Tesi sul tema "Terminal care – South Africa – Grahamstown"

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.
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The study is made in an attempt to evaluate a Non-Profit Organisation established 30 years ago. The organisation is called The St. Mary’s Development and Care Centre. This centre, amongst others, was established in 1982 by a true humanitarian, Mrs Thelma Henderson, and has since had more than 2250 children and lots more families in its care. The research aims to explore and evaluate the impact that the centre has had on the families and communities in Grahamstown. The evaluation is done as part of the current manager’s strategy to assess the strengths of the organisation and to build on the efficacy of the organisation. The researcher understands impact as any change whether positive or negative. This, from a social science perspective, is experienced by the person on a personal level and the effects in different families cannot be measured with a universal measure. Theory proves that because people are at varying levels of development, they therefore experience change and thus impact, differently. With the use of the grounded theory method comprising of systematic, inductive and comparative approaches for conducting inquiry for the purpose of constructing theory (Bryant & Charmaz 2007: 1) the research found that people have experienced change at different levels. This information, triangulated against previous research, validated the claims that child sponsorship at an NGO level indeed has benefits for the children involved in their programs. Therefore this evaluation paper draws the conclusion through similarities found and qualitative personal views that the St. Mary’s Development and Care Centre has indeed had an impact on the Grahamstown community.

South Africa is one of the countries hardest hit with the Human Immunodeficiency Virus (HIV) and Acquired Immuno Deficiency Syndrome (AIDS) epidemic. In response to the epidemic, the South African government adopted the Comprehensive HIV & AIDS Care, Management and Treatment programme strategic plan (CCMT) in 2000 (1) and developed the Operational Plan for CCMT for antiretroviral therapy rollout in 2003 (2). In order to monitor the progress of the implementation of CCMT, the National Department of Health (NDOH) adopted the Monitoring and Evaluation (M & E) framework in 2004 (3). The aim of this study was to assess the HIV & AIDS programme in Grahamstown‘s public sector health care system by using the national M & E indicators of the HIV & AIDS programme. The national M & E framework was used as the data collection tool and available information was collected from various sources such as the District Health Office (DHO), Primary Health Care (PHC) office, accredited antiretroviral sites and the provincial pharmaceutical depot. Group interviews were conducted with key stakeholder health care professionals at the District Health Office, Primary Health Care office, Settlers Hospital and the provincial Department of Health personnel. A one-on-one interview was conducted with the Deputy Director of HIV & AIDS Directorate, monitoring and evaluation in the National Department of Health. Available indicators such as budget and expenditure including antiretroviral procurement; human resources; nutrition-related indicators; prevention care and treatment indicators were collected. A group interview was conducted to document current practices, or where there was a lack of documentation, for indicators such as traditional medicines and pharmacovigilance. Most of the national M & E indicators are not required to be collected or collated by the district because the reporting format designed by the provincial Department of Health is different. Facilities, districts and provinces in South Africa are at different levels of implementation of the antiretroviral programme and hence a common format of the M & E indicators is not used by all provinces. Uniform data collection is not achieved due to human resources‘ constraints and other challenges such as continued use of manual reporting systems by the clinics. Districts are expected to report according to the formats drawn up by the provincial Department of Health (DOH) and there is a lack of awareness regarding the national M & E document amongst the Grahamstown Health Care Professionals. There is a need for training on the use of the M & E national framework so that the HCPs at the primary and secondary levels of the health care system are proficient with the process of M & E, and can provide inputs as well as take ownership of the process. The establishment of an M & E unit in Grahamstown is essential so that data collection and submission of the HIV & AIDS programme in the public sector according to the National M & E framework is addressed. However, despite all constraints and challenges in the public sector health care system in Grahamstown, available human and financial resources are being used effectively to maintain the HIV & AIDS programme.

The neo-liberal restructuring of state assets and facilities, which has taken place internationally over the past three decades, as well as in South Africa, has been a matter of great controversy. Privatisation, in particular, has been a polarising issue, especially when applied to fields like healthcare. Supporters of privatisation view it as cutting costs, mobilising funding, expertise and innovation, resulting in improved delivery, and opening possibilities for a spread of ownership. Critics claim the process involves retrenchments, declining services for the (poorer) majority of people, and a focus on the elites as citizens become transformed into customers, and with any economic empowerment going to the already prosperous. This thesis examines these issues by looking at the privatisation of hospitals in South Africa, with a case study of the Netcare-Settlers Public Private Partnership (PPP) (also known as the Settlers Private Hospital) in Grahamstown, South Africa. Netcare is South Africa’s largest private hospital company, and also has substantial operations in the United Kingdom. The thesis sets out the context: a highly inequitable healthcare system in the country, the rise of privatisation in the apartheid and post-apartheid eras, and healthcare privatisation. In terms of the Netcare-Settlers PPP, the thesis examines how the PPP was structured and developed, focusing on the impact of the PPP on non-clinical operations. The thesis argues that the results of the PPP are mixed, that it has greatly improved areas like facilities, maintenance, cleaning and catering, performed less well in increasing the doctor/ patient ratio or in attracting specialists, and is associated with the widespread and problematic use of outsourcing of service workers like cleaners and security. Overall, the PPP has improved healthcare, with some effective sharing of resources between the public and private parts of the hospital, but also relies on a pool of relatively low waged, under-unionised, labour. In terms of the general debate over privatisation, the Netcare-Settlers PPP shows that both supporters and critics have some valid points, and that privatisation in practice is not an either/ or, black/ white, good/ bad proposition, but something more complex. The success and failure of PPPs depend on the details of the contracts, and these can be used to maximise the performance of both the public and private partners. Better contracts may help avoid the uneven results seen at institutions like the Netcare-Settlers PPP.

One of the greatest challenges facing sub-Saharan Africa, which incorporates South Africa, is the AIDS pandemic. The devastation wrought by this disease is unsurpassed in recent times. The health and social development structures, already overburdened, are totally overwhelmed by the needs of povertystricken households and communities affected by AIDS. Caregivers attempting to support those affected and infected are also facing unique challenges and demands, particularly relating to dealing with the large numbers of deaths due to this disease. Experiences for these caregivers are likely to be varied, ranging on a continuum from positive to negative, for instance, the recovery of patients versus the death of patients. The objectives of this study are to explore and describe the lived experiences of caregivers working with AIDS patients, particularly patients who die from this disease whilst resident in a formal institution. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is grounded in a phenomenological approach to inquiry. Caregivers working fulltime in a formal institution caring for patients who are dying from AIDS were interviewed in an in-depth, unstructured manner in order to gather spontaneous, rich descriptions of their experiences. Through this study the researcher wants their voices to be heard, the potential richness of their reflections acknowledged and the generated data to be applied to the benefit of the field of HIV/AIDS – both for staff and patients. Thirteen in-depth, unstructured interviews provided saturated data, which was then transcribed and coded to yield the central and sub-themes that were identified in this study. One central theme identified the fact that in their daily duties (at their place of work), caregivers experience various challenges as a result of having to deal with the death and dying of their patients suffering from AIDS. These caregivers face the death of their patients daily, from a disease that causes untold suffering to the patient, family members and to the caregivers themselves, who wish they could prevent the anguish, the pain and the inability of the medical profession to do more than they are at present towards curing this disease. ii By describing the lived experiences of these caregivers by means of the research interviews, the researcher gained a clear picture of the AIDS environment. The information shared by the participants formed the foundation of the broad guidelines that were formulated. These are intended to provide support for the caregivers centering around the equipping of mentors of the caregivers, to enable them to support the caregivers in their daily task of caring for patients dying from AIDS. These caregivers, thus supported, will then be in a position to provide optimal care for these dying patients. These broad guidelines are intended to provide support by focusing firstly on the physical environment in which these caregivers work; secondly in providing education for the caregivers to enable them to fulfill their duties, and thirdly to provide adequate counselling to ensure that they do not succumb to caregiver fatigue/burnout, a constant threat in this type of environment. The study concludes with recommendations regarding the areas of nursing practice, education and research.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2010
South Africa currently faces one of the highest HIV prevalence rates in the world. As this prevalence rises, the strain placed on its hospitals is likely to increase due to the shortage of beds. The devastating effects of HIV/AIDS initiated the establishment of a hospice which is a non-governmental organisation whose goal is the provision of care for terminally ill patients, either in their homes, in hospitals or in a hospice’s own in-patients wards. Part of the hospice’s mission is to offer palliative care without charge to anyone who requires it. The basic elements of hospice care include pain and symptom management, provision of support to the bereaving family and promoting a peaceful and dignified death. This also includes the provision of cooked foods to the patients using the kitchen facilities of the hospices for this activity. It is well known that the kitchen is particularly important in the spread of infectious disease in the domestic environment due to many activities that occur in this particular setting. Food and water safety is especially important to the persons infected with the human immunodeficiency virus (HIV) or with immunodeficiency syndrome (AIDS).It is estimated that food-borne pathogens (disease–causing agents) are responsible for 76 million illnesses, some resulting in death, in the United States alone every year. In one study of patients with AIDS, two-thirds had diarrhoeal disease and in two-thirds of these, the following enteric pathogens were identified: Salmonella, Shigella, Listeria, Yersnia, Cryptosporidium, Entamoeba histolylica and Campylobacter sp. In an epidemiological study of patients with HIV infection a close association was found between consumption of raw or partially cooked fish and antimicrobial-resistant Mycobacterium avium complex. Antibiotic resistance in food-borne pathogens has become a reality and this poses a serious threat to the medical fraternity since it diminishes the effectiveness of treatment. This study was undertaken to determine the prevalence of foodborne pathogens including bio aerosols isolated from the kitchen surfaces and food handler’s before and after cooking. The antibiotic resistance of the isolated pathogens was further determined to assess their impact on treatment. The following microbiota were isolated: Total viable counts (TVC), Coliforms, Escherichia coli, Staphylococcus aureus, Pseudomonas and presumptive Salmonella. The hospices had high counts of E.coli and S.aureus on the cutting boards for the breakfast session compared to the traditional home based kitchens. It was speculated that this could have originated from crosscontamination via the foodhandler’s hands and the food served. It is evident from the results that hospices lack a management system regarding the prevalence of E. coli as it was present on the cutting boards throughout the food preparation sessions. Gram negative organisms (coliform and P. aeruginosa) were in particular both resistant to oxacillin and this pose a great challenge in this particular setting. This can be addressed by putting emphasis on hygiene as a strategy per se for reducing antibiotic resistance.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Design in the Faculty of Informatics and Design at the Cape Peninsula University of Technology, 2012
Home-Based Health Care (HBHC) is the provision of health services and social assistance to individuals in their homes. It is an indispensable service to communities in need; presently in South Africa, these health care services are provided by local non-profit and non-governmental organizations. It is mainly targeted at poverty-stricken and under resourced communities and is an important aspect of healthcare in South Africa. A lot of communities in South Africa are still under-resourced and live in impoverished conditions. This is reflected in poor living standards characterized by unemployment, uneasy access to basic amenities, unequal distribution of wealth, poor medical facilities in rural communities, etc. The prevalence of the HIV/AIDS endemic has also worsened the situation. However, the South African government has constantly supported initiatives to enhance better healthcare in rural communities. This research presents a case study of caregivers working in Du Noon, an informal settlement in Western Cape, South Africa. Du Noon is overpopulated and home to lots of foreigners who have migrated in search of better living standards thus stretching an already over-burdened community. Naturally, this development supports poor health practices which encourage the spread of diseases within the community. Health facilities do not sufficiently cater for the ever-increasing healthcare demands and as such lots of people depend on NGOs such as SALT (Sharing Abundant Life Together) who through the help of caregivers and community workers have been providing for some of the healthcare needs of the Du Noon community since 2000. Findings reveal that although caregivers in this community have lots of stories to share about their work practices, they do not have a platform to share these stories. This research focuses on identifying processes involved in capturing these stories and moderating them into educative and entertaining visual contents for the purpose of sharing the stories within the community. Using qualitative research methods, empirical and field study provides the needed data as well as understanding of the multi-dynamism of this community. Data analysis is done through interpretive methods for the purpose of understanding the data collected and analysed during the research process. Finally, as a possible research contribution, the research concludes by examining how other technology can enhance the storytelling experience using interaction design methods that enables caregivers participate in the entire design process. Suggestions are also given as to direction for further research within the subject area.

M.A.
In sub-Saharan Africa the importance of understanding the illness and dying experiences of people living with HIV/AIDS (PLWHAs) is underlined by the fact that some 30 million people are already infected with HIV. Yet, there has been precious little research on chronic illness and dying within the sociology of health and illness. This dissertation begins to address this gap by considering the question ‘how does care of AIDS patients inform a sociology of illness and dying?’ It is argued that AIDS related chronic illness and dying are best understood within the AIDS care context. A theoretical model of quality AIDS care (QACM) was constructed, and highlights access, physical and psychosocial aspects of care. This was evaluated in relation to two South African hospices, both located on the Witwatersrand. In addition, a telephonic survey was undertaken in order to situate the two case studies within a national context of hospice-based AIDS-care. Some of the valuable refinements made to the literature QACM include new staff motivators, self-contained funding, additional dietary concerns, more cost-effective treatments, the importance of stigma, patient-patient support and the advent of hospice day-care centres. It was concluded that caregiver and patient needs must be met to ensure quality care provision. Three noteworthy conclusions were drawn. Firstly, the QACM was found to be a sound reflection of hospice AIDS-care reality. Secondly, the case hospices sufficiently subscribed to the required care standards, but improvements are warranted. Thirdly, and most importantly, the study highlights the impact of stigma on the chronic illness and dying experiences of PLWHAs. This study has taken a small step in the right direction by providing some sociological insights into chronic illness and dying, by the application of Northern-centric literature to the developing context of South African hospice AIDS-care. Further investigations may serve to bear these conclusions out, in alternative care settings, in order to further develop the sociology of illness and dying.
Prof. J.M. Uys Prof. P. Alexander.

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011.
Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support
M

This thesis explores home-based care volunteer (HBCV) identity and how it is shaped by context in rural KwaZulu-Natal, South Africa. The literature on home-based care in Africa is dominated by the "burden of care narrative" which is supported by the themes of "women as caregivers", "poverty" and "stigma". The literature presents government and stakeholder collaboration as the general solution to alleviating the burden of care on women caregivers. A wider scope for research within the themes is necessary to discover alternative solutions to the problem of the burden of care. This study ventured to expand the scope of current research by exploring the area of HIV and AIDS home-based care volunteer (HBCV) identity and participation in care and support. Fifteen HBCVs were interviewed about their work and personal life stories and interviewed reflexively using narrative interviewing. Findings indicate that the women's stories were dominated by narratives of gender, poverty and sociopolitical factors (social field narratives). Meta-narratives influencing the women's lives were stories of communal motherhood, aspirations to service-oriented work and religious beliefs and commitment. The women's personal life stories revealed that they saw themselves as distinctively caring. Connections between the different aspects of identity and context revealed that the women made sense of their community participation through their personal identities as strong and loving mothers and the association with the group identity of community mothering. Home-based-care volunteerism was explored as a form of agency in response to a lack of recognition, support and acknowledgement for AIDS caregivers and their patients. Researcher reflexivity through autoethnography and poetry contributed to achieving depth in the study and to the understanding that HBCVs strive for space recognition, acknowledgement and validation for their work. In a resource strained context a balance must be found between material compensation and respect and recognition which can be effective in sustaining community initiated volunteerism.
Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

South African palliative care volunteer caregivers play a crucial role in caring for people living with HIV and Aids, but frequently do not receive the support and respect that they deserve. The current study explored the psychosocial challenges and coping mechanisms of palliative care volunteer caregivers for people living with HIV and Aids. The researcher conducted in-depth interviews with 24 participants who also filled in questionnaires. The aim was to explore their experiences, their challenges, and coping mechanisms. Although these volunteer caregivers shared many positive experiences, they also faced multiple challenges in the workplace, their personal lives, financial challenges as well as psychological and emotional ones. Despite these challenges, the caregivers showed only moderate levels of stress on the stress scale. Recommendations for overcoming these challenges were provided to caregivers, organisations and the Department of Health
Psychology
M. Sc. (Psychology)

The objective of the study was to identify the factors that affect the survival lifetime of HIV+ terminal patients in rural district hospitals of Albert Luthuli municipality in the Mpumalanga province of South Africa. A cohort of HIV+ terminal patients was retrospectively followed from 2010 to 2017 until a patient died, was lost to follow-up or was still alive at the end of the observation period. Nonparametric survival analysis and semiparametric survival analysis methods were used to analyse the data. Through Cox proportional hazards regression modelling, it was found that ART adherence (poor, fair, good), Age, Follow-up mass, Baseline sodium, Baseline viral load, Follow CD4 count by Treatment (Regimen 1) interaction and Follow-up lymphocyte by TB history (yes, no) interaction had significant effects on survival lifetime of HIV+ terminal patients (p-values<0.1). Furthermore, through quantile regression modelling, it was found that short, medium and long survival times of HIV+ patients, respectively represented by the 0.1, 0.5 and 0.9 quantiles, were not necessarily significantly affected by the same factors.
Statistics
M. Sc. (Statistics)

South African health systems are struggling to cope with the HIV/AIDS pandemic. Home based care has become an invaluable resource that relieves overburdened and under-resourced hospitals. Home based carers provide basic nursing care and support to patients and their families, in the patient's home. Little is know about what motivates home based carers. Minimal research has been undertaken to investigate the expectations and experiences of these noble voluntary helpers. This study was conducted with a sample of home based carers at Community Outreach Centre, St Mary's, Mariannhill. Being field focused it used a qualitative research approach and participatory action research methodology. Focus group discussions were conducted with home based carers to explore their needs, motivations and expectations of Community Outreach Centre. The study enlightens us about issues related to home based care that directly affect them. Despite the painful realities of their lives, they appeared positive about serving as volunteer home based carers.
Social work
M.A. Social Science (Social Work)

This study addresses the effectiveness of communication between the team (doctors, sisters and social workers) and patients at the Breast Cancer Clinic of the Johannesburg Hospital. Tue needs of patients were highlighted, as well as the role of care-giver, both as a group and in their separate disciplines, in attempting to meet these needs. Tue empirical survey was carried out through the use of questionnaires as well as interview schedules. Patients, doctors, nurses and social workers were used as respondents. Results indicated that the majority of patients' needs for information and support were met by the team in general; however, a need for further social work intervention seemed to be apparent. In addition, several barriers were found to inhibit both team-patient and inter-team communication. Tue researcher used the information gathered in this study to make recommendations that will facilitate improved communication in the clinic, with specific reference to the role of the social worker.
Social Work
M.A.(Social Science: Mental Health)

Many of the caring tasks previously done by health care professionals are these days handled by caregivers. Caregivers are selected, trained and to a certain extend supervised. Little attention is however given to the effects that care giving has on their physical and mental health and own needs for caring and support. This study is an exploratory, qualitative and quantitative investigation into the effects of care giving on the physical and mental health of caregivers in HIV and AIDS programmes to determine their needs for ongoing support. A literature study was supplemented by an empirical investigation. The literature study and empirical investigation proved that care giving has a tremendous impact on the lives of caregivers. Recommendations resulting from the study are the need for more education and skills for caregivers, support through counselling, debriefing and support groups, policies and guidelines that makes provision for caregivers to be registered and receive a fixed income.
Social Work
M. A. ((SS)(Mental Health)Social Work)

The hospice volunteer is viewed as an integral member of a multidisciplinary team, with various roles directed at enhancing the quality of life of patients and their families. The purpose of this study is to provide an integrated picture of the hospice volunteer, their role, the human dimensions of this role and the impact this has on their lives as not much has been written in literature about this specific sub-group of hospice workers. The context of the study is a hospice in Gauteng where the researcher works as a volunteer. The ethnographic case study has been chosen as an appropriate research design as it explores the above phenomenon from the volunteers' point of view. The subjects are three volunteers who have been active at the hospice for at least twelve months. Evidence in terms of specific interviews and observations are used to draw conclusions. The interviews are based on a minimal number of open-ended questions. The primary method of analysis is the examination of transcripts from these in-depth interviews. A thematic analysis is carried out in which a detailed description of the emerging themes are given. Four major themes are identified and explored: Description of the role; The experience of being a volunteer; A way of coping; and The influence of the hospice culture. Sub-themes that emerge within each case study vary due to the individual nature of the experience of the role. Themes are explored in light of current theory and findings. This was to note the similarities and differences of this specific sub-group of volunteers compared to others found in the literature reviewed for this study. As there is a scarcity of literature pertaining specifically to hospice volunteers, the study depends mostly on writings pertaining to hospice staff and volunteers in general. A summary and integration of the core findings of the three case studies is given and their similarities and differences are explored. How some of the different themes interlink is also discussed. Although various sub-themes found in the individual case studies are significant to the individual cases, some of them can be incorporated into common themes when looking at the volunteers as a group. The strengths and limitations of the study are discussed as well as recommendations for the hospice organisation and further research.
Psychology
M.A. (Psychology)

The purpose of this study was to explore first year student nurses’ experiences of encounters with death and dying of a patient during clinical practice so as to make recommendations on increase support for first year student nurses. Qualitative research which was explorative, descriptive and contextual was conducted. Data collection was done using in-depth unstructured interview. Nine participants were interviewed and data was analysed. The findings revealed that lack of knowledge, emotional trauma, low self-esteem and nutritional disorder are the results of dealing with death and dying of patients for first year student nurses. Negative attitudes of clinical professionals, shortage of staff and congested block programme were identified as some aspects worsening the situation. Incidental learning that occurs with negative experience encountered was also identified. The findings show the need for review of curriculum for first year student nurses and the need for change of attitudes of clinical professionals
Health Studies
M.A. (Health Studies)