No description available.

published_or_final_version / Architecture / Master / Master of Architecture

It takes several acute and planned transfers between children's intensive care and children's cardiology ward of the week, of children with heartdiseses. At the acute movements it can be difficult for the nurse to take time for the parents. When the nurses talk about how they communicate and take care of the parents, at the movements of the children, it may increase nurses' awareness regarding how parents are treated. The purpose of the study was to describe how nurses feel that parental perspective into account the movement of children with heart disease between the child intensive care and ward. The study was conducted with six nurses in two focus group interviews, and analyzed as a content analysis. The categories that emerged from the study were: information, availability and security. Nurses experienced parental perspective into account, through information on the movement. Accessibility to the nurses affected by the lack of time and that the movement was take at short notice. Time was an area that was identified as a problem, increased accessibility for the nurse to be there for the parents, would give them greater security. To lodge security, it was important for parents to get information about where they would be moved. Further research may lead to attention of the parental perspective and that nurses can influence and improve the way information is given to the parents and a better reporting of what information is given and what they need for further information. / Det sker flera akuta och planerade förflyttningar mellan barnintensiven (BIVA) och barnkardiologavdelningen varje vecka, av hjärtsjuka barn. Vid de akuta förflyttningarna kan det vara svårt för sjuksköterskan att ta sig tid till föräldrarna.Genom att sjuksköterskorna samtalar om hur de informerar och tar om hand föräldrarna, vid förflyttningar av barnen, kan det öka sjuksköterskors medvetenhet gällande hur föräldrar bemöts. Syftet med studien var att beskriva hur sjuksköterskorna upplever att föräldraperspektivet beaktas vid förflyttning av hjärtsjuka barn mellan BIVA och vårdavdelningen. Studien utfördes med sex sjuksköterskor i två fokusgruppsintervjuer, och analyserades enligt en kvalitativ innehållsanalys. Kategorierna som framkom i studien var information, tillgänglighet och trygghet. Sjuksköterskorna upplevde att föräldraperspektivet beaktades, genom information om förflyttning. Tillgänglighet till sjuksköterskan påverkas av tidsbrist även att beslut om förflyttning tas med kort varsel. För att inge trygghet var det viktigt för föräldrarna att få information om dit de skulle flyttas. Vidare forskning kan leda till att föräldraperspektivet uppmärksammas ytterligare och att sjuksköterskor kan påverka och förbättra sättet information ges till föräldrarna och en bättre över rapportering vad för information som är given och vad de behöver för fortsatt information

The purpose of the present study is to obtain an understanding of the primary school child's life world while resident at a Boys' Town. The study presents an extensive review of the literature on developmental phases of the primary school child, relationships with himself, his family and peer group while resident in an institution. The study employed the use of quantitative and qualitative measures to elicit information from the child. To enhance the findings of the study, information from a comparative group of primary school children with intact families from the wider community was utilized. The target subjects in the study included all primary school children resident at a Boy's Town in Tongaat. The results yielded useful insights in the life world of the primary school child. These insights into the life world of the primary school child formed the basis for recommendation and served the direction for future research. These insights into the life world of the primary school child formed the basis for recommendation and served the direction for future research. / Psychology of Education / M. Ed. (Psychology of Education)

Bakgrund: År 2012 skapades Sveriges första nationella program och kunskapsstöd för palliativ vård. Den palliativa vården finns beskriven av Socialstyrelsen utifrån fyra hörnstenar, symtomlindring, multiprofessionellt samarbete, stöd till anhöriga samt kommunikation och relation. Det är oftast sjuksköterskan som identifierar behovet av palliation, men läkaren är den som fattar beslutet om palliation ska påbörjas. Detta kan vara en lång process och orsaka barnet onödigt lidande. Syfte: Att beskriva sjuksköterskans erfarenheter av att avsluta livsuppehållande behandling för att övergå till palliativ vård på barnintensiven. Metod: Studien genomfördes som en kvalitativ intervjustudie. Sex individuella semistrukturerade intervjuer med utbildade intensivvårdssjuksköterskor på en barnintensivvårdsavdelning i Sverige genomfördes. Dessa analyserades med utgångspunkt från Elo och Kygnäs metod för kvalitativ innehållsanalys och utmynnade i tre huvudkategorier. Resultat: Sjuksköterskornas erfarenheter av att avbryta livsuppehållande vård för att övergå till palliativ vård presenterades i resultatet utifrån tre huvudkategorier, Det oåterkalleliga livet, Sista tiden av livet samt Vad kan sjuksköterskan göra för anhöriga?. Slutsats: Att avbryta livsuppehållande vård för att övergå till palliativ vård är ett komplext och etiskt svårt beslut. / Background: In 2012 Sweden created its first natinal program and knowledge base for palliative care. Palliative care is described by the Swedish National Board through four bases, symptom relifes, multi-professional cooperation, support to relatives, and communication and relationship. It is usually the nurse that identifies the need for palliation, but the doctor is the one that makes the decision to begin palliative care. This can be a long process and cause the child unnecessary suffering. Aim: To describe the intensive care nurses experiences in ending life support and the transition to palliative care of children intensive care. Method: The study was conducted as a qualitative interview study. Six individual semi-structured interviews with intensive care nurses at a childrens intensive care unit in Sweden was carried out . These interviews were analyzed on the basis of Elo and Kygnäs method of qualitative content analysis and resulted in three main categories. Result: The nurses' experiences of withdrawing lifesustaining treatment and the transition to palliative care was presented in the result within three main categories, ”The irrevocable life”, ”The end of life” and ”What can the nurse do for the family?”. Conclusion: To discontinue life-sustaining care and transition to palliative care is a complex and difficult ethical decision.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Unnoticed deterioration in the clinical condition of children in ward areas can lead to near or actual cardiopulmonary arrest. Children suffering from a cardiac arrest in hospital often display abnormal physiological parameters hours prior to this event occurring (i.e., within a 24 hour period). Prevention of cardiopulmonary arrest in the wards lies in the ability of nursing and medical staff to be able to identify these abnormal physiological parameters, i.e., early signs of deterioration, and to intervene prior to this event. This study aimed to identify nurses’ experiences with regards to current knowledge, clinical practice and training in the recognition of clinical deterioration in children. It could then be determined whether a formal guideline on the early recognition of clinical deterioration in children would be perceived as being beneficial by the respondents in this study. The research question that guided this study was “what are the perceptions and experiences of registered professional nurses working in paediatric wards with regards to their recognition of unexpected clinical deterioration in children?” An exploratory descriptive study, utilising a qualitative approach was applied. The target population consisted of all registered professional nurses working in paediatric wards in academic hospitals in the Western Cape, South Africa. Ethical approval was obtained. Informed written consent was obtained from the participants. The purposive sampling method was used to select the participants (n=17) who met the criteria. Five focus group interviews were conducted to collect the data, using an interview guide. The planned methodology with its instrumentation and procedures was verified through a pilot study that was conducted on the first focus group interview. The steps of the research process included transcribing the collected data verbatim from the audio recordings and the field notes, and then analysing the data by summarising and packaging the data, identifying themes and trends in the data and verifying and drawing conclusions. The analysis themes identified were based on Donabedian’s conceptual framework, comprising Structure (the environment in which the care takes place), Process (method by which the care takes place), and Quality Assurance (the planned, organised evaluation of the patient care which has been rendered). The findings showed that the increased level of severity of illness of children nursed in paediatric wards, as well as staff shortages, gaps in training on resuscitation and clinical deterioration, limited ICU beds and staff, lack of adequate monitoring and emergency equipment in the wards, and inexperienced staff are all factors that were identified that increase the risk of staff not being able to detect clinical deterioration in children nursed in paediatric wards. Teamwork among nursing staff and other medical professionals, as well as parental involvement in the care of the children, assisted staff in being able to detect clinical deterioration. Most participants were unfamiliar with ‘early warning systems’ and reported that there are no paediatric ‘early warning scores’ (PEWS) in place. They believed such a system would be beneficial; however they had concerns regarding the time it would take to score a patient, the training involved, and the ease of use of such a tool and system. Recommendations for addressing non-recognition of clinical deterioration by nurses in paediatric wards such as appropriate knowledge and skill updating, were put forward in the study. / AFRIKAANSE OPSOMMING: ‘n Kliniese verswakking by kinders wie in pediatriese sale verpleeg word, wat nie betyds waargeneem word nie, kan dit lei tot ‘n amperse of werklike kardio-pulmonale arres. Kardio-pulmonale arres in kinders word dikwels voorafgegaan deur ‘n verandering in die fisiologiese parameters (so vroeg as 24-uur voor die arres). Die voorkoming van saalverwante kardio-pulmonale arres berus op die vermoeë van verpleeg- en mediese personeel om die abnormale fisiologiese tekens so vroeg as moontlik waar te neem en daadwerklik op te tree voordat die arres plaasvind. Die doel van hierdie studie was om die ondervindige van verpleegkundiges te identifiseer met betrekking tot die bestaande protokolle, opleiding en hulpbronne wat beskikbaar is vir die waarneming van die kliniese agteruitgang in kinders. ‘n Bepaling sal gevolglik gemaak kan word of die studie-respondente ‘n amptelike riglyn rakende die vroegtydige waarneming van kliniese agteruitgang in kinders voordelig sou vind al dan nie. Die rigtinggewende navorsingvraag vir die studie was “wat is die sieninge en ondervings van geregistreerde verpleegkundiges in pediatriese sale rakende die herkening van onverwagte kliniese agteruitgang in kinders?” ‘n Verkennende, beskrywende navorsingsmetodologie, met ‘n kwalitatiewe aanslag, is gebruik. Die teikenpopulasie het bestaan uit alle geregistreerde professionale verpleegkundiges, werksaam in die pediatriese sale van die akademiese hospitale in die Wes Kaap, Suid-Afrika. Etiese toestemming, asook ingeligte, skriftelike toestemming is vooraf verkry van elke deelnemer. ‘n Doelbewuste steekproefnemings metode is gebruik om die studie deelnemers, wat aan die navorsingskriteria voldoen het, te kies. Vyf fokusgroep onderhoude is gevoer om data in te samel en ‘n onderhoudsgids is gebruik vir dié onderhoude. Om die navorsingmetodologie, instrumentasie and prosedures te bevestig, is ‘n voortoets tydens die eerste fokusgroep onderhoud gedoen. Die stappe van die navorsingproses is gevolg om die ingesamelde data, bestaande uit klankopnames en veldnotas, woord-vir-woord oor te skryf. Die data is hierna ontleed deur middel van opsomming en samevoeging, terwyl temas en neigings geïdentifiseer is en afleidings geverifieër en gefinaliseer is. Die geïdentifiseerde ontledingstemas is basseer op Donabedian se konsepsuele raamwerk, bestaande uit Struktuur (die versorgingsomgewing), Proses (die versorgingsmetodes) en Kwaliteitsversekering (die doelbewuste en beplande evaluering van gelewerde verpleegsorg). Die navorsingsbevindinge het daarop gedui dat verskeie faktore ‘n rol speel in die risiko-toename wat verband hou met personeel wat nie die kliniese agteruitgang in kinders wat in pediatriese sale verpleeg word, waarneem nie. Die faktore sluit in: die kinders se graad van siekte, personeeltekorte, opleidings tekortkominge ten opsigte van resussitasie- en die identifikasie van kliniese agteruitgang by kinders, tekorte aan genoegsame moniterings- en noodtoerusting in die sale, en onervare personeel. Die waarneming van kliniese agteruitgang is wel bevorder deur spanwerk onder verpleegkundiges en ander mediese personeel, asook ouers wat betrokke was by die versorging van hulle kinders. Die meerderheid van die navorsingdeelnemers was nie vertroud met ‘vroeë waarskuwingsstelsel’ nie, en het aangedui dat geen ‘pediatriese vroeë waarskuwingsstelsels’ beskikbaar is nie. Alhoewel hulle van mening was dat so ‘n stelsel voordelig kon wees, het hulle bedenkinge gehad oor die tyd wat dit in beslag sou neem om die dokumentasie te voltooi, die opleiding wat hulle sou moes ontvang, en wat die moeilikheidsgraad van so ‘n stelsel sou wees. Die voortvloeiende aanbevelings van hierdie studie, wat die nie-herkenning van kliniese agteruitgang deur verpleegkundiges in pediatriese sale aanspreek, sluit in toepaslike kennis- en vaardigheids opdatering.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Pneumonia is the greatest single cause of mortality in children less than five years of age throughout the world causing more deaths than those due to AIDS, malaria and tuberculosis combined. Approximately 50% of all childhood pneumonia deaths occur in sub-Saharan Africa. Children in developing countries being treated for pneumonia frequently have one or more comorbid conditions which increases their risk of dying. The proper management of the child with severe or very severe pneumonia is essential to reduce case fatality. Standard case management (SCM) of pneumonia, has been shown to be an effective intervention to reduce deaths from pneumonia, but what is lacking is a means of delivering it in low-resource/high burden countries. A major barrier to wide application of this intervention in low-income countries is weak health-care systems with insufficient human and financial resources for implementing SCM to a sufficient number of children at a level of quality and coverage that would result in a significant impact. The objective of this dissertation is to address this issue by investigating ways of improving delivery of standard case management of pneumonia in district hospitals throughout Malawi, a high HIV-prevalent country which would result in a decrease in the in-hospital case fatality rates (CFR) from pneumonia in children less than five years of age. We reviewed the evidence base for SCM. Then we evaluated the development and implementation of a national Child Lung Health Programme (CLHP) to deliver SCM of severe and very severe pneumonia and a programme to provide uninterrupted oxygen supply in all paediatric wards at District Hospitals throughout Malawi. We demonstrated that it was feasible to implement and maintain both programmes country-wide. Thirdly we evaluated the trend in case fatality rates in infants and young children (0 to 59 months of age) hospitalized and treated for severe and very severe pneumonia over the course of the implementation of the CLHP. The findings from this study showed that in the majority (64%) of cases, who were aged 2-59 months with severe pneumonia there was a significant effect of the intervention that was sustained over time whereas in the same age group children treated for very severe pneumonia there was no interventional benefit. No benefit was observed for neonates. Fourthly we investigated factors associated with poor outcome reported in the previous study, in a subset of this cohort to determine the individual factors including demographics of the study population, recognised co-morbidities and clinical management that were associated with inpatient death. This study identified a number of factors associated with poor pneumonia-related outcomes in young infants and children with very severe pneumonia. They included co-morbidities of malaria, malnutrition, severe anaemia and HIV infection. The study found that the majority of reported comorbid conditions were based on clinical signs alone indicating a need for more accurate diagnosis and improved management of these comorbidities that may lead to improved outcomes. Other identified factors included a number of potentially modifiable aspects of care where adjustments to the implementation of SCM are indicated. These included enhancing correct classification of the severity of the disease, the use of correct antibiotics according to standard case management, more extensive availability and use of oxygen together with oximetry to guide its use,. Finally recommendations were made to address the identified reasons for poor outcomes and suggested future research. / AFRIKAANSE OPSOMMING: Pneumonie is die grootste enkele oorsaak van sterftes by kinders jonger as 5 jaar in die wêreld en veroorsaak meer kindersterftes as die menslike immuungebrekvirus (MIV), malaria en tuberkulose saam. Ongeveer 50% van kindersteftes van pneumonie kom in sub-Sahara-Afrika voor. Kinders in ontwikkilende lande, wie vir pneumonie behandel word, het dikwels een of meer bydraende toestande wat die doodsrisiko verhoog. Kinders wie ernstige of baie ernstige pneumonie onderlede het moet korrek behandel word om sterfte te voorkom. Die standaard protokolle om kinderpneumonie korrek te behandel het getoon om effektief te wees om die sterftesyfers te verlaag. In lae inkomste lande bestaan die strategieë nie om die protokolle aan te wend nie. ‘n Groot struikelblok in die aanwending van die pneumonie behandelingsprotokolle in lae-inkomste lande is die swak gesondheidsorgsisteme met onvoldoende menslike en finansiële hulpbronne. Die tekorte gee aanleiding tot die beperkte implementering van pneumonie protokolle wat die omvang en kwaliteit van die pneumonie protokolle beperk en daarom impakteer die protokolle nie op die kindersterftesyfer nie. Die doel van die verhandeling is om hierdie probleem aan te spreek deur navorsing hoe om die pneumonie protokolle landwyd in alle distrikhospitale in Malawi, ‘n land met ‘n hoë MIV prevalensie, aan te wend om sodoende die kindersterftesyfer (kinders jonger as 5 jaar) as gevolg van pneumonie te verlaag. Ons het die getuienis van die pneumonie protokolle ondersoek. Hierna is ‘n nasionale Kinderlong Gesondheidsprogram ontwikkel en landwyd geïmplementeer. Volgens die program is kinders met ernstige en baie ernstige pneumonie volgens Wêreldgesondheidsorganisasie (WGO) protokolle behandel. Ononderbroke suurstoftoevoer in alle pediatriesesale in distrikshospitale in Malawi veskaf. Die navorsing het getoon dat die implementering en instandhouding van pneumonie behandelingsprotokolle is landwyd moontlik. Verder het ons die tendens ondersoek of die kindersterftesyfer in babas en jong kinders (0 tot 59 maande) wat in die hospital opgeneem en behandel is vir ernstige en baie ernstige pneumonie tydens die implementering van pneumonie protokolle verminder het. Die bevindinge van hierdie verhandeling wys dat in die meerderheid (64%) van die kinders tussen 2 en 59 maande met ernstige pneumonie, en met die toepassing van die pneumonie protokolle, statistiesbetekenvol die sterfte syfer verlaag het. Die protokolle vir die behandeling van baie erstige pneumonie het nie dieselfde wenslike effek gehad nie. In neonate (jonger as 2 maande) was daar ook geen verlaging in die sterftesyfer nie. Laastens het ons die redes vir die swak uitkomste ondersoek in ‘n substudie en veral klem gelê op bydraende siektes en kliniesesorg tekorte geassosieer met pneumonie sterftes. Die studie het ‘n aantal faktore geïdentifiseer wat bygedra het tot die sterftesyfer in kinders met baie ernstige pneumonie en in neonate. Die geïdentifiseerde bydraende faktore het malaria, wanvoeding, erge anemie en MIV-infeksie ingesluit. Voorkomende maatreëls moet vir die geïdentifiseerde faktore ingestel word. Aanpassings in die pneumonie protokolle is voorgestel. Ten slotte word aanbevelings gemaak om die geïdentifiseerde redes vir swak uitkomste aan te spreek en verdere navorsingidees word aanbeveel.

Thesis (MEd)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: The aim of this study is to research the establisment of a culture of learning in a childcare school. The appeal by the government of the establisment of a culture of learning, serves as background to this study. This appeal implies a change of attitude by both learners and educators with regard to the learning and teaching process. The objective of this change is to prioritize learning and teaching in schools. This will enable learners to effectively develope intelectually, personally and socially. The feasibility to transform the school to a learning organization , is being researched. In a learning organization , learning is being internalised. Transformation to a learning organization will ensure that the school keeps pace with, and make the neccesary adjustments relative to the change. In achieving the transformation to a learning organization, such a school can be sure that learning and teaching will remain a top priority. This study is a situational analysis of a childcare school, which requested to remain anonymous. This analysis clearly expose the lack of a culture of learning at this school, due to the cultural bagage of the learners, which are manifested in serious behavioral problems, and which in turn prevent an effective learning prosess. The behavioral problems impede an the educators abillity to teach effevtively. It leads to high stress levels and a low morale. It is very clear that this situation can only be remedied if the behavioral problems of the learners are effectively dealt with. The study begins with identifying the problems and setting the questions for research. In the ensuring chapters, a study of the literature, a situational analysis and proposed programme to establish a culture of learning, follows. The proposed programme, amongst others, put forward a strategy to eliminate the behavioral problems of learners as well as reducing the stress-levels of the educators. It uniformaly focusses on the role of the prinicipal in obviating the said encumbrances, and the transformation to a learning organization. The programme includes a comprehensive discussion of strategic planning as an instrument In establishing a culture of learning and transformation to a learning organization. The programme can possibly serve as a guideline for schools which accommodate large numbers oflearners with serious behavioral problems. / AFRIKAANSE OPSOMMING: Die vestiging van 'n leerkultuur in 'n kinderhuisskool is in hierdie studie ondersoek. Die studie is onderneem teen die agtergrond van die regenng se oproep om 'n leerkultuur in ons skole te vestig. Hierdie oproep impliseer 'n verandering in leerders en onderwysers se ingesteldheid ten opsigte van leer en onderwys. Hierdie verandering het dit ten doel dat leer en onderrig prioriteit in skole sal geniet. Die moontlikheid om die skool in 'n lerende organisasie te transformeer word ondersoek. In 'n lerende organisasie word leer geïnternaliseer. Transformasie na 'n lerende organisasie sal verseker dat die skool tred hou met verandering en die nodige koersaanpassings maak. Indien 'n skool daarin kan slaag om tot 'n lerende organisasie te transformeer sal dit verseker dat leer en onderrig altyd prioriteit by die skool sal bly. Hierdie studie is 'n situasie-analise van 'n kindershuisskool, wie op versoek anoniem wil bly. Vanuit die situasie-analise blyk dit duidelik dat daar nie 'n leerkultuur in die skool aanwesig is nie. Die leerders se kulturele bagasie, wat uitdrukking vind in ernstige gedragsprobleme, verhoed dat effektiewe leer plaasvind. Die gedragsprobleme kortwiek die onderwysers se werkverrigting aangesien dit aanleiding gee tot hoë stresvlakke en dus 'n lae moraal. Dit blyk baie duidelik dat dit slegs moontlik sal wees om 'n leerkultuur te vestig indien die leerders se gedragsprobleme effektief aangespreek kan word. Die studie begin deur die probleem en navorsingsvrae te stel. Die volgende hoofstukke behels 'n studie van die literatuur, die situasie-analise en 'n voorgestelde program om 'n leerkultuur in die skool te vestig. Die voorgestelde program doen, onder andere, strategieë aan die hand om die leerders se gedragsprobleme te elimineer en om die onderwysers se stresvlakke te laat daal. Dit fokus deurgaans op die prinsipaal se rol in die uitskakeling van bogenoemde hindernisse en sy rol in die vestiging van 'n leerkultuur en die transformering na 'n lerende organisasie. Die program sluit 'n volledige bespreking van strategiese beplanning as instrument in die vestiging van 'n leerkultuur en die transformering na 'n lerende organisasie in. Die program kan moontlik as riglyn dien vir skole wie groot getalle leerders met gedragsprobleme huisves.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Sociology / Doctoral / Doctor of Philosophy