Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: On average one in three patients following lumbar surgery (LS) for radiculopathy experience persistent pain and disability following surgery. No perioperative treatments have shown any ability to decrease this persistent pain and disability. In another challenging low back pain (LBP) population, chronic LBP, pain education focusing on the neurobiology and neurophysiology of pain, has shown an ability to reduce reported pain and disability. The purpose of this research study was to develop and test a preoperative neuroscience education program for LS and determine its effect on pain and disability following LS. Research Design and Methods: After a series of studies, a newly designed preoperative neuroscience educational tool (PNET) was developed. Eligible patients scheduled for LS for radiculopathy participated in a multi-center study where they were randomized to either receive usual care (preoperative education), or a combination of usual care plus one session covering the content of the PNET, as delivered by a physiotherapist in a one-on-one verbal session. Prior to LS, and one, three and six months after LS, 67 patients completed a series of self-report outcome measures consisting of LBP and leg pain rating (Numeric Rating Scale), function (Oswestry Disability Index), fear avoidance (Fear Avoidance Beliefs Questionnaire), pain catastrophization (Pain Catastrophization Scale), pain knowledge (Pain Neurophysiology Questionnaire), various beliefs and experiences related to LS (Likert Scale), and post-operative utilization of healthcare (Utilization of Healthcare Questionnaire). Results: At six month follow up there were no statistical difference (p <0.05) between the experimental and control groups in regards to the primary outcome measures of function (p = 0.296), LBP (p = 0.077) and leg pain (p = 0.074). The experimental group scored significantly better on various questions regarding beliefs and experiences having undergone LS, compared to the control group indicating a more positive surgical experience. Analysis of healthcare utilization showed that patients who received the preoperative neuroscience educational program had dramatically less health care utilization (medical tests and treatments) in the six months following LS (p = 0.001), resulting in a 38% savings in healthcare cost. Conclusion: The addition of a preoperative neuroscience educational program to usual care for LS for radiculopathy resulted in a profound behavioral change leading to a more positive surgical experience, decreased healthcare utilization and resultant savings, despite persistent pain and disability. / AFRIKAANSE OPSOMMING: Agtergrond: Gemiddeld een uit elke drie pasiënte ervaar volgehoue pyn en gestremdheid na lumbale chirurgie (LC) vir radikulopatie. Geen peri-operatiewe behandeling het al getoon dat dit die vermoe het om hierdie volgehoue pyn en gestremdheid te verminder nie. In nog 'n uitdagende lae rug pynbevolking, naamlik chroniese lae rugpyn, het pyn-onderrig, wat fokus op die neurobiologie en neurofisiologie van pyn, getoon dat dit kan lei tot verminderde rapportering van pyn en gestremdheid. Die doel van hierdie navorsingstudie was om 'n preoperatiewe neuro-onderrig program vir lumbale chirurgie te ontwikkel en te toets, en die uitwerking daarvan op pyn en gestremdheid na LC te bepaal. Navorsingsontwerp en Metodiek: Na 'n reeks studies is 'n nuwe preoperatiewe neuroonderrig hulpmiddel (PNET) ontwikkel. Geskikte pasiënte wat geskeduleer was vir LC weens radikulopatie, het deelgeneem aan 'n veelvuldige- sentrum studie. Deelnemers is lukraak in een van twee groepe ingedeel om of gewone sorg (preoperatiewe onderrig), of 'n kombinasie van gewone sorg met een sessie wat die inhoud van die PNET gedek het. Laasgenoemde sessie is aangebied deur 'n fisioterapeut in 'n een-tot-een verbale sessie. Voor die LC, en een, drie en ses maande na LC, het 67 pasiënte 'n reeks van selfverslaggewende uitkoms metings voltooi, wat insluit: Lae Rug- en beenpyn gradering („Numeric Pain Rating Scale‟), Funksie („Oswestry Disability Index‟), Vrees-vermyding („Fear Avoidance Beliefs Questionnaire‟), Pyn-katastrofering („Pain Catastrophization Scale‟), Pynkennis („Pain Neurophysiology Questionnaire‟), verskeie oortuigings en ervarings wat verband hou met LC („Likert Scale‟), en postoperatiewe Gesondheidsorg-benutting („Utilization of Healthcare Questionnaire‟). Resultate: Tydens die ses-maande-opvolg was daar geen statistiese verskil (p <0,05) tussen die eksperimentele- en kontrolegroepe met betrekking tot die primêre uitkoms metings van Funksie (p = 0,296), Lae rug Pyn (p = 0.077) en beenpyn (p = 0,074), nie. Die eksperimentele-groep het betekenisvol beter gevaar met verskeie vrae oor oortuiging en ervarings na afloop van LC. Ontleding van gesondheidsorg benutting, het getoon dat pasiënte wie die preoperatiewe neuro-onderrig program ontvang het, dramaties minder Gesondheidsorg (mediese toetse en behandelings) in die ses maande na LC benodig het, (p = 0,001), wat gelei het tot 'n 38% besparing in gesondheidsorgkoste. Gevolgtrekking: Die byvoeging van 'n preoperatiewe neuro-onderrig program, tot die gewone-sorg vir LC weens radikulopatie, het „n noemenswaardige gedragsverandering veroorsaak wat tot n meer positiewe chirurgiese ervaring, verminderde gesondheidsorg benutting en finansiele besparing gelei het, ten spyte van volgehoue pyn en gestremdheid.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2006. / Postoperative rehabilitation programs have shown little efficacy in decreasing pain and disability in short and long term outcomes for lumbar discectomy. Preoperative education in other disciplines of medicine and physiotherapy has shown to decrease pain and disability postoperatively. No studies to date have been published on preoperative education for spinal lumbar surgery patients with radiculopathy. Objective: The objective of this study was to contribute towards further understanding of the preoperative educational requirements of patients undergoing lumbar surgery for lumbar radiculopthy. Method Two surveys were conducted. A new questionnaire was developed for patients to determine their preoperative educational needs regarding spinal surgery due to radiculopathy. These questionnaires were administered at 4-weeks postoperatively to patients from four spinal surgeons in the Greater Kansas City metropolitan area of the US. A second physiotherapist survey was developed and distributed to physiotherapists registered with the Kansas and Missouri State Boards who were actively involved in treating spinal surgery patients in Kansas and Missouri. The data collected from completed questionnaires were analyzed using descriptive and inferential statistical tests....

Thesis (MEd(Psych))--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The literacy development of learners with special educational needs has traditionally been approached from a behaviouristic framework, which led to the reductionistic teaching of language, focussing on smaller units and sub-skills in order to facilitate a simplification of the learning process. During the 80's changes in the area of literacy development occurred, placing the focus on the whole language approach. This approach (embedded in a constructivistic framework) emphasises the holistic and integrated nature of the language and literacy system, which seems to hold advantages for learners with special educational needs. This also includes learners with Down Syndrome since literature shows that a phonetic approach (which is reductionistic in nature) does not seem to benefit these learners in terms of literacy development and support. The purpose of this study therefore was to ascertain the usefulness of the whole language approach in the development of literacy skills of a , learner with Down Syndrome. This was accomplished by means of a literature review and learner support twice a week. The research methology took the form of a single case study consisting of a learner with Down Syndrome within an inclusive classroom. The qualitative nature of the research, which were descriptive and explanatory, made it possible to provide a rich holistic description of the findings. Data derived from various sources were analyzed according to the constant comparative method in order to identify the main and sub-categories. The findings of the study showed real development in the literacy skills of the learner with Down Syndrome. Noticeable, was the fact that the learner's reading skills developed faster in relation to the other skills. This is supported by the literature review. A fifth dimension, namely personal development was identified which promoted development on the cognitive as well as affective area. Although the scope of the study was limited, it seemed that the whole language a / AFRIKAANSE OPSOMMING: Geletterdheidsontwikkeling van leerders met spesiale onderwysbehoeftes is tradisioneel vanuit 'n behavioristiese raamwerk benader, wat daartoe aanleiding gegee het dat taal gereduseer is tot kleiner eenhede en subvaardighede ten einde die leerproses te vergemaklik. Gedurende die tagtigerjare het veranderinge op die gebied van geletterdheidsontwikkeling plaasgevind, wat die fokus op die geheeltaalbenadering geplaas het. Hierdie benadering (gesetel in die konstruktivistiese verwysingsraamwerk) lê klem op die holistiese en geïntegreerde aard van die taal- en geletterdheidsisteem, wat blyk om voordeel vir leerders met spesiale onderwysbehoefte in te hou. Dit sluit ook die leerder met Downsindroom in, aangesien literatuur daarop wys dat die fonetiese benadering (reduksionisties van aard) nie blyk om tot voordeel van hierdie leerders se geletterdheidsontwikkeling en -ondersteuning te strek nie. Die doel van die studie was gevolglik om die bruikbaarheid van die geheeltaalbenadering in die ondersteuning van 'n leerder met Downsindroom se geletterdheidsvaardighede te ondersoek. Dit is by wyse van In literatuuroorsig en leerondersteuningsessies op 'n tweeweeklikse basis gedoen. Die navorsingsmetodiek het die vorm van 'n enkel gevallestudie aangeneem, bestaande uit 'n leerder met Downsindroom in 'n inklusiewe klaskamer. Die kwalitatiewe aard van die navorsing, wat beskrywend, verkennend en verklarend is, het dit moontlik gemaak om 'n ryk holistiese beskrywing van die bevindinge te gee. Data afkomstig van verskeie bronne is volgens die konstante vergelykende metode geanaliseer ten einde die hoofkategorieë en subkategorieë te identifiseer. Die bevindinge van die studie het gedui op 'n beduidende ontwikkeling van die die leerder met Downsindroom se geletterdheidsvaardighede. Opmerklik was die feit dat die leerder se leesvaardighede, in vergelyking met die ander geletterdheidsvaardighede, vinniger ontwikkel het. Dit word deur die literatuuroorsig ondersteun. 'n Vyfde dimensie, naamlik persoonsontwikkeling, is geïdentifiseer wat ontwikkeling op kognitiewe sowel as affektiewe gebied bevorder het. Alhoewel die omvang van die studie beperk was, blyk dit dat die geheeltaalbenadering tot voordeel van die leerder met Downsindroom se geletterdheidsontwikkeling strek.

published_or_final_version / abstract / toc / Educational Psychology / Master / Master of Social Sciences

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

Sammanfattning Bakgrund För att kunna tillfriskna och återhämta sig efter en hjärtinfarkt så bör patienten göra en livsstilsförändring. Det är därför är det viktigt att sjuksköterskor får vetskap om, får material och resurser för att kunna hjälpa och stärka patienten med dennes copingresurser. Denna studie belyser olika delar som enligt patienter anses viktiga att förbättra i sjuksköterskans arbete. Syfte Syftet med denna litteraturstudie är att beskriva patienters erfarenheter efter hjärtinfarkt och vad de anser kan förbättras i sjuksköterskans arbete för att främja deras återhämtning. Syftet är även att granska de sökta artiklarnas datainsamlingsmetod. Metod Examensarbetet har gjorts i form av en deskriptivlitteraturstudie utifrån artiklar med kvalitativ och kvantitativ ansats. Huvudresultat Denna studie visar på vikten av information till patienter och deras närstående för att återhämtningen ska bli så lyckad som möjligt. Den belyser även olika delar som enligt patienter anses viktiga att förbättra i sjuksköterskans arbete för att främja återhämtningen. .Slutsats Denna studie visar tydligt på vikten av information, att den är tydlig, tillräcklig och fortlöpande och anpassas efter tid utifrån varje enskild patient för att återhämtningen efter en hjärtinfarkt ska bli så lyckad som möjligt. Då rehabiliteringen ofta ligger på patientens och dess anhörigas ansvar så är det också viktigt att de görs mer delaktiga och att informationsflöde till anhöriga förbättras. / Background To be able to convalesce and recover after a heart attack the patient should make a lifestyle change. It is therefore important that nurses have knowledge, the materials and resources to help and strengthen the patient with his copingresourses. This study highlights various elements which the patients are considered essential to improve the nurse's work. Aim The purpose of this study is to describe the experiences of patients after myocardial infarction and what they think could be improved by nurses to promote their recovery. The aim was also to examine the chosen articles data collection methods. Method The work has been done in the form of a descriptive literature review based articles using qualitative and quantitative approach. Main Results This study shows the importance of information to patients and their families that the recovery will be as successful as possible. It also highlights various elements which the patients are considered essential to improve the nurse's work to promote recovery. Conclusion This study clearly demonstrates the importance of information, that it is direct, sufficient and sustained and to time based to each individual patient, so recovery after a heart attack can be as successful as possible. Rehabilitation is often the patient's and the family's responsibility. That it is why it is important that they become more involved and that the information to relatives is improved.

Darbo tema – hemodializuojamų pacientų mokymo programos sukūrimas. Hemodializuojami pacientai turėtų būti mokomi taisyklingos mitybos, arterinio kraujo spaudimo (AKS) reguliavimo principų ir teisingos arterio – veninės (A-V) fistulės priežiūros. Sergantiesiems būtina suteikti psichologinę pagalbą, išmokyti juos pasinaudoti artimųjų parama. Galima daryti prielaidą, kad pradėjus mokyti hemodializuojamus pacientus, gydymo ir slaugos rezultatai bus geresni. Teiginį, kad pacientų mokymas yra nepakankamas, pagrindžia tai, kad nėra sukurtos mokymo programos. Darbo tikslas–ištirti hemodializuojamų pacientų mokymo poreikį ir sukurti hemodializuojamų pacientų mokymo programą. Tyrimo metodai: Mokslinės literatūros analizė; Anketinė apklausa; Statistinė duomenų analizė. Tyrimas buvo atliktas 2006m. gruodžio - balandžio mėnesiais. Tiriamųjų apklausa atlikta Klaipėdos Jūrininkų ligoninės nefrologijos ir hemodializių skyriuje ir UAB „Nefrida“ hemodializių skyriuje. Išvados: Hemodializuojamų pacientų mitybos mokymo poreikis yra didelis. Hemodializuojami pacientai informaciją mitybos apribojimų klausimais gavo, ta�����iau pavėluotai t. y. 29 pacientai (51 proc.) informaciją gavo mažiau nei pusė metų iki pirmos hemodializės procedūros. Dauguma pacientų net 47 pacientai (82 proc.) negavo iš šeimos gydytojo informacijos mitybos apribojimų klausimais. Iš dializės skyriaus slaugytojos daugiau nei pusė pacientų t. y. 34 pacientai (60 proc.) gavo informacijos mitybos apribojimų klausimais... [toliau žr. visą tekstą] / It is necessary to teach haemodialysed patients how to take health nourishment,how to regulate blood pressure (BP),how to take appropriate care about arterial-venal fistula. Patients need psychological help,to take family support. Possibly,this teaching will improve rezults of treatment and medical care.Statement,that teaching of such patients is insufficient, is based on the fact ,that there is no training program nowadays. Aims-to examine haemodialysed patient‘s demand of teaching,and to create training program.Methods- analysis of science terature,questionnaire,statistic data evaluation. Questionnaire took place in nefrology and haemodialysis department of Klaipeda Seamen hospital and in haemodialysis department of private clinic „Nefrida“. Conclusions-almost all patients (95 per cent)with chronic renal insufficiency were informed about nutrition limitation.More than half of them (51 per cent)were informed too late-less tan 6 month before first haemodialysis.The vast majority of patients(96,5)state that information about nutrition limitation they get mostly from nephrologist.17,5 of respondents state that such information they get from family doctor. The most of patients (92 per cent) were informed about A-V fistula imprtance and medical care during haemodialysis.Training program of haemodialysed patients was prepared.It consist of flyer,CD record,booklet about limitation in nutrition and A-V fistula care.The training program for haemodialysed patients are based... [to full text]

This study was aimed at evaluating effects of psycho education on medication compliance and symptom management for clients with bipolar affective disorder attending community psychiatric clinics in the Ethekwini Health District of KwaZulu-Natal Province. A quantitative study was done using a quasi-experimental design. A one group pre-test and post-test design was used to assess the effects of psycho education. The population of the study were all clients with bipolar affective disorder attending Escoval House community psychiatric clinic and its satellite clinic (Austerville). Systematic sampling was used to select clients to participate in the study and a total of forty clients were selected. Two self-administered questionnaires were used to collect data. Clients were assessed in areas of their knowledge, medication compliance and symptom management (Pre-test). The group was then exposed to six sessions of psycho education, and they were assessed again a week after the psycho education (post-test) using the same instruments. The data was analyzed using the Statistical Package for Social Sciences (SPSS). Descriptive statistics were used to analyse participants' characteristics and some selected variables. Cross tabulations, chi-squares and paired t-tests were used on dependent variables and on social variables of interest to compare the changes in scores and means respectively and lastly to determine the relationship of social variables and the dependent variables. The findings of this study revealed that psycho education improved respondents' knowledge about their illness and symptom management techniques (with P-values ranging from 0.0001- 0.03), psycho education also improved medication compliance with P-value =0.000, but it did not affect the respondents' ability to use new techniques in managing their symptoms (with P-values ranging from 0.125- 0.75). / Thesis (M.A.)-University of KwaZulu-Natal, 2005.

The aim of this thesis is to understand the experiences of eight American high school students who have been diagnosed with cancer. By increasing understanding of the challenges that adolescents in cancer survivorship experience, better support can be identified. The experience of cancer survivorship influences the physical, psychological, and social experiences of patients. As the survival rate of childhood cancers continues to increase, death becomes less likely making the need to maintain educational engagement during survivorship increasingly important. The research questions for this study were designed to address two main gaps in the current field of research. The first research question aims to address how the physical and psychological effects of cancer and treatment impact the participants' engagement with school. The second research question aims to understand the role that school plays for adolescents in cancer survivorship, including how participants experienced supplemental education during and after cancer treatment. This study uses a qualitative research methodology to address the research questions utilizing primarily semi-structured interviews and an adjusted version of the Adolescent Coping Scale. When used in combination with the interviews, the scale provides a picture of what the participants experienced and how they have been able to cope with the challenges they have faced. Interpretive phenomenological analysis was used to provide structure to the interview analysis. The results of this study show that fatigue and a compromised immune system have an impact on school attendance more than other physical effects during cancer treatment. As a result, adolescents are most at-risk of experiencing challenges in educational engagement during treatment. The results of this study also show that the feeling of uncertainty throughout cancer survivorship promotes fear and the feeling of a loss of control. Once treatment ends, fear of relapse is common. Physical and psychological effects were felt to improve as time passed. Another key result of this study is that the cancer experience results in a shift in perspective that becomes incorporated into the formation of identity. Participants feel different from peers as a result of the physical and psychological effects of the cancer experience. The results from the Adolescent Coping Scale indicate that school achievement, relapse and the worsening of physical side effects, and being treated different by peers were common concerns for the participants regarding their school, illness, and social concerns, respectively. Lastly, the participants view supplemental education as successful if it meets their personal academic and physical needs, is implemented consistently, and helps them to feel emotionally supported and socially connected. However, more research is needed that focuses on the implementation of policy at the state and district levels to discern whether this is a common challenge unique to this population of students with a physical or medical disability. The sample available for this research topic is not only limited to an extremely small population, but they are also a highly guarded population, making access for recruitment challenging. However, while generalization is difficult with a study of this size, the evidence collected on the participants' experiences during and after treatment provides valuable data on aspects of supplemental education implementation.

In hierdie studie is daar gefokus op Tourettesindroomlyers se leefwereldstigting, met spesifieke verwysing na hulle kognitiewe funksionering. Tourettesindroom is 'n neuropsigiatriese versteuring wat gewoonlik tydens die kinderjare 'n aanvang neem en wat deur motoriese en/of vokale tics gekenmerk word. Tourettesindroomlyers kan 'n verskeidenheid aanverwante versteurings manifesteer, byvoorbeeld Obsessief-kompulsiewe Versteuring, Aandaggebrekversteuring, met of sander hiperaktiwiteit, fobies en ander affektiewe afwykings. Aangesien die werklike oorsake van T ourettesindroom steeds 'n onbekende faktor is, is die behandeling van hierdie chroniese toestand nie 'n gewaarborgde sukses nie. Dit wil voorkom asof die insidensie van Tourettesindroom, wat heelwat hoer onder manlikes as vroulikes is, hoer is as wat aanvanklik vermoed is. Al ses die fasette van menswees kan deur Tourettesindroomlyers negatief beleef word. Op fisiese gebied toon navorsing verskillende abnormaliteite in die brein, byvoorbeeld by die afskeiding van die neurosenders soos dopamien en serotonien, 'n reduksie in die volume van die basale ganglia, 'n kleiner linker globus pallidus en versteurings in die frontale lobbe, die corpus callosum en die basale ganglia se senuweebane. Hulle konatiewe faset kan oorheers word deur hulle ongemotiveerdheid op kognitiewe gebied. Die normatiewe faset word dikwels weens verslawende gedrag belemmer. Die Tourettesindroomlyers se sosialisering kan swak wees weens hulle gedragsprobleme. Hierdie navorsing bevestig vorige ondersoeke wereldwyd wat toon dat depressie, slaapprobleme, angsversteurings en die onvermoe om stres te hanteer by sommige Tourettesindroomlyers kan bydra tot uitputting wat hulle kognitiewe funksionering belemmer. Tourettesindroomlyers presteer op kognitiewe gebied 6f uitstekend 6f uiters swak. Groot uiteenlopendhede word in die neuropsigologiese gedrag van Tourettesindroomlyers gemanifesteer, met 'n vermindering in hulle uitvoerende kognitiewe funksionering weens tekorte in hulle kognitiewe prosesseringsvermoens. Dit het verarmende gevolge vir hulle kognitiewe inhoud, struktuur en uiteindelik kognitiewe produkte. Algemene en spesifieke leerprobleme is die gevolg. Dit is dus te begrype dat Tourettesindroomlyers se betrokkenheid, belewing en betekenisgewing by die skoolsituasie en leerstof negatief beleef kan word. Saam met hulle vernederende simptome, fluktuasie van hulle punte en belemmerde leefwereldstigting, is die logiese gevolg ontwrigte selfbeelde. Tourettesindroomlyers benodig daadwerklike ondersteuning in hulle selfaktualisering ten einde waardevolle mensepotensiaal vir SuidAfrika te behou. / The focus of this study is the life-world formation of Tourette syndrome sufferers, with specific reference to their cognitive functioning. Tourette syndrome is a neuropsychological disorder which usually has its inception during childhood and is characterised by motor and/or vocal tics. Tourette syndrome sufferers may also exhibit a variety of related disorders, for example Obsessive Compulsive Disorder, Attention Deficit Disorder, with or without hyperactivity, phobias and various affective disorders. The cause of Tourette syndrome is still unknown, therefore treatment cannot be guaranteed to be successful. The incidence of Tcurette syndrome is higher than was initially suspected and is more prevalent among men. Tourette syndrome sufferers can negatively experience all six facets of humanity. In the physical area research indicates various abnormalities in the brain, for example the secretion of neurotransmitters, a reduction in the volume of the basal ganglia, a smaller left globus pallidus and disorders in the frontal lobes, the corpus callosum and the nerve circuitry of the basal ganglia. The conative facet may be dominated by their lack of motivation in the cognitive area. The normative facet is often hampered due to addictive behaviour. Socialisation can be poor due to behaviour problems. This research confirms previous investigations world-wide which indicated that depression, sleep and anxiety disorders and the inability to handle stress contributes to exhaustion, which impedes cognitive functioning. In the cognitive area Tourette syndrome sufferers perform either extremely well or extremely poorly. There are great discrepancies in the neuropsychological behaviour of Tourette syndrome sufferers and a reduction in their executive cognitive functioning due to shortages in their cognitive processing abilities. This has impoverishing consequences for their cognitive content, structure and eventually cognitive products resulting in general and specific learning disabilities. It is therefore understandable that Tourette syndrorne sufferers' involvement with, experiences of and attribution of meaning to the school situation and study material are negatively influenced. Add their humiliating symptoms, fluctuation of marks and hampered life-world formation and the logical result is disrupted self-images. Tourette syndrome sufferers need crucial support in their self-actualisation in order to be able to offer South Africa worthy human potential. / Psychology of Education / D. Ed.(Sielkundige Opvoedkunde)