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Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping. / AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.

Thesis (MA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: HIV/AIDS places much stress on those living with the disease. An understanding of the processes of stress and coping and how these relate to people living with HIV/AIDS (PLWHA) can inform the nature of services we offer to PLWHAs. Social support has been shown to playa mediatory role in the stress response and is also considered to be a problem-focused coping strategy. This paper presents an overview of the literature on stress, coping and social support with the aim of assisting healthcare workers to understand how these issues relate to HIV/AIDS and to show how healthcare workers, and, specifically psychologists can use their unique competencies and skills to enhance the quality of life of PLWHAs. / AFRIKAANSE OPSOMMING: MIVNIGS plaas baie druk op mense wat met die siekte moet saamleef. Insig rakende die prosesse van spanning en hantering daarvan en hoe dit verband hou met mense wat met MIVNIGS moet saamleef, het die potensiaal om die aard van die dienste wat aan die spesifieke populasie gelewer word, in te lig. Sosiale ondersteuning blyk 'n bemiddelende rol te speel in spanningsresponse en word ook beskou as 'n probleemgefokusde hanteringsmeganisme. Die betrokke werkstuk bied 'n oorsig van die literatuur rakende spanning, hantering en sosiale ondersteuning. Dit is gefokus daarop om bystand te verleen aan gesondheidsorg werkers om hulle insig te gee hoe hierdie kwessies met MIVNIGS verband hou. Dit poog ook om aan te toon hoe gesondheidsorgwerkers en spesifiek sielkundiges, hul unieke bevoegdhede en vaardighede kan benut om die wat met MIVNIGS moet saamleef, se kwaliteit van lewe te verryk.

La littérature économique défend l'existence d'aides publiques à la R&D privée du fait des nombreuses externalités et distorsions qui conduiraient les firmes à sous-investir en R&D. La multiplication de ces aides à différents échelons territoriaux et l'apparition d'éléments plus contrastés concernant leur justification soulignent un besoin accru d'analyse de ces politiques et de leurs conséquences territoriales. L'objet de cette thèse est d'apporter de nouveaux éléments concernant la rationalité, les effets et l'efficacité des aides financières à la R&D privée.Le premier chapitre propose une discussion de la rationalité des aides financières à la R&D à partir de la littérature sur la croissance endogène et ses raffinements incluant une dimension géographique. Le décalage entre les approchesthéoriques et les approches empiriques concernant les origines et l'ampleur du sous-investissement des firmes en R&D fait plutôt ressortir l'hypothèse d'un sous-investissement limité et spécifique.Les chapitres 2 et 3 fournissent des analyses théoriques des effets dynamiques et spatiaux d'une politique centralisée de subvention à la R&D. Les résultats montrent que cette politique renforce la croissance économique, réduit les inégalitésterritoriales et améliore le bien-être global. Les bienfaits de ce type de politique sont non seulement dépendants de l'hypothèse retenue concernant les rendements de la R&D mais surtout des options retenues concernant le financement et l'allocation géographique des subventions. Le chapitre 4 fournit une analyse empirique de la capacité des aides financièresà la R&D à stimuler l'investissement privé en R&D, à partir d'un panel de pays de l'OCDE. Les résultats indiquent une sensibilité plus forte des investissements privés en R&D aux aides indirectes (incitations fiscales) qu'aux aides directes (subventions) et suggèrent l'existence d'effets de substitution entre ces deux types d'aides.

The aim of this study was to examine the correlation between home care assistants’ job satisfaction and the intent to switch jobs or career path. We also aimed to examine the correlation between home care assistants’ form of employment and their intent to switch jobs or career path. Given the fast approaching difficulties recruiting an adequate amount of care staff in elderly care to cover the demand of care staff in the light of the population at large getting older, which means there are progressively more older people for the younger population to care for. A quantitative study was performed on 74 home care assistants. To analyze our results we used Herzberg’s two-factor theory, the social psychology theory of attitudes and job satisfaction. Our result showed that our respondents were particularly satisfied with the relationship with the care recipients, but it also showed that they were not more inclined to switch jobs or career path when they were dissatisfied with the relationship with the care recipients. The result also showed that the full time employees compared to part time employees had a higher intention to leave their employer. In conclusion, we gathered that there are several components that affect the home care assistants’ inclinations to switch jobs or career path.

Denna kvantitativa studie har som syfte att kartlägga kompetensen/utbildningsbakgrund och belysa möjligheterna till kompetensutveckling inom kommunal äldreomsorg. Studien bygger på svar från 108 elektroniska enkäter från undersköterskor och vårdbiträden inom kommunal äldreomsorg. Studiens resultat visar att det finns så mycket som 23,2% yrkesverksamma inom kommunal äldreomsorg som anser sig inte vara kvalificerade för sitt arbete. Studien visar också att kommunerna runt om i landet generellt erbjuder sina undersköterskor och vårdbiträden en bra mängd kompetensutveckling, dock visar det sig att man i mindre kommuner har sämre tillgång på kompetensutveckling än i mellanstora kommuner. / This quantitative study has the purpose of mapping educational background and illustrate the possibilty of competence development in municipal elderly care. The study is based on answers from 108 electronic questionnaires from assistance nurses and nurse´s aides in municipal elderly care in Sweden. The result of the study shows that as much as 23,2% that are working in municipal elderly care is unqualified for their jobs. The study also shows that the municipalities around Sweden give their employees a good amount of competence development, but in the smaller municipalities there is less access to competence development than in the middle sized municipalities.

Ce travail traite des aides optroniques aux déplacements des non-voyants. Préalablement à ce travail, deux « détecteurs de passage » ont été développés au Laboratoire Aimé Cotton le « Tom Pouce » et le « Télétact ». Le « Tom Pouce » est simple d’utilisation mais présente des limitations pour détecter les passages étroits à des distances supérieures à trois mètres ainsi que pour éviter les poteaux fins. Le « Télétact » permet de gérer l’ensemble des situations mais le nombre d’utilisateurs est limité par l’effort cognitif important que demande son utilisation ainsi que sa fragilité.Le but principal de cette thèse est d’améliorer les capteurs ainsi que leur façon de représenter l’espace afin d’avoir un dispositif facile d’utilisation détectant tous les passages.Dans un premier temps, l’hypothèse que la forme de la zone de protection idéale devrait être d’aspect cylindrique est émise. La réalisation approchée de cette forme à partir de capteurs infrarouges est analysée théoriquement et validée expérimentalement. Deux dispositifs le « Tom Pouce II » et le « Minitact » utilisant ce concept ont été proposés à des non-voyants et ont reçu un accueil favorable. Dans un second temps, les capteurs laser télémétriques du « Télétact » ont été revus afin d’améliorer leurs performances permettant entre autres une moindre sensibilité aux contraintes mécaniques. Une nouvelle forme d’association des capteurs infrarouges et laser permet de gérer l’ensemble des configurations de passages, y compris en chicane, avec une interface tactile ayant seulement trois niveaux d’alerte correspondant à trois zones de protection (moins de 2 mètres de profondeur sur 10 cm de large, entre 2 et 6 mètres sur plus de 50 cm de large, plus de 6m de profondeur et 1m de large ) avec un effort cognitif très réduit par rapport au « Télétact » initial utilisant 32 sons différents. Des outils pour pouvoir analyser objectivement les performances des dispositifs dans des environnements contrôlés ont été mis au point afin de pouvoir ajuster finement les formes des zones de protection. Un dernier point concerne les possibilités d’identification des obstacles, l’imagerie est explorée mais s’avère immature, actuellement seules les « astuces d’utilisation » des capteurs sont opérationnelles. / This work deals with optical electronic travel aids for visually impaired people. Initially, two devices allowing the detection of an unrestricted path were developed at the Aime Cotton Laboratory: the "Tom Pouce" and the "Télétact". The "Tom Pouce" is simple to use but presents limitations for detecting narrow passages at distances over three meters as well as avoiding fine posts. The "Télétact" allows users to manage every situation but the number of users is restricted due to the cognitive effort required.The main purpose of this thesis is to improve the sensors as well as the way the spatial information is transmitted to the user to allow the safe detection of all passages with reduced cognitive effort.First, the hypothesis is that the ideal protection zone could be a cylindrical shape. The approached realization of the cylindrical shape with infrared sensors is theoretically analyzed and experimentally tested. Two devices,"Tom Pouce II" and "Minitact”, using this concept were proposed to visually impaired people already using the “Tom Pouce I”. They greatly appreciated the improvement.Second, the laser telemetric laser sensors of the «Télétact» were modified to improve their performance and to reduce the sensitivity of mechanical constraints during daily use. The association of infrared sensors and laser telemetric sensors allowed the management of all kinds of passages, including chicanes, with a tactile interface having only three levels of alert corresponding to three zones of protection (less than 2 meters deep and 10 cm wide, between 2 and 6 meters deep and about 50 cm wide, and more than 6m deep and 1m wide). The cognitive effort is greatly reduced compared to the initial "Télétact" , which used 32 different sounds.Third, tools to objectively analyze the performance of the implemented devices in controlled environments were developed to finely adjust the shape of the protection zones.The last point dealt with the possibilities of identification of obstacles, imagery is explored but it is proved to be premature. Nowadays only tricks of the trade are effectively working.

Thesis (MBA.) --University of Limpopo, 2016 / The Ward Based Outreach Teams (WBOT) Programme is established in South Africa as part of a series of strategies to strengthen Primary Health Care (PHC) and to improve service delivery in the country. The purpose of the study was to gain an understanding of the experiences of Community Health Workers (CHW) in the implementation of the WBOT programme. The objectives of the study were to evaluate the experiences of CHWs in the WBOT, to evaluate factors that facilitate the implementation and to make recommendations and strategies on what can be done to improve the WBOT programme. A quantitative research design was used where self-administered questionnaires were provided to respondents for data collection. Respondents were asked to complete the questionnaires; completed questionnaires were returned by only 12 of the 27 respondents, resulting in a 44% response rate. The study’s findings indicate that the Community Health Workers (CHWs) regarded the WBOT as helping the community in many ways such reducing the long queues at the clinic and providing the care of the patients in their own homes, although concerns about poor participation by the community structures and nurses in the health facilities were expressed. CHWs expressed experiences that were positive and negative when conducting their work in the community. The results from the study have shown that there are successes, challenges and lesson learned. The results of the study further indicated that the programme is being implemented well even though it is still in a pilot phase in the sub-district. The programme has managed to improve and save many lives in the communities of Kgetleng Sub-district. Despite the level of depth in this study, there is a crucial need for more for more in-depth research regarding the experiences of users of the WBOT services and to conduct similar studies looking into urban areas and to compare and contrast the rural and urban findings.

According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.3 million U.S. residents are residing in nursing homes. CMS enforced regulations in the Nursing Home Reform Act. Training in the use of restraints in nursing homes is monitored through the CMS standards. The purpose of this study was to determine whether there was a correlation between training standards of health care practitioners and their use of restraints in nursing homes based on the patterns of citations by RNs and CNAs. Data were collected from Kansas, Louisiana, and Ohio within the CMS Nursing Home Data Compendium. The key research question examined differences in standard training requirements, policies, and citations regarding restraint use in the selected states. The theoretical framework for this study was the social influence theory. The results of the analysis of variance indicated that between 2008 and 2012, there were significant differences in policy and standards requirements for the training of registered nurses and certified nursing assistants regarding restraint use; there was also a relationship between the training of staff and the number of citations of restraint use in Kansas, Louisiana, and Ohio. There were significant (p < .02) variations throughout the 3 states regarding the policies, procedures, and training expectations. The positive social change that could result from these findings is the standardization of training that may help decrease restraint use and become the foundation of more respectful and caring practices in nursing homes.

This two-part study evaluates a government sponsored Long Term Care Aide/ESL Program taken by a group of immigrant women. The purpose of the first part of the study was to assess how effective a B.C. government sponsored Long Term Care Aide/ESL program was in preparing a group of immigrant women for the workplace. A questionnaire was used to determine demographics and employment status. Also, it obtained perceptions on the strengths and weaknesses of the program. The purpose of the second part of this study was to hear the women's personal insights and voices about their experiences while taking the program and after the program. Semi-structured interviews were used to obtain these stories. Results from the quantitative questionnaire indicated that 94% of the immigrant women who had taken this course were employed as care aides. Three years after the completion this program, the women felt that the course had provided them with both a vocational skill and more English language skills. Results from the qualitative portion of this paper focused on how the women felt about their experiences in this Long Term Care Aide/ESL program in their own words. The data were analyzed and put into themes. Theme 1 was "The pain of renewal". It presented their collective stories of being an immigrant and struggling to begin again. Theme 2 was "The costs and the benefits". This theme presented the women's insights on working as care aides. Most of the women liked their jobs but found trying to secure a full time job difficult. Theme 3 was "The need to learn the language of care". All the women interviewed wanted to have more "caring" language, the "everyday" language to relate to their clients. Theme 4 was "Advice to other immigrant women". This theme revealed how some women felt about the work they did. The last theme, Theme 5, was "Hopes and dreams". Half of the women interviewed had aspirations to continue their education and these women were already enrolled in other health care courses. The results of the study are discussed and implications are drawn for research and pedagogy.