3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Attitudes of doctors working in emergency departments in the Gauteng area towards family witnessed resuscitation(2011-03-16) Gordon, Evelyn DawnResuscitation of patients, be it medical or surgical, occurs on a daily basis in the Emergency Department. The resuscitation is usually pressurised and frantic, as a result family members are escorted out of the resuscitation room to a waiting room where they are isolated from the resuscitation. Since the late 1980’s the practice of Family Witnessed Resuscitation (FWR) has been explored1. FWR means that family members are invited into the resuscitation area whilst the medical team is attempting to resuscitate the patient. This practice has often been suggested but the opinions of medical staff remain varied 2,3,4. Resuscitation as discussed in this report is the medical proceedings that occur at a time when a patient presents with a life threatening emergency, be it medical or surgical, to an emergency department and the medical staff are unsuccessful in re-establishing respiratory efforts and cardiac output to maintain life. A review of the literature indicates that FWR is a means of the family gaining closure when the resuscitation is unsuccessful by observing the process of resuscitation and having their family member’s last moments clearer and more defined in their memory. The decision of FWR is one that needs to be taken by the family after the invitation has been extended by the medical team leader. There needs to be nursing staff available to be in attendance with the family at all times to answer their questions and explain procedures. The views of practitioners surveyed on FWR tend to vary, but irrespective there is a recurrent theme regarding the concerns expressed by emergency room doctors towards FWR. These concerns include traumatisation of the family, increased stress being placed on the medical team to perform while being watched, possible family interference with the resuscitation and the possibility of medico-legal consequences. These concerns are not simply regional but seem to be universal. This study sampled two groups of doctors: Doctors actively working in emergency departments in the Gauteng area in Medi-Clinic and Life Healthcare facilities. These are private healthcare facilities. Doctor participants in the University of the Witwatersrand, Faculty of Health Sciences Master in Science in Emergency Medicine programme. These doctors work in emergency departments in both the private and provincial sectors. This study found that there is not complete acceptance of FWR; 48 out of the 101 doctors in the sample had never considered allowing family to witness resuscitation. Doctor’s opinions vary regarding which family members, if any, they would allow to witness resuscitation, at which point in the resuscitation process they would allow family into the resuscitation area and how many family members would be permitted into the resuscitation at any one time. The opinion in this study was that due to space constraints no more than two family members would be allowed in the resuscitation area at any one time. Training and continued professional development seem to impact positively on the practice of FWR. The attendance at American Heart Association (AHA) courses such as Paediatric Advance Life Support (PALS) and AHA Acute Cardiac Life Support (ACLS) positively influences the doctors’ acceptance of FWR. Should death occur due to the acute life threatening emergency and resuscitation attempts are unsuccessful then FWR assists family in coming to terms with the death of a relative and is seen by the public to make the resuscitation a more humane process. The literature review and findings of this study concur that FWR is a practice that should be occurring in emergency departments. Some nursing councils have drawn up guidelines and mission statements that will ensure FWR is common place in the Emergency Departments (Appendix 1). If FWR is to become common practice then emergency departments need to be encouraged to draw up protocols and have processes in place that ensure that this process is performed in a way that allows staff to operate efficiently and the family to gain the most they can from a grave situation. The emergency medicine doctor that is in charge of the patient needs to be aware of the protocols and procedures that are in place in order to be able to facilitate FWR. In studies from KwaZulu Natal5, Western Cape6 and this study from Gauteng show that no unit in South Africa has policies yet. This study found that although FWR is currently not common practice in emergency departments in the Gauteng area, it is a practice that emergency doctors are willing to encourage in the future. The doctor’s attitude toward FWR is influenced positively by attendance at AHA PALS and AHA ACLS courses and the experience of the doctor of working in the emergency department. Doctors do have some concerns about the practice including psychological traumatisation of family members, extended length of resuscitation and medico-legal complications. It was found that parents would be the family members that are most likely to be invited by the medical team to witness the resuscitation of a family member and that the doctor would restrict witnesses to two family members only. It would seem that FWR will start occurring in emergency departments.Item The multiple formations of identity in selected texts by William Faulkner and Tennessee Williams(2009-09-18T11:56:26Z) Malan, MorneABSTRACT This project compares and contrasts the ways in which selected texts by William Faulkner and Tennessee Williams render their fictional figures as modern subjects engaged in the complex processes of identity-formation and transformation. These processes are deeply rooted within the context of the American South. The interrelatedness of identity and language is explored by investigating how these texts dramatize selfhood not as an essential or homogenous state, but as a perpetual process of self-fashioning and play amid multiple positionings. The central hypothesis is that identity manifests itself necessarily and continuously as a textual discourse in and through language, and that self-fashioning gives rise to ethical questions, because identity involves not only the subject’s relation to the self, but also his or her relationships with others in closely interwoven personal, familial and communal-cultural bonds. This ethical dimension underscores the relational aspects of selfhood, that is, the notion that the individual is always situated inextricably within the social, and that the fashioning of the self is thus inconceivable without a consideration of the other. The following pairs of texts are compared: As I Lay Dying and The Glass Menagerie; The Sound and the Fury and Cat On A Hot Tin Roof; Light in August and A Streetcar Named Desire.Item Diaspora and displacement in the fiction of Abdulrazak Gurnah(2007-02-23T13:07:38Z) Ajulu-Okungu, AnneThis study examines the effects of diaspora and displacement in characters as presented in Abdulrazak Gurnah’s Paradise, Admiring Silence and By the Sea. It looks at the role played by these effects in the construction of ideas of home and identity in the characters. Displacement is studied here against a backdrop of a long history of movements brought about by trading activities, exile and voluntary migrations. The texts are set in the east African coastal region, the islands and in Western countries such as England. The study relies on theories of postcolonialism and diaspora for its reading. The introduction places Gurnah’s work within the postcolonial archive by looking at his stance against the existing postcolonial discourses. It is also of importance to consider Gurnah’s biography and attempt to relate this to the view he takes as he narrates this geographical space in a postcolonial era. Chapter two looks at ideas of home as posited by different theorists in relation to the displaced and scattered characters he presents in these texts. Chapter three is concerned with how characters construct their identities against the ideas of ‘otherness’. In this chapter, I argue that Gurnah’s ideas of ‘otherness’ operate outside the (post)colonial idea of the same where the other is defined purely by difference in race. In chapter four I examine the significance of the preponderance of violence in the families presented by Gurnah. I investigate the connection between this perpetration of violence in the family and the idea of an elusive ‘paradise’ which runs through all Gurnah’s texts. The conclusion summarizes my major findings about Gurnah’s presentation of diaspora and displacement in the East African coast and the islands, and how he uses different structures like the home, self and the family to do this.Item Married Couples’ Understandings of Family Planning and their Communication Processes(2006-11-14T11:32:15Z) Chitavi, Salome OmuyomaThis dissertation examines husbands and wives’ understandings of family planning and communication processes. It examines family planning approval, knowledge of contraceptives and motivations for contraceptive use by husbands and wives. The study provides insights into these variables as held by husbands and wives and implications for contraceptive use. The dissertation also provides insights into the nature of communication processes while relating this to couples’ inconsistencies noted from quantitative data, their marital and reproductive history, and contraceptive use implications. The study uses KDHS 1998 survey Western Province couples’ data set that includes 176 married couples. The study further uses data from Focus Group Discussions conducted amongst husbands and wives in Vihiga District of Western Kenya. The study notes that variables such as contraceptive knowledge, approval of family planning and spousal family planning communication continue to have inconsistent and unclear relationship with contraceptive use. The study argues that these variables are not simply related to contraceptive use and need further examination using qualitative methodologies. The culture and political-economy of fertility conceptual framework and its various aspects of levels, process, causality, time and methodology is applied in the examination of husbands and wives’ understandings of family planning and contraceptive use communication between spouses. The findings of this study reveal that family planning understandings by husbands and wives including knowledge, attitudes and motivations for contraceptive use and spousal family planning communication are related to contraceptive use yet the relationship remains complex and can be understood through examining how different contextual levels and processes enhance varied notions of these factors as held by husbands and wives in relation to contraceptive use; the timing in terms of couples’ marital and reproductive history; the various socio-cultural and politicaleconomic processes surrounding the couples and the individual agency of the husband and wife in pursuing their fertility goals. While none of these factors adequately predicts contraceptive use on their own, an examination of husbands and wives within such a framework provides a better linkage to potential for contraceptive use or lack of it at married couple level. Thus while knowledge or approval of family planning perse fails to provide a clear or consistent link to contraceptive use, the study highlights the various notions of knowledge including individual husbands’ and wives’ perceptions about own knowledge of family planning; and differences in approval ranging from widespread general approval in line with community perceptions, twin perceptions of approval and disapproval common at individual level and disapproval of family planning and the fact that these may change across reproductive histories are factors within the concepts of family planning knowledge and approval that provide better understanding for potential for contraceptive use. The study therefore provides further insights regarding how husbands and wives understand variables commonly related to family planning and varied implications for contraceptive use. With regards to communication, the study underlines that spousal family planning communication is not simply linked to contraceptive use. Instead spousal family planning communication is a complex process informed partly by husbands’ and wives’ understandings of family planning; their perceptions of own knowledge regarding contraceptive methods; their various motivations for family planning involvement and their gender based relationship and perceptions of dominance. The study highlights various forms of spousal family planning communication processes and implications for contraceptive use. This study further argues that the potential of spousal family planning communication’ complex relationship with contraceptive use is related to the nature, timing, content of the communication processes and the agency of the individual husband and wife in influencing spousal family planning communication and decision making. The thesis ends with conclusions and provides recommendations for family planning programs and future studies while highlighting limitations of this study.Item The effect of family structure on the sexual behaviour choices of female adolescents in South Africa(2006-10-31T12:30:42Z) Crosby, Laura CandiceThe sexual behavioural choices made by adolescents is a salient issue in South Africa. The practice of risky sexual behaviour puts one at risk of unwanted pregnancy, STI and HIV infection. These behaviours affect one not only physically but mentally as well. Adolescence is a “turbulent” time in ones life and risky sexual behaviour makes this period all the more difficult and could result in disastrous consequences. This is due to the fact that sexual health and sexual practices of adolescents has implications for morbidity and mortality rates in South Africa. In order to address the issue of risky sexual behavioural choices made by adolescents, this study has examined the effect of family characteristics on adolescent sexual behavioural choices. The 1998 South African Demographic and Health Survey data was used. The data set was a nationally representative data set with a probability sample of 12000 women aged 15-49 taking part in it. Analysis for this study was based on 2373 female adolescent respondents aged 15-19. The association between individual and family background characteristics and risky sexual behavioural choices was examined. Crucial variables were extracted and fitted to logistic regression models. The study found that 47% of the female adolescents were sexually active. Of these, only 15% used a condom at the last sexual encounter despite the fact that 78% had a high degree of knowledge concerning HIV and condom use. South African adolescents are thus engaging in risky sexual behaviour. The family household structures in which adolescents reside was found to be associated with risky sexual behavioural choices. Sexual activity is strongly associated with socioeconomic status of the family. Condom use and HIV & contraceptive (condom) knowledge was found to be less strongly associated with the socio-economic (financial) status of the family but rather the social processes and relationships within the family are speculated to have a greater effect. The need for a more in-depth analysis with reference to family processes and relationships is recommended in order to properly understand the familial effect on sexual behavioural choices. The findings from this study have implications for reproductive health and reproductive rights policies. Appropriate national strategies are needed to reduce risky sexual practices and thus ensure lower morbidity and mortality among South African youth.Item Caregiver experiences and perceptions of the effects of stroke on the family within the South African context(2006-02-14) Felemengas, MaryBackground: With the increasing prevalence of stroke in developing countries, like South Africa, the long-term care of stroke patients living with disabilities has substantial consequences for caregivers and their respective families. Method: This study investigated caregiver perceptions of their experiences, as well as familial implications due to the incidence of stroke within the family system. The assessment, in the form of a semi-structured interview, described the experiences post-stroke as perceived by six primary caregivers. It additionally addressed the challenges the South African context adds to these experiences. This was conceptualised within a systems and biopsychosocial framework, enabling the caregiver and family to be considered in a comprehensive and holistic manner. Results: Prominent themes associated with the caregiving of a stroke patient included: role changes, relationship disruptions within the family system, occupational and social implications, fatigue, anxiety, depression, as well as financial problems. An additional sub theme was that the emotional impact on the family system was greater in cases where younger children were involved. However, social support increased the caregivers’ ability to cope and this additionally assisted the rest of the family in their adjustment. Caregiver experiences were exacerbated by the inadequate support structures available within the South African context, with the lack of post-stroke education being an issue of great concern. Conclusions: Practical implications of this study are discussed, along with considerations of the limitations of the study and suggestions for future research.