Browsing by Author "Dick, Judy"

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    Exploring tuberculosis (TB) patient's adherence to treatment regimens and prevention programmes at a public healt site
    (2006) Naidoo, Pamela; Dick, Judy
    The aim of this study was to explore the factors that contribute to TB patient's adherence to the Directly Observed Treatment Short-Course (DOTS) strategy and the factors that serve as barriers to adherence. The study was set in a historically disadvantaged township, KhayeIitsha, a sub-district of the City of Cape Town in the Western Cape Province. A qualitative, phenomenological research design, which is part of an ethnographic tradition, was used.
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    The role of the professional nurse in providing continuity of care for geriatric patients at Groote Schuur Hospital
    (1982) Dick, Judy; Watermeyer, G S; Meiring, P de V; Jacka, Ethnee
    Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.
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    Treatment adherence among primary care patients in a historically disadvantaged community in the Western Cape : a qualititative study
    (2005) Kagee, Shaheen Ashraf; Dick, Judy
    The question of treatment adherence remains a concern that affects the health outcomes of patients attending public health clinics in South Africa. Patients with chronic illnesses who reside in impoverished communities face particular challenges in terms of managing the often complex aspects of their treatment. The sample for the study was selected from patients diagnosed with diabetes or hypertension attending public health clinics in the Boland area of the Western Cape. A total of 23 patients between the ages of 32 and 80 participated in the study. All participants were Afrikaans-speaking had been classified as Black or "Coloured" under the apartheid system and as such were all historically disadvantaged. Participants were selected by means of convenience sampling and were asked to participate in qualitative interviews under confidential conditions. The interviews addressed various aspects of the participants' experience of their illness and treatment and were conducted by two trained interviewers. Interviews were recorded, transcribed, and entered into Atlas.ti, a computer programme that assists in the analysis of textual data. The analysis of the data focused on the content of participants' concerns and difficulties associated with adhering to treatment recommendations. The themes that emerged from the study included participants' attribution of the origin of their illness, their experience of their illness and of the health care system, their own concerns about the consequences of poor adherence, financial and problems, psychosocial support, spirituality, alternative medicine, and patients' own understanding of the symptoms of poor adherence. The results of the study are discussed in terms of the often hierarchical relationship between health care workers and patients. Public health care workers often hold sceptical and suspicious views about their patients regarding their illness, symptoms, and level of adherence. As such, patients may be regarded in a paternalistic manner and in some cases even be admonished by health care workers for poor adherence. Yet, competing social realities often inhibit patient adherence. These include financial constraints, being labelled a patient, side effects of medication and family opposition to treatment. Adherence may also be related to the notion of responsibility for the causes of and solutions to medical problems. The results of the study were considered in terms of four models of attribution of responsibility for the origin of and solution to the medical problem as identified by Brickman, Rabinovits, Karuza, Coates, Cohn, and Kidder (1982). These models are the moral model, the compensatory model, the medical model, and the enlightenment model. The medical model is the most dominant in the South African public health system. Yet, in many instances, participants appeared to adopt other models of engaging with the causes and solutions to their illness conditions. The question of participants' understanding of the consequences of adherence is discussed in terms of the theoretical work by Pepper's (1942), who proposed four possible perspectives with which people may view the world. These world-views are formism, mechanism, contextualism, and organicism. In many instances adherence as a means of controlling somatic symptoms occurs as part of a logical and mechanistic understanding of health. However, in terms of an organismic worldview, adherence may represent an effort to restore equilibrium to the patient's constitution that has spiralled into disequilibrium as a result of disease.