Ph.D. (Social Work) / Please refer to full text to view abstract

M.A. / The process of sudden hospitalization is often experienced as a negative and traumatic event in people's lives. Traditionally, these traumatic events are dealt with by the medical professionals in the hospital setting. Due to time constraints and the urgent nature ofthe medical crisis, the patient is often left in very capable hands but the family is often left out ofthis process. This type of crisis throws a family into a tumult of disorganization. Parsonnet and Weinstein (1987), state that when patients are critically ill, their families suffer extreme emotional distress, often without the support of medical staffwho must I focus on the needs ofthe patient first. This study focuses on the family from a systemic perspective and looks at the effects on the whole system when one member becomes critically ill. This type of traumatic event can therefore lead to the family experiencing feelings such as fear, helplessness, shock, distress and a total lack ofcontrol. Many ofthese feelings are common to most traumatic events. Three case studies are examined in which families describe their experience ofICU and sudden hospitalization and a qualitative analysis is then conducted to identify common themes among the three families. This research examines how the fields ofsupportive psychotherapy and emergency medicine can be combined in order to create an environment in which not only the patient's needs are attended to, but where the family system's needs can be supported and guided through an otherwise very traumatic experience. The concepts oftrauma and crisis will be discussed, as vyell as how this relates to family systems theory. The experiences offamilies will be discussed in detail and the possible methods that can be employed in order to support a family through this medical crisis. This study is limited in the fact that only one interview was conducted but this is an exploratory study and is therefore only the beginning of an interesting area ofresearch.

The general aim of this study was to determine the experiences of a sample of terminally ill patients in using spiritually focused psychotherapy. This was a qualitative study conducted to a sample of 2 terminally ill patients from hospice in Grahamstown, South Africa. The research was conducted in 3 phases: an initial in-depth interview conducted to determine the participants' level of spirituality as well as the extent to which their terminal illnesses had affected their functioning. This was followed by a minimum of 6 spiritually focused therapy (SFT) sessions as a second phase of the research. To determine the participants' experiences of SFT, 2-3 in-depth interviews were conducted during the 3m phase of the research study. The research revealed that a belief in a higher power helps terminally ill patients cope better with their illness and that social disconnectedness is related to HIV / AIDS stigma. It also revealed that terminal illness is co-morbid with other psychiatric symptoms such as depression, evokes existential concerns, results in a change in the level of spirituality and affects the whole family. Participants blamed themselves for their illness, but found that engaging in the process of forgiveness of self and others brought about psychological healing for them. They experienced SFT as a coping resource that assisted them to deal with the fear of death as well as increased insight into the development of psychopathology and spiritual blockages. It is recommended that a comprehensive and holistic assessment during intake be undertaken so that where spiritual needs are available, therapy can be spiritually augmented to ensure that such needs/ struggles are addressed. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

This essay deals with the experiences of hospital school teachers, when teaching terminally and chronically ill children. Teachers form part of a multidisciplinary team of doctors, nurses, therapists, social workers and other caregivers. As a team they all share the same goal of assisting the child to better health with the minimum disruption to normal development and education. The effects on teachers personally; coping with emotional stresses of children being seriously ill and sometimes, unfortunately dying and professionally; by constantly adapting learning and teaching styles to suit the needs of these learners, are numerous when working in these conditions and often results in burnout. This essay explores these effects by inquiring into the lives of four teachers at one particular hospital school. This phenomenological study comes to a conclusion that hospital teachers need specific and distinctive characteristics to deal with issues out of the norm. They have to own extraordinary commitment and acknowledge the true value of teacher collaboration. Finally teachers needed ongoing support on a personal level; counseling, and on a professional level; teacher training and development in order to remain healthy, personally intact and at the spearhead of developments in the teaching profession. The essay ends with recommendations for hospital school teachers and hospital schools. / Dr. M.P. van der Merwe

Utilizing a collective case study design, I examined and described the filial therapy (FT) process and adaptations discovered to be necessary and unnecessary in working with families who have a child with a life-threatening illness in the hospital setting. Data from a total of 7 parents was utilized, including those who terminated early, in order to gain a greater understanding of adapting FT for families who have a child with a life-threatening illness and their participation patterns. The parents attended 10 one- to two-hour FT sessions. The data was analyzed to examine for themes, patterns and relationships intrinsically with each case participant, as well as across cases. Analysis indicated that parents with a child with a life-threatening illness had great difficulty committing to attend FT; and a high rate of attrition occurred for those who did commit. A theme regarding flexibility was found to be of eminent importance in a variety of manifestations including therapeutic methods, session format, location and time of sessions, and intense vs traditional FT. Therapeutic adaptations in flexibility found to be important including openness to cathartic and personal parenting sessions, tolerance of forgetfulness, and lowering typical therapeutic concerns of dependency in the relationship. An inability for parents in this situation to benefit from intense FT methods was also noted. Changes noted in the child of focus included increased confidence, increased cooperation in the medical setting, increased communication with the parent and with medical staff regarding medical issues, and increased communication with the parent regarding personal feelings and issues. Changes noted in the parents included increased confidence in parenting skills, increased awareness of the child's perceptions of the environment, increased tolerance in allowing the child to struggle in and out of the medical setting, with both emotional and physical pain in order to gain coping skills, increased ability to allow the child to empower self, and increased abilities in limit setting.

Includes bibliography. / The Acquired Immune Deficiency Syndrome (AIDS) has increasingly become a serious public health threat, reaching pandemic proportions. Against this background, the role of health care professionals is becoming progressively more important due to the multi-faceted impact of the disease on the lives of HIV-infected and AIDS-patients. The psychosocial impact of the disease compels social workers to contribute their services. The skills of clinical social workers however distinguish them from their counterparts in generic settings in that it enables them to create a therapeutic milieu conducive to the successful treatment of the AIDS-patient. Social workers in private practice may however be regarded as being in an even better position to deal with AIDS-patients due to the autonomous nature of their work environment. Several studies have been done both locally and abroad, on the role that knowledge, attitudes and behaviour of health care professionals play with regard to the treatment of the AIDS-patient. No such studies have however focussed on social workers in private practice as a population. Al though this population have sets of skills most appropriate for the treatment of these patients, the question however recurs as to whether they are adequately equipped regarding AIDS-education, and if they do perhaps share similar feelings of fear, stigma and attitudes of discrimination towards these patients as have surfaced in the studies mentioned above. This study therefore has as its main objectives the following: To establish whether social workers in private practice feel adequately equipped to deal with issues of HIV, AIDS and human sexuality; and to determine the degree of correlation among attitudes to AIDS-patients, homosexuals, terminally ill patients and sexuality, and other variables such as experience, gender and knowledge on the subject of AIDS.

This is a collection of short stories that traces a chronological movement through one family's experience of the mother's illness. Each piece in the collection is meant to be an independent, free-standing short story. Each story is different, told from distinctive points-of-view, angles, and voices. However, every story covers a span of time within the nine months of the family's experience, in the presented order, as part of a collective movement toward the core. All together, the pieces hope to reflect a mosaic of sorts--one that tells a story that cannot otherwise be told.

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Scholars have recognized the importance of illness narratives, and some of this work hastargeted terminal-illness stories, but little has directly addressed what distinguishes them from other illness narratives. In most illness narratives, recovery and life beyond the acute incident are a critical part of the overall experience of a disease. But terminal illness always ends with death. It has no “after.” This difference fundamentally changes how the illness is experienced – and how we should analyze a story told about it. Recognizing this distinction is important not only from a narratological perspective, but also for the study of the ways people live while dying and the models of behavior these stories reveal. I offer four ways to consider the specific genre of terminal-illness stories: the desire to tell, a turn to living dyingly, the alternative triumph, and endings-beyond-endings. These four elements recognize that terminal-illness stories are a distinct subset of illness narratives, and thus they can yield important insights unavailable through existing methods of looking at illness narratives more generally. Beyond the expanded narratological knowledge, this understanding is crucial because close listening is an ethical responsibility both to the individual and to those who come after her. Thinking about how and why people tell these stories and what we can get from them helps us see how they function in the world. That, in turn, gives us more concrete ways to think about the abstract ideas around terminal illness, dying, and death. This awareness will let us think more carefully about our master narratives of death and dying and what models of behavior are available to those who are terminally ill and those who care for them, and it can also offer insight into societal structures of health care. Such insights can further the cultural movement toward supporting a so-called good death, part of a larger shift from a biomedical model to a biocultural one that incorporates a patient’s subjective experience. Recognizing these signals can help a dying person and her caregivers think through treatment options, social support, and other aspects of care. Truly hearing the stories told by people with terminal illness helps us create a better ethic of caregiving and a better dying for all of us.

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