Set in the mining sector, the aim of this study was to explore the experiences, insights and reflections of a particular group of peer educator's with regard to their organisation’s peer education programme. Using the PRECEDE-PROCEED Model (Green & Kreuter, 1991) as an organising framework, this study explored the pre-disposing, enabling and reinforcing factors that had an impact on this HIV/AIDS peer education programme. The specific objectives to be assessed in this study were the peer educator’s perceived impact on attitude and behaviour change amongst employees; the perceived organisational barriers and supports that peer educators encountered in programme delivery as well as further training needs of the peer educators. Using an interpretivist paradigm, the study was concerned with describing and interpreting people’s feelings and experiences with qualitative depth. Interviewees comprised of a non-probability saturation sample of five current adult peer educators and one adult ex-peer educator, employed in the Eastern Region of the Organisation (KwaZulu-Natal). In addition the regional manager and the human resource manager were interviewed. Semi-structured tape recorded interviews were used to collect data from the peer educators, and the data was transcribed verbatim from the digital recording. Themes were induced and coded by looking for reoccurring peer educator views, following which the researcher was able to induce potential predisposing, enabling and reinforcing factors that the peer educators faced in programme delivery. Based on the findings of the study, appropriate recommendations are offered with a view to improving programme delivery and quality. Finally, the main constraints which limited the study findings are considered. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Syfte: Syftet med föreliggande litteraturstudie var att beskriva vilka omvårdnadsåtgärder sjuksköterskan kan använda sig av i det trycksårspreventiva arbetet. Syftet var även att granska urvalsmetoden som de inkluderade artiklarna har använt sig av. Metod: Artiklar publicerade mellan 2007 och 2013 söktes i databaserna CINAHL och PubMed. Resultatet baserades på tretton artiklar. Resultat: Resultatet utmynnade i fyra kategorier: 1) Riskbedömning; med användandet av ett riskbedömningsinstrument i det dagliga omvårdnadsarbetet minskade förekomsten av trycksår. Det framkom att sjuksköterskans kliniska blick var viktig för att upptäcka patienter med risk för att utveckla trycksår. 2) Tryckavlastande underlag; användande av tryckavlastande underlag var en viktig åtgärd för att förebygga uppkomst av trycksår. Växelvis tryckavlastande madrasser förebyggde uppkomst av trycksår bäst. 3) Lägesändring; 30 graders vinkling i liggande position avlastade riskområden för utveckling av trycksår bäst. När ansvar för lägesändringar tydliggjordes minskade förekomsten av trycksår. 4) Nutrition; ett ökat kaloriintag minskade risken markant för utveckling av trycksår. Metodologisk aspekt; urvalsmetoden beskrevs tydligt i 8 artiklar och mindre tydligt i 5 artiklar. Slutsats: Föreliggande litteraturstudie visade att sjuksköterskan kan använda sig av omvårdnadsåtgärderna riskbedömning, tryckavlastande underlag, lägesändring samt nutrition för att minska risk för uppkomst av trycksår. / Aim: The aim of this literature study was to describe preemptive measures that can be performed by the nurse in order to prevent the development of pressure ulcers. The aim was also to study the sampling methods used in the reviewed studies. Method: The articles for this literature study were gathered from the CINAHL and PubMed databases. Only publications from the years 2007 to 2013 were considered. In total 13 articles were included. Results: The results were divided into four categories: 1) Risk assessment; the use of risk assessment tools was effective in identifying patients at risk for pressure ulcer development. However, it is evident that the nurse experience is an important contributor to identify patients at risk for pressure ulcer formation. 2) Support surfaces; support surfaces is an important measure for prevention of pressure ulcers. Pressure relief mattresses with periodically changing pressure were shown to be the most effective for prevention of pressure ulcers. 3) Reposition; a change of 30 degrees in supine position was the most effective to unload risk areas of pressure ulcers. When the responsibility for changing patient position was clearly defined the frequency of pressure ulcers decreased. 4) Nutrition; with an increaseed caloric intake the risk of developing pressure ulcers clearly decreased. Methodological aspect: The sampling method was clearly described in eight articles and less clear in five articles. Conclusion: This literature study shows that the nurse can use risk assessment, support surfaces, reposition and nutrition to prevent development of pressure ulcers.

SAMMANFATTNING Bakgrund Att arbeta skift har visat sig vara en stressfaktor som påverkar både sömn och hälsa negativt och inom sjukvården kan även patientsäkerheten äventyras om personalen är utmattad på grund av sömnbrist. Syfte Syfte med denna litteraturstudie var att beskriva vilka faktorer som påverkar sömnen och kan medföra sömnstörningar, samt vilka preventiva åtgärder som kan leda till förbättrad sömn hos skiftarbetande vårdspersonal. Metod Resultatet bygger på tio vetenskapliga artiklar publicerade under åren 2007-2013. Dessa söktes genom databaserna Cinahl, PsykINFO och PubMed. Resultat I analysen av artiklarna framkom att skiftarbete som inkräktar på normala sömntider har en uppenbart skadlig effekt på sömnen med svårigheter att somna och sömnighet under både arbetstid och ledighet. Utmärkande var att stigande ålder och låg stresströskel (hardiness) ökade risken för sömnstörningar. Att ges möjlighet till tupplur under nattpass var en viktig åtgärd för att förebygga trötthet och främja hälsan hos skiftarbetande vårdpersonal. Slutsats Eftersom skiftarbete i sig har en uppenbart skadlig effekt på sömnen så är det av största vikt att ge vårdpersonalen bästa möjliga förutsättningar för att bibehålla sin hälsa på sikt. Förutom att planera för bra skiftscheman med schemalagd rast samt möjlighet att sova på nattpassen, bör man ta hänsyn till vårdpersonalens ålder och stresstålighet (hardiness). / ABSTRACT Background Working shift has been shown to be a stressor that impacts both sleep and health negatively and within the healthcare also the patient safety could be affected if the personnel are fatigued due to sleep deprivation. Aim The aim of the literature review was to describe which factors that influences sleep and can lead to insomnia, and which preventive actions that could lead to improved sleep among shift working healthcare personnel. Methods The analysis included then scientific articles (between year 2007-2013). The literature was sought from the databases Cinahl, PsykINFO och PubMed. Result The result showed that shift work that interfere with normal sleep times has an obvious harmful effect on sleep with difficulty falling asleep, and sleepiness during working time as well as leisure time. Significant was that age and low hardiness increased the risk for insomnia. To be able to take a nap during the nightshift was an important action to prevent sleepiness and promote health among shift working healthcare personnel. Conclusion Due to the fact that shift work in itself has an obvious harmful effect on sleep, it is of great importance to ensure the best possible conditions to retain health within the health care personnel in the long term. Beside planning for good shift systems, including night brake with possibility to take a nap, it is important to take age and hardiness into consideration.

Introduction Nearly half of all new HIV infections worldwide occur in young people aged 15-24 years. Risky sexual behaviours may lead to the development of lifelong negative habits like having multiple partners, thereby placing young people at risk of a broad range of health problems, including HIV/AIDS. Prevention is therefore critical and includes changing behaviours that are risky, such as the early age of sexual initiation, having many sexual partners and non-use of condoms. The study aimed to evaluate whether a theory based HIV/AIDS intervention, 'Be A Responsible Teenager' (B.A.R.T.), could produce behaviour change among high school learners in South Africa. Methods A pre-test /multiple post-test intervention study was undertaken. All Grade 10 learners (n = 805) from all three public high schools in Wentworth were included in the study. Eleven teachers were interviewed from these schools. Learners completed a questionnaire at baseline (Tl), immediately post intervention 1 (T2), post intervention 2 (T3) and after a period of seven months (T4). The B.A.R.T.intervention was implemented in the intervention schools while the control group did not receive any intervention. Qualitative data was analyzed according to themes, while quantitative data was analyzed cross sectionally and longitudinally. Results Teachers reported many obstacles in implementing the HIV/AIDS Life Skills' curriculum, including the poor quality of training and inadequate resources in schools. Further, learners practised high-risk sexual behaviours. Gender differences in sexual behaviour were reported with males predominately practising higher risk behaviours than females.The B.A.R.T. intervention did show changes in behaviour for alcohol use at last sex and for the determinants knowledge, attitudes, beliefs, self-efficacy and intentions to practise safer sex respectively, over time. However, the intervention didnot positively impact abstinence behaviours, condom use and the reduction in partners. Further, subjective norms did not change. Conclusion The major obstacles to AIDS prevention include the current practices of risky sexual behaviours including age mixing, early sexual initiation, multiple partners, forced sex and receiving money or gifts for sex among others. Social norms as potrayed by parents, peers and religious groups play a pivotal role in promoting protective sexual behaviours. The role of gender and the gaps in LHAP (Life Skills' HIV/AIDS programme) also require urgent attention. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2008.

The aim of the study was to explore the perceptions of the HIV negative pregnant women, after their hiv negative results, towards preventive sexual behaviour. Methodology: A qualitative approach was used in exploring the perceptions of hiv negative pregnant women and describing their behaviour according to the findings. Fifteen participants were interviewed. Two semi - structured interviews were conducted with each participant, an initial interview and a verifying interview, for the purpose of saturation and verification. Each interview lasted for 20 - 30 minutes. The interviews were recorded and transcribed. Manual data analysis was used to identify categories and themes. Findings: The study revealed that the participants knew what the negative status entailed. They were also aware that there is a chance of hiv negative person being infected by hiv virus if they do not engage in preventive sexual behaviour. Furthermore, they had also disclosed their hiv negative status to their partners and most of the partners refused to go for testing. Though the participants believed that it was necessary to use condoms even if they were hiv negative, most of them had not use condoms during their last sexual intercourse. Reasons for not engaging in preventive sexual behaviour were revealed by the study. Recommendations were suggested for clinical practice, nursing education, management and research. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2005.

In this study, the researcher is interested in the utilization of HIV/AIDS prevention methods among university students. The purpose of this study was to explore factors that influence the utilization of existing HIV/AIDS prevention methods amongst students at the University of KwaZulu-Natal residing in a selected campus. Four residences within the selected campus were randomly selected and participants were conveniently selected from each of sampled residences. There was a total of 335 respondents and 261 (78%) completed the manual questionnaires while 74 (22%) completed online questionnaires. The study used quantitative approach and was descriptive-exploratory in nature. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 15. The majority of respondents were young people with the mean age of 22.9 years. The sample comprised 278 (78%) undergraduate and 57 (17%) post graduate students. Study findings showed that the factors which influenced the utilization of HIV/AIDS prevention methods varied and that they were mainly influenced by the awareness of the existing university-based HIV/AIDS prevention strategies. It also emerged that the mostly utilized HIV prevention methods were VCT services and free condoms. Perceived susceptibility and the perceived threat of HIV/AIDS score was also found to be correlated with HIV Risk Index score. Furthermore, there was Correlation between perceived susceptibility and perceived threat of HIV/AIDS and self-efficacy on condoms and their utilization. However, there seemed to be no relationship between utilization of HIV/AIDS prevention methods and these variables. In conclusion, the findings of this study suggest that most of Health Beliefs Model (HBM) variables were not predictors of the utilization of HIV/AIDS prevention methods among students. Intervention aiming to improve the utilization of HIV/AIDS prevention methods among students at the UKZN should focus on removing identified barriers, promoting HIV/AIDS prevention services and providing correct knowledge on HIV for behavioral change. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2009.

Bakgrund: Trycksår uppstår när hudens syre- och näringstillförsel är otillräcklig på grund avlokalt nedsatt blodcirkulation. Detta orsakar smärta och lidande för den drabbade. Tidigareforskning visar att trycksårsprevalensen är fortsatt hög idag trots medvetenhet om riskfaktorer som bidrar till utvecklandet av trycksår. Samt att sjuksköterskor helst förlitar sig på sina tidigare kunskaper och erfarenheter vad gäller bedömning och beslut kring trycksår. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskans omvårdnadsåtgärder för attförebygga och behandla trycksår. Samt beskriva de inkluderade artiklarnasdatainsamlingsmetoder. Metod: Beskrivande litteraturstudie. Artiklar publicerade mellan 2010.01.01-2015.01.30 söktes i databaserna Cinahl och PubMed. Resultatet baseras på 15 artiklar. Huvudresultat: Resultatet visade att den mest effektiva behandlingen mot trycksår ärförebyggande åtgärder, däribland tryckavlastande åtgärder och hudvård. I bedömning och beslutsfattande gällande trycksårsproblematik har sjuksköterskor riskbedömningsinstrument och beslutsstöd till hjälp. Av de ingående artiklarna i denna litteraturstudie beskrivs datainsamlingsmetoden tydligt i nio av 15 artiklar. Fyra av artiklarna beskriver både validiteten och reliabiliteten för sina datainsamlingsmetoder. En artikel beskriver enbart validiteten och två av artiklarna beskriver enbart reliabiliteten för sina datainsamlingsmetoder. En artikel hade multimetod som ansats och det fanns ingen beskrivning av hur intervjuerna hade gått till. Slutsats: Sjuksköterskans viktigaste omvårdnadsåtgärder för att förebygga och behandla trycksår enligt denna litteraturstudie är riskbedömningar, hudvård, tryckavlasta utsatta hudområden samt att ta hjälp av beslutsstöd. / Background: Pressure ulcers occur when the skin's oxygen and nutrient supply is insufficientdue to local poor blood circulation. This causes pain and suffering to the patient. Previous research shows that pressure ulcer prevalence remains high today despite awareness of the risk factors that contribute to the development of pressure ulcers. Nurses in general rely ontheir previous knowledge and experience in the assessment and decision making regarding pressure ulcers. Aim: The aim of this study was to describe nursing interventions to prevent and treat pressure ulcers. Also to describe the articles included data collection methods.Method: Descriptive literature review. Articles published between 2010.01.01-2015.01.30 were searched in the databases Cinahl and PubMed. The result is based on 15 articles. Main result: The result showed that the most effective treatment of pressure ulcers arepreventive methods, including pressure-relieving mattresses and skin care. Nurses can also use risk assessment tools and decision support regarding pressure ulcer problems. Of the included articles in this study the data collection method is clearly described in nine of 15 items. Four of the articles describe both the validity and reliability of their data collection methods. One article only describes the validity and two of the articles describe only there liability of their data collection methods. One article had a multi-method approach and there was no description of how the interviews were performed. Conclusion: According to this study the main nursing interventions to prevent and treat pressure ulcers is to use risk assessment tools, provide skin care, pressure relieve exposed skin areas and to use decision support regarding pressure ulcer care.

Background: Atrial fibrillation (AF) is the most common arrhythmia in the adult population, affecting about 5% of the population over 65 years. Occurrence of AF is an independent risk factor for stroke, and together with other cardiovascular risk factors (CHADS2/CHA2DS2- VASc), the stroke risk increases. Since AF is often paroxysmal and asymptomatic (silent) it may remain undiagnosed for a long time and many AF patients are not discovered before suffering a stroke. Aims: To estimate the prevalence of previously undiagnosed AF in an out-of-hospital population with CHADS2 ≥1, in patients with an enlarged left atrium (LA) and of total AF prevalence in sleep apnea (SA) patients, conditions that have been associated with AF. To compare the efficacy of short intermittent ECG with continuous 24h Holter ECG in detecting arrhythmias. Methods: Patients without known AF recorded 10−30 second handheld ECG (Zenicor-EKG®) registrations during 14−28 days at home, both regular, asymptomatic registrations twice daily and when having cardiac symptoms. Recordings were transmitted through the in-built SIM card to an internet-based database. Patients with palpitations or dizziness/presyncope referred for 24h Holter ECG were asked to additionally record 30-second handheld ECG registrations during 28 days at home. Results: In the out-of-hospital population with increased stroke risk, previously unknown AF was diagnosed in 3.8% of 928 patients. Comparing AF detection in patients with an enlarged LA versus normal LA showed that eleven of 299 patients had AF. Five of these had an enlarged LA (volume/BSA). No statistical difference in AF prevalence was found between patients with enlarged and normal LA, 3.3% and 3.2% respectively, (p = 0.974). AF occurred in 7.6% of 170 patients with sleep apnea, in 15% of patients with sleep apnea ≥60 years, and in 35% of patients with central sleep apnea. AF prevalence was also associated with severity of sleep apnea, male gender and diabetes. Comparing the efficacy of arrhythmia detection in 95 patients with palpitations or dizziness/presyncope with continuous 24h Holter and short intermittent ECG, 24h Holter found AF in two and AV-block II in one patient, resulting in 3.2% relevant arrhythmias detected. Short intermittent ECG diagnosed nine patients with AF, three with PSVT and one with AV-block II, in total 13.7% relevant arrhythmias. (p = 0.0094). Conclusions: Screening in the out-of-hospital patient population (mean age 69.8 years) yielded almost 4% AF, making it seem worthwhile to screen older patients with increased stroke risk for AF with this method. Screening patients with LA enlargement (mean age 73.1 years) did not result in higher detection rates compared with the general out-of-hospital population. AF occurred in 7.6% of patients with sleep apnea, (mean age 57.6 years) and was associated with severity of sleep apnea, presence of central sleep apnea, male gender, age ≥60 years, and diabetes. Short intermittent ECG is more effective in detecting relevant arrhythmias than 24h Holter ECG in patients with palpitations or dizziness/presyncope.

Bakgrund: Trycksår är ett stort problem inom vården. De uppstår lätt bland äldre patienter och medför lidande för dem. En av sjuksköterskans uppgifter är att identifiera patienternas behov av förebyggande omvårdnadsinsatser. Det finns många insatser för trycksårsprevention, som exempelvis riskbedömning, lägesändring och tryckavlastande underlag. Trots det råder osäkerhet kring hur dessa preventionsinsatser bör användas. Denna litteraturstudie fokuserar på att beskriva evidensbaserade trycksårsförebyggande insatser för äldre för att underlätta sjuksköterskans val av hjälpmedel samt minska förekomsten av trycksår bland äldre patienter. Syfte: Att beskriva evidensbaserade trycksårsförebyggande insatser för äldre patienter. Metod: Detta är en litteraturstudie innehållande tio kvantitativa artiklar. Resultat: Trycksårsincidensen kan minskas genom användning av riskbedömningsinstrument i kombination med sjuksköterskans kliniska bedömning. Viskoelastisk madrass, luftalternerande madrass samt överdrag har visats ha bra effekt som tryckavlastande preventionsinsatser. Lägesändring var tredje timme under natten minskar trycksårsincidensen, detta gör även lägesändring var fjärde timme i kombination med tryckavlastande viskoelastisk madrass. Dessutom kan trycksår på hälar undvikas om en kilformad viskoelastisk kudde eller ett avlastande hälskydd används. Tryckavlastande rullstolsdynor har visat sig minska trycksårsincidensen. Slutsats: Riskbedömningsinstrument bör kombineras med sjuksköterskans kliniska bedömning, och utifrån det resultat som erhålls kan trycksårsförebyggande insats väljas, som till exempel luftalternerande alternativt viskoelastisk madrass eller tryckavlastande rullstolsdyna. Lägesändring har visat minskad trycksårsincidens, men det råder osäkerhet om vilket intervall som bör användas och därför behövs mer forskning inom detta område. Det finns tydligt evidens för att en kilformad kudde eller ett hälskydd ger minskad trycksårsincidens. / Background: Pressure ulcers are a major problem in health care. They easily occur among elderly patients, and cause suffering for them. One task of being a nurse is to identify the patients' needs of prevention. Many pressure ulcer preventions exist, such as risk assessment, repositioning and support surfaces. Despite this, there is uncertainty about how these preventive measures should be used. This work focuses on describing evidence-based pressure ulcer prevention for the elderly to facilitate nurses' choices regarding the application of their resources, as well as reduce the incidence of pressure ulcers among elderly patients. Aim: To describe evidence-based pressure ulcer prevention in elderly patients. Method: A literature review containing ten quantitative articles. Results: Pressure ulcer incidence can be reduced by use of assessment instruments in combination with the nurse's clinical judgment. Viscoelastic mattress, air alternating mattress and cover have been shown to be effective as pressure ulcer prevention. Repositioning every three hours during the night reduces the incidence of pressure ulcers, and so does repositioning every four hours in combination with a pressure-relieving viscoelastic mattress. Additionally, pressure ulcers on heels can be avoided if a wedge-shaped viscoelastic cushion or a heel guard is used. Pressure relieving wheelchair cushions have been shown to reduce the incidence of pressure ulcers. Conclusion: Risk assessment instruments should be combined with the nurse's clinical assessment, and based on the results obtained pressure ulcer prevention efforts can be selected, such as air alternating or viscoelastic mattress, or pressure relieving wheelchair cushion. Repositioning have shown reduced pressure ulcer incidence, but there is uncertainty about the interval that should be used, and therefore more research is needed in this area. There is clear evidence that a wedge-shaped pillow or a heel guard provides reduced pressure ulcer incidence.

This thesis explores how young resisters and desisters in their teenage years maintain their resistance to and desistance from offending and asks to what extent they are agentic in the process. The term 'resister' refers to those who, according to a self-report survey, have never offended, and the term 'desister' to those who have offended and then ceased for at least twelve months. By situating desisters analytically adjacent to resisters, I have moved towards conceptualising desisters as current non-offenders. Desisters may have shared a past with persisters, as they have both offended. However, desisters share their current experience, that of maintaining non-offending, with resisters. It is this obvious, yet largely ignored, link between young resisters and desisters which underpins the thesis. Two qualitative methods, both of which elicited young people's own perspectives, were employed between 2003 and 2005. Secondary analysis of 112 qualitative interviews with resisters and desisters in their teenage years was conducted and peer led focus groups (in which a young peer, rather than an adult researcher, acted as the facilitator) were held with 52 teenage resisters. Young people's resistance to offending does not feature prominently in the literature. When it does, it is often associated with a state of innocence or passivity, while young desisters are said to 'grow out of' offending. This emphasis on an absence of offending, rather than on actively attained resistance, reflects an adult oriented view. The thesis challenges this by drawing on the sociology of childhood, a theoretical perspective which has not previously been applied to young people's resistance to and desistance from offending and which emphasises young people as agentic. Their agency is evidenced by the findings. Chapters Four and Five report how young people employ numerous strategies of resistance and desistance and Chapter Six how that they face trials and tribulations in maintaining their nonoffending, while Chapter Seven focuses on the 'being' rather than the 'doing' of sustaining non-offending. It is the work of Derrida that enables the argument to be taken a step further. Derrida's (1981) assertion is that binary oppositions are rarely neutral, but that one is the dominant pole. For example, in Western society the first of the following binary oppositions are usually regarded as the dominant or privileged pole: white/black, masculine/feminine, adult/child. In respect of the binary opposition at the heart of the current thesis, namely offender/non-offender, the non-offender is - from an adult perspective at least - the dominant pole and the non-offender is hailed as the norm. By contrast, several findings in the thesis point to the fact that the dominant pole in the binary opposition for young people is the offender rather than the non-offender. First, the discourse of young resisters and desisters suggests a view of the offender rather than non-offender as the norm. Secondly, many resisters and desisters face trials and tribulations, such as bullying, relating to their nonoffending status. Yet, if it were the case that the non-offender was the dominant pole and was privileged by young people (as it is in the adult population), resisters would not be penalised in such ways for not offending. Thirdly, some of the strategies used by resisters, such as involvement in anti-social behaviour, signify an attempt to compensate for their non-offending status. Again, if the non-offender was the dominant pole in the binary opposition, far from resorting to mechanisms to compensate for their non-offending behaviour, this behaviour would be encouraged, as it is by adults. This inverted world has implications for young resisters and desisters. Their resistance is to be understood in the context of an expectation of offending, rather than non-offending. Contrary to the notion of the pull of normality bringing desisters back to a non-offending state, the pull of normality among young desisters - and many resisters - is better understood as being towards offending. Resistance, evidenced by the strategies and trials and tribulations of resisters and desisters, is against this pull. Moreover, as non-offending is the modus operandi in the adult world, to be an adult non-offender requires less effort. For a young person, being a non-offender is more challenging than it is for adults and maintenance of resistance constitutes a struggle not previously reflected in adult representations. Adults, not having taken account of the different modus operandi of the young person's world, have not attributed agency to resistance and have underestimated young people's struggle to maintain resistance. The strategies demanded of resisters and desistcrs to maintain non-offending and the trials and tribulations which they face when they do have heretofore been overlooked.