospectively examined. 79 children had systemic artery to pulmonary artery shunt operations (SPS), 40 had pulmonary artery bands (PAB) and 2 had surgical septectomies. SPS was most often done for children with Tetralogy of Fallot (TOF, 26 cases) or complex univentricular hearts with right ventricular outflow tract obstruction (27 cases). PAB was done chiefly for ventricular septa! defects, alone (VSD, 8 cases) or with coarctation of the aorta (9 cases). Children were referred from a wide area with 63 cases being referred from other major centres and foreign countries. Overall, 36 children died (30 % mortality): 5 died at surgery, 6 within 48 hours of surgery, a further 5 within 31 days; and 20 died after 31 days. SPS and PAB had the same early mortality rates ( 13 % ) • SPS had higher late and overall mortality rates (20 and 33 %) than PAB (10 and 23 %). Age at operation was found to be the most significant determinant of the overall mortality rate: children less than six months had a mortality of 42 % and those over 6 months, 13 % • The children were grouped into those with lesions which were probably correctable and those that were unlikely to be so, based on diagnosis and age at surgery: those with correctable lesions had a lower overall mortality (22 %) than those with uncorrectable lesions (43 %). Where the surgery was performed as an emergency, there was a higher overall and early mortality (55 and 35 respectively), compared to those operations which were performed electively ( 25 and 9 % ) • The presence of other medical conditions, for example congenital abnormalities and infections, was also a determinant of death (44 % mortality if other medical condition present, 26 % if absent). sex, population group, home address and type of surgery performed did not significantly affect mortality when examined by multivariate analysis. Using routine methods of follow up, it was initially thought that 17 % of all patients (22 % of survivors) were lost to follow up. An important determinant of this was the referral centre. 31 % of cases from other major centres and 20 % of foreign cases were lost, as compared to 8 % of cases from smaller towns near Cape Town and 2 % of children from Cape Town. Population group (35 % Blacks, 14 % Coloureds and 7 % Whites were lost), and palliative operation (23 % SPS, and 5 % PAB lost) were also significant determinants. It was possible to trace 12 of the 20 children who were thought to be lost to follow. 8 had died, 3 were still awaiting correction and 1 was traced and received corrective surgery. The records of the children who underwent cardiac surgery in 1987 were also analysed. There was no difference in the demographic characteristics of either group, and the early mortality was the same. This study shows that the outcome after palliative cardiac surgery is poor, with a high mortality rate and children often being lost to follow up. The decision to palliate rather than to correct a congenital heart defect must be made after balancing these risks with those of early correction for the particular surgical team. Should palliative surgery be undertaken, careful follow up is essential to ensure that complications of palliation do not set in and that corrective surgery is done at the optimal time.

The aim of this study was to investigate met and unmet palliative care needs for people living with HIV/AIDS in selected areas in Rwanda. The achieve this aim, the study, firstly, identified the palliative care needs of people living with HIV/AIDS, secondly, it identified the health care services available to meet these needs, and thirdly, it determined the extent to which palliative care needs were met.

The aim of this study was to investigate met and unmet palliative care needs for people living with HIV/AIDS in selected areas in Rwanda. The achieve this aim, the study, firstly, identified the palliative care needs of people living with HIV/AIDS, secondly, it identified the health care services available to meet these needs, and thirdly, it determined the extent to which palliative care needs were met.

Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2008. / In South Africa the need for palliative care for the terminally ill is exacerbated by the upsurge of the HIV/AIDS epidemic resulting in more patients being in need of palliative care and the provision of effective pain management as part of providing them with palliative care. Effective pain management requires sound knowledge of the pathophysiology of pain and its treatment. Research found the attitudes, beliefs, and knowledge of healthcare professionals regarding pain management impact significantly on how these professionals practice pain control measures of the terminally ill. Despite the increase in knowledge and technological advances people still die in pain. The upsurge of cancer and AIDS cases require that all nursing practitioners be competent to deliver palliative care. Effective pain management is an integral part of palliative care. South Africa has a nurse-driven health care system where Registered Nurses are expected to become competent in among other health care issues, to manage pain in the increasing numbers of terminally ill patients due to especially AIDS epidemic.

Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2009. / By the end of 2007 an estimated 22 million people in sub-Saharan Africa were living with HIV/AIDS. Of these, 1.8 million (33%) were children under the age of 15 years. The epidemic has left 11.6 million children orphaned by AIDS. Zimbabwe has an estimated population of 12 million people; its HIV infection rate amongst all adults was estimated at 33.7% in 2002, decreased to 15.1% in 2007: most likely due to extensive prevention campaigns that were held by the Ministry of Health and Child Welfare, in partnership with other stakeholders. Despite the decrease in infection rate, 1.3 million people live with the HIV/AIDS and 140 000 have died. United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organisation (WHO) (2008) reported that of the 1.3 million people 120 000 were children and 1 million children had been orphaned due to AIDS in Zimbabwe. Only 3% of children living with HIV/AIDS were on anti-retroviral therapy (ART) due to lack of antiretroviral (ARV) paediatric formulations drugs. The purpose of the study is to determine what palliative care services are available for children diagnosed with AIDS in Harare, Zimbabwe and whether the services provided meet the palliative care needs of the children. The aims of the study are to: describe the palliative care services offered by the public health sector to children diagnosed with AIDS; describe the extent of palliative care services offered by NGOs sector to children diagnosed with AIDS; describe what children diagnosed with AIDS perceive as their care needs; and to compare the needs of the children with the services provided.