Includes bibliographical references (leaves 77-81). / Includes abstract. / This study aimed to investigate the impact that the diagnosis of cancer has on the relationship of couples where one of the partners have been diagnosed with cancer. In order to achieve this, the study explored the elements in the cancer process that were most difficult for couples to cope with and what supported them most in coping. There are already many stressors in couples' lives without the added stress of cancer. When cancer is diagnosed in one of the partners, the couple is exposed to extraordinary challenges that they had never encountered before. It changes the appearance and the quality of the relationship. Their lives are disrupted by changes in all aspects. It was observed that the relationships of the couples were not adequately attended to during the cancer process. The study therefore attempted to assist couples and their medical teams to better understand some of the particular factors that could impinge on the relationship between patient and partner. Couple participants were conveniently selected. The study used qualitative methods to elicit thoughts and attitudes of couples experiencing the cancer process.

Summary Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives. Objective: To explore caring during clinical practice as perceived and experienced by midwives. Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane, South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL). Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation. Results: Themes of caring and uncaring related to patient care and midwives emerged. The findings illustrated that the midwives had excellent theoretical knowledge of caring, but some of them did not display caring behaviour during clinical practice. Conclusion: Some of the midwives did not display caring behaviour. Implication for practice was provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.

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Bibliography: leaves 195-200. / Fibromyalgia is a complex syndrome of diffuse pain associated with non-restorative sleep, fatigue, numerous tender points, depression and other conditions that often does not respond well to treatment posing a dilemma to health professionals. The aim of this study was to explore expressions of abandonment and rejection that emerged from group therapy with eleven fibromyalgia patients at the former Princess Alice Orthopaedic Hospital, Cape Town. It focused on abandonment/rejection by caregivers during childhood, death as a form of abandonment, abandonment/rejection in adulthood by family, spouse and family-in-law, by friends, colleagues and employers, by government and society, the hospital and doctors, and by fellow group members and the facilitator. The study is exploratory, interpretative and explanatory in nature with a purposive non-probability sample. The qualitative research method was used to gain insight into the subjective experiences of the lives and illness of the participants. The method of data collection was mainly the tape recorded and transcribed words of the participants over thirty-three group therapy sessions in eleven months and observations by the researcher as full participant observer. The data was sorted and analysed into emerging themes, patterns and categories. All participants had had repetitive experiences of abandonment/rejection, which they had denied, suppressed and avoided, as it was too painful. Due to a lack of inner and external resources, or any intervention, feelings of abandonment, fear and anger were internalized as an unresolved reservoir of emotional pain. This seemed to have escalated into an eventual expression of physical pain (somatisation). From the findings of this study, there appears to be a relationship between adverse psychosocial factors and stress, particularly experiences of abandonment/rejection and fibromyalgia. However, due to the qualitative nature and small sample, the findings cannot be extrapolated and generalized to the broader population of fibromyalgia patients, and quantitative studies are needed for verification.

The researcher is a social worker at a primary school in Cape Town. This school was previously reserved for white children during the apartheid era, but now provides education for a multi-racial group of children, who are predominantly of mixed race. The researcher became aware that incidents of bullying and learner conflict in the school took on a racial flavour at times, but that there was a tendency to deny that race was a difficulty with which the children struggled. She embarked on this research in order to examine the views and experiences of these learners with regards to race and prejudice. The researcher employed a qualitative research design and made use of a number of focus groups to gather data. These groups were run with Grade Four learners in the primary school, and explored their understanding of race, as well as their views of people from the different races that they identified. They were also asked about their own experiences of being treated in a negatively prejudiced way. The results show that while the children tended to be reluctant at first to speak about issues of race, many of them had very strong views about their own and other groups. Some children showed very strong prejudice towards people from out-groups, while others displayed strong own-group preference, with little out-group prejudice. On the whole, participants were very reluctant to speak of experiences of negative prejudice shown towards them. The report is concluded with some recommendations for further study into this area of South African children, race and prejudice, as well as some recommendations to the school where the study was conducted. KEYWORDS: Racism, Prejudice, Desegregated Schooling, Children, Post Apartheid Education, Contact Hypothesis, Social Identity Development Theory.

Bibliography: leaves 65-69. / Military families are often forced to adjust to changes imposed by military demands. These demands often deprive the soldier of the opportunity of attending to 'personal and family relationships and responsibilities. Military demands often require the soldier to be away from their families. Deployment is one of the major factors that require changes in the family functioning. The changes brought by deployment often cause stress to the family members.1he impact of stress experienced is often determined by the family's preparedness for separation and/or the life cycle of that particular family as it is believed that young couples and families with young children are more vulnerable to deployment stress. Prolonged and enforced military separations have a profound impact on military families. Military families, unlike civilian families, often share the same characteristics as they are often exposed to the same vulnerabilities. Characteristics of the life style of military families include risk of injury or death of the soldier in the course of his/her duty and periodic separation of the soldier from the rest of his family. Many studies revealed that military families are vulnerable to stress as a result of military demands. This resulted to number of programmes designed to help military families cope better with the stress. Social work officers in the military units ate behind the implementation of these programmes. Deployment resilience seminars are one of these programmes designed to help the soldier and his family to survive during the deployment period. This study, amongst other objectives, evaluates the effectiveness of those programmes rendered to soldiers and their families. The study revealed that military families are exposed to a great deal of stress as a result of military demands. The impact of separation due to deployment has a direct effect on children, mothers and fathers. Although there was no interviews done with children the information obtained from the parents showed that children are also the hardest hit in the process. It has been proved,for example by Rosenfeld et al (1973) that the absence of father in the child is often detrimental to the child's development. There were many similarities between wives and husbands experiences to challenges of separation due to deployments. These include the loneliness, boredom, sexual frustration, separation etc. However it was interesting to find that the couples also acknowledged the benefits of separation due to deployment.

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Clinical practice benchmarking is a new quality improvement benchmarking approach that involves structured learning from others in order to improve, accepting the subjective nature of health care. Evaluative research of clinical practice benchmarking requires mixed methods, quantitative and qualitative. This challenges the current reliance upon quantitative consideration of the effectiveness of quality improvement approaches. A worked quantitative example is provided and demonstrates that descriptive statistics support comparison activity only. It rejects the value of inferential statistics, since benchmark scores relate to subjective statements. Therefore, inter-rater reliability is poor and it is not possible to directly attribute any change in clinical practice benchmark scores to actual changes in practice. Following the quantitative analysis, a qualitative research study was undertaken from an interpretative perspective to evaluate the effectiveness of clinical practice benchmarking as a quality improvement approach. Particular emphasis was given to exploring the organisational factors that support its effectiveness. Data were gathered through semi-standardised interviews of nursing leaders of local paediatric benchmarking activity and frontline nurses, with rigour ensured through reflexivity and a critical approach to the analysis. The main empirical contribution of this work provided new knowledge about nurses' understanding of clinical practice benchmarking. They defined it as using all evidence to agree best practice, focusing upon collaboration to support sharing, rather than competition. The findings identified the organisational factors that ensured the effectiveness of clinical practice benchmarking. The main enablers were motivation of those involved and supportive leadership, underpinned by an organisation that promotes learning and innovation. This research provides compelling evidence that clinical practice benchmarking is an effective approach to quality improvement in health care. However, it requires acceptance of the importance of the subjective nature of health care and the necessity for qualitative approaches to evaluation. Methodological insights from this study also inform future evaluative research.

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