Graduation date: 1997

published_or_final_version / Gerontology / Master / Master of Social Sciences

Colorectal cancer has been a major health issue worldwide. Not only it affects the patients but it also carries physical and psychological influences to their caregivers. Despite the concerns of the psychological needs of caregivers of colorectal cancer patients, there has been a lack of a good understanding of their needs, and how to intervene in order to alleviate their psychological problems and burdens. Therefore, this thesis aimed at designing and evaluating a nurse-led telephone based psychosocial education program for improving the psychological conditions and quality of life among Chinese caregivers of patients with colorectal cancer. The nurse-led telephone based psycho-educational program was designed based on the transactional model of stress and copying. It was piloted on 6 caregivers and refined. Its efficacy over the patients discharged under the ‘usual routine hospital standard discharge care procedure’ was assessed in a randomized controlled trial on 140 Chinese caregivers of colorectal cancer patients. Caregivers in the intervention group received three telephone calls from an experienced Nurse Interventionist at 1, 3 and 5 weeks after the patients’ discharge. Each call addressed any unmet needs of the caregivers with the provision of education and psychological support. At baseline, 2 weeks, 4 weeks and 8 weeks, all caregivers were assessed for the primary outcome of depression measured by the Depression Anxiety Stress Scale (DASS), and for the secondary outcomes of anxiety, stress, burden of care and quality of life. The mixed effects model, which takes into account the extra-covariance among repeated measurements, and which is consistent with the intention-to-treat principle, was used in the efficacy analysis. Of the 140 caregivers recruited in the randomized controlled study, 5 dropped out before the end of the study. However, all the caregivers were included in the analysis. There was no significant baseline difference between the intervention and ‘usual care’ groups. The psycho-education program reduced depression more than the ‘usual care’ group by2.7 (95% CI = 0.6 to 4.8, p=0.013) units in DASS at 2 weeks, and even more by 3.5 (95% CI = 1.7 to 5.24, p<0.001) at 4 weeks. However, the ‘usual care’ group caught up at 8 weeks, and no significant effect of the psycho-education program was found (p=0.144). Moreover, the program also reduced anxiety and stress more than the ‘usual care’ group by1.83 (95% CI = 0.61 to 3.50, p=0.004) and 3.50 (95% CI = 1.74 to 5.25, p<0.001) respectively at follow-up. In addition, the burden of care and quality of life were also generally improved more in the psycho-education program group. Furthermore, strong positive associations among depression, stress, anxiety, and burden of care were found. Caregivers perceived to have a high burden of care would be associated with more depression, stress or anxiety(r = 0.53, p<0.001). Moreover, depression, anxiety, and stress had a strong negative association with the physical, psychological, social relationship and environmental well-being but not with social relationships(r = -0.16, p = 0.550). In conclusion, this thesis has developed the first nurse-led telephone based psycho-education program for caregivers of colorectal cancer patients. The program can effectively help caregivers in reducing their feelings of stress from depression, anxiety, stress and the burden of care, as well as improving their quality of life. It paves the way for a new direction for a comprehensive colorectal cancer care service in addressing the caregivers’ needs. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. / The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin's (1998) suggestions for substantive coding: open, axial, and selective coding. / The results lead to the proposition of an explanatory theory titled "the puzzle of pain management," which include: 1) a frame of the process of "drawing on past experiences"; 2) puzzle pieces representing the process "strategizing a game plan" which include the sub-processes of "accepting responsibility," "seeking information," and "establishing a pain management relationship"; 3) puzzle pieces representing the process of "striving to respond to pain" which include the sub-processes of "determining the characteristics of pain," "implementing a strategy for pain relief," and "verifying if pain relief strategies were successful; and 4) "gauging the best fit," a decision-making process that joins the two pieces of the puzzle. / The realization that family caregivers assemble a puzzle of processes indicates that there are factors that nurses must be aware of before creating, teaching, and implementing interventions for pain management. Furthermore, the results provide information to create and subsequently administer interventions based on caregivers' existing knowledge, identified needs for information and support, and current pain management regimens. The puzzle of pain management must be validated by further studies using this theory, in part, to help create interventions that will allow us to know how useful the theory is in practice. / Keywords: family caregivers, carers, pain management, palliative care, cancer pain, home care, grounded theory

Note: / Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin’s (1998) suggestions for substantive coding: open, axial, and selective coding.[...] / Les patients atteints de cancer en fin de v1e eprouvent souvent des douleurs qui doivent etre traitees. Lorsque ces patients demeurent a la maison, ce sont plus souvent les proches-aidants qui sont impliques directement dans la gestion de cette douleur. Peu d’etudes existent sur le processus que les prochesaidants adoptent lorsqu’ils prennent la responsabilite de gerer la douleur. Il est done opportun d’accroltre nos connaissances afin d’outiller les proches-aidants a gerer de fac;on optimale la douleur et de mieux les soutenir dans leurs roles. Le but de cette etude qualitative est d’etudier le processus que les prochesaidants utilisent lorsqu’ils prennent soin a domicile d’une personne en fin de vie. Cette etude se base sur une approche de theorisation an ere e. L’ echantillon de I’ etude se compose de 24 proches-aidants ayant des types et des durees de relation differentes avec le patient. Les proches-aidants ont ete selectionnes selon une procedure d’echantillonnage a choix raisonne, suivi par une procedure d’echantillonnage theorique. Les donnees recueillies sont basees sur des entrevues (semi-structurees) enregistrees et transcrites, ainsi que sur des notes de terrain et des memos. Les analyses de donnees ont ete basees sur les recommandations de Strauss & Corbin ( 1998) pour le codage; c’ est-a-dire codage ouvert, axial et selectif.[...]

The health care system in South Africa is currently under strain and it does not cater for everyone's needs. This has left a gap in society whereby you will find that the poor citizens of the country are not being catered for in terms of getting access to adequate healthcare. With this existing gap, there are Non-Governmental Organizations (NGOs) in some of the poor communities in the country. These NGOs have volunteer caregivers who go around the community and taking care of the sick people. Research has often ignored these volunteer caregivers, this current research study investigated the experiences of these volunteer caregivers. The goals of the research study were to investigate the experiences of the caregiver, the motivations of the caregivers and the challenges that they encounter and how they cope with the challenges that arise while performing their caregiving duties. The study was based on the phenomenological paradigm. This paradigm believes that the subjective experience of the individual is an essential source of information. In-depth interviews were conducted with the four participants who took part in the study. An interview guide was utilised to help guide the interview process. Interpretive Phenomenological Analysis (IPA) was used in analysing the data. IPA is a way of analysing data, which investigates how a person, in a given setting understands an experience. The findings showed that the caregivers had both negative and positive experiences. They experienced the care recipients as being appreciative of them. However, they experienced the family members of the care recipients as being uncaring; financial constraints were also a negative experience. Several challenges were stated by the participants, including a lack of government support, alcohol abuse by the care recipients and challenging working conditions. The participants were motivated to volunteer as caregivers by a number of things. Altruistic motivation was the first, which included the love for the community and the poverty in the community. Reciprocity was another motivating factor, as well as religious duty and career advancement. In this research study there was one coping strategy that came out; the participants stated that they seek advice and consult with someone or go for supervision within the organization when they are faced with a difficult situation. The findings in the research study were similar to those found in previous research. One notably different finding was that in previous research, the caregivers have been found to abuse alcohol in order to cope with stress. However, in this research study, the care recipients are the ones who are abusing alcohol. The research recommends that the government assists the informal caregivers, either financially or with infrastructure.

D.Ed. / Major concern has been expressed both nationally and internationally about the effectiveness of schools. Programmes have been put in place to increase school effectiveness, but these seem to have had very little effect. Why have these programmes not increased school effectiveness? Perhaps the answer lies in the fact that most researchers have not asked the stakeholders themselves about their needs regarding school effectiveness. This study has been undertaken in an attempt to provide some answers. This study followed a qualitative research method: administering and processing open-ended questionnaires. There is a need teachers who show evidence of specific caring characteristics such as, inter alia, helpfulness, patience, availability, kindness and responsibility. A number of guidelines and recommendations (based on stakeholder needs identified in this study) on how to develop a caring attitude in schools are suggested. Further research is strongly recommended into aspects such as: needs of learners of different ages and cultures; views of the teachers, principles and parents specifically on school effectiveness in South Africa. PROBLEM: The restructuring of schools and the continuing low pass rate of school-leavers leads one to consider the following question: Is carinq a determining factor in school effectiveness and if so, to what extent are key players aware of it and do they consciously apply it? AIM: To investigate attitudes of key players regarding caring for the learner as a prerequisite for school effectiveness. To investigate the viability of its application in real schools. The research that resulted was exploratory, descriptive and contextual. A data analysis indicates that in present-day schools there is a greater need for individual care than is at present being provided.there is a need teachers who show evidence of specific caring characteristics such as, inter alia, helpfulness, patience, availability, kindness and responsibility. A number of guidelines and recommendations (based on stakeholder needs identified in this study) on how to develop a caring attitude in schools are suggested. Further research is strongly recommended into aspects such as: needs of learners of different ages and cultures; views of the teachers, principles and parents specifically on school effectiveness in South Africa.

No description available.

The purpose of this study was to examine the effects short-term respite care had on caregivers of elderly and brain-impaired adults. The study also sought to examine the role that social support plays in determining satisfaction with respite care.

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