Thèses sur le sujet « People with disabilities – Medical care – South Africa »

Thesis (MCur)- -University of Stellenbosch, 2011
ENGLISH ABSTRACT: It generally is a problem for persons with disabilities to have barrier free access to buildings, which is their constitutional right. It is however, not only the physical facility that causes barriers for persons with disabilities but also the attitudes of the able-bodied persons. The aim of the study was to explore what opinions the nurses and persons with disabilities held in two healthcare settings in Kimberley with reference to the nursing care provided to persons with disabilities. To the researcher, it was important to gather the opinions of the nursing staff on how they saw persons with disabilities, but also to hear what they thought the problem areas in caring for persons with disabilities were. On the other hand, it was equally important to understand the persons with disabilities’ perceptions of the hospitals, nursing and what they saw as solutions to the problems. The objectives of the study were: • To determine what the opinions and knowledge of nurses working in two healthcare services in Kimberley are regarding the nursing management of persons with disabilities. • To determine what the opinions of persons with disabilities are in healthcare settings in Kimberley, with reference to the nursing care provided for persons with disabilities. Data was collected in two phases namely Phase 1 amongst the nursing staff in the private and state hospital in Kimberley and Phase 2 amongst the persons with disabilities. A list of staff members which was obtained from the Human Resource office in both the private and state hospitals were sent to the statistician Prof Kidd and who prepared a randomised list which was used for the participants in the study. The same process was followed when a list of all the people who are members of the Association for Persons with Disabilities (APD) and with the help of the statistician a randomised list was compiled from which the participants in the study were chosen. The design of this research is an explorative, descriptive non-experimental study with a quantitative approach, utilizing a structured questionnaire with closed and open ended questions. In this study it was found that the nursing staff was aware of the problems and barriers persons with disabilities encounter. The nurses, however, were aware of their own shortcomings. For example, the nurses identified the lack of training to equip them to assist the persons with disabilities during nursing care, while persons with disabilities also saw this as a problem. By addressing this shortcoming, nurses would be able to provide more holistic care. Recommendations were made based on the findings regarding the facility, perceptions, caregivers, procedures, doctors and the training of the nurses.
AFRIKAANSE OPSOMMING: Om toegang te hê tot geboue wat hulle grondwetlike reg is, is vir die meeste mense met gestremdhede ‘n voortdurende stryd. Dit is egter dikwels nie net die fisiese ontoeganklikheid van die geboue wat dit vir die persone met gestremdhede onmoontlik maak om ‘n normale lewe te lei nie, maar die houding van verpleegpersoneel wat dikwels meer ontoeganklik is as die toegang tot die geboue. Die doel van die studie was om te bepaal wat die opinies die verpleegpersoneel sowel as persone met gestremdhede het ivm gesondheidsorg in die privaat en staatshospitale in Kimberley Dit was vir die navorser belangrik om te bepaal hoe die verpleegpersoneel mense met gestremdhede sien, maar ook om hulle opinies te hoor ivm die probleme wat hulle ondervind sowel as moontlike oplossings daarvoor. Aan die ander kant wou die navorser ook weet wat die opinie van mense met gestremdhede is van die hospitale wat hulle besoek. Doelwitte van die studie was: • Om die kennis van verpleegpersoneel in die staat sowel as privaathospitale te bepaal ivm die versorging van persone met gestremdhede.. • .Om die opinies van persone met gestremdhede te bepaal tov die verpleegsorg in die staat sowel as privaathospitale in Kimbelrey. Data is in twee fases versamel. In Fase 1 was die verpleegpersoneel in beide die staat sowel as die privaathospitaal ingesluit en in Fase 2 was die deelname van die persone met gestremdhede verkry. Nadat ‘n personeellys van die Menlike hullpbronafdeling van beide hospitale verkry is, is dit aan die statistikus, Prof Kidd gestuur is vir steekproefneming. .Die persone met gestremdhede is genader nadat ‘n lys van die Assosiasie vir persone met gestremdheide (APD) verkry is. Die lys is deur die statistikus herrangskik,en die personeel en persone met gestremdhede is gevra om deel te neem aan die studie na aanleiding van die orde op die lys, nadat hulle ingligting ontvang het en toestemming geteken het vir deelname aan die studie. Die studie is eksploratief, beskrywend en nie-eksperimenteel van aard met ‘n kwantitatiewe benadering. Gestruktureerde vraelyse wat oop en geslote –einde vrae bevat het, is gebruik.. In die studie is bevind dat die verpleegpersoneel bewus was van die leemtes in die versorging van persone met gestremdhede. Een van die leemtes wat geïdentifiseer is, was dat verpleegsters nie formele opleiding ontvang in die versorging van persone met gestremdhede nie. Die persone met gestremdhede het ook hierdie leemte identifiseer. Deur hierdie leemte aan te spreek behoort verpleegpersoneel ‘n meer holistiese versorging aan persone met gestremdhede te lewer. Aanbevelings wat gemaak is, is gebasseer op die bevindinge in die studie en sluit in: fasiliteitt, persepsies, versorgers, prosedures, dokters en die opleiding van verpleegsters.

The world population is ageing, and this is also relevant to South Africa. At the same time the potential support ratio (the number of persons aged 15 to 64 years per one older person aged 65 years or older) is falling, and the dependency burden on potential workers increases. To alleviate the financial burden on the aged, and their families, it has become necessary to develop a financial plan to cover the cost of frail care. The overall purpose of this research is to determine whether any financial plans exist which are relevant. If nothing existed, a plan had to be developed. The research methodology for this study comprised the following steps: Firstly, the demographics of the world and South Africa were researched. The concept of frail (long-term) care in the United States of America and New Zealand was investigated to determine what is available. The subsidisation concept of the South African Government towards caring for the elderly was also investigated. Secondly, a questionnaire was sent to the residents of five retirement complexes in George to determine their interest in such a plan. The records of the frail care unit that these residents utilise were analysed to determine the number of residents needing frail care. A comparative study of the cost of frail care in the Southern Cape was undertaken. Thirdly, two options to partly subsidise the cost of frail care were examined, where the first option covers the running cost, and the second option, subsidising one third of the frail care cost, builds up a sustainable fund after the first five year period. The funds of the second option can then be utilised in the subsequent years to increase the subsidisation portion of frail care cost. The final step of this study entailed the formulation of recommendations to implement the frail care nursing levy as soon as possible, with special attention given to the following: a) It must be compulsory for new residents to join the fund. b) A yearly capital amount of R100 000 or more is needed to sustain the fund. c) A contract must be drafted to set out all the rules and regulations to the residents. d) An attitude change amongst some residents is required. Individuals must realise that the success of this plan depends upon themselves and with the necessary support could make a significant contribution towards their own peace of mind if and when frail care is needed.

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: South Africa has transformed its mental health service provision from in-hospital care to community-based rehabilitation. Although the idea is sound, the process places the caregiving families under an immense pressure. The aim of this study was to explore the impact that the de-institutionalisation process has had on the families as they care for their child with intellectual disability. The study was conducted by means of qualitative, unstructured interviews with families that have had a child de-institutionalised from Alexandra Hospital in the Western Cape. All of the patients were diagnosed with a dual diagnosis of intellectual disability and mental illness. Even though the patients were in group-homes or attended a day care centre, final responsibility for the patients lay with the parents. Three main themes emerged from the interviews that describe the impact of deinstitutionalisation, viz. the characteristics of the family member with intellectual disability (aggressive, abusive and self-destructive behaviour of the patient), the effect that these characteristics had on the family (marital stress and health risks to the care giver), and community and resource factors. The study placed the family central to its environment and discussed the impact deinstitutionalisation had on its environment as a whole. It was concluded that the burden that de-institutionalisation places on the families far exceeded their ability to cope with these circumstances. This status quo could be improved if adequate resources and skills are given to families prior to de-institutional
AFRIKAANSE OPSOMMING: In Suid-Afrika is geestesgesondheidsorg van hospitaliserende na gemeenskapsgebaseerde rehabilitasie, omskep. Terwyl hierdie stap wel as lewensvatbaar mag voorkom, plaas die proses ‘n hewige las op die sorggewende gesin. Die doel van hierdie studie was om die omvang van die impak hiervan op ‘n gesin met ’n lid met intellektuele gestremdheid en psiegiatriese siekte, te bepaal – nadat so ‘n pasient uit die inrigting ontslaan is. Die ondersoek is uitgevoer by wyse van kwalitatiewe, ongestruktureerde onderhoude met gesinne wie se lede met die diagnose uitgeplaas is deur die Alexandra Hospitaal in die Wes-Kaap. Elkeen van die pasïente is gediagnoseer met ernstige intellektuele gestremdheid, asook bykomende gedragsafwykings. Ten spyte van die feit dat die betrokke pasïente deur groepshuise of dagsorg eenhede versorg word, bly hulle hul ouers se verantwoordelikheid. Drie temas het ontstaan wat die impak van ontslag uit die inrigting omskryf, te wete die karaktertrekke van die gestremde gesinslid (aggressie, misbruikende en vernielsugtige gedrag van die pasïent), die effek van hierdie karaktertrekke op die gesin (stres op die huwelik en potensiële gesondheidsrisiko wat dit vir die versorger inhou), en die gemeenskap en ondersteunende faktore. Tydens die ondersoek is die gesin sentraal geplaas ten opsigte van die omgewing. Die impak van ontslag van die gediagnoseerde pasïent uit die inrigting op die omgewing as geheel, word bespreek. Daar is tot die slotsom gekom dat die vermoë van die gesin wat die las moet dra as gevolg van die ontslag, ver oorspan word. Hierdie toedrag van sake sou egter verlig kon word indien toereikende hulpbronne en vaardighede aan sulke gesinne beskikbaar gestel word alvorens so ‘n pasïent ontslaan is.

Thesis (MSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--Stellenbosch University, 2008.
Purpose To date no health policy analysis tool has been developed to analyse access and equity for people with disabilities. Further, there is very little information available on health and disability policy implementation. The intention of this research is to develop a health policy framework to analyse access and equity, focussing on people with disabilities, that can be used by policy makers. This research analyses four health policies and focuses on the facilitators and the implementation barriers. The findings of this research will impact on new policies developed in the future. Method The study included both a desk - top review and a descriptive study. The desk - top review entailed the formulation of a disability - focussed framework for health policy. This was then used to analyse health policies in terms of their disability inclusiveness. Qualitative data was gathered from interviews and questionnaires and focussed on policy processes and implementation. This was incorporated into the analysis. An ideal seven - step policy process model was developed. This was used to compare the reported policy process with the four policies followed. The four health policies used in the research are: the Primary Health Care Policy, the National Rehabilitation Policy, the Provision of Assistive Devices Guidelines and the Free Health Care Policy. Four key informants with extensive experience and knowledge were interviewed on policy processes and implementation. Questionnaires were also sent to Provincial Rehabilitation Managers to obtain their viewpoints on barriers and facilitators to policy implementation. Results Analysis of the four health policies showed varying levels of access and equity features. In terms of policy processes: all four policies had different stakeholders who initiated the policy development process. Two of the policies viz. the National Rehabilitation Policy and the Provision of Assistive Devices Guidelines, had people with disabilities as part of the stakeholder group involved in the policy formulation. The National Rehabilitation Policy had a comprehensive monitoring and evaluation section whereas this was absent in the other three policies. From the information gained from interviews and questionnaires, it appeared that the barriers to policy implementation included: attitudes, environmental access, human and financial resources. Facilitators to policy implementation include: policy process and design, availability of human and financial resources, support systems, management support, organisational structures and finally positive attitudes that all impacted favourably on policy implementation. Conclusions The developed health policy analysis framework served its purpose. Most policies did not have monitoring and evaluation guidelines that make implementation difficult to assess. Recommendations are made to improve policy design and content, specifically related to access and equity. Intersectoral collaboration and disability coordination needs to be improved. People with disabilities also need to engage with government departments, to monitor implemented policies and to advocate for change from outside the health system.

Thesis (BTech (Surface Design))--Cape Peninsula University of Technology, 2010
The purpose of this research is to generate a social outreach project by raising funds as well as getting sponsors to enhance the living environment at an institution for deaf girls. The focus is on Huis Soekie, a hostel which accommodates 17 deaf girls between the ages of 11 and 15. It is one of eight hostels situated at the De La Bat School for the Deaf in the rural town of Worcester. Frank Vodvarka and Joice Manice Malnar's work about Multi-Sensory design was used as inspiration to establish creative ways in which to enhance the living environment of institutionalized deaf girls. The living room of the hostel was chosen as focus area, since interaction among deaf people is important and the girls spend most of their time in it. To contribute to a more relaxing environment in this living room, secondary research was done on how nature together with the correct choice of colours can have a positive effect on humans' emotions. The living area of the hostel therefore has a central narrative and theme portraying nature as inspiration. All of the products that were designed for this space also incorporate elements of multi-sensory design. This type of design should be beneficial to the Deaf, because their other four senses are better developed than those of able people. This should also enhance their experience of the products.

Thesis (MPhil)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: The implementation of eugenic policies reached its peak during the zo" century when thousands of people with intellectual disabilities and other "undesirable qualities" were involuntary sterilized. Although most of the eugenic policies have been removed, countries such as South Africa, still make legally provision for the involuntary sterilization of people with intellectual disabilities. Torbjërn Tannsjë (1998) used the "argument from autonomy" to argue that involuntary sterilization practices are wrong because it involves compulsion. According to him, society should never interfere with people's reproductive choices and people should never be required to qualify for the right to have children. The aim of this assignment was to systematically assess the "argument from autonomy" as far as the policy of involuntary sterilization of people with intellectual disabilities is concerned. To this end, the concept of autonomy and the principle of respect for autonomy are discussed and applied to the intellectually disabled. It is argued that autonomy and respect for autonomy are useful concepts to apply to some people with intellectual disabilities. These individuals should not be automatically assumed to be incompetent, but their competence needs to be determined on an individual level, with reference to the complexity of the decision to be made. Special effort is needed from health care professionals to obtain (where possible) informed consent from people with intellectual disabilities. The application of the principle of respect for autonomy to matters of reproduction leads to the conclusion that people with severe to profound levels of disability, are unable to provide informed consent for sexual intercourse. Therefore some form of paternalistic protection is needed for these individuals. People with mild to moderate intellectual disabilities who are however competent to consent to sexual intercourse should never be prohibited from procreation by means of involuntary sterilization. State interference in matters of reproduction should be limited to interventions where (i) children are seriously harmed by parents and (ii) to protect those who are incompetent to consent to sexual interactions with others. Apart from these exceptions, the intellectually disabled is entitled to the same procreative rights as all other citizens.
AFRIKAANSE OPSOMMING: Die implementering van eugenetiese beleid het gedurende die 20 ste eeu 'n hoogtepunt bereik met die onwillekeurige sterilisering van duisende persone met intellektuele gestremdhede en ander "ongewensde kwaliteite". Alhoewel meeste van die eugenetiese wetgewing verwyder is, maak lande soos Suid-Afrika steeds wetlik voorsiening vir die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Torbjërn Tannsjo (1998) maak gebruik van die "outonomie argument" om te argumenteer dat onwillekeurige sterilisasie praktyke onaanvaarbaar is omdat dit dwang bevat. Hy voer aan dat die samelewing nooit in die reproduktiewe keuses van mense behoort in te meng nie en dat dit nooit vir mense nodig moet wees om vir ouerskap te kwalifiseer nie. Die doel van hierdie werkstuk was om sistematies die "outonomie argument" te analiseer ten opsigte van die beleid van die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Met hierdie doel voor oë word die konsep outonomie en die beginsel van respek vir outonomie bespreek en toegepas op die intellektueel gestremde persoon. Daar word aangevoer dat outonomie en respek vir outonomie nuttige beginsels is om in ag te neem in kwessies rakende intellektueel gestremdes. Hierdie individue moet nie outomaties as onbevoeg beskou word nie, maar hul bevoegdheid moet eerder op 'n individuele basis beoordeel word, inaggeneem die kompleksiteit van die besluit wat geneem moet word. Voorts word daar van gesondheidsorgpersoneel verwag om moeite te doen met die verkryging van oorwoê toestemming (waar moontlik) by persone met intellektuele gestremdhede. Die toepassing van die beginsel van respek vir outonomie op aspekte rakende reproduksie, lei tot die gevolgtrekking dat persone met ernstige intellektuele gestremdhede nie in staat is om toestemming tot seksuele omgang te verleen nie. Dus, is 'n vorm van paternalistiese beskerming in hierdie gevalle aangedui. Persone met intellektuele gestremdhede wat egter wel bevoeg is om toestemming tot seksuele omgang te verleen, moet nooit weerhou word van voortplanting deur middel van onwillekeurige sterilisering nie. Inmenging deur die staat in kwessies rakende reproduksie moet beperk word tot intervensies waar (i) kinders ernstige skade berokken word en (ii) die beskerming van persone wat onbevoeg is om toestemming tot seksuele interaksies met ander te verleen, benodig word. Afgesien hiervan, is die intellektuele gestremde persoon geregtig op dieselfde reproduktiewe regte as alle ander landsburgers.

Die Dissertation beschäftigt sich mit den Vorstellungen von Krankheit, Behinderung und HIV/AIDS in KwaZulu-Natal, Südafrika. Besonderer Augenmerk liegt dabei auf den kulturellen Wurzeln und sozialen Repräsentationen von Behinderung und HIV/AIDS. Die Ergebnisse der Studie zeigen dass die sozialen Interpretationen von Beeinträchtigung erheblich dazu beitragen dass Menschen mit Behinderungen in KwaZulu-Natal einem hohen HIV-Ansteckungsrisiko ausgesetzt sind und gleichzeitig dafür sorgen dass diese Menschen kaum Zugang zu Aufklärung und medizinischer Versorgung haben. Die Studie geht bei der Analyse über den Blickwinkel Behinderung hinaus und beleuchtet südafrikanische Gesellschaftsverhältnisse auf makrokultureller, mikrokultureller und individueller Ebene. Die Studie schließt mit einem Ausblick auf Veränderungsmögichkeiten im südafrikanischen Kontext.
The study focuses on the interweaving patterns of stigmatisation between disability and HIV/AIDS in KwaZulu-Natal, South Africa. The study was designed to understand the cultural roots of non-medical representations of disability and HIV/AIDS. The results show strong evidence that the way in which people are prone to think about and respond to disability and HIV/AIDS exposes people with disability to a particularly high risk of infection while simultaneously decreasing access to treatment and care. While unfolding hidden meanings and notions about disability and HIV/AIDS, the study analyses both phenomena on a macrocultural, microcultural and individual level. The study concludes with key messages emerging from the empirical research as well as from historical and policy analysis. Through this, it attempts to provide some guidance for transformation.

The purpose of this study was to explore the views of adults with disabilities and their care providers with regard to extent to which health promotion implementation was facilitated within Protective Workshops across several service areas in South Africa. Quantitative and Qualitative Data was collected via a combination of data collection approaches that included the use of a descriptive survey, a self-administered questionnaire and a semi-structured interview. Structured questionnaires and an interview schedule were used to generate data from both the patient and care provider participants in each of the selected facilities. Participants with disabilities and care providers working in the Protective Workshops were identified and sampled through a multi-stage sampling procedure. Participants from 48 facilities participated in the study. The findings revealed that health promotion in Protective Workshops was cursory and informal. Even though health education was provided whenever the need arose, it was neither individualized nor customized in accordance with reasonable accommodation of people with disabilities. There were provincial differences in terms of the levels of participation and organizational support for people with disabilities. In certain cases bureaucratic obstacles were identified during field work. Results show inconsistency regarding access to equal opportunities for people with disabilities, albeit some agreed to a lesser extent (30.5%), others moderately (21.5%) compared to only 22.6% who agreed, were exceeded by 25% of respondents who completely disagreed to the notion that equal opportunities existed for people with disabilities. The latter was confirmed by care providers. The study recommended an urgent need for the development of inclusive health promotion, the enforcement of the requirements for reasonable accommodation and adherence to policy and legal imperatives.
Health Studies
D. Litt. et Phil. (Health Studies)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs.
Health Science
M.A.(Nursing Science)

The system of care for persons suffering from mental retardation is in a state of upheaval. Considering the mentally handicapped as holistic beings, this study explored and assessed the needs of those residing in the community of District 22 (sub-district 222), KwaZulu-Natal, thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on Maslow's hierarchy of needs theory was carried out, using 167 respondents. The study revealed that despite being mentally retarded, they were still regarded as valuable members of the community, their needs did not differ from the needs of others in the rest of the world and that mental retardation is still rated low in the prioritization of health problems, hence the lack of resources and support needed for the rehabilitation of such persons.
Health Studies
M.A. (Health Studies)

We conducted the study to explore and define the role of the social worker in Primary Health Care. The medical care model on its own is viewed as inappropriate for developing countries. We see Primary Health Care as holding the key to improving the health status of the many disadvantaged communities in South Africa. The Primary Health Care approach demands those health care providers, including social workers work collaboratively to provide the best possible services to the communities. Social Work is a profession concerned with the disadvantaged. However, social workers are assigned a very limited role in Primary Health Care. Since participants are concerned about subjective and experiential realities, participatory research was the appropriate research method. The major findings and conclusions were that, social workers have a role in Primary Health Care. They have to be assertive and tell others what is it that they do to find a place in Primary Health Care
Social Work
M.A. (Social Science (Mental Health))

A research report in partial fulfilment of Masters of Arts in Social and Psychological Research, School of Human and Community Development, University of Witwatersrand, 2018
Caregiving is reported in numerous studies to have adverse effects on caregivers, including caregiver stress; mental and emotional strain; feelings of burden; and even the risk of mortality. Specifically for caregivers of adults with physical disabilities (AWPD), it is appreciated that caregiving is a life-changing experience as major modifications have to be made. These numerous changes have been reported to expedite the manifestation of stress that is differently perceived by the caregivers. Caregivers of AWPD are therefore anticipated to be at high risk of stress as this type of caregiving has been reported to be burdensome. In South Africa, researchers seem to have overlooked caregivers of adults with physical disabilities as a group that potentially have specific and unique perceptions in the role of caregiving. Most importantly the literature seemed limited in presenting how caregivers of AWPD qualify stress levels. Another paucity observed in the existing literature is that there are no accounts by caregivers on how the qualified stress levels impact on the relationship between the caregiver and care recipient. The aim of the current research was to explore perceived stress levels of caregivers of AWPDs. A second aim was to establish how caregivers of AWPD perceive stress levels to impact on the caregiver-care recipient relationship. The results highlighted that caregivers perceived stress levels to be fluctuating with time and affecting their health. According to the perspectives of the caregivers of AWPD, stress has either positive or negative impacts on the caregiver-care recipient communication, cooperation and closeness, differing amongst caregivers.
XL2018

This document is submitted in partial fullfilment for the degree: Master of Architecture [Professional] at the University of the Witwatersrand, Johannesburg, South Africa, in the year 2015.
People with intellectual disabilities are considered to be marginalised in our society. They continue to face prejudices, stigmas and are discriminated against resulting in social exclusion. This thesis develops a framework and methodology for pursuing inclusive environments and viable productivity within the workplace for persons with intellectual disabilities. The lack of opportunities within the workplace for individuals with intellectual disabilities intensi es their exclusion from society. The road to achieving inclusivity within the workplace has become a challenging one to navigate, as previous strategies which were developed to enable equality are far removed from what was intended. More often than ever before, employers are challenged from both a legal and political perspective for failing to diversify the workplace. Equality advocates as well as those who attempt to diversify their companies face obstacles within the workplace, namely inadequate resources or uncertainty about their appropriate role or approach in dealing with minorities. The building will serve as a learning hub, used by both persons with intellectual disabilities and people who are commonly referred to as able bodied. It will function as a level between education (if any) and the period before entering the workplace. The learning hub will afford persons with intellectual disabilities the opportunity to explore their capabilities in environments similar to that of a workplace and gain knowledge and experience prior to entering the workplace. The program envisaged in this thesis will demonstrate that this intervention is mutually bene cial to a company and the individual with an intellectual disability. In the first instance, the employer acquires knowledge and skills to act as a catalyst in enabling the transition of a person with an intellectual disability into the workplace to augment inclusivity. Secondly, the person with an intellectual disability through the program will be clothed with knowledge and expertise enabling meaningful participation amongst able-bodied employees. The transformation within workplaces as a result of the knowledge gained through this centre should create an enabling environment that incorporates the individual’s needs or one that best satis es their needs. The support by the employer is vital in the outcome and success of integrating people with disabilities into the social framework. The building is developed around a range of interactive programs between those with intellectual disabilities and people acting as the supervisors from workplaces. The supervisors, through training will be best placed to oversee progression and be empathetic toward staff with intellectual disabilities. This will enable them to transfer their knowledge and expertise of dealing with and accommodating employees with intellectual disabilities to their respective workplaces. A mock work environment will form the basis of the experiential training ground and in conjunction with job sampling will establish where a user will be best suited within the work environment. Public facilities encourage members of the public to become active participants within the space providing exposure and understanding towards those with intellectual disabilities. The centre is expected to be both accessible and lasting and will mediate experiential training and aligning it to workplace practices. The centre will be a vital space to enhance inclusion and for producing sustainable change for this marginalised group of persons. The building is located within an educational precinct on Melle Street, Braamfontein. The site which is in close proximity to the Central Business District allows for the centre to feed into businesses and vice versa. The location also allows for easy access to people from all over Johannesburg utilising various transport methods. The site being amid universities and schools ensures integration and optimum use, for educational facilities to link into this program. It also allows for social cohesion through exposure between the users of the building and other students in the surrounding area.
EM2017

Text in Afrikaans
Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self
Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly.
Health Studies
M.A. (Nursing)

South African nurses have accepted the challenge that was brought about by the Health Reform Policy of 1990 which opened health service centres to people of all racial and cultural groups. However, recent studies on multicultural nursing have revealed that problems have occurred when delivering care across cultural barriers. Most of these studies have approached these problems from the patients point of view, where issues of dehumanized care, labelling and discrimination have been reported. Therefore, this study was an attempt to look into these problems from the nurses point of view, by exploring the source of these problems, their effect on health care delivery and possible solutions. The researcher focussed on three critical issues, namely, lack of cultural knowledge, negative attitudes, as well as difficulty in communication. Through focus group interviews (FGI) and responses to given scenarios, student nurses who had experienced problems with culturally different patients were given a chance to reflect on their experiences, report on these experiences and recommend possible solutions to the experienced problems. The results revealed that: 1. The major source of the problems was lack of experience due to inadequate exposure to culturally diverse groups which in tum led to inappropriate decisions and actions at care delivery level. 2.Difficult perceptions and negative attitudes lead to the formation of stereotypes which block the delivery of culturally congruent care. 3 .Inability to communicate due to differences in spoken language lead to difficulty in building the trust relationship and hence inadequate care delivery.
Health Studies
M.A. (Nursing Science)

MA (Sociology)
Department of African Studies
The aim of the study was to investigate the challenges faced by families living with mentally ill relatives in Thulamela municipality in the Vhembe district, Limpopo province. The objectives of the study were to investigate the impact that caring for a mentally ill person had on the family members; to explore the strategies adopted by families to enable them to cope better with the challenges they faced when caring for their mentally ill relatives; and to understand the support services that were provided to families by health care professionals to enable them to cope with such challenges. A Nonprobability sampling, in particular its subtype convenience samplings was used to select five families who participated in the study. A semi-structured interview schedule was used to collect data from the main care givers and a focus group discussion took place to gather more in-depth information from at least three members of each family. Those selected to participate in the study were all family members who were involved in the care giving responsibility. All participants were caring for mentally ill relatives diagnosed with schizophrenia, substance induced psychosis or bipolar affective. The care recipient had to be admitted at Hayani psychiatry hospital. Data extracted from the participants was analysed thematically following the six stages of thematic data analysis.The research findings obtained from family caregivers from Thulamela municipality found in the Vhembe district within the Limpopo province, highlighted that taking care of a family members with mental illness comes with a number of challenges. The impact was experienced by all members of the family irrespective of the age, social or financial status. The impact was experienced emotionally, physically, socially and financially. All participants also reported to be experiencing burnout. They prefer their loved ones to remain living in mental institution as it gives them a chance to live normal lives.
NRF

Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed) . Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and multivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the multivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. 0Nords 423) Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed). Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and mUltivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the mUltivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. (Words 423)
Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (MPA.) -- University of Limpopo, 2017
The disability grant administration and dispensation has always been a challenge to the Department of Social Development and cause for concern from recipients of the disability grant. The Government decided on establishing the South African Social Security Agency (SASSA) as an entity to specifically deal with the administration of social grants including the Disability Grant. A number of studies have been conducted around the management and administration of the disability grant. The purpose of this study was to assess the efficiency and effectiveness of the administration and management of the disability grant. It further shows that the South African government spends a substantial amount of money in dispensing this grant. It is therefore necessary to investigate through an empirical research if these funds reach their intended beneficiaries, namely, the disabled community. This study employed the qualitative method which involved documents analysis, Questionnaire, interview and observation. Policy documents and reports from SASSA were analysed. Twenty applicants and twelve officials and three assessing doctors were interviewed. The findings of the study reveal that, although the SASSA has an improved model in place to redress and to contribute towards the effectiveness of the administration, there are still certain policy areas that needs to be reviewed. These policy areas include, amongst others, the appeal process, turnaround time, access and processing of the grant. In view of the findings from this study, the major recommendation is that there is a need to review the current booking system to ensure that the applicants are not subjected to unnecessary transports costs, time and delays. The SASSA needs to embark on vigorous and on-going community campaigns to educate the society on the operations of the SASSA and its jurisdiction within the Makhuduthamaga area. KEYWORDS: Administration; applicants; assessment; beneficiaries; Care Dependency Grant; Disability Grant; Grant-in-Aid; Makhuduthamaga; Recipients and the SASSA.

The purpose of this quantitative, descriptive study was to identify shortcomings in the implementation of the Batho Pele Principles in a public hospital. Findings were obtained from a range of patients who had been admitted to specific units for three or more days, and more evidence was gathered from articles in mass media. Data was collected through a structured questionnaire from one hundred respondents (n=100) and analysed by means of descriptive statistics. The research findings revealed that none of the Batho Pele Principles were implemented effectively and that patients in general were not satisfied with treatment in public hospitals. Shortcomings are attributed to insufficient management skills and knowledge on different levels of the health care system, as well as a lack of awareness among patients of their rights and responsibilities in health care.
Health Studies
M.A. (Public Health)

High prevalence of mental illness in South African and limited Mental Health Care (MHC) resources call for ways to supplement the overburdened system to meet the rehabilitative and supportive needs of service users as stipulated in the MHC Act no. 17 of 2002. Various psychological, social, and financial difficulties plaguing MHC users require holistic treatment intervention to help them cope with their conditions. This study explored the meaning of a Tshwane District community-based support group for MHC out-patients to help illuminate the value the group had for the members. A Social Constructionist epistemology informed the qualitative research approach. Data were collected by conducting semi-structured interviews and employing a collage-making method. The main themes illuminated by thematic analysis suggest that the group provided the members with a sense of belonging, mental and physical mobilisation and stimulation, a source of support, multiple learning experiences, and contributed to personal transformation and growth.
Psychology
M.A. (Social Science (Research Consultation))

Abstract in English and Zulu
This qualitative study set out to discover the lived experiences of South African transgender individuals within the liminal space of having been confirmed for gender affirming surgery, yet who have not completed their surgery. The aim included seeking out how participants’ wellbeing was affected by being within this liminal space. Six participants were recruited in Johannesburg, Pretoria and Cape Town. Thematic analysis was used to derive themes from the transcripts. Themes included coming out; relationships; wellbeing; misgendering/misnaming; support; public and private medical care; and liminality. Recommendations for future studies are included, and recommendations on interventions and support are discussed.
Lolu cwaningo lohlobo lwekhethelo lenzelwe ukuthola noma ukubheka izinselelo zabantu abafuna ukushintsha ubulili babo baseNingizimu Afrika ababhekana nazo uma basohlelweni lokuyohlinzwa ngoDokotela ukuze bakhone ukushintsha ubulili babo. Inhloso yalolu cwaningo ukubheka ngqo kubantu abayihambile lena ndima ukuthi bahlukumezeka kanjani ngesikhathi basohlelweni lokuthi bashintshe ubulili babo. Abantu abayisithupha abazibandakanye nalolu cwaningo batholakale eGoli, ePitoli kanye naseKapa. Kusetshenziswe ucwaningo olubheka indikimba ukuze kutholwe izihloko ezivele embalweni osuselwe enkulumeni eqoshiweyo. Izihloko ezivelayo yilezi, ubudlelwano; impilo; ukubizwa ngobulili ongasibona/ukubizwa ngegama okungasilona elakho; ukwesekwa; usizo lwezibhedlela zikahulumeni nezibhedlela ezizimele; kanye nokuba sesimeni sokushintsha ubulili. Izincomo zocwaningo oluzayo zifakiwe nazo, kuphindwe kwakhulunywa noma kwabhekwa ukuthi kungangenelelwa kanjani ngosizo.
Psychology
M.A. (Clinical Psychology)

Despite the fact that albinism affects several South Africans, it is a condition that remains deeply misunderstood. Albinism is steeped in myth and false notions, and is perceived by many as a curse and contamination. For years, persons living with albinism have been treated with doubt and suspicion. Also in schools and in the wider community, children with albinism are subjected to violence and ridicule. In certain areas on the African continent, including Southern Africa, persons living with albinism are killed for the trade in body parts for use as sacramental medicines, or sexually assaulted as a result of the belief that raping them may offer a cure for HIV/AIDS. All of this highlights the extreme vulnerability of persons living with albinism, not to mention the many violations of their fundamental rights that follow from the manner in which they are treated. Within the social context that frames the experience of persons living with albinism, the primary purpose of this study is to highlight some of the pertinent challenges faced by persons living with albinism in South Africa which compromise the full enjoyment of their fundamental rights as enshrined in the South African Constitution. The thesis makes a number of practical recommendations that will assist in promoting the legal position of this vulnerable group, while also contributing to a better understanding of albinism in general which will ultimately change negative perceptions and debunk the myths surrounding the condition.
Jurisprudence
LL. D.