The purpose of this research study was to describe managerial guidelines to support parents with the hospitalisation of their child in a private paediatric unit. The study explored and described: · the nursing care experiences of parents regarding the hospitalisation of their child in a paediatric unit; · managerial guidelines to support parents with their lived experiences of their child’s hospitalisation in a private paediatric unit. To achieve the purpose and the objectives of the research, an interpretivephenomenological qualitative approach was used in the research design and method. Various questioning methods were employed during this study. Parents were invited to take part in unstructured individual interviews to ascertain parents’ experiences of their child’s hospitalisation. A narrative diary was used as the second method of questioning and parents were asked to narrate their lived experiences of their child’s hospitalisation in a private paediatric unit. During the study the researcher kept field notes as she participated in the fieldwork. The data obtained was then incorporated into existing literature during the conceptualisation phase. The population and sampling for this study consisted of seven parents who took part in the interviews and 15 parents who completed the narrative diaries. Purposive sampling was used to achieve saturation of data. The model of Guba and Lincoln (1985) was used to ensure trustworthiness. Ethical considerations were maintained throughout the study and consent was obtained from the respondents. The recommendations of the research were that attention should be given to: · empowering parents to participate in certain aspects of their child’s care to the extent and intensity that they feel comfortable with, recognising parents’ strengths and intrinsic characteristics and minimising feelings of parental guilt created by social roles; · guiding nursing personnel to plan the discharge process effectively; · including parents in the unit routine and managing resources whilst promoting cost containment; II · interpersonal relationships in the paediatric unit, with special emphasis on fostering a trusting and caring relationship between parents and nursing care professionals · promoting the communication of information by using a communication style that ensures parents receive adequate information; and · creating a safe, therapeutic environment for parents, where parents can be comfortable with adequate facilities and minimal external stimuli. / Prof. K. Jooste

D.Cur. / Hospitalisation can be very traumatic for children – and this is especially true for the child admitted to a haematology-oncology unit. These children are subjected to an environment which they do not understand, nor have any control over, they are faced with many unfamiliar sights, sounds and smells and they have to undergo frightening and often painful procedures. In South Africa, there are no associations responsible for monitoring the environment that children are subjected to in hospital; neither does any Child Life Specialists, Hospital Play Therapists or scientifically based programs exist that can ensure that the psychosocial needs of children in hospital are met. The purpose of this study was to develop and describe a model for the facilitation of support for children through the mobilisation of resources according to their needs in a haematology-oncology unit in the private healthcare sector of South Africa. The following research questions were asked: • What are the needs of children in a haematology-oncology unit? • What are the resources that can be mobilised so that the needs of these children can be met? • How can support be facilitated for children in a haematology-oncology unit? During this study a theory generating, sequential explanatory (consisting of a quantitative field study followed by qualitative model development), explorative, descriptive as well as contextual research design was used. A model was developed according to the method of theory generation as explained by Chinn and Kramer (1995:77-102) and involved the following steps: Concept analysis (which includes concept identification as well as concept definition and –classification); description of the links and relationships between the concepts and a description and evaluation of the model. It became evident that children in a haematology-oncology unit are robbed of all feelings of control and choice in the situation, resulting in a sense of powerlessness. For this reason, the focus point of the model was changed to include the empowerment of children in a haematology-oncology unit as the main focus of the model. The final model aims at the facilitation of support in order to empower children in a haematology-oncology unit in the private healthcare sector of South Africa.

The purpose of this study was to compare a tour-based preadmission preparation programme for young children to a video-tape-based programme. Subjects were 30 English speaking children who were admitted to Surrey Memorial Hospital, a community general hospital in Surrey, B.C. The children were admitted for elective surgery which required an overnight stay. The children and their parents participated in the programmes three days to two weeks prior to the child's scheduled surgery. Half of the children and their parents were taken on a tour of the paediatric ward and laboratory. The other group was shown a video-tape made at the Surrey Memorial Hospital, which depicted the hospitalization of a boy and girl for tonsillectomy and adenoidectomy. Both treatments were followed by a discussion and play period. The two groups were not found to differ on sex, previous hospitalizations, types of surgical procedure, length of stay, length of anaesthesia, or prehospital personality as measured by a modification of the Post-hospital Behavior Questionnaire (Vernon, Schulman, & Foley, 1966). However, the tour group was found to contain more younger children (under 6 years of age) than the video group. No significant differences were found between the two groups on the self-report, behavioural, or physiological outcome measures, except for incidence of postoperative vomiting. The video group vomited less than the tour group. Questions concerning the validity of the Hospital Fears Rating Scale and the modified Posthospital Behavior Questionnaire for this age group are raised in the discussion. Complicating factors, such as small sample size, lack of a control group, and lack of control over physiological data collection are addressed in this chapter. Confounding factors, such as a preoperative teaching class and the discussion groups, are also addressed. Finally, the impact of Preadmission Programmes and practical considerations in choosing a programme are discussed. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

This research examined how the needs of elderly women are being met in the hospital setting. Qualitative data were gathered through in-depth interviews with eleven women between the ages of 70 and 93 who had had a hospital stay in the previous year. Data analysis revealed that the system failed to attend to participants' age specific needs. This failure created gaps in care which were particularly troubling for elderly female patients whose frailty made them susceptible to additional health problems. Participants received inadequate care in such areas as bathing, walking assistance and help with eating. Hearing impairments and denture issues were at times overlooked. These gaps in care caused participants to view a hospital stay as a matter of survival. Participants developed strategies to cope with gaps in care which included lowering their expectations, developing support networks and relying on family members to meet their basic needs and advocate on their behalf. Recommendations for change include identifying elderly women as a vulnerable patient population and defining the problems they face as structural issues as opposed to individual problems. / Arts, Faculty of / Social Work, School of / Graduate

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Yes / People living with dementia (PwD) admitted in emergency to an acute hospital may be at higher risk of inappropriate care and poorer outcomes including longer hospitalisations and higher risk of emergency re-admission or death. Since 2009 numerous national and local initiatives in England have sought to improve hospital care for PwD. We compared outcomes of emergency admissions for cohorts of patients aged 65+ with and without dementia at three points in time. Methods: We analysed emergency admissions (EAs) from the Hospital Episodes Statistics datasets for England 2010/11, 2012/13 and 2016/17. Dementia upon admission was based on a diagnosis in the patient’s hospital records within the last five years. Outcomes were length of hospital stays (LoS), long stays (> = 15 days), emergency re-admissions (ERAs) and death in hospital or within 30 days post-discharge. A wide range of covariates were taken into account, including patient demographics, pre-existing health and reasons for admission. Hierarchical multivariable regression analysis, applied separately for males and females, estimated group differences adjusted for covariates. Results: We included 178 acute hospitals and 5,580,106 EAs, of which 356,992 (13.9%) were male PwD and 561,349 (18.6%) female PwD. Uncontrolled differences in outcomes between the patient groups were substantial but were considerably reduced after control for covariates. Covariate-adjusted differences in LoS were similar at all time-points and in 2016/17 were 17% (95%CI 15%-18%) and 12% (10%-14%) longer for male and female PwD respectively compared to patients without dementia. Adjusted excess risk of an ERA for PwD reduced over time to 17% (15%-18%) for males and 17% (16%-19%) for females, but principally due to increased ERA rates amongst patients without dementia. Adjusted overall mortality was 30% to 40% higher for PwD of both sexes throughout the time-period; however, adjusted in-hospital rates of mortality differed only slightly between the patient groups, whereas PwD had around double the risk of dying within 30 days of being discharged. Conclusion: Over the six-year period, covariate-adjusted hospital LoS, ERA rates and in-hospital mortality rates for PwD were only slightly elevated compared to similar patients without dementia and remaining differences potentially reflect uncontrolled confounding. PwD however, were around twice as likely to die shortly after discharge, the reasons for which require further investigation. Despite being widely used for service evaluation, LoS, ERA and mortality may lack sensitivity to changes in hospital care and support to PwD. / This study was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR). ESRC Grant reference: ES/L001772/1.

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Thesis (M.B.A. (Rhodes Investec Business School)) - Rhodes University, 2008. / Submitted in partial fulfilment of the requirements for the degree of Master in Business Administration of Rhodes Investec Business School.