M.A. / The purpose of this research was to compile a psychological information program on stroke, and to provide this psychological information to the spouse of the stroke patient.The emotional status of the spouse of the stroke patient was evaluated during the intervention.The final goal of this research was to give a phenomenological description of the experiences of the spouse of the stroke patient. The method for collecting data was 1) to evaluate the emotional status of the spouse of the stroke patient with the POMS (Profile Of Mood State) inventory before he was exposed to the content of the psychological information program on stroke.2) The spouse of the stroke patient was then introduced to the psychological information program, and any questions which arose were answered. 3) A follow up appointment was arranged for ten days later. During this appointment the POMS inventory was administered again to assess the spouse's emotional status after exposure to the psychological informationprogram on stroke.Any further questions were answered.Within a framework of identified themes a phenomenological description of the experiences of the spouse of the stroke patient was given.The most important experiences were identified as confusion, anxiety, tension, rage, frustration, tiredness, and feelings of not being motivated and depression.The phenomenological themes were "Om-te-wees (Dasein)", "Die wereld", "In-die-wereld-wees", "Om-ingegooi-tewees- in-die-wereld", "Angs as basiese ingesteldheid tot die wereld" and "Liggaamlikheid". The current research was motivated after a thorough study of the literature on stroke.The literature survey revealed a deficiency in terms of availability of information on stroke to the spouse of the stroke patient after the stroke has occured.The literature survey disclosed that the focus of research has been on the stroke patient.Research identified the spouse of the stroke patient as the primary caretaker.Therefore it is important that the spouse of the stroke patient will have access to psychological information on stroke to assist them during their tasks of caretaking. Certain variables influenced theresults of the present research project.These variables were 1) the time when the psychological information was provided to the subjects, 2) the emotional status after the stroke had occurred, and 3) the extent of information the subjects received from other resources. During the current research project the subjects confirmed the value of the availability of psychological information on stroke.The psychological information on stroke is important in assisting the spouse of the stroke patient during their tasks of caret•king.The psychological information on stroke provides the spouse of the stroke patient with 1) a better understanding of the stroke patient, 2) knowledge of what to expect after a stroke had occured, and 3) realistic goals for the future.

Traumatic brain injury (TBI) represents a significant and growing type of disability in South Africa. Coping with the impact of traumatic brain injury is one of the most difficult tasks that can confront a family, and family members experience a wide range of needs as the injured person progresses through rehabilitation. In South Africa, research on family needs following traumatic brain injury has thus far been neglected and rehabilitation resources are sadly lacking. For this reason it is necessary to accumulate knowledge about these families’ needs so as to assist with the planning of future rehabilitation programmes. The study aimed to explore and describe the needs of a sample of families with adult traumatic brain injury individuals in the Eastern Cape utilizing the Family Needs Questionnaire (FNQ). The research approach followed could be described as descriptive and exploratory in nature and was conducted within a quantitative framework. A biographical questionnaire and the FNQ were administered to a heterogeneous sample of 32 family members, including significant others and primary caregivers, of 16 adult traumatically brain-injured individuals, who sustained the TBI one to three years previously, and who underwent rehabilitation treatment at a private rehabilitation hospital in Port Elizabeth. A non-probability, purposive, and convenient sampling method was used. Descriptive statistics were computed to determine the importance and the perceived fulfillment of the needs. The results of the present study indicated that all 40 needs were endorsed by at least half the sample as being important to very important. Furthermore, 52.50% of the needs were endorsed by more than two-thirds of the sample as being important to very important. The needs were rank-ordered according to their importance ratings and the 10 mostly rated as important or very important were identified. These 10 needs were endorsed by between 84.38% and 93.75% of the family members as being important to very important. Six of the important or very important needs related to health information, two to professional support, one to community support, and one to emotional support. The relation between various participant, traumatically brain-injured individual and brain injury characteristics and the 10 important or very important needs, as well as the 10 needs more frequently rated as met were investigated and found to either have a limited or varied relationship. The 10 needs most often rated as met were endorsed by between 43.75% and 56.25% of the family members. Six of the met needs related to health information, two to community support, one to instrumental support, and one to treatment decisions. The highest unmet need was endorsed by 46.88% of the participants and related to the need to discuss their feelings with someone who has gone through the same experience. Based on the findings of the present study, further research on family needs following traumatic brain injury is suggested. It is also recommended that the Family Needs Questionnaire be used to evaluate existing rehabilitation programmes so as to make suggestions as to how to improve them. The results of this study suggested that family members would benefit from receiving educational information material, as well as referrals to professionals for advice and support.

D. Cur. / The greatest potential developed by mankind this century is the increasing awareness of one's portfolio of rights. Amongst the many rights expressed verbally, is the right to mental health. Adolescents whose parents abuse substances also qualify for this right. Fortunately, rights can be earned. Adolescents can acquire the right to mental health if they act in such a way that this will persuade others to notice and listen to them. The reality is that all efforts made towards promoting mental health of these adolescents will improve their general well-being. Mental health is generally regarded as an integral component of a human's emotional, social, spiritual and physical well-being. There is substantial evidence that adolescents living in families whose members abuse substances have difficulty in facilitating their own self-development. As a result, they are deprived of the capacity to mobilise their inner resources promoting their mental health. The study utilised a theory generative, qualitative, explorative, descriptive and contextual design. Two main samples were used. Firstly, adolescents in Grade 11 whose parents abuse substances, who at that time lived in and around rural villages within a 20 km radius of Mafikeng in the North West Province participated as respondents. The second group consist of key community leaders which consisted of groups from the Chiefs Council, police officers, community nurses and ministers of the Christian congregations. The main question that was posed during in-depth group interviews was, "How can adolescents whose parents abuse substances improve their life situations?" Adolescents and traditional healers were interviewed on a one-to-one level. A central question that adolescents had to answer was: "How can you be assisted to improve your day-to-day life?" Informed consent had been obtained from all participating adolescents and their "gatekeepers" (Cresswell, 1994: 142) and the reasons for conducting the research study were explained to all of them. The theory for this thesis has been derived inductively from data obtained from interviews with adolescents, key community people and field notes. Approaches that were used to generate theory are those suggested by Chinn and Kramer (1991: 80-108). In addition, the reasoning strategies that were employed are the analysis, synthesis, inductive and deductive methods described by Tesch (in Creswell, 1994: 155). The results were verified during literature control. Emerging from the results is a strong belief that adolescents selfdevelopment will assist them to overcome the difficulties related to their parents' substance abuse. They can do that by becoming actively involved in the process of improving their social, physical, psychological and spiritual dimensions. Concepts obtained from the results of the interviews were defined according to the steps described in Wandelt and Steward (1975: 64-69), Chinn and Kramer (1991: 84) and Copi (1987: 169). In relation to this, the term self-development was examined by using dictionary definitions, subject definitions and a model case description. Self-responsibility, facilitation and conscious-awareness were identified as essential criteria to selfdevelopment. Measures that were used to maintain trustworthiness in this thesis are truthvalue, applicability, consistency and neutrality (Guba & Lincoln, 1985: 290). The model of self-development therefore emphasises the active participation of adolescents in self-development to develop self-responsibility in their own empowerment. It is envisaged that as adolescents take self-responsibility they will discover the inherent capacities based on their body-mind-spirit and thereby improve their locus of control. Undoubtedly people can gain these capacities through their acquisition of skills, beliefs, attitudes, thoughts and values which enable them to step beyond the environment of substance abuse. This thesis therefore proposes a model of self-development on which guidelines for the advanced psychiatric nurse practitioner can be operationalised. This will assist adolescents to become self-aware and reorganise themselves in order to continue in the lifelong process of self-development.

D.Litt. et Phil. / Please refer to full text to view abstract

Please read the abstract (Summary) in the section, 00front, of this document / Thesis (PhD (Psychology))--University of Pretoria, 2008. / Psychology / PhD / unrestricted

HIV/AIDS has affected families in a profound and tragic way. Children whose parents have succumbed due to HIV/AIDS related infections have to be cared for by their relatives. This study focused on the experiences of primary caregivers of adolescents who are living with HIV in a semi-rural area of Eastern Cape Province, Grahamstown. There is a dearth of literature that is addressing the well-being, experiences and challenges of primary caregivers of adolescents living with HIV. Adolescence is a complex life stage during which adolescents usually present challenging behaviours and are grappling with moral issues. Caregiving to these youngsters who are burdened with HIV infection places additional demands on caregivers, especially so when they are experiencing poverty and poor social and welfare support. A qualitative study was most appropriate to explore and describe the experiences of adolescents infected with HIV. The population of this study was the primary caregivers of adolescents caring for adolescents with HIV in the area of Grahamstown, who are between 11 to 19 years old. A purposive sample of nine primary caregivers of adolescents living with HIV was selected. Data was collected by conducting individual interviews, using a semi-structured interview schedule. Data was analysed thematically according to prescribed theoretical guidelines. Data was verified by means of guidelines for the truth value, applicability, consistency, and neutrality of the study. The findings of the study indicated that primary caregivers experience that caring for adolescents who are living with HIV places a huge burden due to adolescents' negative behaviour, HIV stigma and discrimination, poor support from their families, being confronted with adolescents' emotional issues that they are not capacitated to deal with, and no adequate community resources to assist them. The challenges primary caregivers experience lead to negative effects on their health status. The findings of the study could be useful for informing intervention programmes that are targeting this group and policy development, and implementation of programmes benefiting both infected adolescents and their primary caregivers.

Human Immune Deficiency Virus (HIV), which results in Acquired Immune Deficiency Syndrome (AIDS), has many manifestations. Literature reveals that some of these manifestations may compromise the infected individual’s sense of well-being and negatively impact on health related quality of life. As the number of people living with HIV/AIDS disease grows, so does the need for their care. In the early days of the AIDS epidemic, care was primarily handled by special agencies, hospitals and clinics. These agencies have been inundated with the demands of people living with HIV/AIDS, while their resources are shrinking. As it stands now, the total assistance given to people living with HIV/AIDS is provided by relatives and this responsibility of caregiving will more increasingly rest with families. This situation is particularly salient for the rural community in South Africa, which has been disproportionately affected by the AIDS epidemic. AIDS has a tremendous impact on the entire family system, particularly on the individual who has primary responsibility for caregiving. The caregiver must cope with many circumstances that are frustrating and often beyond their control. Caring for a Person Living with HIV/AIDS (PLWHA) appears to be a major stressor in the lives of caregivers, and can be very demanding, impacting on carers financially, physically, emotionally and socially. Given the lack of research on HIV/AIDS family caregiving from a salutogenic approach, this study aimed to explore and describe the sense of coherence and coping of family caregivers of HIV/AIDS patients in the Kwazakhele area in Port Elizabeth. The sample consisted of 50 participants aged between 21 and 65 years, recruited via the Kwazakhele Masizakhe Project. An exploratory-descriptive design was employed. Data was obtained by a biographical questionnaire, the Coping Resources Inventory (CRI) and the Sense of Coherence (SOC-29) Questionnaire. A non-probability convenience sample of adult male and female family caregivers were sampled. Descriptive statistics and correlation coefficients were utilized to describe and explore the coping and sense of coherence of the family caregivers and the correlation between these constructs, respectively. The data obtained from the biographical questionnaire was analysed by using descriptive statistics and frequency counts. Key findings include the following: Results from the coping resources measure indicated that this sample perceived themselves as having an average level of coping resources. The sample tended to rely more readily on spiritual resources and less on cognitive resources. Results from the SOC-29 revealed fairly high mean scores. There is no positive relationship between the SOC-29 and the CRI for the current sample. No significant relationship existed between the SOC and the subscales of the CRI. Suggestions are made for future research, the limitations and value of research were outlined.

This study was designed to gain an understanding of the family experience when an adult member has chronic obstructive pulmonary disease (COPD). It is recognized that illness within the family affects the well-being of the family unit and the health of all members. To understand the impact of COPD upon the family, however, the literature provides only knowledge of the experience of the individual who has COPD and the spouse, not that of the family unit. Thus, the purpose of this study was to describe and explain the COPD experience from the perspective of the family unit. A qualitative method, phenomenology, was chosen for this investigation. Data were collected through semi-structured interviews with eight families who shared their experiences. From the content analysis of these data, three themes that were common throughout the families' accounts were identified and developed to describe and explain family life with COPD. The first theme, disease-dictated family life, describes four aspects of a common lifestyle that is imposed on the family by the characteristics of COPD. The second theme, isolation, describes the isolation that accompanies the illness experience, for the family group and the individual members within the group. The final theme, family work, describes the four primary challenges the families face and the coping strategies they use to deal with them. These findings revealed that COPD acts as an intense stressor within the family, requiring extensive family work to cope with COPD in a way that maintains the well-being of the family unit. Furthermore, it was found that living with COPD in many ways inhibits the resources within the family and those external sources of support that foster the family's ability to manage the stress associated with living with COPD. The implications for nursing practice and nursing research were delineated in light of the research findings. / Applied Science, Faculty of / Nursing, School of / Graduate

This descriptive exploratory study was designed to determine the perceived importance of selected needs of family members of critically ill brain-injured patients. In addition, the personal/demographic factors which may have influenced the needs of these family members were investigated, as well as the reasons family members perceived these needs as important or unimportant. A convenience sample of one family member for each of 15 critically ill brain-injured patients was selected from two tertiary care hospitals and the community. Family members were interviewed using a pre-determined interview guide and asked to verbally rate 20 need statements on a four-point Likert-type scale. Generally, family members perceived all 20 needs to be important. However, the importance of each need was influenced by the family members' personal/demographic factors. No significant statistical relationship was found between personal/demographic factors and the family members' perceptions of the importance of selected needs. However, the findings of the study suggest that family members relate their needs to their present experience, and thus individual assessment of family members' needs is crucial. / Applied Science, Faculty of / Nursing, School of / Graduate

This interpretive descriptive study explored the meaning and lived experience of breast cancer for 5 mothers and their 5 adolescent daughters, and for these mother-daughter relationships. Mothers had been diagnosed with breast cancer between 2 and 6 years ago, and their daughters were between 11 and 13 years old at the time of the diagnosis. A series of six in-depth interviews with mothers and daughters, conducted both jointly and separately, afforded a view of aspects of experience that were shared and privately held. Interview data were supplemented with participants' drawings of their experience, and the researcher's observations. The interpretive descriptive framework employed was augmented with the lens of portraiture in the conduct of study, data analysis, and composition of the product of inquiry. Portraiture utilizes five essential features: voice, relationship, context, emergent themes, and aesthetic whole. Individual and relational experience and meaning were described in four themes: (a) Inhabiting Another Landscape, (b) Intending and Acting, (c) Acquiring Wisdom, and (d) Enduring Mother-Daughter Relationships. The theme of Inhabiting Another Landscape described a trajectory of experience and meaning that began with diagnosis, persisted through prolonged effects of treatment, and continued in the present and into imagined futures. Mothers and daughters had privately held concerns about the mothers' breast cancer and the possibility that breast cancer might one day visit daughters as well. The most prominent reminder of vulnerability was recurrence among friends in the social networks of breast cancer. The theme of Intending and Acting described the mutual caring and protectiveness of these mothers and daughters. Mothers and daughters described actions and strategies to minimize the threat of breast cancer for themselves and for the other person. Actions included attempts by both persons to create and maintain a sense of normalcy. Conversations between mothers and daughters on the experience of breast cancer were limited, in particular around prognosis and the possibility of death. The theme of Acquiring Wisdom described personal growth and change after the diagnosis of breast cancer. For both persons, realizations of mortality brought a new perspective on what was important in life. Mothers passed on the wisdom gained from their experience either directly in what was said to daughters or indirectly in the attitudes and behaviours they modelled. The theme of Enduring Mother-Daughter Relationships described the quality of mother-daughter relationships and the import of breast cancer for these relationships. Mothers and daughters described their relationships as close. Daughters described their relationships as closer than most, in part because of their experience with breast cancer. Parenting and being parented was in some cases complicated by breast cancer. Friction between mothers and daughters was described as par for the course during the teen years, but one source of friction was the unexpected and prolonged effects of treatment. The findings in this study indicate the value in attending to the voices of teenage daughters, which remain largely absent in the literature. Mothers and daughters have needs for information and support that are not being met. The emotional landscape of breast cancer, which entails prolonged uncertainty for both mothers and daughters, deserves further study. Personal growth described by both mothers and daughters provides an alternative view of the largely problem-focused perspective in the literature of the meaning and experience of breast cancer. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate