Masters of Science - Msc (Physiotherapy) / The Physiotherapist is an important member of the multidisciplinary team managing critically ill patients in the ICU. Physiotherapy practice in the ICU has shown itself to be effective, whereas the lack of physiotherapy management in the care of critically ill patients may prolong recovery. Therefore, the knowledge and attitudes about physiotherapy management by the other Health Care Professionals of the team is essential in order to facilitate efficient and effective medical services. This study aimed to determine other Health Care Professional' knowledge, attitudes regarding physiotherapy management in the ICU. As well as, it determined the current physiotherapy practices applied by physiotherapists in ICUs in Khartoum State - Republic of Sudan. The study was conducted due to limited studies in this field.

Objectives: Depression is often unrecognised or sub-optimally treated in primary care. This has led to research exploring the barriers and enablers to effective recognition but little is known about health care professionals’ (HCPs) beliefs or personal illness models about depression in patients with long term conditions (LTCs), the presence of which may affect recognition and management. Using Leventhal’s Common Sense or Self-regulatory Model this thesis aimed to: explore HCPs’ illness representations and management in people with LTCs and depression; to understand the role of personal models and perceived barriers to depression recognition and management; and to address them in a theory-based online training intervention. Methods: This thesis was undertaken in three stages; a scoping review with narrative synthesis was conducted to explore the role of HCPs’ personal illness models of depression, a qualitative study using semi-structured interviews with 16 HCPs to investigate their illness beliefs about depression in patients with LTCs and finally, the development and feasibility assessment of a theory-based online training intervention to target HCPs’ attitudes, beliefs and self-efficacy. During this stage a new measure of HCPs’ beliefs and attitudes towards depression in patients with LTCs was developed as no appropriate measures were currently available to capture HCPs’ personal illness models of depression as a comorbid condition. Results: Twenty-seven papers were included in a mixed method scoping review. The review concluded that HCPs mainly normalised depression but lacked a complete conceptualisation of depression in primary care. HCPs reported time constraints and lack of skills as important barriers to recognising of depression in primary care. Negative attitudes towards depression and lack of confidence to recognise and manage depression were also commonly reported. In the qualitative study, the main themes were; 1) Recognition of depression in people with LTCs is complex (unclear illness identity) 2) Attitudes towards recognition and management of depression in people with LTCs act as either barriers and enablers to depression management 3) The necessary level of condition-related knowledge and understanding of depression in the context of a LTC 4) Controllability of depression in people with LTCs. The findings suggested that HCPs’ illness beliefs about depression in people with LTC varied in crucial ways with some participants prioritising the management of the LTC or expecting patients with diabetes or CHD to diagnose depression themselves due to time constraints. Some HCPs also reported simplistic views of causation which appeared to impact on their decisions whether or not to detect depression in people with LTCs. The findings of the qualitative study were used to inform the content of a novel online training intervention using illustrations to facilitate engagement. Thirty one HCPs were recruited and 15 completed the evaluation. The results of the feasibility study suggested that the method, context and mode of intervention was feasible but the lack of validated measures and the small sample size hinder conclusions about changes in participants’ illness beliefs, intentions, self-efficacy and perceived barriers towards depression. Comments: The scoping review study provided new insights into why HCPs may not engage with detection of depression but only a limited amount of research has explored HCPs’ beliefs about depression in patients with LTCs. The qualitative study addressed this and contributes new knowledge about the way HCPs conceptualise depression in patients with LTC and was used to design an online intervention to improve the management and recognition of depression in these patients. Further research to develop this intervention and evaluate it on a larger scale is needed.

The aim of this study was to shed light on the influence of trauma on aspects of musicians’ music-making, particularly but not exclusively limited to its effects on emotional expression and memory during music performance and study. Effects on performers and teachers were considered, explicated and discussed in the light of the rapidly expanding body of knowledge about factors involved in psychological sequelae following exposure to traumatic event(s). Examples are given of how trauma has affected famous musicians and composers. Questionnaires sent to healthcare professionals and music teachers and four case study investigations illuminated specific signs of trauma. Findings underlined that, while responses to trauma are always of a very individual nature, these often particularly affected emotional expression and altered the perceived experience of emotions. Dissociative symptoms were found to affect memory and concentration. Trauma sequelae caused interference, drained energy levels, affected motivation, interpersonal relationships and self-esteem but also led to growth and trauma-catalyzed transformation. Anxiety and tension-related problems had pronounced effects on music performance and high levels of ‘stage fright’ were reported by previously traumatized participants. Trauma was shown to influence the career paths and decisions of musicians. As gleaned from the literature and research surveys, the following therapeutic approaches appear to be effective: Psychotherapy, trauma counselling, Cognitive-Behavioural therapy, hypnotherapy, EMDR (Eye Movement Desensitization and Reprocessing), EMI (Eye Movement Integration), pharmacological treatment, natural supplements, body therapies such as SE (Somatic Experiencing) and complementary techniques such as acupressure. Sound and music were identified by respondents and participants as playing an extremely beneficial role in the healing process. The possible benefits of incorporating alternative healing modalities are discussed, but it is made clear that this should only be used in conjunction with scientifically proven and thoroughly researched psychotherapeutic intervention strategies. This study’s results, appropriately disseminated, are intended to increase awareness and knowledge in performers and teachers, and enable particularly teachers to refer students to appropriate healthcare services in ways not risking further traumatization. Findings can assist healthcare professionals to better understand particular manifestations of trauma responses in musicians and enable them to intervene in more effective ways. / Thesis (DMus)--University of Pretoria, 2010. / Music / unrestricted

Introduction and background: Family-centred care in the intensive care unit has increased steadily over the past three decades, based on the premise that the illness and health of an individual family member affects the whole family unit. Although widely researched there are still inconsistencies in implementing family-centred care, which influences the ability to transfer research findings into practice. Research has shown that recognising the role of family members in the critical care environment should be considered an essential component to caring for the critically ill patient. Although recommendations have been made for the implementation of familycentred care, it is not feasible for all recommendations to be adopted by nurses and healthcare professionals in a single ICU. Nurses and healthcare professionals need to customise strategies to an individual intensive care unit to improve family-centred care. Aim: The aim of the study was to explore and describe nurses, healthcare professionals and family members’ perceptions of family-centred care in the intensive care unit. Research design and methods: A quali-quanti research design was used. Participants included nurses, healthcare professionals and family members in the intensive care unit of a private hospital in Gauteng, South Africa. There were a total of sixty (60) participants who took part in the study. Nurses were selected using stratified random sampling, healthcare professionals were selected using total population sampling and family members were selected using purposive, maximum variation and convenience sampling. Data was collected over a period of one month by means of structured interviews using an associative group analysis technique. Participants were asked to write down free word associations in relation to the stimulus word “family-centred care” in order to explore and describe their perceptions of family-centred care in the intensive care unit as it is currently, as it could be in the “ideal world” and any gaps that exist around these perceptions. Results: Five themes were derived from the data: communication, environment, continuum of feelings, reflections and spiritual care. Conclusion: The implementation of family-centred care should involve all stakeholders in the intensive care unit in order to address inconsistencies in perceptions around family-centred care. Keywords: Associative group analysis, intensive care unit, family-centred care, healthcare professionals, nurses, perceptions, stakeholders / Dissertation (MNur)--University of Pretoria, 2019. / Nursing Science / MNur (Clinical) / Unrestricted