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.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Background: Advanced breast cancer (ABC) is affecting substantial number of Chinese women in Hong Kong. Understanding their unmet supportive care needs (SCNs) is important for health care system to precisely allocate resources to areas demanded for help the most and for patients to achieve better quality of life. Objectives: (1) To validate Chinese version of Supportive Care Needs Survey Questionnaire (SCNS-SF34), (2) to address the prevalence of unmet SCNs at baseline (newly diagnosis of ABC) and explore relevant factors associating with baseline unmet SCNs, (3) to identify the trajectories of unmet SCNs from baseline, 6-week, 12-week, 18-week to one-year post-diagnosis of ABC among Hong Kong Chinese women and identify the predictors related to individual resources. Methods: The study consisted of two phases. In Phase I, breast cancer (BC) patients were recruited from six public hospitals and the SCNS-SF34 (which covers five domains of needs) was administered concurrently with measures of psychological distress CHQ-12 (Chinese Health Questionnaire-12), HADS (Hospital Anxiety and Depression Scale), symptom distress (MSAS-SF), and patient satisfaction (ChPSQ-9) to explore factor structure by using Exploratory Factor Analysis (EFA) and to examine internal consistency, and convergent, divergent and discriminant validities of the identified factor structure. In phase II, women newly diagnosed with ABC were recruited and followed up to assess their unmet SCN trajectories one year after diagnosis. Prevalence of initial baseline SCNs and associated demographic, medical and psychological factors were identified. Linear Mixed Modeling (LMM) was performed to assess trajectories for each SCNs domain. Hypothesized variables reflecting personal and social resources (optimism, trait hope, social support, psychological distress and patient satisfaction) were examined for association with the changes of unmet SCNs after adjusting for demographic and medical characteristics. Results: Instead of five-factor structure identified in the original SCNS-SF34, a four-factor structure with 33 items was identified, comprising: 1) Health system, information and patient support needs (HSIPS), 2) Psychological needs (PSYC), 3) Physical and daily living needs (PDL) and 4) Sexuality needs (SEX). The SCNS-SF33-C demonstrated moderate-to-good internal consistency (Cronbach’s alphas=0.75-0.92) across all domains. Acceptable convergent and divergent validity were demonstrated. Discriminant validity was demonstrated in the SCNS-SF33-C’s ability to differentiate between clinically distinct patient groups (ABC vs. localized BC and active treatment vs. no active treatment). Of the top 15 unmet SCNs, all belonged to the HSIPS domain. There were significant linear declines in unmet HSIPS and PSYC needs over the year after diagnosis, but not in PDL and SEX. After adjusting for demographic and medical factors, LMM identified symptom distress, patient satisfaction and patient satisfaction x time are predictors of HSIP. Total symptom distress, optimism, anxiety and anxiety x time predicted PSYC. Total symptom distress was predictor of PDL. Anxiety was predictor of SEX. Conclusions: The SCNS-SF33-C has a suitable factor structure and psychometric properties for the use in assessing unmet psychosocial SCN among Chinese women with BC. Generally, unmet HSIP and PSYC tended to decline, while levels of unmet PDL and SEX tended to persist over time. Specific individual resources predicted the future change of unmet SCNs. / published_or_final_version / Community Medicine / Master / Master of Philosophy

South Africa has one of the highest country HIV/AIDS statistics in the world. The large number of ill individuals has created an unprecedented care work crisis in the country. In the absence of an adequate state supported care work response, the task of caring for people living with HIV/AIDS has fallen on community members. Under-resourced communities often do not have the capacity to engage in such intensive care work, and this shift has resulted in deleterious emotional, physical and financial consequences. This study sought to create greater understanding of the support available and accessible to friends and family members who serve as informal carers of people living with HIV/AIDS. Methodologically, this is a qualitative study. Nine participants from KwaNgcolosi, a periurban area in KwaZulu Natal, were interviewed. A semi-structured interview schedule was directed to elicit participants’ perceptions of the support that is available and accessible to them. Data was thematically analysed. Perceptions of support were understood in the context of the elements of social capital, namely trust, reciprocity, norms and networks, as well as the sociological strata in which these elements function, the bonding, bridging and linking levels. Findings suggest that informal carers perceive low levels of support. Participants reported poor support from local community and extra-community members which include friends and family members, local political and traditional leadership and leadership at a governmental level. Low levels of social capital exist in the community evidenced by lack of reciprocity, norms that isolate the carer, mistrust, lack of control over resources, and weakened networks which inhibit the participants’ pool of human resources. Stigma, discrimination and conditions of extreme poverty were major impediments to the availability and accessibility of beneficial social capital and thus the social support inherent in it. On the converse, the home-based carer (HBC) emerged as the strongest source of assistance to informal carers. The support reportedly received by the HBC 6 include emotional, instrumental and informational assistance. However, these contributions were insufficient, evidenced by the testimony from all participants that they were still experiencing extreme hardships in their care work. The findings suggest that development, project and policy initiatives should focus on empowerment, greater involvement of all stakeholders ranging from individual community members to government policy makers, greater networking and participation and finally that there should be greater investment in the HBC and the informal carer in terms of resources and capacity building. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (PhD)--Macquarie University, Division of Linguistics & Psychology, Department of Linguistics, 2003. / Bibliography: p. 397-424. / Introduction -- Models of shared decision-making in medicine -- Framing the study -- The analytic goals of modelling agency -- The context of treatment decision-making in HIV -- Agency and alignment -- Study conclusions and implications. / The quality of doctor-patient communication has been shown to influence treatment uptake, adherence and effectiveness in HIV medicine and elsewhere. Increasingly, it is considered essential that doctors and patients jointly participate in decisions concerning treatment. There is a growing body of literature describing joint decisionmaking and suggesting guidelines for its practice. Few of these studies, however, relate their descriptions of medical decision-making as a social process to the ways in which patterns of verbal interaction realize or foreclose on joint decision-making. -- Dominant models of medical decision-making view shared decision-making as a midpoint between enlightened paternalism and informed choice. Based on a corpus of HIV consultations audio-recorded in Sydney in the late 1990s, this thesis argues that it can be better modelled as a particular type of social process, which differs across a number of dimensions from other styles of medical decision-making, specifiable as contextual parameters of meaning. The thesis then identifies ways in which specific discursive practices realize these contextual parameters. -- A major component of the thesis focuses on agency, and a model is presented in the form of a socio-semantic network, drawing on work by van Leeuwen (1996) and others, which relates a range of grammatical features, not only transitivity patterns, to ways of construing social agency. The thesis then considers the way in which doctors and patients mobilise these and other resources for bringing together potentially conflicting points of view in framing and articulating treatment decisions. Here I draw on notions of mutual alignment (e.g., Goffman 1981) but expand the analysis of what is aligned to account for speakers' implicit discourse orientation, as well as more overt markers. -- Findings emphasise the relationship between representing and enacting agentive roles; the importance of doctors and patients mutually projecting each other's voices; and the variable and iterative character of shared decision-making. The research demonstrates how doctors and patients negotiate a complex, interactionally and symbolically mediated agency, and shows that patients often take the lead in developing more collaborative decision-making practice. There are still institutionally and socially determined limits to the degree of control patients may exercise within the consultation, many of which are of course well founded. / Mode of access: World Wide Web. / xvii, 533, [22] p. ill

In South Africa, mental health care is being integrated into primary health care services. The integration of services was aimed at increasing the accessibility and availability of all health care services at primary health care level. The integration was well intentioned, and it was hoped that mentally ill clients would benefit from having a service near their homes. However, the process of integration is fraught with challenges, for instance, staff shortages, which lead to ineffective nursing management of mentally ill clients at the primary health care clinics. As a result, one professional nurse is often allocated to manage the clinic services on a daily basis with the assistance of an enrolled nurse or auxiliary nurse. The professional nurses therefore experience high levels of stress due to gross staff shortages and lack of time to conduct proper nursing assessments. This led to the research question: “What are the experiences of professional nurses with regards to the nursing management of mentally ill clients in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape?’’ The proposed objectives of the study were to explore and describe the experiences of professional nurses working in rural primary health care clinics with regard to the nursing management of mentally ill clients. The researcher thereafter made recommendations to the district managers regarding effective nursing management of mentally ill clients in rural primary health care clinics. A qualitative, exploratory, descriptive and contextual design was used. The research population comprised of professional nurses working in rural primary health care clinics in the O.R. Tambo District in the Eastern Cape. Purposive sampling was used to identify participants and the sample number was determined by data saturation. Unstructured interviews and observation notes were used to collect data. The eight steps of data analysis suggested by Tesch were utilized to analyze the data. The researcher conducted an in-depth literature review in order to identify research gaps pertaining to the study. To ensure that a high level of validity and reliability was exercised throughout the study, the researcher conformed to Lincoln and Guba’s model of trustworthiness. The study was conducted in an ethical manner and ethical principles were adhered to. Findings: Three themes with subthemes emerged. The study showed that professional nurses experienced challenges related to the nursing management of mentally ill clients. These challenges included shortage of staff, a heavy workload, and lack of resources, lack of in-service training and workshops related to mental health issues coupled with lack of support from the supervisors. Due to the challenges, the mentally ill clients were not getting quality nursing care leading to complications and relapse. Conclusion: It emerged from the study that matters pertaining to mental illness and mental discomfort were still a serious problem in rural areas. The problems were related to the challenges which prevented professional nurses from providing quality nursing care to mentally ill clients with subsequent complications and relapse. Recommendations: Recommendations were made as an effort to ensure that the nursing management of mentally ill clients in rural primary health care clinics is improved. These recommendations were categorized as related to nursing practice, nursing education and nursing research.

Background: Despite the prevalence of HIV/AIDS stabilizing and slightly decreasing in certain provinces, there are a number of People Living With HIV/AIDS (PLWHA) in South Africa. Many people seek help at primary health clinics and hospitals and receive chronic care at these facilities. Caring for these chronic patients and new patients entering the health system can be stressful to the health professionals who are involved. Many studies that have been conducted have focused on the clinical aspects of individual patients, while few studies have focused on the experiences and stressors of health professionals looking after PLWHA. To ensure quality of care for patients with HIV/AIDS, it is important to understand the experiences of health professionals looking after HIV/AIDS patients and how stressful experiences may influence their attitude towards these patients. Aim: The aim of this study is to report the factors health professionals perceive as occupational stressors caring for people living with HIV/AIDS in the public health sector of the Nelson Mandela Metropolitan Municipality. Research design and Methodology: A quantitative, descriptive and non-experimental research design was followed. A pilot study was conducted to determine the clarity of questions, effectiveness of the instructions, completeness of the response sets, the time required to complete the questionnaires and the success of the data collection. The primary method of data collection was self-administered questionnaires. The questionnaires were dispatched to 30 health professionals at the public health facilities in the Nelson Mandela Metropolitan Municipality. A descriptive statistical analysis was done using a Statistical Package. This revealed the following findings. Findings: The following are the findings that were perceived to be occupational stressors: organizational factors, job design factors, career and promotional factors, role-related factors and cultural factors. iv Conclusion and recommendations: There are occupational stressors that affect health care professionals working in an HIV/AIDS setting. The following are the recommendations to rectify or to improve the situation: • Improve the communication of goals and objectives; • Redesign the job; • Human-resources development ; • Improvement of salaries; • Career planning and mentoring; and • Sensitisation of employees to cultural differences.

No description available.