M.Cur. (Psychiatric Nursing) / The purpose of this study was to explore the experiential world of the chronic psychiatric patient In a rehabilitation centro and to sot guidelines for the psychiatric nurso to utilize the principles of restoration of merital health. Various stumbling blocks In the recovery process of chronic psychiatric patients were noticed in a rehabilitation centre. The centre Is highly structured and democratic decision making does not always transpire. The external environment Is In a residential area characterised by violence. The question arising, was to what degree the chronic psychiatric patient's experience of his/herworld In the rehabilitation centre, can contribute towards the mobilization of resources In order to facilitate the restoration of mental health of the chronic psychiatric patient and reintegration Into society. The approach followed, was that of the Nursing Whole Person Theory. With this theory as basis, the chronic psychiatric patient Is viewed as a whole In Interaction with his/her Internaland external environment In his/her questfor mental health as Integral part of wholeness. An exploratory and descriptive qualitative study, contextual of nature, was used as research design. The method for research was phenomenological, semi· structured interviews with chronic psychiatric patients In a rehabilitation centre. The participants In this study were selected In a purposive and non-selective manner. Botes' Model for Nursing Research was used to structure the research of this study. Measures used for reliability and validity, were that of Woods and Catanzaro. The central question "How do you experience living In this rehabilitation centre?" was asked. Similar studies were Investigated In order to ascertain similarities and unique aspects of this study. Categories of experience within the unit of assessment and diagnosis from the Nursing for the Whole Person Theory, Indicated both stumbling blocks and facilitating elements. Stumbling blocks In chronic psychiatric patients' (In a rehabilitation centre) quest for wholeness were experiences of avoidance, frustration, anxiety, lack of motivation, Inability to maintain longstanding relationships and dispute.

Magister Scientiae (Physiotherapy) - MSc(Physio) / HIV and AIDS are now being considered as a chronic disease. As people live longer the possibility of physical disability increases. This study aimed to investigate the nature of physical disability among HIV/AIDS adults cared for by the Makeni home-based carers in Lusaka, Zambia. Disability was measured based on the World Health Organisation International Classification of Functioning, Disability and Health. This study demonstrated that mostly mild impairments and mild to moderate activity limitations and participation restrictions exists among patients in the Makeni home-based care programme. This study concluded that physiotherapists and other health professionals will have to be more involved in the community home-based programs that are suited for people living with HIV/AIDS so that they are also provided with clinical assessments and rehabilitation services. / South Africa

Magister Scientiae - MSc / Clinical research has shown that patients experience difficulty in adjusting to their pre-morbid worker roles after they have been through a back rehabilitation programme. The pressure and competitiveness of modern day society to achieve competence and to survive has proven to be stressful, both for the injured and uninjured, the unemployed and employed. Back rehabilitation and the successful return of the injured worker to the workplace have been of great interest to industry for the last decade, due to the ever-increasing support of legislature for the injured. There is a range of medical interventions available but few of these achieve successful outcomes due in part to the fact that many intervention strategies do not take the patients perspectives into consideration. Therefore, the purpose of the study was to explore back rehabilitated clients perceptions and experiences of the challenges they face in adapting to their worker roles. / South Africa

Post Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis receiving increased attention. Occupational therapists are becoming more involved with this diagnosis, particularly with Vietnam Veterans in Veteran Affairs Hospitals. Aerobic exercise is a treatment which has not been explored with this population. Depression and anxiety are symptoms commonly associated with PTSD. This study sought to determine whether aerobic exercise would reduce overall PTSD symptomatology, including depression and anxiety. Three psychological inventories: The Penn Inventory for PTSD, The Beck Depression Inventory (BDI), and The Beck Anxiety Inventory (BAI) and one physiological inventory: The Queens Step Test for VO2 Max were given to eighteen subjects before and after a four week period. Ten subjects engaged in no exercise, and eight subjects participated in an aerobic exercise program. Results indicate that aerobic exercise has a significant effect on reducing depression and anxiety and a marginal effect on their overall symptomatology.

Self-help groups have emerged as a system of care for groups of people sharing a common problem or condition. Most of the interest in research came from professionals in mental health and social services. Educators have traditionally viewed self-help groups as outside their domain. The focus of this study is the phenomenon of personal change within self-help groups. This is viewed as “learning with peers.” The subject of the study was HOPE Cancer Health Centre, a non-profit community based self-help organization in Vancouver, B.C. Appropriate to the study of phenomena in their natural surroundings, data collection methods were qualitative in nature. Fourteen in-depth interviews were carried out with members and leaders of the self-help group. Two introductory workshops were attended for participant observation and several pertinent documents were reviewed. A full description of HOPE Cancer Health Centre as a self-help group and as a context for adult learning was developed. To clarify the description of HOPE, a framework of characteristics of self-help groups was developed. It was used to organize data collection and analysis. Compilation and analysis of the findings created a description of HOPE that adds to the understanding of self-help groups as organizations in a larger system of care provision. It also adds to the understanding of HOPE as an organization with the purpose to assist cancer patients who are interested in actively participating in their cancer treatment and recovery. In order to enhance understanding of adult learning in the context of a selfhelp group, three perspectives from the literature on adult learning were selected for their potential to organize and explain the resulting data. Four important themes emerged from the data on the learning experiences of the members of HOPE. First, the ideology of HOPE, “self as participant in healing,” is the framework of learning and within that frame there are four forms of learning, the forms of transformative learning being the most significant. Second, for the learners of HOPE, the basis of knowledge is their personal experience; therefore, processes of experiential learning are important as well as those of perspective transformation. Third, the affective dimension of the experiential learning process was found to be integral in the process of learning. The fourth theme is “learning with peers,” the innate characteristic of self-help groups. All members interviewed placed high value on their experiences of learning with peers and of learning at HOPE. Meaningful interpretation of the data resulted from application of concepts and theoretical propositions from three perspectives on adult learning: experiential learning, transformative learning and situated learning. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

The individualization and medicalization of the emotional distress of those given psychiatric diagnoses deny the social, political, and economic context in which the presenting behaviours arose and leads away from making changes to society. Some people who are psychiatrically labelled join in groups for solidarity in the face of being stigmatized. In these groups the members can resist the disempowerment and helplessness learned in the psychiatric system. With co-researchers from a self-help group this study gives expression to the usually silenced voices of psychiatrized people. Feminist and standpoint theories, co-cultural and living systems theories form a framework for this narrative study. A structural narrative method is used to analyze the stories, found in the transcripts of six individual interviews, told by the co-researchers about their experiences in psychiatric services and in the recovery process. The stories reveal how the ideology and practices of psychiatry use stigma, oppression and the creation of the identity of psychiatric patient for control and management. The stories also reveal the reality of hope for recovery through the support of peers and from the role models of those who have significantly recovered their mental health. Two focus group interviews were conducted with members of the self-help group where suggestions for programs were developed to address issues raised within the groups and in the individual interviews. The findings of the research will be reported to the self-help group who will use the study to back proposals for the funding of recovery-oriented programs. When social workers and other mental health professsionals recognize the importance of supporting the process of recovery, consumer/survivor-run programs will be acknowledged as effective and integral parts of any mental health system / Arts, Faculty of / Social Work, School of / Graduate

D.Litt. et Phil. / The mentally ill population is one of the most neglected subpopulations of the Western World and this is most certainly the case in Southern Africa. With the restructuring of the mental health system, the process of discharging properly rehabilitated individuals from long term hospital stays into a strong community mental health support structure has become a priority. In order to embark on a process driven by an ethos of primary health care, the present inpatients in custodial settings need to be discharged into the open community. This process is termed deinstitutionalisation, and involves the discharge of all able patients from chronic or long-term custodial care institutions, into the open community as functional members, with all of the rights and freedom which this may imply. Deinstitutionalisation as a concept embraces the essence of human rights, as the person takes control of his/ her life circumstances with all of the accompanying responsibilities. Present deinstitutionalisation practice in traditional South African long-term care facilities has no rehabilitation/ recovery focus with which to drive the discharge process of patients. Barriers to the success of the process are the lack of rehabilitation services, poor discharge planning and process, and lack of follow-up and integration of community services. These would seem to be the biggest stumbling blocks to the success of a deinstitutionalisation initiative. The initial process of design and implementation of a viable programme, and one that addresses uniquely South African issues was challenging. This was because of the lack of information, and reliable reporting systems with which to identify availability and need of service, client subpopulations, and service provision agencies. A preexisting NGO system was described and assessed for service provision and success rates, and the same system was used to measure the availability and applicability of psychosocial rehabilitation service in South Africa. The process comprised describing a the necessary components required by a recovery-driven, psychosocial rehabilitation system, using international literature as well as the early findings and results of the changed system. Suggestions have been made in terms of necessary facilities and services required, as well as staff competencies and methods of addressing historic issues of anti trust which have developed because of apartheid mental health practice.

Coronary Artery Disease (CAD) is one of the most common cardiovascular disorder in adults. CAD often results in myocardial infarction or angina (Wilson, 2003:21). It is an accepted fact that the incidence of CAD has reached endemic proportions in South Africa (Venter, 1993:15). Coronary Artery Bypass Graft (CABG) surgery, Percutaneous Transluminal Coronary Angioplasty (PTCA) and insertion of a coronary stent are major therapeutic approaches to the treatment of CAD. However, these procedures do nothing to correct the underlying disease process (Hunt, Hendrata, Myles, 2000:389; Venter, 1993:15). Due to physiological changes patients suffering from CAD are expected to make lifestyle adaptations, in order to improve quality of life and prevent further damage to coronary arteries (Gotto, 1987:29). It is suspected that patients do not always adapt their lifestyle when they suffer from CAD, or if they do, do not maintain these adaptations. The following question emerges: • Do patients with coronary artery disease adapt their lifestyle and if they do, do they maintain these adaptations? The purpose of this study is to explore and describe the extent to which patients with CAD who underwent CABG, PTCA or insertion of a coronary stent adapt their lifestyles and to what extent they maintain these adaptations. Secondly, the purpose is to set guidelines to help with the improvement of lifestyle adaptations and contingency of adaptations. The objectives of the study is to explore and describe the extent to which patients with CAD adapt their lifestyles following CABG surgery, PTCA or insertion of a i coronary stent, the comparison of the extent of these lifestyle adaptations after two and four months and to set guidelines to improve the extent and contingency of lifestyle adaptations. An explorative and descriptive study was done in order to explore and describe the extent to which patients with CAD, who underwent CABG surgery, PTCA or insertion of coronary a stent, adapted their lifestyle, and to determine the maintenance of these lifestyle adaptations. For the purpose of this study questionnaires, based on a conceptual framework, were designed. The questionnaires enabled the researcher to explore and describe the lifestyle adaptations that patients with CAD underwent. The study was conducted in five private hospitals in Gauteng. The data obtained confirmed that patients suffering from CAD do adapt their lifestyle after having CABG surgery, PTCA or insertion of a coronary stent. Data also showed that the presence of a cardiac rehabilitation centre at the hospital where participants were treated, has a significant influence on patients’ ability to adapt their lifestyle and to maintain this new lifestyle. / Dr. W.O.J. Nel Ms. W. Jacobs

M.Ed. / This study focuses on the role of the medico-legal team, and the educational psychologist in particular, towards the family whose child has survived Traumatic Brain Injury through an involvement in a motor vehicle accident. In South Africa there is a high incidence of motor vehicle accidents. This incidence, adversely affects families, emotionally, socially and economically. Research has shown that the incidence of Traumatic Brain injury (TBI) is higher in South Africa than the worldwide average as compared to other developing countries. This prevalence is confirmed by the Road Accident Fund, a government entity that is responsible for compensating victims of negligent road users that approximately 10 000 people die and 150 000 sustain injuries in South African roads every year. The study was conducted as an attempt to answer the research question: What is the experience of a family whose child has sustained a Traumatic Brain Injury? The envisaged outcomes of the research would then assist the researcher to offer recommendations for educational psychologists working with children who had survived TBI and their families, aimed addressing the needs of such families. The research paradigm emanates from a systemic view. It is a qualitative case study, drawn from a particular selected family, as a unit of study. Data was collected through unstructured interviews, and interviews were audio-taped and transcribed. Other sources of data were collected from hospital records, psychological records and letters from the school to be used as supporting evidence. The findings of the study suggest that families are subject to shock of the trauma, that they experience loss, they grieve for a lost one and have to cope with daily frustration, when their child survives a Traumatic Brain Injury. Recommendations have been drawn to provide a sound framework for educational psychologists who work with families whose children has experienced TBI. / Mrs. J.V. Fourie

Neuropsychological rehabilitation following acquired brain injury is increasingly recognized as essential with the advancements in research evidence of its effectiveness, particularly as current estimates of disability following the most common forms of brain injury (traumatic brain injury and cerebrovascular accident) are so high. Improvements in predictive capabilities of researchers and clinicians are paramount in designing effective interventions. As many variables associated with outcome following brain injury are not controllable (e.g. severity of the injury, age, education), it is essential that rehabilitation programs design interventions to target those variables that are susceptible to amelioration. While personality factors have been shown to affect outcome in other medical illnesses, only a few studies have examined the influence of personality on outcome following neurorehabilitation for acquired brain injury. The results of these studies have been mixed. This study used the Millon Behavioral Medicine Diagnostic (MBMD) to predict outcome as measured by the Mayo-Portland Adaptability Index (MPAI-4) following brain injury rehabilitation in a heterogeneous sample of persons with acquired brain injuries (N = 50). It was hypothesized that specific coping styles scales from the MBMD (Introversive, Dejected, Oppositional), which are based on Millon's personality system, would predict outcome. Results indicated that both the Introversive and Oppositional coping styles scales accounted for significant amounts of variance in outcome beyond that accounted for by the severity of the injury alone (p < .001). In both cases, individuals with mild/moderate-moderate/severe limitations following completion of the rehabilitation program had significantly higher scores on the Introversive and Oppositional coping compared to individuals with more successful outcomes. The hypothesis that a dejected coping style would predict outcome was not supported. Implications for rehabilitation are discussed in the context of Millon's personality system.