Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The Human Immunodeficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are critical concerns worldwide; this is particularly true of South Africa. The consequences of HIV infection and complications of AIDS are a challenge that extends into the nursing profession and into the community of student nurses. Support groups can form an important part in educating nursing students about HIV and AIDS, as well as in supporting nursing students through the processes of counselling, testing and managing the physical, as well as other impacts of this syndrome. When considering the current situation at an Eastern Cape nursing college and the literature reviewed on this topic, the research question posed for this study was: ‘Why is the support offered by the HIV support group to the nursing students having such a limited effect on the students’ motivation to participate in HIV counselling and testing (HCT) and support activities to de-stigmatise HIV/AIDS?’ The aim of this study was to explore and describe the nursing students’ experiences and perceptions of the support group activities in order to improve the relevance of this initiative for students. The objectives of this study were to - Explore and describe the student’s experiences and perceptions of the support group activities - Identify and describe the student’s expectations of the support group. A qualitative approach with an exploratory and descriptive design was used to elicit data to answer the research question. Ethical approval was obtained from the Health Research Ethics Committee and access to the college campus was obtained through the appropriate authorities. The accessible population for this study were 1st, 2nd, 3rd, and 4th year students at one campus of the provincial nursing college in the Eastern Cape. In-depth individual interviews were conducted with eight participants who met the study inclusion criteria of having had experience of the support group and its activities. Interviews were recorded and transcribed by the researcher. Content analysis was used to analyse the interview data through applying Tesch’s eight steps of analysis. Data analysis revealed that participants did not experience the support group as helpful; although they had joined the support group they remained fearful of receiving test results and what their future may hold should they be diagnosed as being HIV positive. The participants experienced rejection and discrimination by the support group committee members; they also identified that the committee displayed hypocritical behaviours and a lack of respect for confidentiality of information which further undermined the functioning and influence of the group. Results revealed that joining the support group means one is automatically stigmatised as being HIV positive. The support group committee members were seen to be inaccessible having only limited communication with participants. Recommendations from the study were to hold personal and group development sessions for the committee and interested students to assist them in learning how to manage ethical issues related to counselling and testing, how to conduct effective campaigns to de-stigmatize HIV/AIDS, and to determine clearly what the purpose of this particular group is that it may better meet the needs of the student group. Limitations of this study were that the qualitative research approach that was applied limited the generalisation of the findings. The study focused only on experiences and perceptions of the undergraduate nursing students on one campus of the nursing college about the support group and its activities. Thus, the study offered an initial insight into the current negative perceptions of students towards the support group and offered a foundation for further investigation. In conclusion, experiences and perceptions of the support group were explored and elaborated on. Currently, the support group does not offer the support the students would like to be available as the fundamental functioning of the group is compromised by a lack of trust between students and the committee members. / AFRIKAANSE OPSOMMING: Die menslike immuungebreksvirus (MIV) en verworwe immuniteitsgebreksindroom (VIGS) is wêreldwyd kommerwekkende aangeleenthede, veral met betrekking tot Suid-Afrika. Die gevolge van MIV-infeksie en komplikasies van VIGS is uitdagings wat die verpleegberoep en die verpleegstudente-gemeenskap met verreikende gevolge raak. Ondersteuningsgroepe kan ’n belangrike rol speel om verpleegstudente in verband met MIV en VIGS op te lei, asook om ondersteuning te bied deur middel van die prosesse van berading, toetsing en die bestuur van die fisiese en ander gevolge van die sindroom. Toe die huidige situasie by ’n Oos-Kaapse verpleegkollege, asook die literatuuroorsig oor die onderwerp in oënskou geneem is, is die navorsingsvraag vir die studie gestel: “Waarom het die ondersteuning wat deur die ondersteuningsgroep aan die studentverpleegsters aangebied word so ’n beperkte effek op die studente se motivering om deel te neem aan MIV-berading en toetsing, asook ondersteuningsaktiwiteite om MIV/VIGS te destigmatiseer?” Die doel van hierdie studie was om die verpleegstudente se ervaringe en persepsies van die ondersteuningsgroep se aktiwiteite te ondersoek en te beskryf, ten einde die relevansie van hierdie inisiatief vir die studente te verbeter. Die doelwitte van hierdie studie was om die student se: - ervaringe en persepsies van die ondersteuningsgroep se aktiwiteite te ondersoek en te beskryf - verwagtinge van die ondersteuningsgroep te identifiseer en te beskryf. ’n Kwalitatiewe benadering met ’n ondersoekende en beskrywende ontwerp is gebruik om die data aan die lig te bring om sodoende die navorsingsvraag te beantwoord. Etiese goedkeuring is van die Universiteit van Stellenbosch se Gesondheidsnavorsingsetiekkomitee verkry en toegang tot die kollege-kampus is deur die betrokke owerhede verleen. Die toeganklike bevolking vir die studie was eerste-, tweede-, derde- en vierdejaarstudente by een kampus van die provinsiale verpleegkollege in die Oos-Kaap. Deurtastende individuele onderhoude is met agt deelnemers gevoer wat aan die studie se inklusiewe kriteria voldoen het en wat ondervinding het van die ondersteuningsgroep en hul aktiwiteite. Data is deur die navorser opgeneem en getranskribeer. Inhoudelike analise is gebruik om die data van die onderhoud te analiseer deur Tesch se ag stappe van analise toe te pas. Analise van die data het aan die lig gebring dat deelnemers nie die ondersteuningsgroep as behulpsaam ervaar nie. Ten spyte van aansluiting by die ondersteuningsgroep bly hulle angstig vir wanneer toetsresultate ontvang moet word en wat dit vir hul toekoms mag inhou indien hulle MIV-positief gediagnoseer word. Die deelnemers het verwerping en diskriminasie deur die ondersteuningsgroep se komitee-lede ervaar; hulle het ook skynheilige optredes en ’n gebrek aan respek vir vertroulikheid van inligting wat die funksionering en invloed van die groep verder ondermyn, geïdentifiseer. Resultate het aan die lig gebring dat aansluiting by die ondersteuningsgroep beteken dat hulle outomaties gestigmatiseer word as MIVpositief. Die komitee van die ondersteuningsgroep word gesien as ontoeganklik met beperkte kommunikasie met die deelnemers. Aanbevelings vanuit die studie sluit in die opvoeding en die ontwikkeling van ’n komitee en belangstellende studente om etiese kwessies te bestuur wat verband hou met berading en toetsing, veldtogte om MIV/VIGS te destigmatiseer en om duidelik te bepaal watter tipe ondersteuningsgroep hierdie betrokke groep moet nastreef om te wees. Beperkinge van hierdie studie is dat ’n kwalitatiewe navorsingsbenadering toegepas is wat die veralgemening van die bevindings beperk het. Die studie het slegs gefokus op ervaringe en persepsies van die voorgraadse verpleegstudente op een kampus van die verpleegkollege aangaande die ondersteuningsgroep en hul aktiwiteite. Sodoende, gee die studie ’n aanvanklike insig in die huidige negatiewe persepsies van studente oor die ondersteuningsgroep en bied ook ’n grondslag vir verdere ondersoeke. Ten slotte, ervaringe en persepsies van die ondersteuningsgroep is ondersoek en daarop uitgebrei. Tans bied die ondersteuningsgroep nie die ondersteuning wat die studente benodig nie, vanweë die fundamentele funksionering van die groep se gebrek aan vertroue deur studente in die komitee-lede.

Made available in DSpace on 2015-05-14T12:47:13Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1460771 bytes, checksum: 3d11ce6ff96fa527cbd7d63366657307 (MD5) Previous issue date: 2012-11-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research has as an object of study the syllabus of courses related to Nursing Sciences which are part of the curriculum of undergraduate courses and aims to understand how the process of decision making has been aired in these subjects with a focus on the training of nurses. The research is justified by the fact that there is a lack of information about the existence of contents related to decision making in subjects which comprise the Nursing Sciences as there is a continuous demand for immediate action by this profession al that represents a significant portion of the work force in the health system. This is an exploratory, descriptive and inferential research with quantitative and qualitative approaches. Institutions of Higher Education in the city of João Pessoa were used as the research scenario. Data were collected through questionnaires and semi-structured questionnaires. They were analyzed quantitatively by tests of hypotheses to proportion with the support of the R software, which provided statistical evidence and underpinned the decision making, and qualitatively by using the technique of discourse analysis. The data brought contributions that led to the following result: most of the teachers mention the nonexistence of specific training to perform their activities in the institutions and the non-interference of the coordination on the planning of the subject taught. Statistical evidence also highlighted the significant association between the Type of institution and the Interference of the coordination on the planning of subjects. Also, very close to the threshold of dependence, the possible association between Teaching Experience in the institution and the Interference of the coordination on the planning of subjects was observed. The study culminated with a proposed model of decision-making, which was composed of three steps, directed to subjects related to Nursing Sciences. We concluded that the teaching of a model of decision making, taught at the undergraduate, will result in a better training of professionals who will be prepared for the labor market promoting efficiency and effectiveness of their actions in work processes in the health system. / A presente investigação científica tem por objeto de estudo os conteúdos programáticos das disciplinas vinculadas às Ciências da Enfermagem, inseridas nas matrizes curriculares dos cursos de graduação e objetiva compreender como o processo de tomada de decisão tem sido veiculado nessas disciplinas, com foco no processo formativo de enfermeiros. A pesquisa justifica-se em face da falta de informações sobre a existência de conteúdos relativos à tomada de decisão em disciplinas que compõem as Ciências de Enfermagem, tendo em vista a exigência constante de ações imediatas por esse profissional, que representa uma parcela significativa da força de trabalho em saúde. Trata-se de uma pesquisa exploratória, descritiva e inferencial, de abordagens quantitativa e qualitativa. As Instituições de Ensino Superior da cidade de João Pessoa foram utilizadas como cenário da pesquisa. Os dados foram obtidos por meio de formulários e questionários semiestruturados, analisados quantitativamente através de testes de hipóteses para proporção com apoio do software R, que forneceram evidências estatísticas e alicerçaram as tomadas de decisões e, qualitativamente, por meio da técnica de análise de discurso. Os dados trouxeram contribuições que fizeram emergir o seguinte resultado: a maioria dos docentes refere-se à não formação específica para exercer suas atividades nas instituições e à não interferência da coordenação nos planos de curso da disciplina. Evidências estatísticas também ressaltaram a associação significativa entre Tipo de instituição e a Interferência da coordenação nos planos de curso da disciplina e, muito próximo do limite de dependência, a possível associação entre o Tempo de Ensino na instituição e a Interferência da coordenação nos planos de curso das disciplinas. O estudo culminou com uma proposta de modelo de tomada de decisão direcionado às disciplinas vinculadas às Ciências da Enfermagem, composto por três etapas. Conclui-se que o ensino de um modelo de tomada de decisão, ainda na graduação, resultará na formação de profissionais melhor preparados para o mercado de trabalho promovendo eficiência e eficácia de suas ações nos processos de trabalho em saúde.

It is a qualitative research, fulfilled on a quilombos remaining rural community in the south region of Brazil. The goal was to know the social support network of caregivers of relatives with chronic condition of health of this community. The individuals of research were caregivers of relatives with chronic health condition. It was used as criteria for inclusion: be the caregiver with chronic condition of health person, possess some degree of kinship with the person cared for, be caregiver for at least six months and not more than five years. It was used the data Saturation criterion for definition of the number of participants, totaling 13 caregivers. The data collection occurred through semi structured interview, observation and documentary analysis. Data analysis was through content analysis. The ethical principles were respected, in order to protect the rights of the participants, with the formalization of participation through the enlightened and free Term of agreement. The standards of resolution nº 196/96 of the National Health Council governing the researches involving human subjects were respected. The categories from data analysis are described and discussed in four articles, which compose the essence of this work. The social network was composed by the family, by neighbors and friends, by groups of coexistence, by members of religious congregations and by health professionals. The social support in networks was classified as emotional, informational and instrumental. The emotional support was received by family and living groups. The popular informative support was received from experienced people in the community, those who had gone through similar situations, by members of religious congregations and the belief system of each caregiver, being the professional informative support provided by health professionals. The instrumental backing was provided especially by the family. Social support is understood as inherent to the social networks of caregivers that can be mobilized in times of need. Generally, the social support network is characterized for being extensive and structured, providing social support to caregivers. This support is important, both to the personal life of the caregiver, as in assistance of family care activities. It was noted that care to a family member is perceived as a collective commitment of this family. On the basis of reciprocity, the care happens because the person "deserves" to be cared for. In dispensing care to another family member, naturally expected the consideration at the moment of weakness. In this context, the care can be considered as the boon that circulates between the members of each family. It is therefore concluded that if makes relevant to nursing and healthcare team, knowing the social networks of users of health services, as well as social support circulating in social networks, in order to act effectively and in a coordinated way with the support networks, considering that this effort can help in the conduct of home care, improving the quality of life of the sick person as well the family caregiver. / Trata-se de uma pesquisa qualitativa, realizada em uma comunidade rural remanescente de quilombos na região sul do Brasil. O objetivo foi conhecer a rede de apoio social dos cuidadores de familiares com condição crônica de saúde desta comunidade. Os sujeitos de pesquisa foram os cuidadores de familiares com condição crônica de saúde. Foi utilizado como critérios de inclusão: ser cuidador da pessoa com condição crônica de saúde, possuir algum grau de parentesco com a pessoa cuidada, ser cuidador há pelo menos seis meses e não mais de cinco anos. Foi utilizado o critério de saturação dos dados para delimitação do número de participantes, totalizando 13 cuidadores. A coleta dos dados ocorreu por meio de entrevista semi-estruturada, observação e análise documental. A análise dos dados foi por meio da análise de conteúdo. Os princípios éticos foram respeitados, de forma a proteger os direitos dos participantes, com a formalização da participação por meio de Termo de Consentimento Livre e Esclarecido. As normas da Resolução nº 196/96 do Conselho Nacional de Saúde, que regem pesquisas envolvendo Seres Humanos foram respeitadas. As categorias oriundas da análise dos dados são descritas e discutidas em quatro artigos, que compõem a essência do presente trabalho. A rede social foi composta pela família, pelos vizinhos e amigos, pelos grupos de convivência, pelos integrantes das congregações religiosas e pelos profissionais de saúde. O apoio social circulante nas redes foi classificado como emocional, informativo e instrumental. O apoio emocional foi prestado pela família e pelos grupos de convivência. O apoio informativo popular foi recebido das pessoas experientes da comunidade, daqueles que já haviam passado por situações semelhantes, pelos membros das congregações religiosas e pelo sistema de crenças de cada cuidador, sendo a apoio informativo profissional prestado pelos profissionais de saúde. O apoio instrumental foi prestado especialmente pela família. O apoio social é compreendido como inerente ás redes sociais dos cuidadores podendo ser mobilizado em momentos de necessidade. De forma geral a rede social de apoio caracteriza-se por ser ampla e estruturada, propiciando apoio social aos cuidadores. Este apoio é importante, tanto para a vida pessoal do cuidador, quanto no auxilio as atividades de cuidado ao familiar. Observou-se que o cuidado a um membro da família é percebido como um compromisso coletivo dessa família. Em função da reciprocidade, o cuidado acontece porque a pessoa merece ser cuidada. Ao dispensar cuidados a outro familiar, espera-se de forma natural a retribuição no momento da fragilidade. Neste contexto o cuidado pode ser considerado como a dádiva que circula entre os integrantes de cada família. Conclui-se, que se faz relevante para a enfermagem e equipe de saúde, conhecer as redes sociais dos usuários dos serviços de saúde, bem como o apoio social circulante nas redes sociais, de maneira a atuar de forma efetiva e coordenada com as redes de apoio, considerando que este esforço pode ajudar na condução do cuidado domiciliário, melhorando a qualidade de vida da pessoa doente, bem como do familiar cuidador.

Bakgrund: I Sverige beräknas att cirka 40% av personer med kognitiv sjukdom vårdas på särskilt boende och innan de flyttar dit är det ofta anhöriga som ger informell om­vårdnad i hemmet. Tidigare forskning har visat att vården av en person med kognitiv sjukdom och processen att flytta denne till särskilt boende är påfrest­ande för anhöriga, med stor risk för att utveckla egen ohälsa. Regeringen har under 2022 beslutat om en anhörig­strategi för att stärka anhörigas rätt till stöd, och Socialstyrelsen publicerade ett kunskapsunderlag för vårdgivare under 2023 i syfte att underlätta implementering av anhörigperspektivet. Därför är det intressant att studera hur sjuksköterskor idag stöttar anhöriga under denna process. Syfte: Studiens syfte är att utforska hur sjuksköterskor i kommunal verksamhet beskriver stödet de ger till anhöriga till personer med kognitiv sjukdom under transitionsprocessen från ordinärt boende till särskilt boende, samt om de upplever att det finns förbättringsmöjligheter.  Metod: En kvalitativ intervjustudie med induktiv ansats genomfördes. Det gjordes 13 semistrukturerade intervjuer med sjuksköterskor inom kommunal hemsjukvård och särskilt boende, med minst ett års erfarenhet från ena eller båda verksamheterna. En kvalitativ innehållsanalys med en manifest tolkning gjordes för att få fram ett resultat.  Resultat: Analysen resulterade i fyra huvudkategorier: 1. Att hjälpa anhöriga ur en ohållbar situation. 2. Att skapa en god relation. 3. Att samverka. 4. Att förhålla sig till brister i verksamheten. Resultatet visade att sjuksköterskorna börjar stötta anhöriga i processen långt tidigare än förväntat och är medvetna om de svåra känslor som anhöriga brottas med innan de fattar beslut om flytt. Sjuksköt­erskorna på särskilt boende arbetar ofta hårt med att öka tryggheten för anhöriga och göra dem delaktiga, och ett väl fungerande teamarbete är viktigt för ett gott samarbete med anhöriga, liksom att det finns anhörigstödjare att tillgå. De pekade också på att det finns brister i verksamheten, både av organisatorisk och kulturell art, som påverkar stödet till anhöriga negativt.  Slutsatser: Studien visade att sjuksköterskor i hög grad är medvetna om de problem och utmaningar som anhöriga står inför när de måste separera från en familje­medlem med kognitiv sjukdom. Studien pekar på förbättringsbehov avseende sjuksköterskors kompetensnivå, rutiner som verkar för ett mer jämlikt tillhanda­hållande av stöd för anhöriga, samt att sjuksköterskor får mer resurser för denna folkhälsofrämjande verksamhet. / Background: Some 40% of persons with dementia in Sweden live in care homes, and before they move there, are cared for by informal family caregivers in the home. Previous research has shown that the process of caring for a person with dementia and moving them to a care home is taxing for family caregivers, with increased risk of developing health problems of their own. The Swedish government has in 2022 presented a national next-of-kin strategy aiming to strengthen the right to support for family caregivers and Socialstyrelsen published a guide for healthcare providers to implement the next-of-kin perspective in 2023. In this light, it is of interest to study how registered nurses working in homes and care homes support family caregivers today.  Aim: The aim of the study is to investigate how registered nurses in the context of elder care, both in ordinary homes and in nursinghomes, describe the support they give to relatives of persons with dementia during the transitionprocess from ordinary living to care home living, and if they see possibilities for improvement.  Method: A qualitative interview study with inductive approach was made. There were 13 semistructured interviews made with registered nurses working in home care and care home settings, having at least one year of experience from one or both of the settings. A qualitative content analysis with a manifest interpretation was made to generate a result.  Results: The analysis resulted in four main categories: 1. Helping family caregivers in an untenable situation. 2. Creating a good relationship. 3. Cooperation. 4. Relating to the shortcomings of the area of care. The result showed that registered nurses support family caregivers long before expected and are aware of the difficult feelings relatives deal with before they decide on care home living. The nurses in care homes often work hard aiming to create a sense of security and participation for relatives. A well functioning team is a foundation for a good collaboration with relatives, and access to external support is an important resource. The nurses also identified organizational and cultural problems, affecting the support negatively.  Conclusions: The study shows that registered nurses are highly aware of the problems and challenges facing family caregivers when needing to separate from a family member with dementia. The study indicates areas of improvement concerning the nurses need for further education, routines that facilitate a higher degree of equal opportunities for relatives, and that the nurses have more resources allocated for this area of preventative public health care.

Text in English / In South Africa, retention of newly qualified professional nurses in public health institutions upon completion of their year of compulsory remunerated community service remains a challenge that exacerbates the shortage of professional nurses in these institutions. The literature indicates that many newly qualified professional nurses leave the public health institutions due to lack of professional development support and heavy workloads while they are still finding their feet. A mixed-methods design of concurrent triangulation approach was used to answer the question: How are the newly qualified professional nurses supported in terms of induction and professional development during community service in South Africa? Triangulation was achieved by using both quantitative and qualitative methods. Induction/orientation documents from public health institutions were analysed using a checklist. A survey questionnaire with mixed quantitative closed items (1–43) and qualitative open-ended questions (43–46) was sent to newly qualified professional nurses who had recently completed community service. Focus groups held with operational nurse managers and individual interviews with coordinators of community service for nurses yielded rich qualitative data. Descriptive and inferential statistics were used to describe and synthesise data. The qualitative findings confirmed the quantitative findings. Findings were lack of professional development support in some public health institutions, informal, non-comprehensive support where given, shortage of experienced professional nurses, reluctance by some professional nurses and operational nurse managers to supervise newly qualified nurses, and increased workload due to the shortage of experienced professional nurses in the public health institutions. Inadequate clinical skills, poor discipline and lack of professionalism in the newly qualified professional nurses also played a part. Respondents suggested constructive recommendations for the induction and professional development support of the newly qualified professional nurses, and these were incorporated in the recommended guidelines for the induction and professional development support of newly qualified professional nurses during community service. / Health Studies / D. Litt. et Phil. (Health Studies)