The excessive use of chemical and physical restraints in intermediate care facilities has been a subject of study since the early eighties, and has produced several explanations for why restraint use continues to be practiced. One of the primary reasons often cited is that restraints are used to control "problematic behavior" commonly exhibited by a person suffering from dementia. The focus of the proposed project is to analyze whether restraint practices for residents with moderate to severe dementia differ between Special Care Units and integrated units within long term care facilities. The main objective of the study is to demonstrate whether seniors with dementia residing in Special Care Units will be less likely to encounter physical and chemical restraints than demented residents living within an integrated facility. This objective explores the assumption that Special Care Units were designed to meet the needs of residents with dementia, and therefore, care providers should be more accepting of deviant behaviours. The findings revealed that the more severe the level of memory impairment the more likely a resident would be placed in a Special Care Unit. Once located in these Special Care Units, residents were more likely to experience physical and chemical restraints than their counterparts in integrated care units. / Arts, Faculty of / Anthropology, Department of / Graduate

No description available.

The number of elderly people moving into long-term care facilities is expected to increase as the population of people 65 and older continues to rise at a significantly high rate. Simultaneously, the number of people expected to be diagnosed with dementia will also increase unless a cure for this devastating disease is found. In the meantime, caregivers face many problems in providing healthy and humane treatments. One such problem that is a major concern for caregivers is controlling wandering behavior. This behavior often places patients in life threatening situations, and the current methods used by many facilities do not promote a high quality of life. The purpose of this study was to examine the effects of various tape patterns on the wandering behaviors of residents living in a special dementia care unit in Heritage Hall Nursing Home, Blacksburg, Virginia. Similar studies revealed that alternative methods using tape patterns could reduce exiting attempts at a fire exit door or could possibly increase these attempts. In order to address these inconsistencies, exiting attempts at a fire exit door were recorded during one baseline and two similar test conditions. It was found that exiting attempts was a serious problem in this unit as 40% of the residents attempted to exit the faci I ity during the study. The use of tape patterns reduced exiting attempts by 19.05% and 11.12%; however, this reduction was not statistically significant. In conclusion, the use of these tape patterns affected wandering behavior differently for each of the residents, suggesting that a multi-method approach for controlling exiting behavior may prove to be more successful when dealing with a heterogeneous sample and their multi-needs. / Master of Science

Unsafe exits from dementia care units present problems for residents and pose ethical dilemmas for caregivers. The purpose of this experimental research was to determine whether visual barriers reduced the exiting behavior of residents in a long-term care facility. A visual barrier was defined as one that appeared to be an obstruction, but that did not impede egress through the door. The study was conducted in a 30-bed dementia care unit and was limited to the emergency exit door where an alarm sounded each time the panic bar was touched. An “exit" was defined as a resident touching the panic bar and sounding the alarm. The sample consisted of 3 females and 6 males who attempted to exit the unit at least once during baseline condition. All residents were diagnosed with some form of dementia. The tests were conducted under three visual barriers and one baseline condition. Each condition was observed for seven days from 2:00 to 4:00 p.m. The schedule was as follows: Baseline Condition: No experimental manipulation was used. This observation provided a comparison for the three test conditions. Test Condition 1: Mini-blinds that covered the glazing of the door. Test Condition 2: Cloth panel that covered the panic bar of the door. Test Condition 3: Both the mini blind and the cloth panel. During baseline collection, 9 residents triggered the alarm for a total of 120 attempted exits. Test condition 1 decreased exiting to 73 attempts. During test condition 2, 5 attempted exits occurred, and 18 attempted exits occurred during test condition 3. Statistical analysis included Friedman’s Rank test for correlated samples and Wilcoxon Sign Rank tests for treatment versus control comparisons. Test conditions 2 and 3 significantly reduced attempted exits while test condition 1 was not statistically significant. In conclusion, visual barriers were a safe and effective method for deterring resident exiting for this particular nursing home. / Master of Science

Introduction: South Africa is currently experiencing one of the most severe AIDS epidemics in the world with South Africa‘s public sector under great stress and under-resourced whilst there exists a vibrant private healthcare sector. Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. However not much is known about the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients. In addition these doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. With the availability of antiretroviral drugs only since around 1996, many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients, further it is very important that these doctors constantly update their knowledge and obtain information in order to practise high-quality medicine. Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV brings a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management thus it becomes important to ascertain these doctors‘ training needs together with where these doctors source information on HIV/AIDS to stay updated. In South Africa two thirds of the doctors work in the private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness on the part of private sector doctors in the eThekwini Metro of KwaZulu-Natal, to manage public sector HIV and AIDS patients. Though many studies have been undertaken on HIV/AIDS, fewer have been done in the private sector in terms of the management of this disease which includes doctors‘ adherence monitoring practices, their training needs and sources of information and their willingness to manage public sector patients. A study was therefore undertaken to assess the involvement of private sector doctors in the management of HIV, their training needs and sources of HIV information, the quality of HIV clinical management that they provided, together with their strategies for improving adherence in patients. Further the study assessed factors that affect adherence in patients attending private healthcare, and finally investigated whether private sector doctors are willing to manage public sector HIV infected patients. A literature review of the barriers that prevent doctors from managing HIV/AIDS patients was also undertaken. Method: A descriptive cross sectional study was undertaken using structured self reported questionnaires. All private sector doctors practising in the eThekwini Metro were included in the study. The study was divided into different phases. After exclusions a valid sample of 931 participants was obtained in Phase 1. However only 235 of these doctors indicated that they managed HIV infected patients, of which only 190 consented to be part of Phase 2 of the study. In Phase 2 the questionnaires were administered by trained field workers to the doctors after confirming doctors‘ consent. The questionnaires were thereafter collected, the data captured and analysed using SP55 version 15. Results: Although 235 (71.6%) doctors managed HIV and AIDS patients, 93 (28.4%) doctors did not, and of the latter 48 (51.61%) had not encountered HIV and AIDS patients, twenty five (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst twelve (12.90%) doctors, though they indicated that there were other reasons for not managing HIV infected patients, did not specify their reasons. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Significantly younger (recently qualified) doctors rather than older (qualified for more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients. Eighty five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors 134 (78.5%) initiated therapy at CD4 count < 200cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI +1 NNRTI combination. Doctors who used CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p<0.001). At initiation of treatment 68.5% of the doctors saw their patients monthly and 64.3% saw them 3-6 monthly when stable. The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. Of the respondents, 78.9% indicated that they monitor for adherence. Comparison of GPs and specialists found that 82.6% of the GPs monitor for adherence compared to 63.6% of the specialists. (p=0.016). Doctors used several approaches with 60.6% reporting the use of patient self reports and 18.3% pill counts. Doctors (68.7%) indicated that their adherence monitoring is reliable, whilst 19.7% stated they did not test the reliability of their monitoring tool. The most common strategy used to improve adherence of their patients was by counseling. Other strategies included alarm clocks, SMS, telephoning the patient, encouraging family support and the use of medical aid programmes. One hundred and thirty three (77.8%) doctors were willing to manage public sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling was the distance from public sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). There was no statistical difference between adherence to treatment and demographics of the respondent patient such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included that tablets would save their lives (83.6%); they understood how to take the medication (81.8%); tablets would help them feel better (80.0%); and that they were educated about their illness (78.2%). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: All doctors in the private healthcare sector were not involved in the management of HIV/AIDS patients. Doctors indicated that they required more training in the management of HIV/AIDS patients. However private sector doctors in the eThekwini Metro do obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients, with the majority of private sector doctors being compliant with the current guidelines, hence maintaining an acceptable quality of clinical health care. These doctors do monitor for adherence and employ strategies to improve adherence in their patients who do have problems adhering to their treatment due to various factors. Many private sector doctors are willing to manage public sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background & rationale: South Africa is faced with the major challenge of HIV/AIDS. Every South African has a vital role to play in managing this public health problem. One of the best ways of managing it is by informing and educating the communities about HIV/AIDS, as the communities lack knowledge about it. Problem statement: Due to the increase in the number of patients infected with HIV/AIDS, an informal caregiver’s programme was introduced to ensure that patients are better cared for at home, in a familiar environment and by their family members. Purpose and objectives: The purpose of the study was to evaluate the effect of an informal caregiver’s programme on the care of patients with HIV/AIDS. The objectives included evaluating the effect of care, physically, socially, spiritually, emotionally, information and educational support given. Methodology: A phenomenological research design was applied to evaluate the effects of an informal caregiver’s programme implemented for the care of patients infected with HIV/AIDS at Mfuleni Township in the Cape Metropolitan area. Population and sampling: The population of this study were HIV/AIDS infected patients who were participating in the informal caregiver’s programme. Ten of these patients, who gave consent, participated in the study. Reliability, validity & pilot study: The trustworthiness of this study was assured with the use of Lincoln and Guba criteria of credibility, transferability, dependability and conformability. A pre-test study was also completed. Ethical considerations: Ethical approval was obtained from the Stellenbosch University and the required consent from the individual participants. Data collection, analysis and results: Data was collected through an interview using an interview schedule based on the objectives. Data was analysed and the findings show that the care given to patients infected by HIV/AIDS at home through an informal caregiver’s programme has a positive outcome. Recommendations and conclusion: On the spot training of participants and their family members is recommended. The community health workers form a very strong support base for the participants. / AFRIKAANSE OPSOMMING: Agtergrond en rasionaal: Suid-Afrika kom te staan voor ’n reuse uitdaging t.o.v. HIV/VIGS. Elke Suid-Afrikaner het ’n belangrike rol te speel in die beheer van hierdie openbare gesondheidsprobleem. Een van die beste maniere om dit te beheer, is om gemeenskappe in te lig en op te voed aangaande MIV/VIGS, aangesien daar ’n gebrek aan kennis hieromtrent is. Probleemstelling: Weens die toename in die aantal pasiënte wat deur MIV/VIGS geaffekteer word, is ’n informele versorgingsprogram daarop ingestel om te verseker dat pasiënte beter tuis versorg word in ’n bekende omgewing en deur hul familielede. Doel en doelwitte: Die doel van hierdie studie was om die effek van ’n informele versorgingsprogram in die versorging van pasiënte met MIV/VIGS te evalueer. Die doelwitte is uiteengesit om die effek van die versorging wat gegee is, te evalueer met verwysing na die fisiese, sosiale, geestelike, emosionele, inligting en opvoedingsondersteuning te evalueer. Metodologie: ’n Fenomenologiese navorsingsontwerp is toegepas om die effekte te evalueer van ’n informele versorgingsprogram wat geïmplementeer is vir die versorging van pasiënte wat deur MIV/VIGS geaffekteer is in die Mfuleni woonbuurt in die Kaapse Metropolitaanse area te evalueer. Bevolking en steekproef: Die bevolking van hierdie studie is MIV/VIGS geaffekteerde pasiënte wat deelgeneem het aan die informele versorger se program. Tien van hierdie pasiënte wat toestemming verleen het, het deelgeneem aan hierdie studie. Betroubaarhied, geldigheid en loodsondersoek: Die betroubaarheid van hierdie studie is verseker deur die gebruik van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, afhanklikheid en ooreenstemmigheid. ’n Aanvoortoets is ook voltooi. Etiese oorwegings: Etiese goedkeuring is van die Stellenbosch Universiteit en die vereiste toestemming van die individuele deelnemers verkry. Dataversameling, analise en uitslae: Data is ingesamel deur gebruik te maak van ’n onderhoudskedule wat gebaseer is op die doewitte. Data is geanaliseer en die bevindinge het bewys dat versorging wat by die huis deur ’n informele versorgingsprogram aan pasiënte gegee word wat met MIV/VIGS geaffekteer is, ’n positiewe uitkoms het. Aanbevelings en gevolgtrekkings: Op-die-plekopleiding van HIV geïnfekteerde pasiente en hul familielede word aanbeveel. Die gemeenskap se gesondheidswerkers bied ’n sterk ondersteuningsbasis aan die deelnemers.

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007. / Stroke is a difficult condition to manage because of the complex nature of its effects. Caregivers are therefore, crucial in providing ongoing care for the stroke patient at home. Caregivers experience considerable strain during caregiving, as their needs are often overlooked because therapeutic management tends to focus mainly on the stroke patient. In third world countries like South Africa, there are currently no research studies found describing an optimum support intervention which addresses the caregivers' needs and reduces their strain levels. Objective To determine the effectiveness of a caregiver support intervention programme (CSIP) that was developed to address the expressed needs identified by the primary caregiver of the stroke patient in the Bishop Lavis community. Method A prospective and descriptive qualitative study design was used to evaluate the effectiveness of the CSIP. A total of 29 caregivers participated in three CSIPs, which were implemented over five sessions each. The Barthel Index was used to measure the functional level of each stroke patient. The needs of stroke caregivers were determined by 15 semi-structured interviews, until data saturation was reached. The Caregiver Strain Index was completed before and after implementation of the CSIP, in order to measure whether the intervention programme had been effective in reducing the caregivers' level of strain. Written or verbal feedback forms was also completed by the caregivers after each of the five intervention sessions. Results were analysed using repeated measures ANOVA and descriptive qualitative analysis. Results The qualitative results of this study suggest that the CSIP was effective in addressing mainly the physical needs, as well as the emotional, educational and socio-economic needs of the primary caregivers. The CSIP was also effective in reducing caregiver strain in 61.5% of the sample (N=13). However, an additional finding of this study was the personal and logistical barriers identified which limited the caregivers' attendance of the sessions. Conclusion The CSIP was effective in addressing the physical, emotional, socio-economic and educational needs of the primary caregiver. In addition, the results also verified that the CSIP was effective in reducing caregiver strain in the majority of the caregivers, despite a small sample size. The barriers identified which affected the caregivers' attendance, need to be taken into consideration when planning future intervention programmes for caregivers in poor socioeconomic communities. Due to the low attendance rate by the caregivers, a larger sample size is recommended to accommodate for the high drop-out rates in such a population.

Thesis (M. Th.)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The thesis introduces a spiritual understanding of terminal care as life care within a pastoral approach to death and dying. The presupposition is that life and death are unavoidably connected, and that a meaningful approach to death and dying in terms of a Christian theological hermeneutics needs to start with the question “What is life?” The concept of a theological hermeneutics serves as an overall paradigm, which is implied within the interplay of life and death. The aim of a hermeneutical approach is to find meaning in living and dying in the fundamental God-human relationship. The eschatological perspective plays a significant role, as it emphasises the already and not yet of eschatology that become evident in every life event. An analysis of the theoretical paradigms and philosophical presuppositions behind a widespread “psychology of death and dying” shows that the phenomenological, client-centred models suffer from an overreliance on inner human potentials in coping with dying. Although these models provide valuable insights into the needs of the dying, they fail to equip individuals with a meaningful paradigm that lasts despite the reality of death. As a result, I propose a “theology of death and dying” that opts for a much more holistic approach to terminal care. Based on the impact of a Christian spiritual concept of life and a pastoral anthropology on a pastoral approach to terminal care, I argue that we do not have to cope with dying by ourselves but can trust in the faithfulness of God who will keep us strong to the end (1 Cor 1:8). As fear of death can effectively only be coped with by caring for life, pastoral care to the dying needs to emphasise the fundamental God-human relationship that guarantees life in spite of death. A unique stance of hope follows from a Christian spiritual understanding of life that overcomes the paradigmatic gap left by psychological approaches to death and dying, and makes us aware that the new life in the Spirit is a quality that we already possess. Eventually, the life care approach is applied to a pastoral prevention strategy in the context of the HIV pandemic. I argue the thesis that prevailing HIV prevention programmes suffer from a lack of an overall frame of reference from which to reflect on the necessity for behavioural change. To fill this gap, a spiritual life care approach to the HIV pandemic emphasises the development of a Christian ethos based on an internalised assurance of the purpose and destiny of human life, which can function as an overall paradigm behind a prevention strategy. This pastoral prevention strategy is based on the assumption that positive change, the anticipation of a better future and true hope derive from an understanding of who we are as human beings before and in relationship with God. / AFRIKAANSE OPSOMMING: Hierdie tesis stel ʼn spirituele begrip van terminale sorg as lewensorg binne ʼn pastorale benadering tot dood en sterfte bekend. Die voorveronderstelling is dat lewe en dood onlosmaakbaar verbind is, en dat ʼn betekenisvolle benadering tot dood en sterfte in terme van ʼn Christelike teologiese hermeneutiek met die vraag “Wat is lewe?” ’n aanvang moet neem. Die konsep van teologiese hermeneutiek dien as 'n oorkoepelende paradigma, wat geïmpliseer word binne die wisselwerking van lewe en dood met die doelwit om betekenis te vind in lewe en dood in die fundamentele Godmens- verhouding. ’n Eskatologiese perspektief speel ’n beduidende rol, aangesien dit die alreeds en die nog nie van eskatologie beklemtoon, wat in elke lewensgebeurtenis duidelik word. ’n Ontleding van die teoretiese paradigmas en filosofiese voorveronderstellings rakende die wydverspreide “sielkunde van dood en sterfte” toon aan dat die fenomenologiese, kliëntgesentreerde modelle gebrek lei as gevolg van hul heftige aanspraak op die innerlike menslike potensiaal om sterfte te hanteer. Alhoewel hierdie modelle kosbare insigte ten opsigte van die behoeftes van die sterwendes bied, faal hulle daarin om individue toe te rus met ’n betekenisvolle paradigma wat volhoubaar is, afgesien van die werklikheid van die dood. Ek staan dus ’n “teologie van dood en sterfte” voor wat ’n veel meer holistiese benadering tot terminale sorg meebring. Gegrond op die impak van ’n Christelike, spirituele konsep van lewe en ’n pastorale antropologie op ’n pastorale benadering tot terminale sorg, argumenteer ek dat ons nie nodig het om die dood op ons eie te hanteer nie omdat ons op die getrouheid van God, wat ons sterk sal hou tot die einde (1 Kor 1:8), kan vertrou. Aangesien die vrees vir die dood slegs deur die omgee vir lewe hanteer kan word, is dit noodsaaklik dat pastorale sorg aan die sterwende die God-mens-verhouding, wat lewe te midde van dood waarborg, beklemtoon. ’n Unieke gesigspunt van hoop volg vanuit ’n Christelike, spirituele begrip van lewe, wat die paradigmatiese gaping wat gelaat word deur psigologiese benaderings tot dood en sterfte vul. Dit maak ons bewus dat die nuwe lewe in die Gees ’n kwaliteit is wat ons alreeds besit. Die lewensorg-benadering word uiteindelik in ’n pastorale voorkomingstrategie in die konteks van die MIV-pandemie toegepas. Ek argumenteer in die tesis dat heersende MIV-voorkomingsprogramme gestrem word deur ’n tekort aan ’n algehele verwysingsraamwerk, vanwaar oor die noodsaaklikheid van gedragsverandering nagedink kan word. Om hierdie gaping te vul, stel ek ’n spirituele lewensorg-benadering voor, wat die ontwikkeling van ’n Christelike etos beklemtoon, gegrond op ’n inwendige sekerheid van die doel en bestemming van menslike lewe, wat as ’n algehele paradigma vir ’n pastorale voorkomingstrategie kan funksioneer. Hierdie voorkomingstrategie is gegrond op die veronderstelling dat positiewe verandering, die verwagting van ’n beter toekoms, en ware hoop voortspruit uit ’n begrip van wie ons as mense voor en in verhouding met God is.

Personality characteristics of spousal and adult children and active potential caregivers of persons with Alzheimer's Disease were studied in order to better predict caregiver burden and aspects of well-being. Contrary to prediction, no differences were found between spouse and adult children active caregivers on measures of well-being. Additionally, adult children potential caregivers indicated feeling less control over their lives than spouse potential caregivers. When social desirability was controlled, active caregivers reported greater fluctuations in affect than did potential caregivers. As predicted, personality characteristics of individuals were found to have the biggest role in determining which individuals experience stress or burden.

Thesis (M. Cur.)-- University of Limpopo, 2013 / Background: The growing human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic continues to make a serious impact on all countries throughout the world. Globally, countries have responded to the HIV/AIDS pandemic by investing millions of dollars to help fight the disease, but the impact of HIV/AIDS is even greater in developing countries of Sub-Saharan Africa, including South Africa. Aims: The aims of this study were to describe the perceived problems experienced by professional nurses who provide health care to patients living with HIV/AIDS in public hospitals of Polokwane municipality, Limpopo Province and to identify guidelines to support these professional nurses. Study method: A qualitative, descriptive and contextual method was used in this study. Semi-structured, one-to-one interviews were conducted with professional nurses who participated voluntarily in the study. Tesch’s open-coding method was used for data analysis. Results: Professional nurses who provided care to people living with HIV/AIDS at Polokwane Hospital expressed feelings of frustrations and work overload, treatment delay, lack of knowledge on HIV/AIDS, lack of support systems, poor prognosis and patients presenting with confusion and mental disturbances. Conclusion and recommendations: Despite the fact that the professional nurses expressed negative experiences as they carried out their daily activities, and they still continued rendering care to HIV/AIDS patients, notwithstanding the obstacles they encountered. Recommendations were made with regard to nursing practice and nursing education, staff support by vii management, education and counselling for relatives, reaching out to the relatives and community, and further research.