More than three decades after the outbreak of the AIDS pandemic, sub-Saharan Africa is home to the largest epidemic in the world. Over 70% of infected people live in this region and are aged 15–49 years. Given that it is at this age that young adults are more likely to start families, their death as a result of AIDS gives rise to the crisis of AIDS-orphaned children. Several studies show that the number of AIDS orphans is on the rise and can reach up to 18 million throughout the continent. Generally, patients expect to be admitted in formal health care facilities for adequate treatment but the absence of cure and an increasing number of infected make it difficult for them to be treated as in-patients. In order to fill the gap, the elderly care for AIDS patients and take on the parenting role of AIDS orphans. However, there is not much information on the implications of caregiving on the well-being of the elderly. This dissertation aims at shedding light on this issue – using data from an informal settlement in the province of KwaZulu-Natal – in order to highlight the risks to the health of elderly caregivers. The elderly are the primary caregivers to thousands of AIDS patients and AIDS-orphaned children across sub-Saharan Africa. Their caregiving activities are strenuous and repetitive on a daily basis. Through qualitative data collected from 14 elderly caregivers, this project found that their well-being was compromised by several caregiving activities and the expectations placed upon them were unbearable. The vulnerability of caregivers was emphasized by the high number of dependents that resulted in lowered standard of living. There was also the risk of contracting HIV during caregiving since the elderly were not able to afford protective equipment. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. The purpose of the study is to explore patients’ perceptions, attitudes and beliefs about the safety practices utilized by nurses when administering medications. Specifically, the study addresses patients’ perceptions of nurse behaviours regarding safe medicine administration, patient behaviours, patients’ perceptions and nurse behaviours regarding pain medicine, patients’ perceptions of nursing care, and patients’ perceptions of their participation/accountability in care. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care. / x, 125 leaves ; 29 cm

The onset and rapid spread of the HIV/AIDS pandemic in Sub-Saharan Africa has challenged and continues to challenge the church in its doctrine as well as its practical ministries. The Evangelical Lutheran Church in Namibia has been no exception. The disease challenges the theological and pastoral disciplines, especially in the area of contextuality. This thesis is developed at the very site of the struggle to care for the infected and affected individuals and families in the ten Evangelical Lutheran Church parishes in the Oshana Region, Namibia. Healing and caring for the sick is the primary mission of this church. Therefore, the quest of this study is to investigate how ELCIN through pastoral care and counselling helps HIV/AIDS infected and affected family members cope with their situation. The study concentrated mainly on ten ELCIN parishes in the Oshana Region, Namibia. Chapter one is an introduction to the whole thesis. Included is the statement of the problem, the methodology used to collect data and the literature review. Chapter two deals with pastoral care and counselling of HIV/AIDS infected and affected families. The African understanding of heath and illness is also considered as well. Chapter three is about the Church and HIV/AIDS in the Oshana Region, Namibia. This chapter investigates the responses of ELCIN's pastors towards HIV/AIDS affected families in the Oshana Region, and how they understand HIV/AIDS biblically. Chapter four deals with the impact of HIV/AIDS on affected families in Oshana Region, Namibia. This chapter discusses how HIV/AIDS affects the family members, nurses, and community ministers and how pastoral care and counselling help the widowers, widows, orphans, caregivers of orphans and nurses to take care of orphans. This is the main chapter of this thesis. Chapter five is about data analysis, recommendations and research findings using the Christian theoretical framework of Mwaura, van Dyk, Msomi, Snidle and Welsh, and Dube. Chapter six is the conclusion of the whole thesis. / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

The purpose of this descriptive study was to document and analyze the perceptions of family caregivers of non-institutionalized Alzheimer's patients about the benefits and limitations of Alzheimer's support groups. Survey methodology was used to survey caregivers and support group leaders from eight Alzheimer's support groups in the central Indiana area. Several of the major findings challenge the literature. These findings are as follows: The majority of caregivers attended the support group to receive information. None of the caregivers attended the support group due to frustration, and only one caregiver responded that relieving frustration was a benefit of participating in the support group. A majority of caregivers and support group leaders were positive about mixed (spouses and adult children) support groups. A majority of caregivers responded that they did not have guilt, anger, fears about caregiving in the future, or stress concerning their caregiving responsibilities. The study generated several implications that can be used by planners to improve support groups. / Department of Educational Leadership

This study explores the challenges posed by the HIV-AIDS epidemic on the Holiness Union Church leadership in Pietermaritzburg KwaZulu-Natal: towards a holistic Pastoral care model. South Africa has the highest prevalence rate of HIV infection in Sub-Sahara Africa and the province of KwaZulu-Natal is the epicentre of the epidemic. This motivated the researcher to investigate the role of the HUC-PMB leadership in the struggle against the HIV-AIDS epidemic within and outside the Church. The Church leaders in this context of the HIV-AIDS are expected to play a significant role, so that the campaigns of HIV prevention, intervention, care and support for those living with the HIV-AIDS should have positive impact in the Church and the community. The literature review argues that this can be achieved when church leaders are well trained and equipped with all necessary skills and acquire comprehension information about the HIV-AIDS. The study adopted an empirical research using qualitative using interview schedule, focus group discussion and church archives for data collection. Five Church leaders and four church members participated in the study. The investigations were led by the following research question: What are the challenges posed by the HIV-AIDS epidemic on the HUC leadership in Pietermaritzburg KwaZulu-Natal? In order to address the main question of this study, the following questions were formulated. What is the current situation of the HIV-AIDS epidemic in the HUC-PMB? How is the HUC-PMB leadership response to the HIV-AIDS epidemic? What kind of Pastoral care model that would enhance the HUC leadership holistic response to the HIV-AIDS epidemic? The study findings show that the Church leaders at HUC-PMB do not officially engaged in the struggle against the HIV-AIDS epidemic in the church and in the local community. This implies that the HUC-PMB has limited spiritual and support work for those who are HIV infected and affected within and without the church. The study thus recommends that knowledge on the HIV-AIDS epidemic is vital to all people especially the church leaders; and the church must use its pastoral approach to pursue this goal; the leaders must be thoroughly educated and equipped on the HIV-AIDS related issues, so that to be able to minister (w)holistically in the light of the HIV-AIDS epidemic; the Church and its leaders is also recommended and called to be HIV-competent in terms of their belief approach in dealing with epidemic and stigma within and outside the church context. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Background: Evidence-based medicine (EBM) involves the care of patients using the best available evidence from the results of good quality clinical research to guide clinical decision making 1 – 3. By incorporating the principles of Evidence-based Medicine (EBM), the family practitioner would be able to treat a patient according to the best clinical research available. This principle is implemented widely in the USA, Canada, the United Kingdom and Europe. In South Africa, however, EBM is not yet as widely incorporated into family practice. This is so despite the plethora of websites available to practitioners and the relative ease with which applicable research evidence can be found. Very few published studies are available regarding EBM or Evidence–based Practice (EBP) in the South African context. The findings of this study would thus highlight reasons and/ or barriers preventing family practitioners from implementing EBM in their respective practices. This could also lead to further research into possible methods of implementation of EBM into South African family practices. Aim: The aim of the study was to describe the perceptions, knowledge and attitudes of private practitioners regarding evidence based practice and to identify the barriers encountered in evidence based practice. Methods A questionnaire survey of general practitioners in Gauteng, South Africa, was conducted. Questionnaires were distributed to a random sample of practitioners in the Gauteng region. Two hundred and twenty one (221) practitioners participated in the survey and responded to questionnaires mailed to them. The questionnaire was mailed, faxed or e-mailed to the practitioners, which they then completed and returned for statistical analysis. Study design The study design is that of quantitative, statistical analysis (descriptive cross-sectional survey). Setting General practitioners were randomly selected from a list of practitioners in the Gauteng Province. Doing a nationwide survey would have been a mammoth undertaking. It was therefore decided to limit the research to one province and therefore it was only concentrated on practitioners practicing in the Gauteng area. Results It is interesting to note that of the two hundred and twenty one participants in this study; only 10% of the practitioners were against using EBM in their practices. This, however, stands in stark contrast to the 56% of practitioners who do not implement EBM in their practices or make use of the EBM principle at all. The major barriers preventing practitioners from implementing EBM is depicted in the following graph: Lack of time and the training in aspects of Evidence-based medicine were the main barriers preventing the full scale implementation of EBM in family practices in Gauteng. Conclusion Participating Gauteng doctors were in principle, very positive towards the implementation of EBM in their respective practices. Most of the participants agreed that EBM would benefit their patients’ care and treatment. Very few of the participants, however, make use of EBM in practice. A lack of training and time constraints were the main barriers with regards to the implementation of EBM. Proper training of medical students at undergraduate level at faculties of health sciences, would go a long way assisting prospective doctors in mastering the concept of EBM and increasing their overall awareness of EBM. Further definitive research would assist in establishing whether such awareness would be associated with improved implementation of evidence in the form of evidence based guidelines in practice.

This thesis considers whether the concept of resilience is applicable to people ageing with dementia; and, if so, what the implications are for social work practice. It begins with an exploration of the literature on dementia, resilience and social work. Using a symbolic interactionist approach it then details how the interactions of people with dementia and their social workers can potentially influence the realisation of resilience in practice. I collected data over a two year period. During this period six dyads comprising a person with dementia and social worker provided rich verbal accounts of their respective experiences. Using narrative analysis the stories of each person with dementia were explored to reveal threats to identity and possible resilience strategies. A resilience lens was applied to the verbal accounts of social workers in order to reveal opportunities and challenges to using resilience in practice. The findings indicate that identity continues to be of importance to people who are ageing with dementia. The preservation of identity could therefore be re-framed as the outcome of a resilience process. Each person could potentially acquire resources over their life which could help to mitigate threats to identity. This is referred to as the resilience reserve. This thesis details the potential domains of such a reserve. Further, it contains details of possible resilience strategies that a person with dementia might employ within stories of self. These strategies are placed within the context of protective and vulnerability factors in order that a resilience framework can emerge. This thesis argues for a re-framing of theories of what social work is. This, combined with a definition of resilience, and the development of a resilience practice framework could promote and realise the resilience of the person ageing with dementia.

M.Cur. / During the time as an infection control professional, there was close contact with patients with Acquired Immunodeficiency Syndrome (AIDS). During this contact period many needs regarding health support were identified. Discrimination and the testing of patients for Human Immunodificiency virus anti·bodies (HIV) without their permission, were the main problem areas. The purpose of the study was to determine the nature and extent of comprehensive health care services for patients with AIDS. The research design is a contextual, exploring and descriptive study. This study was done in the Northern half of economic development area H where 16 health care services were identified. These include clinics, community hospitals, regional- and academic hospitals and the local authority clinic. Private hospitals were not included in the study. Criteria for the nature and extent of comprehensive health care services were based on literature studies. Data was collected by means of structured interviews with nursing professionals in the employ of identified services and patients making use of those services. The results of the research showed various needs in the nature and extent of the comprehensive health care services of the patients with AIDS In order to improve the health care services, recommendations were made and guidelines given to nursing professionals. Recommendations were also made regarding other aspects of the multi·disciplinary team approach. Based upon this study other topics were identified to enable the health care services to provide health care to the patient with AIDS.

Standard economic models often emphasize inputs, outputs and an examination of the structures in order to conduct an economic performance evaluation. This study applies the Institutional and Development Framework (IAD) in the broader context of New Institutional Economics (NIE) in order to examine the transaction costs of delivering Community and Home Based Care and Support (CHBC) to HIV/AIDS sufferers. For purposes of unveiling the empirical reality guiding decision making processes in the CHBC service delivery, comparative qualitative research techniques of normative variable and concept formation have been adopted to draw out the relative institutional influences from the HIV/AIDS national response partnerships. The study identifies the conflict between the predominantly standardized and more rigid formal management techniques adopted by key members of the national response and the informal cultural techniques familiar to the rural communities, and a lack of motivational incentives in the CHBC structures as the key factors against CHBC capacities to draw external funding for service delivery. CHBCs are also weakened by incoherent governance structures at the district level for facilitation of funding and information flow exacerbating the community vulnerability. Rationalization of the institutional arrangements and a clarification of roles from district to community levels, a shift of focus to facilitation of informal techniques and an integration of performance enhancing incentives are the critical policy insights envisaged to spur CHBCs to work better.

Innovative primary care models that deliver comprehensive primary care to address medical and social needs are an established means of improving health outcomes and reducing healthcare costs among persons living with chronic disease. Care management is one such approach that requires providers to monitor their respective patient panels and intervene on patients requiring care. Health information technology (IT) has been established as a critical component of care management and similar care models. While there exist a plethora of health IT systems for facilitating primary care, there is limited research on their ability to support care management and its emphasis on monitoring panels of patients with complex needs. In this dissertation, I advance the understanding of how computational methods can better support clinicians delivering care management, and use the management of human immunodeficiency virus (HIV) as an example scenario of use. The research described herein is segmented into 3 aims; the first was to understand the processes and barriers associated with care management and assess whether existing IT can support clinicians in this domain. The second and third aim focused on informing potential solutions to the technological shortcomings identified in the first aim. In the studies of the first aim, I conducted interviews and observations in two HIV primary care programs and analyzed the data generated to create a conceptual framework of population monitoring and identify challenges faced by clinicians in delivering care management. In the studies of the second aim, I used computational methods to advance the science of extracting from the patient record social and behavioral determinants of health (SBDH), which are not easily accessible to clinicians and represent an important barrier to care management. In the third aim, I conducted a controlled experimental evaluation to assess whether data visualization can improve clinician’s ability to maintain awareness of their patient panels.