Rehabilitation of the handicapped as a result of tuberculosis is a most involved and complex process. In Canada today, the organization of rehabilitation services for tuberculous persons varies from province to province. In some provinces the rehabilitation services are handled exclusively by the provincial health departments; in other provinces the programmes are the responsibility of the provincial tuberculosis associations; in still other provinces, rehabilitation of the tuberculous is to a considerable extent a joint effort by voluntary and governmental agencies. This thesis examines the programmes for the tuberculous which are offered under public auspices in the province of British Columbia by the Division of Tuberculosis Control, and under private auspices in the province of Alberta by the Alberta Tuberculosis Association. The purpose of the study is to review the concept of rehabilitation, and to determine if differences of significance exist between the two programmes. The necessary material was compiled by a series of selected interviews with personnel involved in the operation of tuberculosis rehabilitation services in Alberta and British Columbia; analysis of annual reports of agencies in both provinces directly concerned in providing these services; and, by drawing upon the writer's own staff experience in one of these programmes. The scheme of analysis utilizes the following headings: (a) sponsorship and administration (b) facilities and personnel (c) rehabilitation services, and (d) co-ordination. The study reveals measurable differences in the two programmes selected, and these are reviewed. The major difference between the programmes is in terms of organizational structure. In British Columbia, a composite programme consisting of two specialized departments is in operation; one offering vocational rehabilitation services and the other welfare services. The Alberta programme in contrast, integrates vocational rehabilitation and social services, but has a smaller professional staff. The extent to which differences can be directly attributed to different auspices is doubtful; and there is room for further research. There is evidence, however, of need for more professionally trained social workers in comprehensive rehabilitation programmes. / Arts, Faculty of / Social Work, School of / Graduate

"The purpose of this study is to provide information in the area of tuberculosis admission practices and policies which may assist in the control of tuberculosis in the State of Florida"--Introduction. / Typescript. / "May 12, 1953." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Joseph Golden, Professor Directing Study. / Includes bibliographical references.

Thesis (M.Dev.) --University of Limpopo (Turfloop Campus), 2005 / The aim of this study was to investigate the socio-economic impact of interrupting TB treatment to the families of the TB sufferers and the reasons for patients interrupting treatment. The study was conducted at Mashishimale Village, Ba- Phalaborwa Municipality, Mopani District, Limpopo Province in South Africa. A sample of 35 tuberculosis patients and their family members was drawn from the Mashishimale population. The sample comprised of 17 (49%) males and 18 (51%) females. Self-administered questionnaires were distributed to the participants to complete. The questionnaire elicited demographic information; knowledge about TB, its causes, signs and symptoms, transmission, the reasons for interrupting treatment, and the patients’ coping and support structures. The findings of the study reported that 50% of TB patients are conversant with the signs, symptoms and mode of the spread of TB. However, 43% of the TB patients reported that there was a perception that TB patients are also HIV positive. A further 29% mentioned that there is stigma attached to TB disease. The lack of a Directly Observed Treatment Supporter, poverty and poor nutrition, side-effects of drugs, loss of disability grants, long clinic queues, and traditional healing were some of the reasons cited for the interruption of TB treatment. The interruption of TB treatment had an impact on the socio-economic situation of the family as they often relied on assistance from social grants, other family members and churches.

M.Cur. / Tuberculosis is regarded as a global health problem as accelerated by the impact of the HIV/AIDS epidemic. In South Africa it is regarded as a top national health priority. Taking treatment regularly prevents multi-drug resistance TB. The introduction of Directly Observed Treatment Short-course (DOTS) ensures that treatment supporters observe TB patients swallow tablets under direct supervision. In the area of research, treatment supporters are trained by South African National Tuberculosis Association trainers to supervise treatment. It happened on a regular basis that patients complain about various aspects of the observational progress, resulting in change of treatment supporters, some preferred to be supervised from the clinic. The researcher developed interest to find out about the shortcomings in the observation of TB patients by treatment supporters, so as to address those shortcomings. A qualitative, exploratory, descriptive and contextual research study was conducted to identify the experience of treatment supporters in observing tuberculosis patients on TB treatment and also, the experience of TB patients as observed by treatment supporters. Permission was obtained from both treatment supporters and TB patients. A pilot phenomenological interview was conducted from one TB patient and one treatment supporter supervising TB treatment, who met the selection criteria. The phenomenological interviews were conducted in Northern Sotho (Pedi), Shangaan, Tswana, Xhosa, Zulu, Southern Sotho and Northern Sotho (Tlokwa) from both treatment supporters and TB patients. The samples comprises of 14 TB patients and 14 treatment supporters supervising those TB patients. Steps were taken to ensure trustworthiness. Tesch’s method of data-analysis was followed to analyze the data. Results indicated that there are interfering factors relating to the working relationship between the TB patients and the treatment supporter. From the findings, facilitative factors are used as proposals to promote the observation of TB patients by treatment supporters. Strategies are described from the rationale, which explain how the proposal can be reached. The strategies were based on the study findings and the literature reviewed.

Submitted in partial fulfilment of the requirements for the Degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2013. / Introduction : Effusive constrictive pericarditis (ECP) is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction where constrictive haemodynamics are persistent after the pericardial effusion is removed. Although first observed in the 1960s, it was not until the publication of a 13 patient-case series by Hancock in 1971, and the prospective cohort publication by Sagrista-Sauleda in 2004, that more information about the aetiology, incidence, and prognosis of effusive-constrictive pericarditis became known (Sagrista-Sauleda, Angel, Sanchez, Permanyer-Miralda, and Soler-Soler 2004). Hancock (1971) first recognized that some patients presenting with cardiac tamponade did not have resolution of their elevated right atrial pressure after removal of the pericardial fluid. In these patients, pericardiocentesis converted the haemodynamics from those typical of tamponade to those of constriction. Thus, the restriction of cardiac filling was not only due to the pericardial effusion but also resulted from pericardial constriction (predominantly the visceral pericardium). The hallmark of effusive-constrictive pericarditis is the persistence of elevated right atrial pressures after the intrapericardial pressure has been reduced to normal levels by the removal of the pericardial fluid. Aims and Objectives : This study was carried out to determine the prevalence of ECP in a cohort of patients with large effusions of Tuberculosis origin. The primary objective was to measure pre and post- pericardiocentesis intrapericardial and right atrial cardiac pressures in all patients undergoing pericardiocentesis in order to determine the relative proportion of effusive constrictive pericarditis in these patients. The secondary objective was to determine if any echocardiographic features can help predict the presence of ECP by studying the three parameters two-week post-pericardiocentesis. Methodology : Fifty consecutive patients with pericarditis presenting to Groote Schuur Hospital and surrounding hospitals referred for pericardiocentesis, who met the inclusion criteria were recruited to participate in the study. All patients had the right atrial and intrapericardial pressures simultaneously measured and recorded, before and after pericardiocentesis. The pressures were analyzed to determine the presence of ECP, which was defined as failure of the right atrial pressure to fall by 50% or to a new level of ≤12 mmHg after the intrapericardial pressure is lowered to below 2 mmHg. Participants also had an echocardiogram done two weeks post pericardiocentesis. Three echocardiographic features of constriction were studied, to determine if they can predict the presence of ECP. The parameters studied were 1) Thickened pericardium, 2) Dilated inferior vena cava (IVC) and 3) Septal bounce. Results : This study showed a 34% (17 0f 50) prevalence of ECP in patients with TB pericarditis. It also showed a statistically difference in the right atrial and intrapericardial pressures pre and post pericardiocentesis, between patients with ECP and those without. The echocardiographic parameters studied showed no difference between ECP and non ECP, and also did not predict the presence of ECP. Discussion : In the cohort of patients (n=50), the prevalence of ECP was found to be 34%. This is much higher than that observed in the Sagrista-Sauleda et al., (2004) study. They found a prevalence of 1.3% amongst patients with pericardial disease of any type and 6.95% amongst patients with clinical tamponade. The authors did state that they expected the true prevalence to be higher than estimated as not all patients underwent catheterization. Pre-pericardiocentesis pressures, both right atrial and intrapericardial, were found to be higher in patients with ECP than in those without. This is in keeping with published results, such as the study of Hancock (1971) The echocardiographic parameters studied were two weeks post pericardiocentesis, because the diagnostic accuracy of echocardiogram has been shown to be very poor at the time of tamponade. The presence of these parameters (thickened pericardium, dilated IVC and septal bounce), did not predict the presence of ECP. This could be due to the fact that less than 50% of participants had an echocardiogram two weeks post pericardiocentesis. Conclusions : The results of this study show that ECP is actually more common than thought in a population with TB pericarditis. This syndrome may be missed in most patients due to the fact that not all centres measure right atrial and intrapericardial pressures at the time of pericardiocentesis. Echocardiography is not able to predict the presence of ECP. Other non-invasive imaging techniques such is computerized tomography (CT) and cardiac magnetic resonance imaging (CMRI) have shown good results in diagnoses of ECP. The importance of early diagnosis of ECP lies in recognition that removal of pericardial fluid alone may not be enough; patients may need to have surgery. Given the high prevalence shown by the study, ideally all patients with pericardial effusion should have haemodynamic monitoring at the time of pericardiocentesis.

Although effective anti-tuberculosis agents have been available for over thirty years, tuberculosis (TB) is still a global health concern and the incident rate in Hong Kong remains high. Directly Observed Therapy, Short-course (DOTS) strategy, in combination with patient education are proved to be more effective in reducing TB incidence than the DOTS strategy alone. However, there is a lack of evidence based protocol to guide nurses through the implementation of health education for TB patients. This dissertation is a translational nursing research aims at developing an evidence-based health education guideline for nurses to deliver health education to TB patients to improve treatment adherence. The objectives are to gather evidence on the effectiveness of nursing health education in promoting treatment adherence among TB patients, conduct quality assessment of the reviewed articles, develop evidence-based health education protocol for TB patients, assess the implementation potential of the innovation and discuss its implementation and evaluation plan. In this dissertation, a systematic review of 8 relevant and up-to-date research papers was performed and a guideline was then generated based on the extracted data. The guideline consists of 3 components: effective individual health education, essential elements for health education booklet and training for nurses. The implementation potential of the guideline is considered to be high while the implementation and evaluation plan of the guideline are also discussed. With the implementation of the evidence-based protocol on TB health education, the treatment adherence of the TB patients is expected to be increased. / published_or_final_version / Nursing Studies / Master / Master of Nursing

M.A. (Clinical Social Work) / The focus of this study is to understand patients’ experience of the long-term hospitalization from drug resistant tuberculosis (DR-TB). Tuberculosis (TB) has been prevalent in many societies over a long period with significant effects, and the World Health Organisation (WHO) has declared TB a global emergency. The eventual emergence of DR-TB globally has added to the TB burden. DR-TB is highly infectious and difficult to treat, with less chance of cure, more complications of the disease and more side effects of treatment. It is also more expensive to treat. The treatment and management of DR-TB requires a protracted course of medication (18-24 months), requiring long-term hospitalization, which is often involuntary. Hospitalization involves complete withdrawal of patients from their regular social environment. When DR-TB patients are hospitalized, it means that they can no longer perform their normal roles. Prolonged hospitalization brings sudden changes and interrupts the patients’ lives and compounds all kinds of losses. The isolation of DR-TB patients in the hospital, away from the social environment, to receive medical treatment and management of the disease, can have a complex biopsychosocial impact on the patient. DR-TB is complex and requires a multidisciplinary approach, not just medical treatment. The key to DR-TB control and management requires biopsychosocial intervention to ensure holistic care and treatment of those infected. Social work care and support is imperative and plays a very significant role. My premise is that DR-TB patients, who are hospitalized for a long time experience and confront overwhelming existential problems which they are unable to understand and address – questions of mortality, purpose and meaning, hope, belonging and identity. Yalom (1980) states that the givens of existence are important and will happen to each person during life. Unless they are discovered, one’s existence will be frustrated, leading to pain and great confusion as well as an inauthentic existence. The existential issues are very painful, with devastating and complex effects on their lives, and require adequate and relevant social work care and support. The existential framework is vital, as different people attach different meanings to their daily life experiences of being hospitalized for DR-TB. This will enable the social worker to explore, understand and raise patient awareness of his/her existence and help the patient deal effectively with these issues. This study seeks to answer the question: What is the experience of long term hospitalization like for DR-TB patients? This study adopted a qualitative, exploratory-descriptive approach to understand in-depth the patients’ experience of being hospitalized for a long time due to DR-TB.A phenomenological research design was used in this study to describe and reduce the participants’ experiences to a central meaning or essence of experience. This study was conducted at a DR-TB hospital in Gauteng with three adult participants, who were living with DR-TB and had been in hospital for at least 12 months. Unstructured interviews were used to explore the participants’ existential experience of long term hospitalization due to DR-TB. The history of existentialism, what it is, philosophy and clinical practice is outlined, and followed by a discussion on Yalom’s existential framework on how to understand and use it to identify and deal with the patients’ existential problems. It is observed in this study that the participants experienced existential concerns emanating from their long term hospitalization due to DR-TB which they could not understand and did not know how to deal with. They were as a result distressed, overwhelmed, frustrated and confused, with constant emotional chronic pain. Such participants’ experiences are understandable since human beings at one point of their life are faced with problems which arise from an individual person’s concerns about existence (Yalom, 1980). Six themes emerge that are consistent with literature for this study: anxiety, hospitalization and death; time; isolation; loss; stigma (social pain) and loss of perspective (living with endless uncertainty). The study findings may broaden insight on the hospitalization experience of DR-TB patients, and on the psychosocial impact of prolonged hospitalization. The study concludes that the participants experience existential problems during their long term hospitalization, which they are not able to deal with on their own. Therapy based on the existential approach plays a very critical role and is helpful in exploring and dealing effectively with these existential concerns. Therapeutic intervention, with necessary care and support, will help the patients become aware and understand their situation, including own behaviour and emotions and help them confront and manage their situation effectively achieving change and wholeness. The medical social worker plays an important role in this regard.

Thesis (M.Cur) --University of Limpopo, 2011 / The aim of this study was to determine the factors that contribute to the increase in the number of tuberculosis (TB) patients in Mpumalanga Province, and to develop guidelines and recommendations to address the challenges of this health issue. The design of the study was qualitative phenomenological. The population consisted of all TB patients who were receiving treatment either at the intensive or the continuation phase. The sampling method was purposive and the sample size comprised 20 participants, of whom 10 were drawn from Shatale clinic at Bushbuckridge, and 10 from Mashishing clinic at Thabachweu municipalities in the Ehlanzeni district of Mpumalanga Province. The data was gathered by means of semi-structured interviews. Data analysis was performed, from which themes and categories were derived. This study revealed several factors that contributed to the increase in the number of TB patients at the study sites. The factors considered most important in this study were the general lack of knowledge of TB among participants, despite their various levels of education, poverty, overcrowding, poor ventilation in the shacks and Reconstruction and Development Program (RDP) houses, unemployment, lack of support while taking treatment, religious and ritual beliefs, and the influence of traditional healers who dispense herbal medicines with the dictum that participants have been possessed by evil spirits and witches. The majority of patients developed TB as a secondary opportunistic infection because of their HIV-positive status, and lack of capacity to practice personal hygiene and proper infection control. Guidelines, strategies and recommendations were formulated to address these public health challenges in the context nursing education, research, administration and practice

Thesis (MPH.) -- University of Limpopo, 2019 / The purpose of this study was to investigate the challenges faced by health care workers caring for patients diagnosed with Tuberculosis at Tertiary 1 Military Hospital, Gauteng Province, South Africa. The quantitative research study was conducted and data was collected from 56 respondents who participated in this study conducted at Tertiary 1 Military Hospital, Gauteng Province, South Africa. Self-administered questionnaires were used to collect data from the respondents through a self-administered questionnaire. Data was then analysed using statistical STATISTICA 7, Software SPSS 23, as well as Microsoft Excel for presentation of tables and graphs. Respondents consisted of 59% females, compared to 41% of males. Majority of respondents (76.4%) were between the ages of 23-32. Respondents who were single were 66% compared to 32.1% married and 1.8% widowed. The findings of this study indicates that the health care workers, work in challenging environment with a lack of resources and need to be supported, as they experience more negative than positive experiences whilst caring for patients diagnosed with TB, further, revealed that, the health care workers did not get support from management. The analysis of the data has shown that management seemed not to understand fully what health care workers at grass-roots level are experiencing. Furthermore, findings of this research revealed that health care workers have never received any formal training on management of patients diagnosed with TB, wherein at times they have questions they have to ask their colleagues/friends, which at times they felt frustrated, the findings of this study furthermore revealed the lack of in-service training. The study concluded that, the respondents fears contracting TB from patients diagnosed of TB: there is compromised TB infection control measures, such as failure to wear protective masks (N95), and lack of adequate resources was also revealed by several respondents. The general findings of this research demonstrate that there should be adequate resources allocated to healthcare workers caring for TB, there should also be an initiatives to establish the health care worker‟s training regarding TB management and regular in-service training especially on TB management. This was also demonstrated in the study conducted by Chung et al, 2005, on the experiences of nurses while caring for Severe Acute Respiratory Syndrome (SARS) patients, the findings revealed a variety of emotions that were experienced, whereby, health care workers considered themselves vulnerable and at risk of contracting the disease themselves especially airborne diseases.

MCur / Department of Advanced Nursing Science