Doctoral Degrees (Nursing)

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An analysis of nurse managers' human resources management related to HIV and tuberculosis affected/infected nurses in selected hospitals in KwaZulu-Natal, South Africa - an ethnographic study.
(2014) Kerr, Jane.; Brysiewicz, Petra.; Bhengu, Busisiwe Rosemary.
INTRODUCTION: Providing sufficient quality nurses in resource strapped countries is a human resource management challenge which nurse managers’ experience on a daily basis. THE PURPOSE of this study was to analyse and to determine the issues which affect the the human resources management of nurse managers in selected hospitals in the eThekwini District of the Province of KwaZulu-Natal, South Africa, and to formulate draft guidelines to assist nurse managers with human resource management. METHODOLOGY: A constructionist, reflexive ethnographic approach was used. The ethnographer spent two years in the field collecting data from informants, who were nurse managers, in four (4) selected district hospitals. Data was collected using unstructured informant interviews, non-participant observation and confirmatory document analysis. Data analysis led to eliciting codes from the data, searching for semantic relationships, performing componential analyses and discovering the themes for discussion within the final ethnographic report. A nominal group process was used to develop the draft guidelines. FINDINGS: The findings showed that the human resources management around sick nurses is a complex task. The themes of nurse managers’ experiences were a “burden” of maintaining confidentiality, as well as an emotional burden. Administratively, they experience the burden of absenteeism and the burden of policy compliance. The final theme is the burden of the deaths of HIV and Tuberculosis affected/infected nurses. CONCLUSION AND RECOMMENDATIONS: Organizations should create a non-judgmental work environment where non- disclosure by employees is respected in order to promote disclosure. They should have an awareness of the emotional effect on nurse managers and provide them with support. Emphasis needs to be placed on an HIV and AIDS policy and programme, incapacity leave workplace strategies and return to work policies. It is also recommended that contingency plans be provided when the death or prolonged absence of an employee impacts the staffing of the organization; consideration to be given to piloting and refining the draft guidelines; the management of employees on prolonged sick leave be included in the Nursing Administration Curricula taught to future nurse managers; and further research be conducted to assess employee reluctance to report needle stick injuries (sharps injuries) as well as the related phenomenon of stigmatization.
Developing an intervention model to manage caregiver burden experienced by family caregivers of patients living with end-stage renal disease in Nigeria.
(2017) Oyegbile, Yemisi Okikiade.; Brysiewicz, Petra.
The purpose of the study was to develop and implement an intervention model to manage caregiver burden experienced by family caregivers of patients with End-Stage Renal Disease in South-West Nigeria. The model that was developed may be used by nurses to assist these family caregivers. Methodology Using an action research process, a complementary mixed-method data collection strategy explored and described the extent of caregiver burden, and described family caregivers’ experiences of caregiving. With assistance from the research team, 96 participants were selected for the quantitative aspect of the study, and 15 for the qualitative aspect. Through the cyclical nature of the action research, establishing and exploring the experiences of family caregivers later resulted in the emergence of the crucial concepts and the development of the model. The knowledge process development of Chinn and Kramer (2011) guided the development of an intervention model, and the model implementation process was facilitated by the use of an implementation checklist. Findings On measuring the caregiver burden, the family caregivers experienced moderate to severe burden in all domains of care. Family caregivers’ descriptions of their experience of family caregiving led to the identification of five categories, namely: disconnectedness with others and self; never-ending burden; “feeling like “a fool being tossed around”; obligation to care and promoting a closer relationship. The diagrammatical model to manage caregiver burden resulted from the collaboration of the research team members, and the crucial concepts emerged from the integration of the findings from the study and the interrogation of the existing literature. Model implementation was not evaluated and feedback from nurses and family caregivers indicated that they were excited that the process helped them to manage their burden as caregivers. Conclusion and recommendations Family caregivers’ need for support should be addressed when they begin caregiving, and then subsequently as they continue to provide care, so that they their health is not compromised. There is a need for the implementation and evaluation of this model to assist family caregivers cope with the challenges of prolonged caregiving.
The development of an intervention model for managing abrupt death trajectories in KwaZulu-Natal level 1 emergency departments.
(2004) Brysiewicz, Petra.; Uys, Leana Ria.
AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's.
The development of an intervention model to manage secondary traumatic stress in mental health workers in Rwanda.
(2010) Iyamuremye, Jean Damascene.; Brysiewicz, Petra.
Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress.
An exploratory study towards disclosure of status and reduction of stigma for people living with HIV/AIDS in a low income community : the development of a community-based framework.
(2010) Razak, Ayisha.; Bhengu, Busisiwe Rosemary.; Brysiewicz, Petra.
Introduction: Stigma associated with HIV/AIDS creates a barrier to prevention, care and treatment of HIV/AIDS. It further restricts PLWHA from learning about their status, disclosing their status, adopting safe behaviour and accessing services such as antiretroviral treatment. Disclosure of HIV status and a reduction in stigma may contribute to the decrease in new HIV cases. Purpose: The purpose of the study was to develop a community-based framework that would encourage people living with HIV/AIDS to disclose their HIV status and reduce the stigma associated with the disease. Method: This study used the action research method to explore the experiences of stigma and disclosure of HIV status and to develop a community based framework with PLWHA who encouraged disclosure and promoted the reduction of stigma in a community-based setting. The research setting was Bhambayi, an informal settlement in the district of Inanda. Non-probability purposive sampling was used. In-depth interviews with PLWHA that had disclosed their HIV status and focus group discussions with family members, adult children and community members were conducted. Findings: The data was analyzed manually and the following categories and subcategories emerged. The categories were experience of disclosure, stigmatizing reactions, lifestyle changes after disclosure and supports to reduce stigma. Some of the sub-categories were ‘opens out the illness’, gossiping and pointing fingers, discrimination against PLWHA by family and community, changes in relationships, community awareness and formation of support groups. The findings revealed that PLWHA that had disclosed their HIV status had changed their lifestyles. Recommendations were made on the need for nurses to develop community engagement projects and establish partnerships in order to reach out to communities regarding HIV/AIDS. Incorporate HIV/AIDS stigma and discrimination into the current nurses’ curriculum. The need for research is expressed on the evaluation of the framework and conducting similar research in larger communities. Conclusion: PLWHA who had disclosed their HIV-status shared their experience of being HIV-positive and encouraged other people to get tested. The community-based framework to facilitate disclosure and reduce stigma among PLWHA can be operationalised in other informal community-settings.
Management of the long term psychological effects of rape among women survivors of the 1994 genocide in Rwanda : a grounded theory approach.
(2013) Mukamana, Donatilla.; Brysiewicz, Petra.; Collins, Anthony John Louis.
In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi women. This study explored the long term psychological effects of rape experienced by these women in order to develop a middle range theory to guide the management of the lasting psychological effects of rape in the context of genocide. A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin, 1990) was used. Data collection entailed in-depth interviews of twenty nine participants, twelve of whom were rape survivors, ten were women who had not been raped, and seven were men from their community. Open coding, axial coding and selective coding were used to analyse the data. The results have shown that women were negatively affected, physically, psychologically and socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness, somatic distress, negative self-image, altered intimate relationships and social isolation. The extreme brutality, the humiliation that accompanied the experience of rape and multiple losses were reported as risk factors for the lasting psychological effects of rape. These negative outcomes were maintained by poverty, poor physical health, the burden of raising the children born of rape, hostility and stigma from their community, and lack of appropriate support and effective health care services. Facilitating the management of Genocide Rape Trauma emerged as the core category of the middle range developed theory. Recovery from Genocide Rape Trauma required formal and informal support, including psychological and medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic empowerment was a key element, while educating the community contributed to the social integration of rape survivors and their children born of rape into their community. Women had developed coping mechanisms of their own to attain psychological relief, and had organized themselves into support groups. This study contributed to clinical practice by providing a holistic approach to taking care of rape survivors. The inclusion of such theory in the curriculum of health care professionals should contribute to the understanding of the lasting impact of rape and how to handle it in an efficient manner. Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of the long term psychological effects of rape and Grounded theory.
Residential care for the elderly in eThekwini Metropolitan Municipality : a case study approach.
(2010) Dolo, Meiko Josephine.; Brysiewicz, Petra.; Adejumo, Oluyinka.
Aim: This study explored and described residential care for the elderly in eThekwini Municipality in terms of the organizational structure, staff and residents, and determined how those factors influenced elder care. This was aimed to make recommendations for residential care in eThekwini Metropolitan Municipality. Methodology: A descriptive explorative case study design, using both quantitative and qualitative approaches was adopted for this study. The study participants included eight administrators, twenty elderly residents and thirty nursing staff from four residential care facilities (RCFs) in eThekwini Municipality, Durban. Data were collected through interviews, questionnaires, record review and observation based on the structure, process and outcome of the study's conceptual framework. Qualitative data were gathered from administrators and elderly residents. The data were transcribed and analyzed manually using Framework Analysis (Ritchi & Spencer, 1994). Quantitative data was obtained from nursing staff using questionnaires, and analyzed using SPSS. Findings: Administrative fmdings followed the structure, process and outcome of the study. The structural findings were focused on facility philosophy and human-material resources, as well as on emerging themes from the data. The emerging themes from facility philosophy were assisting vulnerable people across age groups, document review, quality indicators, admission criteria and reasons for admission to each facility. Emerging themes from human-material resources were fmancial sustainability, staff-resident ratio and material resources. The process findings were focused on care and service delivery to the elderly and the emerging themes were one big family, incidence of abuse, methods of elder care and service delivery, knowledge about elder care, relationship of control, being there, gentle restraint, setting boundaries with the residents, medication safety, common religious belief and resident satisfaction. Findings from the outcome were focused on success and challenges of elder care, experiences of the elderly and nursing staff care experiences. Thus, emerging themes from success and challenges were strong bond, retaining staff, maintenance of physical structure, location of care centre; success and its dependence and challenges of procuring basic medical equipment. Findings from experiences of the elderly were reasons for admission, relationship, experiences of the elderly, response shift, psychosocial support and satisfaction with care, cultural belief and well respected. Emerging themes from nursing staffs experiences of caring for the elderly was mainly focused on their professional knowledge about elder care. Details of these findings are written down in Chapters Four and discussed in relation to literature in Chapter Five. Conclusion: The study concluded by making recommendations for the care of the elderly in -RCFs in eThekwini Municipality in line with the findings of the study. The recommendations have implications for the government, policy makers, nursing education and nursing research. Moreover, those concerned are encouraged to adopt and use the recommendations where applicable to promote residential care quality for the elderly in eThekwini Metropolitan Municipality.

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Browsing Doctoral Degrees (Nursing) by Author "Brysiewicz, Petra."