Dissertations / Theses on the topic 'Hysterectomy patients'

Over 500,000 hysterectomies are performed yearly in the United States, and they often result in a moderate to severe amount of pain. Nurses play a significant role in postoperative pain management. However, studies have shown that despite technological advances and nurses' theoretical knowledge of pain, postoperative pain management remains a challenge among healthcare providers. The purpose of this study was to examine how nurses' and patients' attitude towards abdominal hysterectomy can impact postoperative pain management and hospital length of stay after a hysterectomy. Informed by the theory of reasoned action, the study examined the differences in the nurses' and patients' attitudes to abdominal hysterectomy and postoperative pain management. It also examined the correlation between attitudes toward postoperative pain management and hospital length of stay after a hysterectomy. A convenience sample of 147 participants were recruited from a self-administered online survey. Using the SPSS software, data was analyzed by an independent t test, Pearson correlation, and multiple regression. No statistical difference was found between patients and nurses' attitudes toward abdominal hysterectomy. However, a significant difference was found between the attitudes of each group toward postoperative pain management. There was also a strong negative correlation between attitudes to postoperative pain management and hospital length of stay. This study may aide nurses on ongoing pain management education for both new and seasoned nurses in practice. It will also help hospitals with pre- and postoperative patient education, which will lead to better collaboration with their nurse caregivers. Finally, this study will add to the existing body of research.

This study was undertaken to assess the performance of the peri-operative pain management and describe the patient satisfaction following elective total abdominal hysterectomy cases at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa. The data obtained were collected utilising the questionnaire of the international pain registry PAIN-OUT, to allow for a standardised means of assessment and follow-up. All patients who presented for this procedure during a three-month period from September to November 2015 were approached on the first post-operative day. Patient demographics and details regarding the peri-operative interventions were collected from patient charts and a self-reported patient questionnaire was completed. The data obtained examined the personal pain experience as well as resultant functional limitations and emotional factors involved. Medication side-effects, patient opinions regarding appropriateness of their pain management, their degree of participation, whether information was offered to them and their overall satisfaction levels with care was sought. The study included 76 patients and highlighted unacceptable acute pain levels. It revealed deficiencies in administration of analgesics on the ward and a lack of standardised protocols or collaboration between Anaesthesiology and Gynaecology in managing acute postoperative pain. Patients were not uniformly advised regarding the post-operative expectations of their pain and non-pharmacological measures were not emphasised by the treating team. Despite these deficiencies, patients reported high levels of satisfaction with the care received. The information provided allows for a more focused quality improvement strategy to manage acute post-operative pain in this group more effectively and move toward better collaboration between departments involved in the care of patients peri-operatively.

Bakgrund: I Sverige är det vanligaste större gynekologiska ingreppet hysterektomi, som innebär att livmodern avlägsnas. Denna operation kan vara påfrestande för kvinnan på grund av att livmodern ofta har stor betydelse som symbol för kvinnlighet och fertilitet, vilket gör att operationen kan medföra psykiska påföljder så som depression. En av sjuksköterskans uppgifter vid operationen är att göra patienten delaktig i sin vård. Delaktighet kräver en god vårdrelation där patienten får adekvat information. Syfte: Syftet med litteraturöversikten var att beskriva patienters behov av information från vårdpersonal i samband med hysterektomi. Metod: En litteraturöversikt baserad på 11 vetenskapliga artiklar som svarade på syftet. Artiklarna inhämtades från databaserna Cinahl Complete och PubMed. Båda författarna läste och granskade artiklarna för att sammanställa de meningsbärande enheterna. I de meningsbärande enheterna fann författarna likheter och skillnader. Materialet sorterades och presenteras under huvudteman med tillhörande underteman. Resultat: Resultatet presenteras i tre huvudteman, varav två av dem har underteman. Huvudtemana består av; Behov av att få veta, Individanpassad information och Konsekvenser av bristande information. Kvinnor upplevde att de hade ett behov av att få veta vad som väntade dem och när detta inte uppfylldes ledde det till bland annat oro och rädsla. Konsekvenserna av bristande information från vårdpersonalen var även att kvinnors delaktighet i vården påverkades och att information söktes på annat håll. Diskussion: Hildegard Peplaus omvårdnadsteori användes vid resultatdiskussionen, då denna kan vara ett stöd för sjuksköterskan vid undervisande och informativa möten. Det diskuteras kring att utvecklingen av vårdrelationen har stor betydelse för hur information ges och på vilket sätt det uppfattas. Vidare diskuteras på vilket sätt vårdrelationen och delaktighet kan integreras i vården för att sjuksköterskan ska kunna ge en god omvårdnad.
Background: In Sweden the most common gynecological surgery is hysterectomy which is a procedure where the uterus is removed. This kind of surgery might be difficult for the patient because the uterus has great significance as a symbol of femininity and fertility. This means that the operation can lead to reactions such as mental depression. One of the nurses functions at surgery is to participate the patient in their care. Participation of the patient requires a good nurse-patient relationship in which the patient receives adequate information. Aim: The aim of this literature review was to describe patient’s needs for information from health professionals during hysterectomy. Method: A literature review that was based on 11 original papers which also responded to the purpose. The used databases were Cinahl Complete and PubMed. Both authors read and reviewed the articles to compile their meaningful units. In the meaningful units the authors found similarities and differences. The material was then sorted and presented under main themes with matching subthemes. Results: The results are presented in three main themes, where two of them has subthemes. The mainthemes are; The need to know, Individualized information and The consequenses of insufficient information. Women experienced that they had a need to know what was going to happen, and when this was not fullfilled it caused feelings such as anxeity and fear. The consequenses of insufficient information from health professionalswas that women's participation in their care was affected and they ended up seeking information elsewhere. Discussion: The discussion is based on Hildegard Peplau's nursing theory, which can be used as a support for the nurse in educational and informative meetings. It is discussed that the development of the nurse-patient relationship has great significance for how information is being presented and how it is being perceived. Further discussed is in what way the nurse-patient relationship and participation can be integrated within the care in order to provide a good care.

Oavsiktlig hypotermi är ett ämne som hamnat i skymundan i den hektiska intraoperativa fasen för anestesisjuksköterskan. Patientens nedkylning påbörjas redan vid de preoperativa förberedelserna. En salstemperatur under 22˚C är den vanligaste orsaken till hypotermi hos patienterna och deras kroppstemperatur bör inte understiga 36,5˚C. Förebyggande åtgärder som att använda värmefiltar, salstemperatur på 22˚C-23˚C, varma infusioner i blodvärmare, inte exponera mer hud än nödvändigt samt postoperativt använda sig av värmetak. Kroppstemperaturen bör övervakas vid operationer längre än 30 minuter. Genom ökat fokus på kroppstemperaturen i den intraoperativa fasen kan postoperativa komplikationer minskas samt förkorta vårdtiden. Kan påverkbara faktorer under den intraoperativa fasen påverka och minska risken för oavsiktlig hypotermi? Fokus ligger på utvärdering av metod och mätinstrument. Syftet med den randomiserade pilotstudien är att undersöka patienter som drabbas av oavsiktlig hypotermi som genomgår hysterektomi med generell anestesi. Metoden är en kvantitativ pilotstudie med randomiserat urval samt en litteraturgranskning för förbättring av instrumentutveckling. Antalet deltagare i studien var 15 stycken, inga generella slutsatser kan dras. Mild hypotermi har 60 % av deltagarna redan innan operationsstart. Tio av 15 patienter uppnår ej 37°C under de första 30 minuterna oavsett bair hugger eller ej. Temperaturtagning 30 minuter efter ankomst till postoperativaavdelningen är mellan 35,4°C-37,2˚C. För att få ett heltäckande formulär om den perioperativa vården utförs en instrumentutveckling inför kommande primärstudie. Anestesisjuksköterskan är ansvarig för att förebygga och åtgärda hypotermi i enlighet med vad som är bäst för patienten. Vårdtagaren ska alltid stå i centrum och hypotermi är något som lätt kan åtgärdas bara medvetandet inom kunskapsområdet ökar.
Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård

MMed, Faculty of Health Sciences, University of the Witwatersrand
Postoperative pain is prevalent and not optimally managed in most patients. Pain can lead to adverse emotional and systemic consequences. Numerous device orientated studies have been done in other countries looking at the effect of infusions of local anaesthetic at the wound site postoperatively via an elastomeric pump. There have however been no similar studies done in South Africa. The aims of this study was to assess whether the use of an incisional wound catheter and 0.39% bupivacaine infusion in patients post total abdominal hysterectomy for a 30 hour period will decrease opioid requirements compared to a control group having only systemic analgesia. Pain intensities were also documented at set observation periods. The opioid requirements between the 2 groups were comparable however the participants who had the bupivacaine infusion in their incisional site had less pain intensity scores until 6 hours post operation and had less pain intensity on movement at 30 hours post operation. A bupivacaine infusion in the incisional site decreases pain intensity in the above mentioned parameters but does not reduce opioid requirements.

by Li Ho Cheung, William.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1999.
Includes bibliographical references (leaves 82-88).
Abstracts in English and Chinese.
Abstract --- p.ii
Acknowledgements --- p.vi
Table of Contents --- p.vii
List of Tables --- p.viii
List of Appendices --- p.x
Chapter Chapter 1 : --- Introduction and Literature Review --- p.1
Chapter Chapter 2 : --- Method --- p.31
Chapter Chapter 3 : --- Results --- p.48
Chapter Chapter 4 : --- Discussion --- p.60
Reference --- p.82
Appendices --- p.89

碩士
國立中山大學
醫務管理研究所
99
Hysterectomy is the second highest frequency of gynecologic surgery. With limited medical resources, understanding of qualities and expenses of different types of surgery can be used as a reference for patients and hospital administrators in making related decisions. Therefore, the purpose of this study is to compare the outcomes between “Total Abdominal Hysterectomy” and “Laparoscopic Hysterectomy”. Data sources are the health insurance report data files and charts of a regional teaching hospital. There were 114 cases between January 2006 and June 2010 at the sample hospital. Operating time, length of stay, and intra-operative blood loss between both types of hysterectomy are analyzed and compared by using t-test. Linear regression analysis is then used to examine the predictive factors that impact the outcomes of both types of surgery. The results indicate that, in terms of clinical results, laparoscopic hysterectomy takes 120.45 minutes on average, and total abdominal hysterectomy 104.35 minutes; laparoscopic hysterectomy requires an average of 4.73 days of hospital stay, and total abdominal hysterectomy 5.54 days; and finally, laparoscopic hysterectomy causes an average of intra-operative blood loss of 249.70cc, and total abdominal hysterectomy 290.21cc, laparoscopic hysterectomy costs an average of NT$69,268.85, and total abdominal hysterectomy NT$46,634.88. In regard to hospitalization costs, laparoscopic hysterectomy costs an average of NT$49,732.50, and total abdominal hysterectomy costs NT$42,066.27. Based on findings of this study, the following suggestions are proposed: (1) Laparoscopic hysterectomy can be safely and effectively used for patients with large uterine myoma or multiple myoma. (2)Hospitals should develop standardized medical treatment procedures; therefore, cost control would not be at the expense of the quality of care. Furthermore, standardization of medical treatment can be used to pinpoint whether there is any waste in the medical treatment process. Keywords: uterine myoma, hysterectomy, total abdominal hysterectomy, laparoscopic hysterectomy, outcome.

碩士
國立陽明大學
公共衛生研究所
100
Objective Hysterectomy is the most frequently performed surgical procedure in the field of gynecology. Past researchers focused mostly on the rate rather than the types of hysterectomy procedures performed annually. The current study aimed to assess the general trend in the utilization of different hysterectomy types (abdominal, Vaginal, laparoscopic) in Taiwan during the period between 2000 and 2009; as well as the effect of both patient and provider characteristics on the selected hysterectomy type. Method We conducted a study using the Taiwanese National Health Insurance database from the years 2000 to 2009. All women managed by hysterectomy were identified from the database. The incidence cases of hysterectomy in the past ten years were estimated and the effects of patient characteristics and providers on the selected hysterectomy type were investigated using polynomial regression. Results Ever since the year 2003, approximately 23,000 cases of hysterectomy procedure were performed each year in Taiwan with a mean patient age of 48.2 years. Although most patients preferred abdominal hysterectomy, the majority of elder patients favored vaginal hysterectomy, whereas younger patients chose laparoscopic hysterectomy. On the other hand, older doctors favored abdominal hysterectomy, whereas younger doctor mainly chose laparoscopic hysterectomy. In terms of departmental variation, gynecologists favored laparoscopic hysterectomy, whereas most surgeons preferred abdominal hysterectomy. The most performed hysterectomy was abdominal hysterectomy, followed by laparoscopic hysterectomy in hospitals and clinics. However, abdominal hysterectomy was the most popular hysterectomy procedure in clinics, followed by laparoscopic hysterectomy. Conclusion The current study revealed that both patient and provider characteristics had an influence on the selection of the hysterectomy type. Age, occupation, status of catastrophic illness, the experience of c-section and the reason of operation were patient-level characteristics that contributed significantly to outcome selection; whereas physician’s level characteristics such as age, gender, department, and the number of surgical procedures performed were also important covariates. Hospital-level characteristics such as hospital accreditation level, hospital ownership, the region, and the urbanization of the region also contributed to the selected hysterectomy type. Future study is required to examine if the training in medical centers have led to the higher proportion of laparoscopic hysterectomy utilization in medical centers than other hospital levels.

Tese de doutoramento em Psicologia especialização em Psicologia da Saúde
Pain is a complex human subjective and idiosyncratic experience. After surgery, acute pain is the most common and expected problem. The development of persistent post-surgical pain (PPSP) is an undesirable but common adverse outcome after surgery. Surgery provides a unique opportunity to examine the influence and predictive nature of a variety of demographic, clinical and psychological factors on subsequent pain persistence. Psychological factors have emerged as consistent predictors of acute and persistent post-surgical pain. Factors identified to date include negative emotions, coping strategies and surgery-specific beliefs or expectations, suggesting that perceptual/cognitive, emotional, and behavioral factors play key roles in influencing post-surgical pain experience. The aim of this thesis was to explore and examine, prospectively, the joint role of demographic, clinical and psychological variables as predictors of the following outcomes: a) acute post-surgical pain; b) PPSP; c) post-surgical rescue analgesia provision; and, d) post-surgical anxiety. A consecutive sample of 203 women (age: 51.0 ± 9.22) undergoing hysterectomy for benign disorders and of 130 patients (age: 65.2 ± 7.97) scheduled for total knee and hip arthroplasty (TKA and THA), were evaluated in a single site prospective study with assessments 24h prior to surgery (T1), 48h (T2), and 4/6 months (T3) after surgery. In the five studies conducted, several demographic and clinical variables were evaluated. Psychological variables assessed were anxiety, depression, pain coping skills (e.g. pain catastrophizing), surgical fears, optimism and illness representations. Acute post-surgical pain, in the hysterectomy sample (study 1), was better predicted by an integrative model which included younger age, pre-surgical pain severity, pain due to other causes, pre-surgical anxiety and pain catastrophizing. The results indicated the full mediation role of pre-surgical pain catastrophizing between pre-surgical anxiety and post-surgical pain intensity, which is a novel finding. As pre-surgical anxiety increases, women tend to catastrophize more about pain and this seems to predict increased acute post-surgical pain intensity. Study 2 examined post-surgical rescue analgesia (RA) provision in an effort to understand the variables that influence clinical decisions on RA provision. The results indicated that RA provision may be influenced not only by clinical variables (e.g. post-surgical pain intensity) but also by patient presurgical fear, pain catastrophizing and post-surgical anxiety. These psychological factors are likely to influence patient-provider interactions. Study 3 investigated the predictors of PPSP among women submitted to hysterectomy, with age, pain due to other causes and type of hysterectomy emerging as predictors. Pre-surgical psychological factors, such as anxiety, emotional illness representations and pain catastrophizing, were found to be additional risk factors for PPSP. Postsurgical anxiety added to the prediction of PPSP. In arthroplasties (study 4), the model which predicted acute pain in hysterectomy could not be replicated and optimism was the only significant predictor of pain intensity 48 hours after surgery. In this sample, there was also a strong association between post-surgical anxiety and acute pain after surgery. Moreover, post-surgical anxiety was predicted by a similar model to the one found for the prediction of acute post-surgical pain. Pre-surgical optimism, emotional representations and pre-surgical anxiety were significant predictors of post-surgical anxiety (T2). After total knee and hip arthroplasty (Study 5), PPSP seems to be better predicted by pre-surgical (T1) and post-surgical anxiety, as well as by acute post-surgical pain intensity (T2). In conclusion, the five studies conducted highlight the role of psychological factors in crucial aspects of the surgical experience: a) acute and persistent post-surgical pain; b) rescue analgesia administration; and, c) post-surgical anxiety. These results have important implications for patient care at pre-surgery and during the post-surgery follow up. The data points to the need to assess psychological factors at different stages of the surgery process, and the important role of Health Psychologists within acute pain team services. These professionals can contribute to a multidisciplinary and systemic approach in acute pain management and control, which aims at preventing the development of persistent post-surgical pain.
A dor é uma experiência humana complexa e idiossincrática. A dor aguda é o problema mais comum e esperado após uma cirurgia. Por sua vez, o desenvolvimento de dor persistente póscirúrgica (DPPC) é uma ocorrência adversa indesejável mas comum. A cirurgia é um excelente modelo para examinar a influência e a natureza preditiva de uma variedade de factores no desenvolvimento subsequente de dor persistente. No contexto da investigação sobre dor cirúrgica, os factores psicológicos têm emergido como preditores consistentes de dor póscirúrgica aguda e persistente. Os factores identificados até agora incluem emoções negativas, estratégias de coping e crenças ou expectativas específicas à cirurgia, sugerindo que os factores perceptuais/cognitivos, emocionais e comportamentais desempenham um papel chave na influência da experiência de dor pós-cirúrgica. O objectivo desta tese foi de explorar e examinar prospectivamente a influência de um conjunto de variáveis demográficas, clinicas e psicológicas como predictores dos seguintes resultados: a) dor aguda pós-cirúrgica; b) DPPC; c) administração pós-cirúrgica de analgésicos de resgate; e d) ansiedade pós-cirúrgica. Uma amostra consecutiva de 203 mulheres (idade: 51.0 ± 9.22) com histerectomia programada devido a causas benignas e uma amostra consecutiva de 130 pacientes (idade: 65.2 ± 7.97) agendados para a realização de artroplastia de joelho ou anca, foram avaliados num estudo prospectivo 24 horas antes da cirurgia (T1), 48 horas (T2) e 4/6 meses (T3) depois da cirurgia. Nos cinco estudos descritos, diversas variáveis demográficas e clínicas foram analisadas. As variáveis psicológicas avaliadas foram a ansiedade, a depressão, estratégias de confronto da dor (ex: catastrofização), os medos cirúrgicos, o optimismo e as representações da doença subjacente à realização da cirurgia. Na amostra de mulheres submetidas a histerectomia (estudo 1) foi identificado um modelo integrativo preditor da dor aguda pós-cirúrgica que incluía a idade (mais jovem), a intensidade da dor pré-cirúrgica, a dor devido a outras causas, a ansiedade pré-cirúrgica e a catastrofização da dor. Os resultados identificaram ainda o papel mediador da catastrofização da dor entre a ansiedade pré-cirúrgica e a intensidade da dor pós-cirúrgica, achado inovador na literatura deste dominio. À medida que aumenta a ansiedade pré-cirúrgica, as mulheres tendem a catastrofizar mais acerca da dor e isso parece associar-se a um aumento da intensidade da dor aguda póscirúrgica. O estudo 2 debruçou-se sobre o consumo pós-cirúrgico de analgesia de resgate, no sentido de compreender as variáveis que influenciam as decisões clínicas subjacentes à provisão de analgesia de resgate. Os resultados indicaram que a provisão de analgesia de resgate pode ser influenciada não só por factores clínicos (intensidade da dor pós-cirúrgica), mas também pelos medos pré-cirúrgicos, catastrofização da dor e ansiedade pré-cirúrgica. Estes factores psicológicos têm o potencial de influenciar as interacções entre os pacientes e os prestadores de cuidados. O estudo 3 investigou os preditores de DPPC nas pacientes submetidas a histerectomia, evidenciando-se a idade, a dor devido a outras causas e o tipo de histerectomia como preditores. Os factores psicológicos pré-cirúrgicos como a ansiedade, as representações emocionais da doença subjacente à cirurgia e a catastrofização da dor, surgiram como factores de risco adicionais para o desenvolvimento de DPPC. A ansiedade pós-cirúrgica revelou-se como um factor adicional para a predicção da DPPC. Nas artroplastias (estudo 4), o modelo predictor da dor aguda após a histerectomia não se confirmou e o optimismo foi o único predictor significativo da intensidade da dor 48 horas após a cirurgia. Nesta amostra, observou-se também uma forte associação entre a ansiedade póscirúrgica e a dor aguda pós-cirúrgica. A ansiedade pós-cirúrgica também foi predicta a partir dum modelo semelhante ao utilizado para a previsão da dor aguda pós-cirúrgica. O optimismo précirúrgico, a representação emocional da doença e a ansiedade pré-cirúrgica, revelaram-se como preditores significativos dos níveis de ansiedade após estas cirurgias. Por sua vez, os níveis de ansiedade pré e pós-cirúrgica, bem como a intensidade da dor pós-cirúrgica, foram preditores de DPPC após artroplastia total do joelho e da anca (estudo 5). Em conclusão, os cinco estudos apresentados evidenciam o papel dos factores psicológicos nos seguintes aspectos da experiência cirúrgica: a) dor aguda e dor persistente pós-cirúrgica; b) administração de analgesia de resgate; e, c) ansiedade pós-cirúrgica. Estes resultados têm implicações clinicas importantes no acompanhamento dos pacientes no momento pré-cirúrgico e no seguimento pós-cirúrgico. Os dados salientam a necessidade de avaliação dos factores psicológicos ao longo dos varios momentos do processo cirúrgico, assim como a importância da colaboraҫão de Psicólogos da Saúde nos serviços de dor aguda. Estes profissionais podem contribuir para uma abordagem multidisciplinar e sistémica na gestão e controlo da dor, de forma a prevenir o desenvolvimento de dor persistente pos-cirúrgica.

碩士
長庚大學
醫務管理學研究所
91
The objectives of this research are to study the perceptions of gynecologists and current practice on the rights to information of hysterectomy patients. Analysis is focused on the provision method and content of diagnostic information, reasons of inability to provide diagnostic information, and ways to improve it. Furthermore, the relationship between the provision of information, hospital’s accreditation status, as well as physicians’ demographic data are being explored. The research findings aim to aid hospital administrators in planning future supportive policies, measures and management schemes. The researcher had designed a questionnaire which was mailed to Gynecology departments of 19 Hospitals accredited as regional hospital or above in Taipei City from April 28 to May 16, 2003. A total of 161 questionnaires were sent, and 72 responses were received. Hence, the response rate is 44.72%. It is found that, according to the responding physicians, “Diagnosis of disease” (83.83%) and “Pathology finding” (75.76%) are the most important information to potential hysterectomy patients. “Providing channels of related information on the illness”, “Payment by National Health Insurance and out-of-pocket expenses” are of lowest importance. In addition, “patient’s inability to understand” (23.83%) is deemed to be one of the major reasons affecting provision of related information. In conclusion, the researcher has proposed the following four recommendations: establishing inter-active education materials, creating “standard procedures on providing necessary information to hysterectomy patients”, infusing important information related to patient’s right into clinical care and health insurance system and preparing a checklist on information provision by treatment procedures with designated personnel.

One purpose of teamwork is to pool the skills of individuals in order to produce a better result than that which could be achieved by each individual working on their own. The total effect should therefore be greater. Such sharing of knowledge permits the development of multidisciplinary teamwork. However, the mere existence of a number of different professionals does not guarantee teamwork. Traditional professional boundaries may be threatened and such interchange will only take place in an atmosphere of mutual trust and respect. Multiple individual consultations may lead to confusion about who is responsible for what. It may also lead to the possibility of repetition and overlap. Teamwork therefore is seldom easy but can be satisfying despite some personal loss of professional autonomy. The multi-disciplinary approach is an opportunity for supporting a patient within the framework of realistic expectations for the outcome of any intervention for a patient or family. The biopsychopastoral approach to patient care is intimately associated with psychology, medicine and theology. This approach differentiate the following separate aspects: emotional care, informational care and counselling. Although the final goal of therapy the ultimate well-being of the patient is, each of the discipliners in the team should have separate clear objectives. Problems are however always complex and changing and no person in the team is likely to have all the answers all the time. The biopsychopastoral model provides an approach to the understanding of the physical disease, psychological problems and theological questions, and of their assessment and management. It outlines the way that all the systems function, whether they are biological, psychological or theological and views health care problems in a holistic way.
Thesis (Ph.D.)-University of Durban-Westville, 1999.