3. Electronic Theses and Dissertations (ETDs) - All submissions

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    The Role of Social Support in the Relationship between Exposure to Traumatic Stressors and Posttraumatic Stress Symptoms in a Sample of Emergency Care Practitioners
    (2007-02-22T12:54:15Z) Basedau, Natascha Tanya
    The present study served to investigate the way in which continuous exposure to potentially traumatic incidents impacts on the South African Emergency Care Practitioner (ECP). The study sought to investigate the presence of symptoms of posttraumatic stress (PTS) in the sample and the events which appear to pose the greatest threat to these ECPs’ mental health. The notion that individuals exposed to the same traumatic stressors can present with very different posttraumatic responses has led to the acknowledgement that the relationship between exposure and PTS is a complex one. Studies have examined a multitude of variables believed to impact in some way on this relationship, with particular emphasis on individual appraisals and coping styles. Less attention has been afforded the role of social phenomena in the development of posttraumatic stress disorder (PTSD). The attention that has been afforded these phenomena has tended to examine social support as a unidimensional construct, and studies have often measured different social support conceptualisations. Utilising a recognised psychosocial framework, the present study sought to investigate the impact of social support in the relationship between exposure and PTS. It sought to examine three distinct facets of social support, namely: the appraisal of being supported, the perception of available supportive behaviours from family and friends, and an individual’s orientation towards utilising support. The study used a cross-sectional, correlational design to investigate the relationships between exposure, PTSD symptoms and social support. The procedure involved the anonymous completion of several standardised self-report measures by 107 ECPs from Netcare 911, a private South African emergency care organisation. These measures included a revised version of the Paramedic Work Exposure Checklist (PWEC), the Revised Impact of Event Scale (RIES), the Social Support Appraisals Scale (SS-A), the Social Support Behaviours Scale (SS-B) and the Network Orientation Scale (NOS). The events that tended to be rated as having the most negative emotional impact among respondents involved assisting abused or injured children, witnessing the death or injury of a coworker, assisting victims of sexual assault, dealing with equipment failure or the incompetence of others and receiving inadequate or incorrect information when dispatched on a call. The correlational analyses revealed that exposure to events rated as having a negative emotional impact was significantly and positively associated with symptoms of PTSD in the sample. Correlational analyses also revealed that each of the facets of social support measured was significantly negatively associated with symptoms of PTSD. The results indicate that the mode and source of support most significantly associated with symptoms of PTSD in the sample was the perception of available emotional support from friends. In spite of the direct relationships observed between symptoms of PTSD and the facets of social support examined, none of the social support facets investigated emerged as a significant buffer in the relationship between exposure and PTSD. The study highlights the need for additional research, including longitudinal investigation, into the role of multiple facets of social support in the relationship between exposure and PTSD. Some suggestions for future research and the practical application of the findings of the research are offered.
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    A Study to Determine if South African Medical
    (2006-10-25T07:58:13Z) Van Niekerk, Diederik Johannes
    The prescription habits of general practitioners are continually under the scrutiny of ethical critics. There are numerous factors that influence a practitioner’s decision as to which antihypertensive agents to prescribe for the treatment of hypertension. As outlined in various international and national guidelines for the management of hypertension, the recommended treatment depends on ethnicity, current life-style, diet, smoking, age, gender, family history and possible underlying or secondary conditions such as diabetes mellitus, heart failure, isolated systolic hypertension, myocardial infarction, pregnancy, and evidence of coronary artery disease (CAD), stroke or peripheral vascular disease. Currently the control of blood pressure in patients with hypertension is far from optimal with over 70% of hypertensive patients being reported as having imperfect control. A number of factors related to the patient, the practitioner or the medication may explain the high incidence of inadequate blood pressure control. One possible explanation for the poor control of blood pressure may be that practitioners fail to comply with the guidelines. Hence the aim of my study was firstly to determine whether a practitioner’s decision as to which medication to prescribe in the treatment of hypertension is influenced by the Southern African Hypertension Society Guidelines. Secondly, in an attempt to assess the validity of the results of the primary analysis, the actual prescription habits (MediCross® database) were assessed and compared to the general practitioner’s recall of their prescription habits. Questionnaires were distributed to 320 MediCross® practitioners and prescription habits were identified and substantiated by the screening of an existing MediCross® database. I chose as my sample MediCross® general practitioners, as they are demographically representative of all major urban areas in South Africa; likely to be open-minded to supporting research and answering questionnaires (as MediCross® is part of a Clinical Research Site Management Organisation); and I had access to the database of the prescriptions made by MediCross® practitioners hence enabling me to fulfil my second objective. However, it must be kept in mind that these practitioners are representative of general practitioners in urban areas only (as the title of my research report indicates). My results show that 33.1% adhere to the guidelines (when a non-conservative definition of diuretics is used); 27% have heard of the guidelines and have a copy of them. When asked to give their own opinion however, 39% thought they adhered to the guidelines. The results also show that ACE inhibitors are the most commonly prescribed drug class for uncomplicated hypertension but a comparison to a MediCross® database, of which the quality is questionable, does not support this. As the response rate to the questionnaires was only 24.7%, these results are only a pilot study; however they suggest that few general practitioners use the guidelines or even have a copy of the guidelines. This pilot study suggests that the guidelines need to be distributed more widely. Furthermore the general practitioners that responded to the questionnaire indicated that the management of hypertension is difficult in that there is no single treatment regimen appropriate for all populations and each different - 5 - patient. It was also their view that clinical guidelines for the management of hypertension should more accurately reflect the uncertainty of when to initiate treatment and individual variation if they are going to take these guidelines seriously and comply with them.
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