Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: South Africa has transformed its mental health service provision from in-hospital care to community-based rehabilitation. Although the idea is sound, the process places the caregiving families under an immense pressure. The aim of this study was to explore the impact that the de-institutionalisation process has had on the families as they care for their child with intellectual disability. The study was conducted by means of qualitative, unstructured interviews with families that have had a child de-institutionalised from Alexandra Hospital in the Western Cape. All of the patients were diagnosed with a dual diagnosis of intellectual disability and mental illness. Even though the patients were in group-homes or attended a day care centre, final responsibility for the patients lay with the parents. Three main themes emerged from the interviews that describe the impact of deinstitutionalisation, viz. the characteristics of the family member with intellectual disability (aggressive, abusive and self-destructive behaviour of the patient), the effect that these characteristics had on the family (marital stress and health risks to the care giver), and community and resource factors. The study placed the family central to its environment and discussed the impact deinstitutionalisation had on its environment as a whole. It was concluded that the burden that de-institutionalisation places on the families far exceeded their ability to cope with these circumstances. This status quo could be improved if adequate resources and skills are given to families prior to de-institutional / AFRIKAANSE OPSOMMING: In Suid-Afrika is geestesgesondheidsorg van hospitaliserende na gemeenskapsgebaseerde rehabilitasie, omskep. Terwyl hierdie stap wel as lewensvatbaar mag voorkom, plaas die proses ‘n hewige las op die sorggewende gesin. Die doel van hierdie studie was om die omvang van die impak hiervan op ‘n gesin met ’n lid met intellektuele gestremdheid en psiegiatriese siekte, te bepaal – nadat so ‘n pasient uit die inrigting ontslaan is. Die ondersoek is uitgevoer by wyse van kwalitatiewe, ongestruktureerde onderhoude met gesinne wie se lede met die diagnose uitgeplaas is deur die Alexandra Hospitaal in die Wes-Kaap. Elkeen van die pasïente is gediagnoseer met ernstige intellektuele gestremdheid, asook bykomende gedragsafwykings. Ten spyte van die feit dat die betrokke pasïente deur groepshuise of dagsorg eenhede versorg word, bly hulle hul ouers se verantwoordelikheid. Drie temas het ontstaan wat die impak van ontslag uit die inrigting omskryf, te wete die karaktertrekke van die gestremde gesinslid (aggressie, misbruikende en vernielsugtige gedrag van die pasïent), die effek van hierdie karaktertrekke op die gesin (stres op die huwelik en potensiële gesondheidsrisiko wat dit vir die versorger inhou), en die gemeenskap en ondersteunende faktore. Tydens die ondersoek is die gesin sentraal geplaas ten opsigte van die omgewing. Die impak van ontslag van die gediagnoseerde pasïent uit die inrigting op die omgewing as geheel, word bespreek. Daar is tot die slotsom gekom dat die vermoë van die gesin wat die las moet dra as gevolg van die ontslag, ver oorspan word. Hierdie toedrag van sake sou egter verlig kon word indien toereikende hulpbronne en vaardighede aan sulke gesinne beskikbaar gestel word alvorens so ‘n pasïent ontslaan is.

Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007. / Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.

Purpose: The purpose of this study was to explore the experiences of forensic nurses when providing care to victims of sexual assault in selected public hospitals of Limpopo province. Methods: A qualitative, explorative, descriptive and contextual research design was employed in this study. A sample of 7 registered nurses was purposively selected to partake in in-depth unstructured interviews. Results: Four themes associated with the experience of providing care to victims of sexual assaults emerged during data analysis. These included (1) psychological experiences of nursing victims of sexual assault, (2) physical challenges associated with implementing the forensic nursing specialty in a clinical setting, (3) psychological coping strategies to deal with challenges experienced, and (4) the experience of managerial support. Conclusion: Participants reported negative psychological and physical experiences of providing care to victims of sexual assault, which resulted to occupational stress. Recommendations of forensic nurses support guidelines and further research were made. / Health Studies / M. A. (Health Studies)

The aim of this qualitative study was to understand how older women experience their roles as care-givers to HIV/AIDS affected households in the Atteridgeville community and to identify specific problems they encounter. Twelve older women attending three elderly day care centres in Atteridgeville participated in the study. Purposive sampling was done and data was collected through two focus group interviews. Colaizzi‟s seven-step method of data analysis yielded the following four main themes: Caring for adult children with HIV/AIDS, Caring for HIV affected and infected grandchildren, Multiple role players involved in caring for HIV/AIDS persons, The impact on the lives of care-givers. Factors with a positive and negative impact on caring for HIV/AIDS households were identified. The study raises awareness for the need for social workers in Atteridgeville to intervene in assisting older women in their challenging role of caring for HIV/AIDS households / Health Studies / M. A. (Public Health)

The hospice volunteer is viewed as an integral member of a multidisciplinary team, with various roles directed at enhancing the quality of life of patients and their families. The purpose of this study is to provide an integrated picture of the hospice volunteer, their role, the human dimensions of this role and the impact this has on their lives as not much has been written in literature about this specific sub-group of hospice workers. The context of the study is a hospice in Gauteng where the researcher works as a volunteer. The ethnographic case study has been chosen as an appropriate research design as it explores the above phenomenon from the volunteers' point of view. The subjects are three volunteers who have been active at the hospice for at least twelve months. Evidence in terms of specific interviews and observations are used to draw conclusions. The interviews are based on a minimal number of open-ended questions. The primary method of analysis is the examination of transcripts from these in-depth interviews. A thematic analysis is carried out in which a detailed description of the emerging themes are given. Four major themes are identified and explored: Description of the role; The experience of being a volunteer; A way of coping; and The influence of the hospice culture. Sub-themes that emerge within each case study vary due to the individual nature of the experience of the role. Themes are explored in light of current theory and findings. This was to note the similarities and differences of this specific sub-group of volunteers compared to others found in the literature reviewed for this study. As there is a scarcity of literature pertaining specifically to hospice volunteers, the study depends mostly on writings pertaining to hospice staff and volunteers in general. A summary and integration of the core findings of the three case studies is given and their similarities and differences are explored. How some of the different themes interlink is also discussed. Although various sub-themes found in the individual case studies are significant to the individual cases, some of them can be incorporated into common themes when looking at the volunteers as a group. The strengths and limitations of the study are discussed as well as recommendations for the hospice organisation and further research. / Psychology / M.A. (Psychology)

South Africa is called "the rainbow nation" because it has so many different cultures. These have an impact on the provision of primary health care. The purpose of this research is to foster good relationships between community health nurses and traditional healers and to explore, identify and describe the attitude of community health nurses towards the integration of traditional healers into primary health care. A non-experimental, explorative and descriptive research strategy was designed to explore the working relationship between community health nurses and traditional healers. Data was collected using a structured questionnaire. Quantitative as well as qualitative data analysis techniques were adopted to interpret the findings. The results indicated that respondents demonstrated positive attitudes towards working with traditional healers, especially in the provision of primary health care. Positive opinions, ideas and views were provided about the integration of traditional healers into primary health care. Respect, recognition and sensitivity were emphasized by respondents. / Health Studies / M.A. (Nursing Science)

Text in Afrikaans / Die probleem wat in die studie ondersoek word is: wat die aard van die behoefte aan gemeenskapgesondheidsinligtingdienste (GGID) in Suid-Afrika, met besondere verwysing na Bloemfontein en Mangaung, is. Daar word van 'n verkennende studie gebruik gemaak om die navorsingsdoelstellings te bereik. Die metodes wat gebruik is, is literatuurstudie, gevallestudie en opname. Die tegnieke wat gebruik is, is vraelys, skedule en onderhoud. 'n Oorsig oor gesondheidsorg, met die klem op primere gesondheidsorg as agtergrond vir gesondheidsopvoeding en -inligting, word gegee. Daar word verwys na die rol van verskillende biblioteektipes en die bibliotekaris. Redes vir die ontstaan van gemeenskapgesondheidsinligting, die verspreiding van GGID in die buiteland en die fvksionering daarvan word beskryf. 'n Ondersoek is in Mangaung en Bloemfontein gedoen om die behoefte aan GGID en die aard van gesondheidsinligting te probeer bepaal. 'n Model word saamgestel uit die behoeftebepaling en die literatuurstudie / The subject investigated by this study is: the nature of the need for community health information services (CHIS) in South Africa, with special reference to Bloemfontein and Mangaung. An exploratory study has been used to achieve the research objectives. The methods used are review of the literature, case study and a survey. The techniques used are a questionnaire, schedule and interview. A review of health care, emphasizing primary health care as a backgound to health education and information, is given. The role of different types of libraries and the librarian is discussed. Reasons for the development of community health information, the distribution of CHIS overseas and their functioning are described. An investigation was done in Bloemfontein and Mangaung to gauge the need for CHIS and the nature of health information. A model has been formulated, based on this survey and the literature review / Information Science / M. Bibl. (Inligtingkunde)

The purpose of this study was to explore the lived experiences of older caregivers of adult AIDS ill children in Umlazi Township in the province of Kwa- Zulu Natal. A qualitative research design which was exploratory was executed with a sample of purposively selected participants who are the members of the organization that provides support to the older caregivers. Data saturation occurred after focus group and in depth individual interview with ten participants. The findings revealed that older caregivers experience lot of challenges which ranges from emotional, physical, financial, psychological, social and time constraints when caring for their adult AIDS ill children .The study further revealed that older caregivers developed a wide range of coping strategies to face their challenging caregiving task and most of the older caregivers utilized positive coping strategies. Recommendations that are described focus on the inclusion and consultation of older caregivers in all decisions and programmes about them. / Appendix C (Interview guide) in English as well as in Zulu / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

In South Africa prior to 1994, community-based care and support services were established for whites only. The majority of older African (black) persons received informal support from their adult children and relatives. This has waned over the years due to the social and economic changes that have put into doubt the continued viability of such support. The Older Persons Act of 2006 requires social workers to establish community-based care and support services for older persons. Hence, the study was conducted to understand the factors that influence social workers in establishing CBCSS for older persons in Bloemfontein in the Free State Province. A qualitative research method was undertaken to accomplish the goal of the study. Purposive and snowball sampling techniques were used to identify suitable participants. Face-to-face semi-structured interviews were conducted with fifteen social workers who provide services to older persons. The data was analysed through Tesch’s (cited by Creswell, 2009:186) eight steps of qualitative analysis and data verification was conducted following Guba’s (Kreftling, 1991) model. The major finding is that there is a need for social workers to specialise in older persons programmes (gerontology). For the programmes to be a success, it is recommended that the Department of Social Development (DSD) strive to retain social workers who are knowledgeable and experienced in older persons programmes. / Social Work / M.A. (Social Science)

Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.