Doctoral Degrees (School of Nursing)

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Browsing Doctoral Degrees (School of Nursing) by Subject "AIDS (Disease) -- Nursing"

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    Models of care for antiretroviral treatment delivery : a faith-based organization's response
    (University of the Free State, 2012-04-14) Wilke, Marisa; Botma, Y.; Stark, R.; Van Rensburg, H. C. J.
    Background: Since 1849, Catholic religious have provided health services in South Africa. They have established hospitals, clinics, and have provided community-based preventive and curative services throughout the country. Today faith-based organizations (FBOs) continue to play an important role in healthcare delivery and are crucial to the goal of providing universal access to antiretroviral therapy (ART). In order to scale up HIV care and treatment, there is a need to describe and analyze ART models of care (MOC) that address the challenges faced by developing countries. The South African Catholic Bishops’ Conference (SACBC) manages twenty ART clinics in medically underserved South African communities, where the need is great, but the resources limited. These SACBC managed ART clinics operate on different MOC. A study to describe, analyze and compare the different MOC can inform future directions in healthcare delivery in resource-constrained settings. Method: A single case-study design was used to describe, analyze and compare four different MOC (managed by the SACBC) for ART delivery, as embedded units of analysis. A mixed method approach was used, incorporating qualitative and quantitative information. Data were collected using structured interviews (n=1,006 adult ART patients), file audits (n=1,006 files of the respondents), semistructured interviews (n=27 healthcare workers) and nominal groups (n=12 groups with Home Based Care-workers). Descriptive and inferential data analyses were conducted by a biostatistician from the Department of Biostatistics at the University of the Free State and the researcher. Findings: In the study, patients accessed care late (CD4=119 cells/mm3). Decentralized care provided better access. Family members are a potential source of support because disclosure rates to relatives and others were high (95.63%). Nurse-driven, doctor supported care was not inferior to doctor-driven care. Task-shifting to registered nurses and HBC-workers can be implemented successfully with support. Differences exist between the South African Government (SAG) -managed model and the FBO–managed models. Partnership between the SAG and FBO strengthened the SAG-managed MOC, while capitalizing on the sustainability of the government services. Functional information systems, developed by the FBO, were implemented at all the MOC in 2009. All the MOC focused on acute care. Conclusions: Nurse-driven decentralized service can most effectively and appropriately address the chronic nature of HIV and strengthen the healthcare system by a paradigm shift to a chronic care model. Based on the findings, a chronic care model was adapted for South Africa that has seven elements: (1) an integrated, decentralized chronic care system based within a primary health setting; (2) partnerships with NGOs; (3) an effective information management system; (4) patients and their families; (5) self-management support to patients; (6) provider decision support and (7) delivery system redesign. Implications for the nursing profession include adaptation of focus and training, as well as the recognition of the nurse practitioners/specialist role in South Africa.
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    ItemOpen Access
    Verpleegsorgbehoeftes van HIV positiewe pasiënte
    (University of the Free State, 1996-05) Basson, Petro Magdalena; Van Rhyn, W. J. C.; Viljoen, M. J.
    English: HIV infection causes AIDS, a communicable, stigmatised and terminal disease. It leads to the progressive deterioration of the immune system that ends in death. HIV infection affects the total human being. Never in history were health care workers so drastically challenged to look beyond an illness and to take on a holistic approach to health, as in the case with AIDS. The research was done in two phases. The first phase was the reconnaissance and description of HIV positive patients' nursing care needs as well as nurses' view thereof. The selection of nurses and patients were done by purposiveness selection. The researcher has established the nursing care needs of the HIV positive patient in the study by in-depth interviews. Nurses' views of the nursing care were also obtained through in-depth interviews. Interviews were recorded on tape and were transcribed afterwards. Data analysis was done according to Giorgi's model. After data analysis had been done, the results were controlled and verifted with the literature. The abovementioned processes were completed according to the philosophic foundation of the researcher, namely the Christian anthropology. Several needs and problems of the HIV positive patients with regard to their nursing care were identified. Nurses also experienced problems in the delivery of their nursing care. The primary problems that nurses experienced were, a lack of information about HIV and AIDS as well as limited time to deliver quality nursing care. Phase two: From the gathered information from HIV positive patients, nurses and literature, a nursing care model was compile to provide in the needs of the HIV positive patients. The model makes provision for application in any stage of AIDS. The family, community, resources and the multi-disciplinary team fugerate in this model. The nurse is the key role player in the model. The model is framed by the 15 aspects of Dooyeweerd and therefore shows that the HIV positive patient is nursed according to the holistic approach. The description and reconnaissance of the concepts applicable to the model were done according to the theory generated by Marriiler-Tomey,(1989:5), Woods and Catenzaro (1988:20), Walker and Avant (1988: 10) and Kim (1983: 131). This middle range theoretical model was compiled to ease the task of the nurse in practice and also to deliver quality nursing care to HIV positive patients.