Hypothermia is commonly found in injured victims who suffer from central nervous system injury, hypovolemic shock, exposure to environment, administration of anesthetic drugs and cold intravenous fluid. All these factors decrease the abilities of trauma victims to maintain normothermia and conserve body heat. Hypothermia in injured victim is a significant contributor to a well known cycle—triad of death and associated with increased mortality, morbidity and length of hospital stay. Hypothermia is one of the preventable complications in trauma patients. Therefore nurse plays a vital role to evaluate the methods of preventing hypothermia. However, there is no systematic review of effectiveness of different warming methods in local setting. The purpose of this dissertation is to develop an evidence-based guideline to prevent hypothermia in trauma patients by reviewing existing evidence, to assess the feasibility and transferability of implementing the guideline and to develop its implementation and evaluation plan. Five articles meeting the inclusion and exclusion criteria are identified after a systematic research of six electronic databases. Among these articles, four of them are randomized controlled trials while the remaining one is quasi-experimental design with prospective randomized assignment. The quality of these identified articles is evaluated with the methodology checklist for randomized controlled trials which is developed by Scottish Intercollegiate Guideline Network (SIGN). All studies of medium and high quality would be considered as sufficient evidence to support the proposed innovation in preventing hypothermia for trauma patients in Accident & Emergency Department. After assessing the implementation potential, an evidence-based guideline in preventing hypothermia for adult trauma patients is established. The proposed innovation is necessary and beneficial for adult trauma patients to prevent hypothermia. The grade of recommendation in the guideline is rated based on the SIGN grading system from A to D. Communication plans with stakeholders and 3-month pilot study on 20 patients are conducted before implementing the innovation into clinical setting. Evaluation is made to assess the effectiveness of the proposed guideline after the end of pilot study and the end of implementation of guideline. The effectiveness of the proposed innovation is determined by change of core temperature as + 1.1 °C/hr and at least 90% reduction in shivering and thermal discomfort which are reported in the reviewed articles. The guideline is considered as clinical effective when similar outcome is obtained. / published_or_final_version / Nursing Studies / Master / Master of Nursing

In addition to alleviating pain and physical symptoms, caring for the psychosocial, spiritual and existential needs of terminal cancer patients is very important. Existential issue such as meaning is one of their major concerns. Meaning making can be a powerful mean to enhance the well being of these patients at their end of life. There is limited research on the meaning and meaning making experiences among the Chinese population. This study aims to examine the sources of meaning of these patients and illuminate how they make meaning at the end of life. Cultural features associated with meaning and meaning making at the end of life are explored as well. The current study adopted a constructivist grounded theory approach. Purposive sampling was used to recruit twenty terminal cancer patients from the palliative care unit. Semi-structured interviews and brief life review exercise were conducted with the patients. Forty-three interviews were produced and provided a foundation for the data, along with field notes, interview memos and journals. This study revealed that sources of meaning among the Chinese terminal cancer patients were derived from four major domains. They were self domain, relational domain, physical domain and spiritual domain. These domains were interrelated and having dynamic interactions with each other. A proposed model of meaning making at the end of life also emerged from the collected data. It consisted of four processes: sense making, self constructing, script creating and experiencing sense of connectedness (The 4S Model). Meaning making at the end of life was found to be a cognitive, affective and relational process. Findings revealed the significant role culture and family play in the meaning and meaning making processes of Chinese terminal cancer patients. Knowledge generated from this study informs the development of clinical intervention and practice to improve the well being of patients at the end of life. Implication for the development of meaning measurement and family intervention are suggested. Healthcare practitioners are equipped to move further on the path of developing a holistic care model at palliative care. This study also shed lights on promoting life education in the local community. Life can be brimmed with meaning even in the toughest hours. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Most demented individuals are now cared for at home by family members. The present study examined the coping strategies employed by family caregivers, their perception of burden, and the internal dialogues employed by caregivers to stressful events. Sixteen (13 females, 3 males) participants with an average age of 67.4 years were interviewed. Results indicate that caregivers who spend less hours per week caring for their care receiver perceived less overall burden and caregivers who subjectively felt that they were coping with their role tended to use more coping strategies. Caregivers' internal dialogues and comments concerning problems coping with Alzheimer's patients are included.

Caregiving for two parents affected by chronic dementia was the original impetus for this study. My negative experiences led to a quest for insight and solutions through volunteer, professional and academic pursuits. It culminated in this exploration of caregivers' experiences and their decision-making to expose the educational support they need. Caregivers tend to be family members, and overwhelmingly women. Studies from various disciplines confirm that caregivers need educational support to make decisions. Yet, little is known about what type of educational support they need and how it is to be provided. Caregivers' voices are seldom included in research and they are frequently blamed for the problems they confront. This qualitative study honours caregivers' voices. Through in-depth semi-structured interviews, the perspectives of five women form my primary source of data. Personal documentation, archival materials, and interviews with experts in the field supplement these data. To analyze the data two complementary analytic approaches are used: categorization and contextualization. A categorization approach organizes the data into conceptual themes. These themes include activities of multitasking, being locked into a state of heightened alert, interpreting the disease, and managing care. These activities reveal physical and psychological suffering. Contextualization approaches situate the dilemmas the women face in particular contexts. These dilemmas highlight their lack of authority. The analyses indicate that the women engage in a wide range of decision-making and that they need both similar and specific types of educational support. These types of support include (1) lessening their burdens and their frustrations of decision-making; (2) facilitating ethical decision-making; (3) providing information about medical treatments; and (4) assisting with the access to and with the assessment of suitable resources. Overall, caregiving is a ve

The purpose of this study was to determine if distinct subgroups of patients with Senile Dementia of the Alzheimer Type (SDAT) could be identified using seven scales of the Cognitive Behavior Rating Scale (CBRS). Ward's method of cluster analysis was used to group 104 patients with a probable diagnosis of SDAT into subtypes.The following three clusters were identified: (a) Moderately Impaired, (b) Severely Impaired, and (c) Emotionally Intact which displayed differences in symptom severity. Clusters could be partially defined by the amount of time they had been diagnosed with the disease. Differences in the cluster's configuration of scores had little/no descriptive utility. Subsequent discrimination analyses indicated that patient demographics were not as useful as the CBRS in classification of patients.This study provided evidence for the CBRS's ability to differentially portray SDAT patients' profiles. Results provide partial support for a stage model of SDAT. Implications of existing subgroups in SDAT are discussed as they pertain to patient management issues. / Department of Counseling Psychology and Guidance Services

Objective To determine the reasons for the change or modification in the first line HAART regimen (1a and 1b) in HIV positive patients at the Thusong CCMT site. Methods This study is a quantitative descriptive study using a standardized data collection tool to extract retrospective data from medical records. Subjects Subjects for this study included patients 18 years or older attending the Thusong CCMT site, which were started on HAART regimens 1a or 1b and were on treatment for at least 6 months. The final sample size evaluated was 257 patients. Results There was a high rate (43%) of change or modification of the first line HAART regimen. Majority of the patient’s (72%) had their regimen modified due to side effects of the drugs and only a small number (9.7%) of patients had a complete change in the regimen due to virological failure. Stavudine (d4T) associated lipodystrophy was the most common side effect (45.5%) followed by peripheral neuropathy (16.7%), leading to treatment modification. Conclusion The rate of modification or change of first line HAART regimen, at Thusong CCMT, was fairly high (42.6%), and the most common reason for the modification or change was drug side effect of stavudine (d4T).

D.Cur. (Psychiatric Nursing) / Malawi has a population of 9 million people with AIDS the leading cause of death in the age group of 20 • 40. The HIV prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994: I). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but testing is increasingly refused by patients who do not see the benefit of knowing their HIV status. The counselling practice as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of this research study is to describe a model of counselling that would meet the needs of an AIDS patient in a rural community in Malawi. A qualitative research design that is explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is also examined. The experience of counsellors of AIDS patients is explored as the other major factor in the phenomenon examined. In the first phase of the study in-depth phenomenological interviews were conducted with identified groups. Focus interviews were conducted with a hundred AIDS patients to identify the needs and resources of the patients and to compile a demographic profile. Focus group discussions were conducted with counsellors for more complete comprehension. Data analysis and a literature control were undertaken. In the second phase of the study theory generation was used in order to develop a counselling model for AIDS patients and guidelines for implementing the model were generated. Based on the results of the analysis the major concept enable was identified as the essence of a model for counselling AIDS patients in rural Malawi.

No description available.

Colorectal cancer has been a major health issue worldwide. Not only it affects the patients but it also carries physical and psychological influences to their caregivers. Despite the concerns of the psychological needs of caregivers of colorectal cancer patients, there has been a lack of a good understanding of their needs, and how to intervene in order to alleviate their psychological problems and burdens. Therefore, this thesis aimed at designing and evaluating a nurse-led telephone based psychosocial education program for improving the psychological conditions and quality of life among Chinese caregivers of patients with colorectal cancer. The nurse-led telephone based psycho-educational program was designed based on the transactional model of stress and copying. It was piloted on 6 caregivers and refined. Its efficacy over the patients discharged under the ‘usual routine hospital standard discharge care procedure’ was assessed in a randomized controlled trial on 140 Chinese caregivers of colorectal cancer patients. Caregivers in the intervention group received three telephone calls from an experienced Nurse Interventionist at 1, 3 and 5 weeks after the patients’ discharge. Each call addressed any unmet needs of the caregivers with the provision of education and psychological support. At baseline, 2 weeks, 4 weeks and 8 weeks, all caregivers were assessed for the primary outcome of depression measured by the Depression Anxiety Stress Scale (DASS), and for the secondary outcomes of anxiety, stress, burden of care and quality of life. The mixed effects model, which takes into account the extra-covariance among repeated measurements, and which is consistent with the intention-to-treat principle, was used in the efficacy analysis. Of the 140 caregivers recruited in the randomized controlled study, 5 dropped out before the end of the study. However, all the caregivers were included in the analysis. There was no significant baseline difference between the intervention and ‘usual care’ groups. The psycho-education program reduced depression more than the ‘usual care’ group by2.7 (95% CI = 0.6 to 4.8, p=0.013) units in DASS at 2 weeks, and even more by 3.5 (95% CI = 1.7 to 5.24, p<0.001) at 4 weeks. However, the ‘usual care’ group caught up at 8 weeks, and no significant effect of the psycho-education program was found (p=0.144). Moreover, the program also reduced anxiety and stress more than the ‘usual care’ group by1.83 (95% CI = 0.61 to 3.50, p=0.004) and 3.50 (95% CI = 1.74 to 5.25, p<0.001) respectively at follow-up. In addition, the burden of care and quality of life were also generally improved more in the psycho-education program group. Furthermore, strong positive associations among depression, stress, anxiety, and burden of care were found. Caregivers perceived to have a high burden of care would be associated with more depression, stress or anxiety(r = 0.53, p<0.001). Moreover, depression, anxiety, and stress had a strong negative association with the physical, psychological, social relationship and environmental well-being but not with social relationships(r = -0.16, p = 0.550). In conclusion, this thesis has developed the first nurse-led telephone based psycho-education program for caregivers of colorectal cancer patients. The program can effectively help caregivers in reducing their feelings of stress from depression, anxiety, stress and the burden of care, as well as improving their quality of life. It paves the way for a new direction for a comprehensive colorectal cancer care service in addressing the caregivers’ needs. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

D.Litt. et Phil. (Sociology) / Reid and Walker (2005) suggest that black South African men are ‘behaving differently’. Added to this Budlender (2008) has found that South African men are more likely to engage in unpaid community care work than conventional wisdom suggests. Part of this community work involves black men acting as AIDS caregivers. It is imperative to gain knowledge about masculine caregivers as the informal health care sector bears the brunt of the HIV pandemic. The fragmented and over-burdened public health system simply cannot absorb the 15-20% of HIV infected South Africans. Coovadia et.al. (2009) point to a lacuna in the scholarship regarding community health workers (CHW) in South Africa. My study of black masculine caregivers, located in the world of informal AIDS care, hopes to fill this gap. Yet, I do something more for I tackle the conventional wisdom that suggests South African men are different and exceptional if they conduct feminised care work. The emotions involved in care processes are the basis upon which society may feminise care work. My argument is also premised upon forging links between the past and the present. As such, I focus upon determining the extent to which emotional labour that may be exhibited by historical and contemporary black men. I make use of W.E.B. Du Bois’ (1903) notion of double-consciousness to show how the normalising society, surrounding masculine care, impacts this category of black men. In so doing, I not only forge links between past and present by means of doubleconsciousness, but I perform an intersectional analysis of emotional labour, and the context, in which it occurs. In so doing, I show how double-consciousness is an intersectionally-forged mechanism for Foucault’s (1978) biopower, and one that has become reinvented in present day South Africa. In this way I augment the works of Du Bois (1903) and Foucault (1978) for both did not give primacy to gender as a construct. It is essentially this view of black men, involved in AIDS care that contributes to the originality of this work. This historical-sociological investigation relied upon the linking of cases. I conducted historical research upon two cases: ‘houseboys’ in colonial Natal (1850 – 1928) and mine hospital ‘ward boys’ (1931 – 1959). Contemporary cases were constructed to reflect the world of AIDS and cancer care. The 13 original cases were compressed into seven case categories and based on triangulated survey and interview data (29 AIDS and 18 cancer caregivers were interviewed; while 195 community workers involved in AIDS care were surveyed in 2005/6; follow-up interviews were conducted with 11 caregivers across all case categories in 2010).