Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2016 / The purpose of the study was to develop a protocol to enhance patient satisfaction with regard to nursing care at Health Centres and to determine factors leading to patient dissatisfaction. A quantitative, descriptive and cross-sectional research design was used for this study. The population of the study for the two Health Centres was: Agincourt Health Centre= 5697 while Thulamahashe Health Centres= 5696. Systemic random sampling method was used to select 400 respondents from each Health Centre. Data were collected through self-developed questionnaire. The questionnaire was pre-tested at Cunningmoore clinic. Reliability was ensured through conducting of a pre-test. Validity was ensured through undertaking extensive literature review. The questionnaire was also given to the supervisor for content validity. Data analysis was done through descriptive and inferential statistics using SPSS version 22 programme of data analysis. The findings indicated that factors leading to patient dissatisfaction with regard to nursing are: long waiting time, poor communication and information between nurses and patients, shortage of nurses, poor service and environmental condition and shortage of treatment (medication). The study recommends that waiting time should be reduced to less than 3 hours, shortage of nurses should be addressed, workshops and inservice training should be implemented and treatment should be monitored.

This comparative research explores the work experiences of dementia care workers in nursing homes. The aim of this study is to understand concepts central to care and to gain insights from the care workers‟ perspectives. A comparative framework and symbolic interactionist approach is used to analyse data collected using ethnographic methods from 59 dementia care workers in Canada, Scotland, and the United States. The fieldwork settings are institutionalised; dominated by for-profit ownership; and provide care for a resident population with high cognitive and physical needs. The comparative findings underscore the importance of work conditions that provide care workers with sufficient resources to do their job and enough time to complete their work. The absence of these critical components creates stressful work conditions for the care workers. The lack of time, staff and supplies such as towels, wash cloths, and continence products do not allow the residents‟ choices in their care and disregard their dignity and rights. The inability to deliver care for the residents according to the guaranteed government care standards often result in the violation of human rights for the care workers and residents. The care workers are unable to supply the quality of care they know the residents need and are capable of providing given better circumstances. There are frequently not enough care workers, resources, or time to meet the level of care that relevant standards mandate or the care workers know is possible. The analysis reveals that care workers struggle to provide more than basic physical care and are seldom able to meet essential social care needs for the residents. Unwritten rules are implemented in each setting that include separating people with dementia, placing these residents out of view of the public, not allowing the residents access to go outside, and not providing them with engaging and meaningful interactions. While policies are frequently developed with good intentions, many are counter-productive without dementia knowledge. This comparative research reveals care practices and routines share strong similarities across the fieldwork sites while the care worker characteristics as a workforce vary the most between countries. Some differences involve the training required, average age, pay and mode of dress or appearances. Too often researchers frame stress issues for care workers as problems with attitudes, motivation, training and incentives. Yet, the broader social structures and conditions that set the context in which these problems have their origins are commonly ignored. Good working conditions for care workers are precursors to good care for the residents. This thesis concludes with recommendations for practice, research and policy development.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The overall objective of this study was to ascertain whether lay counsellors offer psychosocial counselling to clients at antiretroviral therapy clinics. The study was conducted at two clinics in the Greater Tzaneen municipality, Limpopo province, South Africa. The sample of 14 consisted of seven female lay counsellors and seven HIV positive clients, three females and four males, at Xihlovo and Nyeleti antiretroviral clinics. They were interviewed using 11-item and 12-item interview guides, respectively. Interviews were conducted in the local languages. Qualitative data were collected for the study. The data were audiotaped, translated, transcribed and then categorised into a thematic framework. HIV positive participants were found to be suffering from psychosocial consequences of living with HIV, such as shock, denial, anger and blame, fear of death, fear of disclosure, and intimate-partner violence. However, lay counsellors did not offer effective counselling that could relieve the psychosocial consequences. They instead used religion to console clients, discouraged clients from expressing their feelings, and minimised their clients’ concerns. It is recommended that lay counsellors be taught basic counselling theories as part of their training so that they are better able to screen their clients for psychosocial problems and provide basic counselling. / AFRIKAANSE OPSOMMING: Die algehele doelwit van dié studie is om te bepaal of leke-beraders psigo-sosiale berading aan kliënte by die die anti-retrovale terapie klinieke bied. Kwalitatiewe data is vir dié studie versamel. Die studie is by twee klinieke in die groter Tzaneenmunisipaliteit in Limpopo provinsie in Suid‐Afrika gedoen. Die eksperimentele groep van 14 het bestaan uit sewe vroulike leke-beraders en sewe MIV-positiewe kliënte: drie vrouens en vier mans, by Xihlovo en Nyeleti anti-retrovale klinieke. Daar was onderskeidelike onderhoude met hulle gevoer en die 11-item en 12-item onderhoudriglyne is toegepas. Onderhoude is in inheemse tale gevoer. Die data was opgeneem, vertaal, getranskribeer en in 'n tematiese raamwerk vasgevang. Daar is gevind dat die MIV-positiewe persone negatiewe psigo-sosiale gevolge ervaar: skok, ontkenning, woede, blaam, vrees vir die dood, vrees dat hul status openbaar sal word, asook geweld binne hul verhoudings. Leke-beraders het egter nie doeltreffende berading gegee om bogenoemde psigo-sosiale gevolge te verlig nie. Hulle het eerder godsdiens gebruik in 'n poging om hul kliënte te vertroos, nie die kliënte aangemoedig om hul gevoelens uit te druk nie en hul gevoelens en kommer afgemaak. Daar word aanbeveel dat leke-beraders basiese beradingsteorie as deel van hul opleiding ontvang sodat hulle psigo-sosiale probleme in hul kliente kan uitken en beter basiese berading kan verskaf.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The topic of perinatal depression (i.e. depression during and after pregnancy) remains a subject of continued research interest, as a broad literature body reports that a large proportion of women suffering from this mental disorder do not receive appropriate treatment. This is worrisome, firstly, because mental health treatment is often readily available to the public and at no cost. Secondly, untreated perinatal depression not only holds dangerous consequences for the mother but also for the infant and the rest of the family. It is therefore important to identify those factors that act as barriers to mental health care utilization for perinatal depression. Although this is a persistent problem within the South African context, to date, little is known about the barriers to the utilization of available mental health services experienced among pregnant South African women. For this reason, the Perinatal Mental Health Project (PMHP) aims to provide mental health services at the same location where women receive obstetric services. However, despite their efforts, the number of women who decline available treatment is still of great concern. The present study offers a unique perspective on counselling for perinatal depression appointment-keeping barriers as it provides a holistic view of these barriers that exist not only within the women but also in their multi-levelled environments. Secondly, it addresses the problem of nonattendance to mental health care treatment offered by the PMHP and consequently also addresses the gap in South African research on the topic. The sample for this study was selected from PMHP files of those patients who failed to attend scheduled counselling appointments. The participants included in this study were selected by means of purposeful sampling to participate in face-to-face and telephonic semi-structured interviews. Participants were assured of confidentiality and anonymity. The semi-structured interviews were audio-recorded and transcribed after which transcriptions were entered into MS Word for textual analysis. Transcriptions were thematically analysed. The main themes that emerged from the present study included individual-related barriers, social-related barriers, institution-related barriers, community-related barriers and poverty-related barriers. The results of the present study reflect the motivations for depressive pregnant women to decline available and free mental health services provided by the PMHP, according to five main themes. These themes were then discussed according to Bronfenbrenner’s (1977; 1979) Ecological Systems Theory, which categorised the main themes identified according to the different systems operating within the patient’s environment, i.e. the individual-, micro-, meso-, exo-, and macrosystem. The individual system comprised the individual-related barriers, which included poor mental health, and ambivalent feelings toward the pregnancy. The microsystem comprised the social-related barriers, which included low social support and self-help strategies. Community-related barriers were considered within the mesosystem of the patient’s ecological environment, with stigma and pity as sub-barrier. The exosystem comprised the institution-related barriers, including referral protocol barriers, lack of information provided by the nurses, and nurses’ attitudes as experienced by participants. Lastly, poverty-related barriers were considered within the macrosystem, with financial life hardship, constant child-care demands, and transportation barriers as sub-barriers. The significance of this study lies in the original perspective offered on mental health care appointment-keeping behaviour within the South African context. Future research could, in addition to conducting interviews with hospital patients, include health care professionals and focus groups as this will allow for triangulation of the perspectives of all significant players. Also, having identified the problems and concerns with regards to attending counselling appointments, future research direction may be aimed at creating interventions designed to reduce the identified barriers to mental health care service use. / AFRIKAANSE OPSOMMING: Perinatale depressie (d.w.s. depressie voor en na swangerskap) bly ʼn onderwerp van voortdurende navorsings belang, aangesien ʼn breë navorsingsveld aandui dat ʼn groot proporsie van vroue wat aan hierdie geestesversteuring lei, nie die gepaste behandeling ontvang nie. Dit is kommerwekkend, eerstens, aangesien behandeling vir geestesgesondheid meestal openlik verkrygbaar is aan almal sonder enige koste. Tweedens, onbehandelde perinatale depressie hou nie slegs gevaarlike gevolge vir die moeder in nie, maar ook vir die baba en die res van die gesin. Dit is daarom belangrik om daardie faktore te identifiseer wat as hindernisse optree tot geestesgesondheid sorg diensgebruik vir perinatale depressie. Alhoewel dit ʼn voortdurende probleem binne die Suid-Afrikaanse konteks is, is daar tot op hede geen navorsing wat hindernisse tot gebruik van beskikbare geestesgesondheidsdienste bekend gemaak nie, veral wat ervaar word onder swanger Suid-Afrikaanse vroue nie. Vir hierdie rede, beoog die Perinatal Geestesgesondheid Projek (Perinatal Mental Health Project - PMHP) om geestesgesondheidsdienste te lewer by dieselfde plek waar vroue verloskundige dienste kan ontvang. Nietemin, ten spyte van hul pogings, is die getal vroue wat beskikbare behandeling van die hand wys steeds van groot kommer. Dié studie bied ʼn unieke perspektief op hindernisse tot berading vir perinatale depressie afspraak-ooreenkoms gedrag, aangesien dit ʼn algehele uitkyk bied op hindernisse wat nie slegs binne die vroue bestaan nie, maar ook in hul veelvlakkige omgewings bestaan. Tweedens, spreek dit die probleem van nie-bywoning van geestesgesondheidsbehandelingsdienste wat aangebied word deur die PMHP aan en gevolglik ook die gaping wat binne Suid-Afrikaanse navorsing rakende dié onderwerp bestaan. Die steekproef vir die studie was gekies van PMHP lêers van daardie pasiënte wat nie hul geskeduleerde terapie afsprake bygewoon het nie. Die deelnemers ingesluit in die studie is deur middel van doelgerigte-steekproefneming geselekteer om aan aangesig-tot-aangesig of telefoniese semi-gestruktureerde onderhoude deel te neem. Deelnemers is van hul vertroulikheid en anonimiteit van die proses verseker. Die semi-gestruktureerde onderhoude was oudio-opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in MS Word gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer. Die hooftemas wat na vore gekom het, sluit in individuele-verwante hindernisse, sosiale-verwante hindernisse, institusie-verwante hindernisse, gemeenskapsverwante hindernisse en armoede-verwante hindernisse. Resultate van dié studie reflekteer die motiverings van depressiewe swanger vroue om beskikbare en gratis geestesgesondheidsdienste wat verskaf is deur die PMHP van die hand te wys, volgens die vyf hooftemas. Hierdie temas is toe volgens Bronfenbrenner (1972) se Ekologiese Sisteemteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die individuele-, mikro-, meso-, ekso-, en makrosisteem. Die individuele sisteem het die individuele-verwante hindernisse ingesluit, wat swak geestesgesondheid, en teenstrydige gevoelens teenoor die swangerskap omvat het. Die mikrosisteem het die sosiale-verwante hindernisse ingesluit, wat swak sosiale ondersteuning, en self-help strategieë omvat het. Gemeenskapsverwante hindernisse is binne die mesosisteem van die pasiënt se ekologiese omgewing beskou, en het stigma en jammerte as sub-hindernisse ingesluit. Die eksosisteem het die institusie-verwante hindernisse ingesluit, wat verwysing protokol hindernisse, gebrek aan inligting verskaf deur die verpleegsters, en verpleegsters se houdings soos ervaar deur die deelnemers omvat het. Laastens is die armoede-verwante hindernisse binne die makrosisteem beskou, en het finansiële lewens swaarkry, konstante kindersorg eise, en vervoer-verwante struikelblokke as sub-hindernisse ingesluit het. Die belang van dié studie lê in die oorspronklike perspektief van geestesgesondheidsbehandeling dienste afspraak-ooreenkoms gedrag binne die Suid-Afrikaanse konteks, wat aangebied is. Toekomstige navorsing kan, bykomend tot die voer van onderhoude met hospitaal pasiënte, fokus daarop om gesondheidsorg kenners en fokus groepe in te sluit, aangesien dit die triangulasie van perspektiewe moontlik maak van al die belangrike rolspelers. Ook, aangesien die probleem en bekommernisse rakende bywoning van terapie afsprake reeds geïdentifiseer is, mag toekomstige navorsing in die rigting beweeg met die doel om intervensies te omskep wat beoog om die geïdentifiseerde hindernisse tot geestesgesondheidsorg diensgebruik te verminder.

Thesis (MA)--Stellenbosch University, 2015 / ENGLISH ABSTRACT : Worldwide there are various reports on the prevalence of depression in patients diagnosed with brain tumours. In South Africa, psychological research in relation to psychiatric symptoms among patients with brain tumours is lacking. The aims of this study were to determine the incidence of depression in patients diagnosed with brain tumours and to clarify our understanding of the relationship between depression and tumour localisation, histopathological type of tumour, and participant characteristics. The study sample consisted of 35 patients (11 males and 24 females) aged between 21 and 64 years with a solitary primary brain tumour. The patients were treated at the neurosurgery clinics located at Tygerberg Hospital in the Western Cape and Universitas Hospital in the Free State between mid-2010 and 2013. The major histological subgroup consisted of meningiomas (47%), glioblastomas (22%), astrocytomas (19%), gliomas (9%) and epidiomas (3%). The tumour distribution was as follows: 52% in the left hemisphere, 37% in the right hemisphere, and 11 % in the midline. The psychiatric symptoms of the patients were assessed before treatment by the Beck Depression Inventory and Mini International Neuropsychiatric Interview. In addition, the patients’ neuropsychological functions were evaluated by a short neuropsychological test battery (Mini Mental State Examination, Trail Making Test (Part A), Letter Number Sequencing subtest, Hopkins Verbal Learning Test – Revised, and Brief Visuospatial Memory Test – Revised). Results from the quantitative data, showed the prevalence of mild depression was 26% for men and 43% for women. Overall 37% of the total sample had depressive symptoms. No significant relationship was found between depression and tumour location or between the various neuropsychological characteristics and neurological symptoms and tumour location. The study showed that depression is a common symptom in patients diagnosed with brain tumours and therefore depression symptoms have to be recognised and treated by psycho-educating the patients and their families, pharmacotherapy, or psychotherapy as soon as possible. However, due to the relatively small sample size, the results are of limited generalisability. / AFRIKAANSE OPSOMMING : Wêreldwyd is daar verskeie verslae oor die voorkoms van depressie in pasiënte gediagnoseer met breingewasse. In Suid-Afrika is daar ’n tekort aan sielkundige navorsing met betrekking tot psigiatriese simptome by pasiënte. Die doel van hierdie studie was om die voorkoms van depressie te bepaal in pasiënte gediagnoseer met breingewasse en om duidelikheid te kry oor die verband tussen depressie en die ligging van breingewasse, histopatologiese tipe gewas en karakter eienskappe van die deelnemers. Die steekproef van die studie het bestaan uit 35 pasiënte (11 mans en 24 vroue) tussen die ouderdomme 21 en 64 jaar met ‘n soliede breingewas. Die pasiënte is behandel by die neurochirurgiese klinieke by Tygerberg Hospitaal in die Wes-Kaap en by Universitas Hospitaal in die Vrystaat vanaf middel 2010 tot 2013. Die mees algemene histologiese subgroep het bestaan uit meningiome (47%), glioblastomas (22%), astrocytomas (19%), gliomas (9%) en epidiomas (3%). Die verspreiding van die gewasse was soos volg: 52% in die linkerhemisfeer, 37% in die regterhemisfeer en 11% in die middel. Die psigiatriese simptome van die pasiënte is voor behandeling geëvalueer met behulp van die Beck Depression Inventory en die Mini International Neuropsychiatric Interview. Bykomend is die pasiënte se neurosielkundige funksies geëvalueer met behulp van ‘n neurosielkundige toetsbattery (Mini Mental State Examination, Trail Making Test (Part A), Letter Number Sequencing subtest, Hopkins Verbal Learning Test – Revised en Brief Visuospatial Memory Test – Revised). Die resultate van die kwantitatiewe data het getoon die voorkoms van matige depressie was 26% vir mans en 43% vir vroue. In geheel het 37% van die totale steekproef depressiewe simptome getoon. Daar was geen beduidende verhouding tussen depressie en die ligging van die gewas of tussen die verskeie neurosielkundige eienskappe en die ligging van die gewas nie. Die studie het getoon dat depressie ’n algemene simptoom is in pasiënte gediagnoseer met breingewasse en daarom moet depressiewe simptome herken en so gou as moontlik behandel word deur psigo-opvoeding van die pasiënte en hul familie, farmakoterapie of psigoterapie. As gevolg van die relatiewe klein steekproef grootte het die resultate ’n beperkte veralgemeenbaarheid.

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

The purpose of the study was to develop a behavioral nursing intervention strategy for specific deficits in grooming performance of elders with dementia. A quasi-experimental two-group design using switching replications with removed intervention was employed. Three residents with severe cognitive impairments and three residents with mild cognitive impairments were chosen from a special dementia care unit of a long-term care facility. Three residents among six residents were randomly selected to receive the behavioral intervention early. Baseline and post-intervention assistance was provided by nurse aides. Each resident was asked to wash hands, brush teeth, wash face, and comb hair in a sequence. Ten intervention sessions were conducted by the trained intervener for two consecutive weeks. The intervention consisted systematic prompting and social reinforcement. A total of 21 sessions were collected in the morning using videotape recordings. Interobserver agreement for the instruments designed by the investigator was measured by the trained observers. Data were analyzed in two phases. First, the quantitative data were analyzed to determine the independent functional behaviors of individuals, and the change in the intensity of nursing effort associated with grooming of elders with dementia. Data were examined by individual graphic display throughout the three phases (baseline, nursing intervention, post-intervention). Second, the qualitative data were analyzed to determine the antecedents, consequences, and resident responses associated with grooming, the caregiver problem behaviors, and resident problem behaviors associated with grooming performance. The results show that the functional behaviors of even severely demented elders can be promoted, indicating the effectiveness of nursing care strategies on the ADL task of grooming. The data in this research suggest that maintaining or improving functional ability is possible with a behavioral nursing intervention, which was a highly structured and systematic approach that involved modifying the environmental and behavioral context, through strategies such as prompting and social reinforcement, when necessary. Furthermore, through the qualitative analysis, the functional relationships between antecedents, consequences, and behaviors of demented elders allowed the investigator to analyze the caregiver problem behaviors and resident behavior problems associated with grooming.

Trauma-informed care (TIC) is an approach to service delivery based on the understanding of the prevalence of psychological trauma among service users, knowledge about the impact trauma has on engagement to services, and recognition that service settings can be re-traumatizing. For more than a decade, momentum has been building on this topic. Practitioners are pursuing the knowledge and skills needed to implement trauma-informed service delivery, while organizations are building infrastructure and processes aimed at supporting this approach. Disciplines across many human service sectors are eager to incorporate TIC into policy and practice. Despite this enthusiasm, implementation efforts are slow. Acquiring foundational knowledge about TIC has typically been recommended as a first step when implementing a trauma-informed approach. However, slow progress in implementation suggests knowledge may not be enough. This study investigated the individual characteristics that impact a commitment to TIC, with specific attention to the relationship between foundational knowledge about trauma-informed care and commitment to TIC. Other variables of interest included perceived principal support, TIC self-efficacy, beliefs about trauma and its impact, and organizational strain. Survey data were collected from 118 participants working in mental health, public health, and early childhood. Results from structural equation modeling suggest that foundational knowledge predicts affective commitment to TIC both directly and with the partially mediated paths through principal support, TIC self-efficacy, and beliefs about trauma. Organizational strain does not moderate these effects. However, group differences based on high and low levels of perceived organizational strain were observed and discussed. These findings add to the growing literature on TIC and should be considered as organizations strive to implement TIC.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The introduction of Antiretroviral Therapy (ART) has shown a tremendous reduction in HIV-related mortality and morbidity in people living with HIV / AIDS. Adherence to ART is the key to a successful treatment outcome. This study investigates the adherence of people living with HIV who are on ART. Since high levels of adherence of more than 95% are required to achieve effective suppression of the viral load, the researcher finds it very important to establish whether the people are pursuing what is expected of them. While the use of ART has brought much excitement and hope to both patients and medical practitioners in the world, it has also brought many new questions and challenges, including adherence issues. Adherence is, therefore, essential to achieve the success of ART. Aim: The main objective was to determine which factors influence adherence to ART among HIV and AIDS patients. Methods: This study utilised a quantitative cross-sectional descriptive design that was conducted at the Kwa-Thema Clinic, Ekurhuleni District, Gauteng Province. Data was collected using a structured questionnaire with open- and closed-ended questions where a total of 290 respondents were interviewed. Data was analysed using SPSS software version 22 and the analysed data was presented by means of charts, graphs, and frequency tables. Results: The findings indicated that the adherence to ART at the Kwa-Thema Clinic was 77%. Factors that were significantly associated with adherence were gender ((χ2 = 3.78, df = 1, p < 0.05).), level of education ((χ2 = 3.52, df = 3, p = 0.032), co-treatment of HIV and other infections (χ2 = 5.46, df = 4, p = 0.019).), ability to follow ART ((χ2 = 12.82, df = 1, p = 0.000 < 0.05), and types of ARV drugs. Recommendation: To enhance ART adherence the study recommends intensification of health education campaign against stigma and gender discrimination. Providing feedback to the patients by the healthcare providers regarding the benefits of ART is important. ix Conclusion: It was concluded that the adherence to ART at the Kwa-Thema Clinic was sub-optimal (less than 95%) at 77% but comparable to the adherence levels in other developing countries.

Bibliography: leaves 347-361. Presents results of 2 longitudinal studies investigating the oral health of older adults with dementia, using questionnaires and clinical inspections at baseline and one year. Groups studied were nursing home residents and those living in the community, with moderate to severe dementia or no dementia diagnosis. Caries experience was related to dementias severity and not to specific dementia diagnoses. Coronal and root caries experience was higher in dementia participants with moderate-severe dementia, the socio-economically disadvantaged, more functionally dependent, taking neuroleptic medications with high anticholinergic adverse effects, with eating and swallowing problems, were not attending the dentist, who needed assistance and were behaviourally difficult during oral hygiene care and whose carers were burdened.