MPH / Department of Public Health / HIV/AIDS is an overwhelming global pandemic that affects the country’s health-care system. In order to reduce HIV/AIDS morbidity and mortality, the World Health Organization has called on countries to provide earlier access to antiretroviral therapy. In order to comply with the World Health Organization’s call, South Africa has developed the National Consolidated Guidelines, which were aimed at increasing access to ART as well as reducing new infections through viral suppression. Although the new guidelines have been implemented, they have not been fully implemented, especially in rural-based Primary Health Care facilities. The researcher observed that women who were pregnant were not tested every three months, as prescribed by the HIV/AIDS guidelines. The aim of this study was to investigate Challenges faced by health professionals regarding the implementation of HIV/AIDS guidelines at PHC facilities of Vhembe District, South Africa. This study adopted a qualitative, explorative, descriptive and contextual approach targeting nurses working at rural-based primary health care facilities at Vhembe District. Face-to face in-depth, Semistructured interviews were conducted, audiotaped and transcribed verbatim. The study used non-probability quota sampling method to identify participants until data saturation was reached with 12 participants. The results revealed that nurses faced some challenges when implementing HIV/AIDS guidelines, including shortages of resources, poor technical support, poor infrastructure, work overload, patients starting ART while there are not ready, shortage of ART, late booking of antenatal care, and mothers’ denial of HIV positive status, HIV positive babies, and poor RPC after birth. Ethical considerations were observed throughout the study. The data collected was analyzed using interpretative phenomenological analysis and all measures to ensure trustworthiness of the study findings were ensured. Some recommendations were made based on the findings of the study / NRF

Bakgrund: Autismspektrumtillstånd, AST, är ett samlingsnamn för flertalet neuropsykiatriska funktionsnedsättningar. AST påverkar hjärnans kognitiva delar och resulterar i svårigheter med det sociala samspelet, kommunikation och begränsad föreställningsförmåga. 1 av 160 barn har diagnosen och antalet individer med AST ökar i samhället och stor sannolikhet föreligger därmed att vårdpersonal möter dem som patienter. Syfte: Syftet med litteraturstudien är att undersöka vårdpersonals erfarenheter av att vårda patienter med autismspektrumtillstånd.  Metod: En kvalitativ litteraturstudie baserad på åtta vetenskapliga artiklar. Artikelsökning genomfördes i databaserna Cinahl, PubMed, PsycInfo och Google Scholar. Analys utfördes utifrån Fribergs femstegsmodell.  Resultat: Utifrån analysen formades två huvudteman med tillhörande subteman. De huvudteman som bildades var; Svårigheter i mötet med vården och Faktorer som underlättar mötet.  Konklusion: Vårdpersonal är i behov av kontinuerlig träning och utbildning för att kunna ge lämplig vård anpassad för patienter med AST. Kommunikationssvårigheter upplevs som ett hinder i omvårdnaden och sjukhusmiljön behöver anpassas. Vidare forskning bör utföras för att belysa vårdpersonals erfarenheter så att fler kan bli medvetna om hur vården kan anpassas för att gynna patienter med AST. / Background: Autism Spectrum Disorder, AST, is a collective name for most neuropsychiatric disabilities. AST affects the cognitive parts of the brain and results in difficulties with social interaction, communication and limited imagination. 1 in 160 children has the diagnosis and the number of individuals with AST is increasing in society and there is a high probability that care staff will meet them as patients.  Aim: The aim of this literature study is to examine healthcare professionals' experiences of caring for patients with autism spectrum disorders. Methods: A qualitative literature study based on 8 scientific articles. Article search was performed in the databases Cinahl, PubMed, PsycInfo and Google Schoolar. Analysis was performed based on Friberg's five-step model. Results: Based on the analysis, two main themes with associated sub-themes were designed. The main themes that were formed were: Difficulties in the encounter with care and Factors that facilitate the encounter. Conclusion: Healthcare professionals are in need of continuous training and education to be able to provide appropriate care adapted for patients with AST. Communication difficulties are perceived as an obstacle in nursing and the hospital environment needs to be adapted. Further research should be carried out to shed light on the experiences of healthcare professionals so that more people can become aware of how healthcare can be adapted to benefit patients with AST.

Vårdsituationen i Sverige präglas av personalbrist, långa arbetsdagar och stress. Under dessa arbetsförhållanden uppstår det situationer som kan upplevas hjälplösa av vårdpersonal. Vårdpersonals tilltro till att hantera dessa situationer påverkas. Studiens syfte var att undersöka hur vårdpersonalen upplevde hjälplösa situationer, samt hur de upplevde sin tilltro till sin förmåga till att lösa eller hantera olika situationer på arbetet. Åtta personer som arbetade inom vården intervjuades. Resultat av en tematisk innehållsanalys visade att vårdpersonalen upplevde sin self-efficacy relativt god i hjälplösa situationer. Detta berodde på att vårdpersonalen gav stöd till varandra i dessa situationer. Erfarenhet och kunskap var faktorer som stärkte vårdpersonalens self-efficacy i hjälplösa situationer. Däremot så upplevde deltagarna att tilltron till att påverka beslut var bristande, då kommunikationen mellan undersköterskor och personal med högre status var bristfällig. Studien gav beskrivningar kring vårdpersonalens uppfattningar och förutsättningar i hjälplösa situationer. Vårdpersonalens beskrivningar kan bidra till en ökad kunskap om hur vårdpersonalen upplevde sin self-efficacy i hjälplösa situationer.

The aim of this study was to shed light on the influence of trauma on aspects of musicians’ music-making, particularly but not exclusively limited to its effects on emotional expression and memory during music performance and study. Effects on performers and teachers were considered, explicated and discussed in the light of the rapidly expanding body of knowledge about factors involved in psychological sequelae following exposure to traumatic event(s). Examples are given of how trauma has affected famous musicians and composers. Questionnaires sent to healthcare professionals and music teachers and four case study investigations illuminated specific signs of trauma. Findings underlined that, while responses to trauma are always of a very individual nature, these often particularly affected emotional expression and altered the perceived experience of emotions. Dissociative symptoms were found to affect memory and concentration. Trauma sequelae caused interference, drained energy levels, affected motivation, interpersonal relationships and self-esteem but also led to growth and trauma-catalyzed transformation. Anxiety and tension-related problems had pronounced effects on music performance and high levels of ‘stage fright’ were reported by previously traumatized participants. Trauma was shown to influence the career paths and decisions of musicians. As gleaned from the literature and research surveys, the following therapeutic approaches appear to be effective: Psychotherapy, trauma counselling, Cognitive-Behavioural therapy, hypnotherapy, EMDR (Eye Movement Desensitization and Reprocessing), EMI (Eye Movement Integration), pharmacological treatment, natural supplements, body therapies such as SE (Somatic Experiencing) and complementary techniques such as acupressure. Sound and music were identified by respondents and participants as playing an extremely beneficial role in the healing process. The possible benefits of incorporating alternative healing modalities are discussed, but it is made clear that this should only be used in conjunction with scientifically proven and thoroughly researched psychotherapeutic intervention strategies. This study’s results, appropriately disseminated, are intended to increase awareness and knowledge in performers and teachers, and enable particularly teachers to refer students to appropriate healthcare services in ways not risking further traumatization. Findings can assist healthcare professionals to better understand particular manifestations of trauma responses in musicians and enable them to intervene in more effective ways. / Thesis (DMus)--University of Pretoria, 2010. / Music / unrestricted

Introduction and background: Family-centred care in the intensive care unit has increased steadily over the past three decades, based on the premise that the illness and health of an individual family member affects the whole family unit. Although widely researched there are still inconsistencies in implementing family-centred care, which influences the ability to transfer research findings into practice. Research has shown that recognising the role of family members in the critical care environment should be considered an essential component to caring for the critically ill patient. Although recommendations have been made for the implementation of familycentred care, it is not feasible for all recommendations to be adopted by nurses and healthcare professionals in a single ICU. Nurses and healthcare professionals need to customise strategies to an individual intensive care unit to improve family-centred care. Aim: The aim of the study was to explore and describe nurses, healthcare professionals and family members’ perceptions of family-centred care in the intensive care unit. Research design and methods: A quali-quanti research design was used. Participants included nurses, healthcare professionals and family members in the intensive care unit of a private hospital in Gauteng, South Africa. There were a total of sixty (60) participants who took part in the study. Nurses were selected using stratified random sampling, healthcare professionals were selected using total population sampling and family members were selected using purposive, maximum variation and convenience sampling. Data was collected over a period of one month by means of structured interviews using an associative group analysis technique. Participants were asked to write down free word associations in relation to the stimulus word “family-centred care” in order to explore and describe their perceptions of family-centred care in the intensive care unit as it is currently, as it could be in the “ideal world” and any gaps that exist around these perceptions. Results: Five themes were derived from the data: communication, environment, continuum of feelings, reflections and spiritual care. Conclusion: The implementation of family-centred care should involve all stakeholders in the intensive care unit in order to address inconsistencies in perceptions around family-centred care. Keywords: Associative group analysis, intensive care unit, family-centred care, healthcare professionals, nurses, perceptions, stakeholders / Dissertation (MNur)--University of Pretoria, 2019. / Nursing Science / MNur (Clinical) / Unrestricted

Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care.  Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain.  Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II. Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain.  Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) initially emerged in the 1980s and ever since, a battle has been underway with regard to understanding some of the root issues attributed to behavior and HIV/AIDS. AIDS is prevalent in the men sleeping with men (MSM) community. There is lack of studies evaluating the quality and quantity of communication between MSM and medical professionals, which can be a catalyst to help reduce HIV/AIDS within this community. The aim of this quantitative study was to evaluate the relationship between quantity and quality of medical professionals' communication and regular HIV screening and testing, as well as modifying high-risk behaviors attributing to HIV/AIDS MSM behaviors, controlled for race/ethnicity, educational level, and income. Universal precautions theory and health belief model were the theoretical framework of this study. A total of 126 MSM were evaluated via survey research. Chi-square analysis revealed that MSM who have ever visited a medical professional about HIV/AIDS were tested in significantly higher frequency compared with those that did not visit medical professional for this reason (51.5% vs. 18.5%, respectively, p < .001). Also, significantly more participants changed their sexual behavior during the last 5 years and considered that the approach of the medical professional contributed in this change, compared with those who changed their sexual behavior but did not consider this approach helpful (73.7% vs. 26.7%, p < .001). This research can provide positive social change to the MSM community as well as medical professionals, by encouraging MSM to seek more information pertaining to safe sexual health practices, prevention, and awareness.

Orientador: Ana Cláudia Bortolozzi Maia / Resumo: Pensar sobre a saúde sexual no processo do envelhecimento representa um desafio para os profissionais da saúde e para as políticas públicas no que concerne à necessidade de ampliar as discussões sobre sexualidade, as práticas sexuais no processo de envelhecimento, a prevenção de infecções sexualmente transmissíveis (IST) e o impacto dessas questões na promoção de saúde da pessoa idosa. Esta pesquisa investigou como a saúde sexual no período de desenvolvimento do envelhecimento é retratada em pesquisas e documentos no Brasil, a partir de dois objetivos específicos: (a) realizar um estudo de revisão sistemática da literatura (RSL) para verificar quais categorias temáticas aparecem quando se pensa em saúde sexual no envelhecimento nas produções de pesquisa no Brasil e (b) descrever e analisar os materiais disponibilizados pelo governo federal sobre saúde sexual e/ou sexualidade na idade avançada, para identificar a visão de envelhecimento, sexualidade, gênero, saúde, prevenção, etc. Trata-se de um estudo descritivo e exploratório de abordagem qualitativa e de natureza documental. O método foi de RSL em publicações nacionais na base de dados Scielo e localização e leitura de três materiais disponibilizados pelo Governo Federal sobre saúde sexual e envelhecimento no site do Ministério da Saúde, a partir de um “Guia” de análise elaborado pela pesquisadora. Os resultados encontrados foram um total de 68 artigos, entre 2001 e 2018, com maior concentração em 2015. A área de maior prod... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Thinking about sexual health in the aging process represents a challenge for health professionals and public policies regarding the need to expand discussions on sexuality, sexual practices in the aging process, the prevention of sexually transmitted infections (STIs) ) and the impact of these issues on health promotion for the elderly. This research investigated how sexual health in the period of development of aging is portrayed in research and documents in Brazil, based on two specific objectives: (a) to conduct a systematic literature review study (SLR) to verify which thematic categories appear when thinking about sexual health in aging in research productions in Brazil and (b) describing and analyzing the materials made available by the federal government on sexual health and/or sexuality in old age, to identify the vision of aging, sexuality, gender, health, prevention, etc. It is a descriptive and exploratory study with a qualitative and documentary approach. The method was SLR in national publications in the Scielo database and location and reading of three materials made available by the Federal Government on sexual health and aging on the Ministry of Health website, based on an analysis “Guide” prepared by the researcher. The results found were a total of 68 articles, between 2001 and 2018, with the highest concentration in 2015. The area of greatest production was in Nursing, followed by Health and Gerontology. The articles were divided into 4 categories: A) Viole... (Complete abstract click electronic access below) / Doutor

Ethics are important in every aspect of our professional lives. Actions have consequences and in the Human Services field, decisions that we make will potentially directly impact our clients. A human services professional’s responsibility is to care for their clients and provide them with the appropriate resources needed to succeed in their daily lives. When a professional begins working with a trauma victim, they must be sure to assess their ethical behaviors and provide proper resources to the victim. This work is often referred to as trauma informed care which goes beyond the typical helping process of professionals. It is a unique kind of care that requires a great deal of time and dedication in order to help the client through the difficult experience of trauma.

This thesis explores career trajectories and experiences of Czech Roma professionals in order to understand the relation between their ethnic affiliation and career development in terms of obstacles, strategies and relationships that enabled them to succeed in becoming professionals. The study produces knowledge that fills the empirical research gap about Roma professionals in the Czech Republic. Thematic analysis was used to analyze seven semi-structured interviews. The analysis concludes that the Roma professionals face obstacles that include the lack of cultural capital in families, gender-related obstacles, ‘Roma bubble’ and finally the racial prejudices and workplace incivility. However, the projects supporting Roma and a range of supportive relationships have the exceptionally important role in overcoming those obstacles. The study also contributes to the theoretical discussion about the link between social mobility of minorities and their identification. It shows that the processes of selective and consonant assimilation take place at the same time.