Academic literature on the topic 'Rural nursing Victoria Psychological aspects'

Australia's rural health services commonly face serious and protracted workforce shortages. To help address such shortages in rural and remote areas, a range of programs exist to support university students to undertake placements in a rural setting. In particular, University Departments of Rural Health (UDRHs) are funded to support nursing and allied health students to undertake a rural placement. As UDRHs encourage students to 'go rural' and as they coordinate and facilitate placements in rural settings, a range of enablers and barriers emerge. This study investigates the lived experiences of nursing and allied health students on placement in public health services in rural and regional Victoria. Its purpose was to identify the enablers and barriers most strongly affecting placement satisfaction and personal wellbeing. The intended outcome was to identify modifiable factors that could potentially improve the rural placement experience. Eighteen students were interviewed by a student undertaking her placement. Interviews were 45-60 minutes in length and all face-to-face. The 18 participants were from five universities and were undertaking their placement at one of seven public hospitals operating in northeast Victoria. The researcher recruited participants by attending scheduled debrief meetings at their placement organisation, briefly discussing the research and inviting students to participate. Data were analysed using a thematic analysis approach. The study found that most participants were positive and enthusiastic about their rural placement, both professionally and personally. Three key enablers were identified: 1) enjoyment of the rural environment and community; 2) working in a positive, friendly and supportive workplace; and 3) exposure to broad practice and enhanced learning opportunities. Simultaneously many had also experienced significant barriers before, during or as a consequence of undertaking their placement, and these negatively affected placement satisfaction and personal wellbeing. Identified barriers were: 1) increased financial stress; 2) travel and accommodation challenges and concerns; 3) study-work-life balance and isolation issues; 4) encountering stressful work situations and/or personal events while on placement; and 5) communication issues with universities. The findings are strongly consistent with those identified in the extant literature. The findings add to previous research by deepening understanding about the financial burden and barriers experienced by nursing and allied health students as a result of undertaking rural placements. Disruption to students' lives socially, psychologically, financially and in terms of employment were significant. The study identified some important aspects of the placement experience, suggesting that nursing and allied health students can be dissatisfied with increased financial stress, isolation and inflexibility from universities.

The assessment of the palliative client and family caregivers by an interdisciplinary team comprising medical, nursing, and allied health allows for all aspects including the physical, social, and psychological and spiritual needs to be incorporated into care planning. This comprehensive level of planning for the care of the client and family caregivers can allow for a client to fulfil their own definition of a good death, or dying well. Whilst the provision of psychosocial support can be the seen as the role of the social worker in the team, all members of the palliative care team, especially in rural and remote areas with fewer members, will at times face a situation where they need to provide some psychosocial support. It is acknowledged by the authors that the social work professional identity, responsibilities, and skills are not easily understood, and this identity is further challenged with the prospect of interdisciplinary work. This paper describes and illustrates the psychosocial considerations for the palliative client and family caregiver and has been developed following a review of the definition of a “good death” in consultation with rural and remote-based palliative care team members in South Australia. A literature search of the skills of the social work trained professional applicable to interdisciplinary palliative care work is included. A workforce evidence-based (WEB) diagrammatic tool is offered to illustrate the areas for assessment and intervention. Tasks associated with the psychosocial service to the client and family caregivers, the members of the palliative care team, and the community are defined with the goal of developing a consistent expectation of the role. The contribution of the psychosocial worker in assessing the need for ongoing bereavement support and provision is included.

In this article I discuss a story told by the South Australian Ngarrindjeri Aboriginal elder, Aunty Hilda Wilson (nee Varcoe), about the time when, at not quite sixteen, she was sent from the Point Pearce Aboriginal Station to work in the Adelaide Hills, some 500 kilometres away, as a housekeeper for “one of Adelaide’s leading doctors”. Her secondment was part of a widespread practice in early and mid-twentieth century Australia of placing young Aboriginal women “of marriageable age” from missions and government reserves into domestic service. Consciously deploying Indigenous storytelling practices as pedagogy, Hilda Wilson recounted this episode in a number of distinct ways during the late 1990s and early 2000s. Across these iterations, each building on the other, she exhibited a personal resilience in her subjectivity, embedded in Indigenous knowledge systems of relationality, kin and work, which informed her agency and determination in a challenging situation in which she was both caring for a white socially-privileged family of five, while simultaneously grappling with the injustices of a state system of segregated indentured labour. Kirmayer and colleagues propose that “notions of resilience emerging from developmental psychology and psychiatry in recent years address the distinctive cultures, geographic and social settings, and histories of adversity of indigenous peoples”. Resilience is understood here as an ability to actively engage with traumatic change, involving the capacity to absorb stress and to transform in order to cope with it (Luthar et al.). Further to this, in an Indigenous context, Marion Kickett has found the capacity for resilience to be supported by three key factors: family connections, culture and belonging as well as notions of identity and history. In exploring the layers of this autobiographical story, I employ this extended psychological notion of resilience in both a domestic ambit as well as the broader social context for Indigenous people surviving a system of external domination. Additionally I consider the resilience Aunty Hilda demonstrates at a pivotal interlude between girlhood and womanhood within the trajectory of her overall long and productive life, and within an intergenerational history of resistance and accommodation. What is especially important about her storytelling is its refusal to be contained by the imaginary of the settler nation and its generic Aboriginal-female subject. She refuses victimhood while at the same time illuminating the mechanisms of injustice, hinting also at possibilities for alternative and more equitable relationships of family and work across cultural divides. Considered through this prism, resilience is, I suggest, also a quality firmly connected to ideas of Aboriginal cultural-sovereignty and standpoint and to, what Victoria Grieves has identified as, the Aboriginal knowledge value of sharing (25, 28, 45). Storytelling as Pedagogy The story I discuss was verbally recounted in a manner that Westphalen describes as “a continuation of Dreaming Stories”, functioning to educate and connect people and country (13-14). As MacGill et al. note, “the critical and transformative aspects of decolonising pedagogies emerge from storytelling and involve the gift of narrative and the enactment of reciprocity that occurs between the listener and the storyteller.” Hilda told me that as a child she was taught not to ask questions when listening to the stories of an Elder, and her own children were raised in this manner. Hilda's oldest daughter described this as a process involving patience, intrigue and surprise (Elva Wanganeen). Narratives unfold through nuance and repetition in a complexity of layers that can generate multiple levels of meaning over time. Circularity and recursivity underlie this pedagogy through which mnemonic devices are built so that stories become re-membered and inscribed on the body of the listener. When a perceived level of knowledge-transference has occurred, a narrator may elect to elaborate further, adding another detail that will often transform the story’s social, cultural, moral or political context. Such carefully chosen additional detail, however, might re-contextualise all that has gone before. As well as being embodied, stories are also emplaced, and thus most appropriately told in the Country where events occurred. (Here I use the Aboriginal English term “Country” which encompasses home, clan estate, and the powerful complex of spiritual, animate and inanimate forces that bind people and place.) Hilda Wilson’s following account of her first job as a housekeeper for “one of Adelaide’s leading doctors”, Dr Frank Swann, provides an illustration of how she expertly uses traditional narrative forms of incrementally structured knowledge transmission within a cross-cultural setting to tell a story that expresses practices of resilience as resistance and transformation at its core. A “White Doctor” Story: The First Layer Aunty Hilda first told me this story when we were winding along the South Eastern Freeway through the Adelaide hills between Murray Bridge and Mount Barker, in 1997, on our way home to Adelaide from a trip to Camp Coorong, the Ngarrindjeri cultural education centre co-founded by her granddaughter. She was then 86 years old. Ahead of us, the profile of Mt Lofty rose out of the plains and into view. The highest peak in the Mount Lofty ranges, Yurrebilla, as it is known to Kaurna Aboriginal people, or Mt Lofty, has been an affluent enclave of white settlement for Adelaide’s moneyed elite since early colonial times. Being in place, or in view of place, provided the appropriate opportunity for her to tell me the story. It belongs to a group of stories that during our initial period of working together changed little over time until one day two years later she an added contextual detail which turned it inside out. Hilda described the doctor’s spacious hill-top residence, and her responsibilities of caring for Dr Swann’s invalid wife (“an hysteric who couldn't do anything for herself”), their twin teenage boys (who attended private college in the city) along with another son and younger daughter living at home (pers. com. Hilda Wilson). Recalling the exhilaration of looking down over the sparkling lights of Adelaide at night from this position of apparent “privilege” on the summit, she related this undeniably as a success story, justifiably taking great pride in her achievements as a teenager, capable of stepping into the place of the non-Indigenous doctor's wife in running the large and demanding household. Successfully undertaking a wide range of duties employed in the care of a family, including the disabled mother, she is an active participant crucial to the lives of all in the household, including to the work of the doctor and the twin boys in private education. Hilda recalled that Mrs Swann was unable to eat without her assistance. As the oldest daughter of a large family Hilda had previously assisted in caring for her younger siblings. Told in this way, her account collapses social distinctions, delineating a shared social and physical space, drawing its analytic frame from an Indigenous ethos of subjectivity, relationality, reciprocity and care. Moreover Hilda’s narrative of domestic service demonstrates an assertion of agency that resists colonial and patriarchal hegemony and inverts the master/mistress-servant relationship, one she firmly eschews in favour of the self-affirming role of the lady of the house. (It stands in contrast to the abuse found in other accounts for example Read, Tucker, Kartinyeri. Often the key difference was a continuity of family connections and ongoing family support.) Indeed the home transformed into a largely feminised and cross-culturalised space in which she had considerable agency and responsibility when the doctor was absent. Hilda told me this story several times in much the same way during our frequent encounters over the next two years. Each telling revealed further details that fleshed a perspective gained from what Patricia Hill Collins terms an “epistemic privilege” via her “outsider-within status” of working within a white household, lending an understanding of its social mechanisms (12-15). She also stressed the extent of her duty of care in upholding the family’s well-being, despite the work at times being too burdensome. The Second Version: Coming to Terms with Intersecting Oppressions Later, as our relationship developed and deepened, when I began to record her life-narrative as part of my doctoral work, she added an unexpected detail that altered its context completely: It was all right except I slept outside in a tin shed and it was very cold at night. Mount Lofty, by far the coldest part of Adelaide, frequently experiences winter maximum temperatures of two or three degrees and often light snowfalls. This skilful reframing draws on Indigenous storytelling pedagogy and is expressly used to invite reflexivity, opening questions that move the listener from the personal to the public realm in which domestic service and the hegemony of the home are pivotal in coming to terms with the overlapping historical oppressions of class, gender, race and nation. Suddenly we witness her subjectivity starkly shift from one self-defined and allied with an equal power relationship – or even of dependency reversal cast as “de-facto doctor's wife” – to one diminished by inequity and power imbalance in the outsider-defined role of “mistreated servant”. The latter was signalled by the dramatic addition of a single signifying detail as a decoding device to a deeper layer of meaning. In this parallel stratum of the story, Hilda purposefully brings into relief the politics in which “the private domain of women's housework intersected with the public domain of governmental social engineering policies” (Haskins 4). As Aileen Moreton-Robinson points out, what for White Australia was cheap labour and a civilising mission, for Indigenous women constituted stolen children and slavery. Protection and then assimilation were government policies under which Indigenous women grew up. (96) Hilda was sent away from her family to work in 1927 by the universally-feared Sister Pearl McKenzie, a nurse who too-zealously (Katinyeri, Ngarrindjeri Calling, 23) oversaw the Chief Protector’s policies of “training” Aboriginal children from the South Australian missions in white homes once they reached fourteen (Haebich, 316—20). Indeed many prominent Adelaide hills’ families benefited from Aboriginal labour under this arrangement. Hilda explained her struggle with the immense cultural dislocation that removal into domestic service entailed, a removal her grandfather William Rankine had travelled from Raukkan to Government House to protest against less than a decade earlier (The Register December 21, 1923). This additional layer of story also illuminates Hilda’s capacity for resilience and persistence in finding a way forward through the challenge of her circumstances (Luthar et al.), drawing on her family networks and sense of personhood (Kickett). Hilda related that her father visited her at Mount Lofty twice, though briefly, on his way to shearing jobs in the south-east of the state. “He said it was no good me living like this,” she stated. Through his active intervention, reinforcement was requested and another teenager from Point Pearce, Hilda’s future husband’s cousin, Annie Sansbury, soon arrived to share the workload. But, Hilda explained, the onerous expectations coupled with the cultural segregation of retiring to the tin shed quickly became too much for Annie, who stayed only three months, leaving Hilda coping again alone, until her father applied additional pressure for a more suitable placement to be found for his daughter. In her next position, working for the family of a racehorse trainer, Hilda contentedly shared the bedroom with the small boy for whom she cared, and not long after returned to Point Pearce where she married Robert Wilson and began a family of her own. Gendered Resilience across Cultural Divides Hilda explicitly speaks into these spaces to educate me, because all but a few white women involved have remained silent about their complicity with state sanctioned practices which exploited Indigenous labour and removed children from their families through the policies of protection and assimilation. For Indigenous women, speaking out was often fraught with the danger of a deeper removal from family and Country, even of disappearance. Victoria Haskins writes extensively of two cases in New South Wales where young Aboriginal women whose protests concerning their brutal treatment at the hands of white employers, resulted in their wrongful and prolonged committal to mental health and other institutions (147-52, 228-39). In the indentured service of Indigenous women it is possible to see oppression operating through Eurocentric ideologies of race, class and gender, in which Indigenous women were assumed to take on, through displacement, the more oppressed role of white women in pre-second world war non-Aboriginal Australian society. The troubling silent shadow-figure of the “doctor’s wife” indeed provides a haunting symbol of - and also a forceful rebellion against – the docile upper middle-class white femininity of the inter-war era. Susan Bordo has argued that that “the hysteric” is archetypal of a discourse of ‘pathology as embodied protest’ in which the body may […] be viewed as a surface on which conventional constructions of femininity are exposed starkly to view in extreme or hyperliteral form. (20) Mrs Swann’s vulnerability contrasts markedly with the strength Hilda expresses in coping with a large family, emanating from a history of equitable gender relations characteristic of Ngarrindjeri society (Bell). The intersection of race and gender, as Marcia Langton contends “continues to require deconstruction to allow us to decolonise our consciousness” (54). From Hilda’s brief description one grasps a relationship resonant with that between the protagonists in Tracy Moffat's Night Cries, (a response to the overt maternalism in the film Jedda) in which the white mother finds herself utterly reliant on her “adopted” Aboriginal daughter at the end of her life (46-7). Resilience and Survival The different versions of story Hilda deploys, provide a pedagogical basis to understanding the broader socio-political framework of her overall life narrative in which an ability to draw on the cultural continuity of the past to transform the future forms an underlying dynamic. This demonstrated capacity to meet the challenging conditions thrown up by the settler-colonial state has its foundations in the connectivity and cultural strength sustained generationally in her family. Resilience moves from being individually to socially determined, as in Kickett’s model. During the onslaught of dispossession, following South Australia’s 1836 colonial invasion, Ngarrindjeri were left near-starving and decimated from introduced diseases. Pullume (c1808-1888), the rupuli (elected leader of the Ngarrindjeri Tendi, or parliament), Hilda’s third generation great-grandfather, decisively steered his people through the traumatic changes, eventually negotiating a middle-path after the Point McLeay Mission was established on Ngarrindjeri country in 1859 (Jenkin, 59). Pullume’s granddaughter, the accomplished, independent-thinking Ellen Sumner (1842—1925), played an influential educative role during Hilda’s youth. Like other Ngarrindjeri women in her lineage, Ellen Sumner was skilled in putari practice (female doctor) and midwifery culture that extended to a duty of care concerning women and children (teaching her “what to do and what not to do”), which I suggest is something Hilda herself drew from when working with the Swann family. Hilda’s mother and aunties continued aspects of the putari tradition, attending births and giving instruction to women in the community (Bell, 171, Hughes Grandmother, 52-4). As mentioned earlier, when the South Australian government moved to introduce The Training of Children Act (SA) Hilda’s maternal grandfather William Rankine campaigned vigorously against this, taking a petition to the SA Governor in December 1923 (Haebich, 315-19). As with Aunty Hilda, William Rankine used storytelling as a method to draw public attention to the inequities of his times in an interview with The Register which drew on his life-narrative (Hughes, My Grandmother, 61). Hilda’s father Wilfred Varcoe, a Barngarrla-Wirrungu man, almost a thousand kilometres away from his Poonindie birthplace, resisted assimilation by actively pursuing traditional knowledge networks using his mobility as a highly sought after shearer to link up with related Elders in the shearing camps, (and as we saw to inspect the conditions his daughter was working under at Mt Lofty). The period Hilda spent as a servant to white families to be trained in white ways was in fact only a brief interlude in a long life in which family connections, culture and belonging (Kickett) served as the backbone of her resilience and resistance. On returning to the Point Pearce Mission, Hilda successfully raised a large family and activated a range of community initiatives that fostered well-being. In the 1960s she moved to Adelaide, initially as the sole provider of her family (her husband later followed), to give her younger children better educational opportunities. Working with Aunty Gladys Elphick OBE through the Council of Aboriginal Women, she played a foundational role in assisting other Aboriginal women establish their families in the city (Mattingly et al., 154, Fisher). In Adelaide, Aunty Hilda became an influential, much loved Elder, living in good health to the age of ninety-six years. The ability to survive changing circumstances, to extend care over and over to her children and Elders along with qualities of leadership, determination, agency and resilience have passed down through her family, several of whom have become successful in public life. These include her great-grandson and former AFL football player, Michael O’Loughlin, her great-nephew Adam Goodes and her-grand-daughter, the cultural weaver Aunty Ellen Trevorrow. Arguably, resilience contributes to physical as well as cultural longevity, through caring for the self and others. Conclusion This story demonstrates how sociocultural dimensions of resilience are contextualised in practices of everyday lives. We see this in the way that Aunty Hilda Wilson’s self-narrated story resolutely defies attempts to know, subjugate and categorise, operating instead in accord with distinctively Aboriginal expressions of gender and kinship relations that constitute an Aboriginal sovereignty. Her storytelling activates a revision of collective history in ways that valorise Indigenous identity (Kirmayer et al.). Her narrative of agency and personal achievement, one that has sustained her through life, interacts with the larger narrative of state-endorsed exploitation, diffusing its power and exposing it to wider moral scrutiny. Resilience in this context is inextricably entwined with practices of cultural survival and resistance developed in response to the introduction of government policies and the encroachment of settlers and their world. We see resilience too operating across Hilda Wilson’s family history, and throughout her long life. The agency and strategies displayed suggest alternative realities and imagine other, usually more equitable, possible worlds. References Bell, Diane. Ngarrindjeri Wurruwarrin: A World That Is, Was and Will Be. Melbourne: Spinifex, 1998. Bordo, Susan. “The Body and the Reproduction of Femininity.” Writing on the Body: Female Embodiment and Feminist Theory. Eds. Katie Conboy, Nadia Medina, and Sarah Stanbury. New York: Columbia UP, 1997. 90-110. Collins, Patricia Hill. Black Feminist Thought. New York: Routledge, 2000. Fisher, Elizabeth M. "Elphick, Gladys (1904–1988)." Australian Dictionary of Biography. National Centre of Biography, Australian National University, 29 Sep. 2013. ‹http://adb.anu.edu.au/biography/elphick-gladys-12460/text22411>. Grieves, Victoria. Aboriginal Spirituality: Aboriginal Philosophy, The Basis of Aboriginal Social and Emotional Wellbeing, Melbourne University: Cooperative Research Centre for Aboriginal Health, 2009. Haebich, Anna. Broken Circles: The Fragmenting of Indigenous Families. Fremantle: Fremantle Arts Press, 2000. Haskins, Victoria. My One Bright Spot. London: Palgrave, 2005. Hughes, Karen. "My Grandmother on the Other Side of the Lake." PhD thesis, Department of Australian Studies and Department of History, Flinders University. Adelaide, 2009. ———. “Microhistories and Things That Matter.” Australian Feminist Studies 27.73 (2012): 269-278. ———. “I’d Grown Up as a Child amongst Natives.” Outskirts: Feminisms along the Edge 28 (2013). 29 Sep. 2013 ‹http://www.outskirts.arts.uwa.edu.au/volumes/volume-28/karen-hughes>. Jenkin, Graham. Conquest of the Ngarrindjeri. Adelaide: Rigby, 1979. Kartinyeri, Doris. Kick the Tin. Melbourne: Spinifex, 2000. Kartinyeri, Doreen. My Ngarrindjeri Calling, Adelaide: Wakefield, 2007. Kickett, Marion. “Examination of How a Culturally Appropriate Definition of Resilience Affects the Physical and Mental Health of Aboriginal People.” PhD thesis, Curtin University, 2012. Kirmayer, L.J., S. Dandeneau, E. Marshall, M.K. Phillips, K. Jenssen Williamson. “Rethinking Resilience from Indigenous Perspectives.” Canadian Journal of Psychiatry 56.2 (2011): 84-91. Luthar, S., D. Cicchetti, and B. Becker. “The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work.” Child Development 71.3 (2000): 543-62. MacGill, Bindi, Julie Mathews, Ellen Trevorrow, Alice Abdulla, and Deb Rankine. “Ecology, Ontology, and Pedagogy at Camp Coorong,” M/C Journal 15.3 (2012). Mattingly, Christobel, and Ken Hampton. Survival in Our Own Land, Adelaide: Wakefield, 1988. Moreton-Robinson, Aileen. Talkin’ Up to the White Woman. St Lucia: UQP, 2000. Night Cries, A Rural Tragedy. Dir. Tracy Moffatt. Chili Films, 1990. Read, Peter. A Rape of the Soul So Profound. Crows Nest: Allen & Unwin, 2002. Tucker, Margaret. If Everyone Cared. Sydney: Ure Smith, 1977. Wanganeen, Elva. Personal Communication, 2000. Westphalen, Linda. An Anthropological and Literary Study of Two Aboriginal Women's Life Histories: The Impacts of Enforced Child Removal and Policies of Assimilation. New York: Mellen Press, 2011.

Who Are Carers? A carer is any individual who provides unpaid care and support to a family member or friend who has a disability, mental illness, drug and/or alcohol dependency, chronic condition, terminal illness or who is frail. Carers come from all walks of life, cultural backgrounds and age groups. For many, caring is a 24 hour-a-day job with emotional, physical and financial impacts, with implications for their participation in employment, education and community activities. Carers exist in all communities, including amongst Aboriginal communities, those of culturally and linguistically diverse backgrounds, amongst Gay, Lesbian, Bisexual, Transgender, Intersex communities, and throughout metropolitan, regional and rural areas (Carers NSW). These broad characteristics mean that caring occurs across a wide variety of situations and care responsibilities can impact an even wider group of people. The ubiquitous nature of informal care warrants its consideration as a major social issue, as well as the potential impacts that these roles can have on carers in both short and long term contexts. Caring for a loved one is often an unseen component of people’s domestic lives. As will be outlined below, the potentially burdensome nature of care can have negative influences on carers’ wellbeing. As such, factors that can enhance the resilience of carers in the face of such adversity have been widely investigated. This being said, individual differences exist in carers’ responses to their caring responsibilities. The caring experience can therefore be argued to exist on a continuum, from the adversity in relation to stressful challenges through to prosperity in light of their caring responsibilities. By considering the experience of care as existing along this continuum, the place of resilience within people’s domestic spaces can be viewed as a mechanism towards identifying and developing supportive practices. Negative Impacts of Care A significant body of research has identified potential negative impacts of caring. Many of the most commonly cited outcomes relate to negative effects on mental health and/or psychological functioning, including stress, anxiety and depression (e.g. Baker et al.; Barlow, Cullen-Powell and Cheshire; Cheshire, Barlow and Powell; Dunn et al.; Gallagher et al.; Hastings et al.; Lach et al.; Singer; Sörensen et al.; Vitaliano, Zhang and Scanlan; Whittingham et al.; Yamada et al.). These feelings can be exacerbated when caring responsibilities become relentlessly time consuming, as demonstrated by this comment from a carer of a person with dementia: “I can’t get away from it” (O'Dwyer, Moyle and van Wyk 758). Similarly, emotional responses such as sorrow, grief, anger, frustration, and guilt can result from caring for a loved one (Heiman; Whittingham et al.). Negative emotional responses are not necessarily a direct result of caring responsibilities as such, but an understanding of the challenges faced by the person requiring their care. The following quote from the carer of a child with autism exemplifies the experience of sorrow: “It was actually the worst day of our lives, that was the day we came to terms with the fact that we had this problem” (Midence and O’Neill 280). Alongside these psychological and emotional outcomes, physical health may also be negatively impacted due to certain demands of the caring role (Lach et al.; Sörensen et al.; Vitaliano, Zhang and Scanlan). Outcomes such as these are likely to vary across individual caring circumstances, dictated by variables such as the specific tasks required of the carer, and individual personality characteristics of both the carer and the person for whom they care. Nevertheless, an awareness of these potential outcomes is particularly important when considering the place of resilience in the domestic space of individuals caring for a loved one. This conceptualisation of caring as being a burdensome task reflects many publicly held perceptions. If caring is widely viewed as compromising carers’ wellbeing, then there is likely to be an increased likelihood of carers viewing themselves as victims. This is particularly true amongst children and adolescents with caring responsibilities, since young people are most susceptible to having their personal identities shaped by others’ perceptions (Andreouli, Skovdal and Campbell). Resilience in Caring Adversity Despite the widely acknowledged potential for caring to have negative consequences for carers, it must be noted that the occurrence of these outcomes are not inevitable. In fact, much of the research that has identified increased stress amongst carers also finds that the majority cope well with the demands of their role (Barnett et al.). These carers have been considered by many researchers to demonstrate resilience (e.g. Barnett et al.; O'Dwyer, Moyle and van Wyk). The ability to respond positively despite exposure to risk or adversity is a key feature of most definitions of resilience (Luthar, Cicchetti and Becker; Masten and Obradović; Zauszniewski, Bekhet and Suresky). Resilience in this context can thus be defined as a psychological process that facilitates healthy functioning in response to intense life stressors (Johnson et al.). Since caring experiences are likely to continue for an extended period of time, resilience is likely to be necessary on an ongoing basis, rather than in response to a single traumatic event. A resilient carer is therefore one who is able to effectively and adaptively cope with extenuating pressures of caring for a loved one. This involves the presence of personal, social, familial, or institutional protective factors that enable carers to resist stress (Kaplan et al.). For example, support from health professionals, family, or community has been found to effectively support carers in coping with their role (Bekhet, Johnson and Zauszniewski; Gardiner and Iarocci; Heiman; Whittingham et al.). The benefit of support networks in assisting carers to cope in their role is widely reported in the associated research, reinforced by many examples such as the following from a carer of a person with dementia: “It’s a social thing, like, I’ve got friends on there… I find that is my escape” (O'Dwyer, Moyle and van Wyk 758). At an individual level, those who demonstrate resilient in the face of adversity demonstrate optimistic or hopeful outlooks (Ekas, Lickenbrock and Whitman; Lloyd and Hastings; Whittingham et al.), while simultaneously holding realistic expectations of the future (Rasmussen et al.; Wrosch, Miller, et al.; Wrosch, Scheier, et al.). Such attitudes are particularly significant amongst people caring for family members or friends with disabilities or illnesses. The following attitude held by a carer of a child with cerebral palsy exemplifies this optimistic outlook: “I look at the glass half full and say that “well, it’s only his walking, everything else is fine”. “So, get over [it] and deal with it” (Whittingham et al. 1451). Those who cognitively process information, rather than reacting in a highly emotion way have also been found to cope better (Bekhet, Johnson and Zauszniewski; Heiman; Monin et al.; Pennebaker, Mayne and Francis), as have those with a greater sense of self-efficacy or an internal locus of control (Bekhet, Johnson and Zauszniewski; Kuhn and Carter). However effective these coping strategies prove to be, this is unlikely to provide the full picture of caring experiences, or the place of resilience within that space. Associating resilience with adversity presumes a consensus on what constitutes adversity. Taking the typical approach to investigating resilience amongst carers risks making undue assumptions of the nature of individual carers’ experiences – namely, that caring equates to adversity. The following paragraphs will outline how this is not necessarily the case. And furthermore, that the concept of resilience still has a place in considering informal caring, regardless of whether adversity is considered to be present. Benefits of Care While a great deal of evidence suggests that caring for a loved one can be a stressful experience, research has also demonstrated the existence of positive impacts of care. In many instances, carers not only cope, but also thrive in their caring roles (Turnbull et al.). Elements such as positive relationships within caring relationships can both challenge and strengthen individuals – factors that only exist due to the specific nature of the individual caring role (Bayat; Heiman). Such positive elements of the caring experience have been reflected in the literature, illustrated by quotes such as: “In some sense, this makes our family closer” (Bayat 709). Rather than viewing carers from a perspective of victimisation (which is particularly prominent in relation to children and young people with caring responsibilities), recognising the prevalence of positive wellbeing within this population provides a more nuanced understanding of the lived experiences of all carers (Aldridge). Reported benefits of caring tend to revolve around personal relationships, particularly in reference to parents caring for their children with special needs. Reflective of the parental relationship, carers of children with disabilities or chronic illnesses generally report feelings of love, joy, optimism, strength, enjoyment, and satisfaction with their role (Barnett et al.; Heiman). The views of such carers do not reflect an attitude of coping with adversity, but rather a perspective that considers their children to be positive contributors to carers’ quality of life and the wellbeing of the wider family (King et al.). This point of view suggests an additional dimension to resilience; in particular, that resilience in the relative absence of risk factors, can cause carers to flourish within their caring role and relationships. In addition to benefits in relationships, carers may also prosper through their own personal growth and development in the course of their caring (Knight). This includes factors such as the development of life skills, maturity, purpose, social skills, a sense of responsibility, and recognition – particularly amongst young people in caring roles (Earley, Cushway and Cassidy; Early, Cushway and Cassidy; Jurkovic, Thirkield and Morrell; Skovdal and Andreouli; Stein, Rotheram-Borus and Lester; Tompkins). Recognition of the potential personal benefits of caring for a loved one is not intended to suggest that the view of carers coping with adversity is universally applicable. While it is likely that individual caring situations will have an impact on the extent to which a carer faces adversity (e.g. intensity of caring responsibilities, severity of loved one’s impairment, etc.), it is important to recognise the benefits that carers can experience alongside any challenges they may face. Circumstances that appear adversarial may not be thought of as such by those within that context. Defining resilience as an ability to cope with adversity therefore will not apply to such contexts. Rather, the concept of resilience needs to incorporate those who not only cope, but also prosper. Carers who do not perceive their role as burdensome, but identify positive outcomes, can therefore be said to demonstrate resilience though contextually different from those coping with adversity. This is not to suggest that resilience is the sole contributing factor in terms of prospering in the caring role. We must also consider individual circumstances and nuances differ between carers, those they care for, interpersonal relationships, and wider caring situations. Continuum of Care Awareness of the range of impacts that caring can have on carers leads to a recognition of the broad spectrum of experience that this role entails. Not only do caring experiences exhibit large variations in terms of practical issues (such as functional capacities, or type and severity of illness, disability, or condition), they include carers’ diverse personal responses to caring responsibilities. These responses can reflect either positive or negative dimensions, or a combination of both (Faso, Neal-Beevers and Carlson). In this way, caring experiences can be conceptualised as existing along a continuum. At one end of the spectrum, experiences align with the traditional view of caring as a struggle with and over adversity. More specifically, carers experience burdens as a result of their additional caring responsibilities, with negative outcomes likely to occur. At the other end of the spectrum, however, carers prosper in the role, experiencing significant personal benefits that would not have been possible without the caring role. This continuum makes a case for an expanded approach to stress and coping models of resilience to include positive concepts and a benefit-orientated perspective (Cassidy and Giles). In contrast to research that has argued for a progression from stress and coping models to strengths-based approaches (e.g. Glidden, Billings and Jobe; Knight), the continuum of care acknowledges the benefits of each of these theoretical positions, and thus may prove more comprehensive in attempting to understand the everyday lived experiences of carers. The framework provided by a representation of a continuum allows for the individual differences in caring situations and carers’ personal responses to be acknowledged, as well as accounting for any changes in these circumstances. Further, the experience and benefits of resilience in different contextual spheres can be identified. The flexibility afforded by such an approach is particularly important in light of individual differences in the ways carers respond to their situations, their changing caring contexts, and their subsequent individual needs (Monin et al.; Walsh; Whittingham et al.). As the caring experience can be dynamic and fluctuate in both directions along the continuum, resilience may be seen as the mechanism by which such movement occurs. In line with stress and coping models, resilience can assist carers to cope with adversarial circumstances at that end of the continuum. Similarly, it may be argued that those who prosper in their caring role exhibit characteristics of resilience. In other words, it is resilience that enables carers to cope with adversity at one end of the continuum and also to prosper at the other. Furthermore, by supporting the development of resilient characteristics, carers may be assisted in shifting their experiences along the continuum, from adversity to prosperity. This view extends upon traditional approaches reported in the stress and coping literature by contending that caring experiences may progress beyond positions of coping with adversity, to a position where caring is not understood in terms of adversity at all, but rather in terms of benefits. The individual circumstances of any carer must be taken into consideration with this framework of resilience and the continuum of care. It is unrealistic to assume that all caring situations will allow for the possibility of reaching the end point of this continuum. Carers with particularly high demands in terms of time, resources, effort, or energy may not reach a stage where they no longer consider their caring role to involve any personal burden. However, the combination of a coping and strengths-based approach suggests that there is always the possibility of moving away from perceptions of adversity and further towards an attitude of prosperity. Implications for Supportive Practice From the perspective of this continuum of care, the protective factors and coping strategies identified in previous literature provide a valuable starting point for the facilitation of resilience amongst carers. Enhancing factors such as these can assist carers to move from situations of adversity towards experiences of prosperity (Benzies and Mychasiuk). Research has suggested that carers who are less analytical in their thinking and less optimistic about their personal situations may find particular benefit from support systems that assist them in redirecting their attention towards positive aspects of their daily lives, such as the benefits of caring outlined earlier (Monin et al.). The principle of focusing on positive experiences and reframing negative thoughts is thought to benefit carers across all levels of functioning and adaptive experience (Monin et al.). While those entrenched in more burdensome mindsets are likely to experience the greatest benefit from supportive interventions, there is still merit in providing similar supports to carers who do not appear to experience the similar experiences of burden, or demonstrate greater resilience or adaptation to their situation. The dynamic view of caring situations and resilience suggested by a continuum of care incorporates benefits of stress and coping models as well as strengths-based approaches. This has implications for supportive practice in that the focus is not on determining whether or not a carer is resilient, but identifying the ways in which they already are resilient (Simon, Murphy and Smith). For carers who experience their role through a lens of adversity, resilience may need to be purposefully fostered in order to better enable them to cope and develop through the ongoing stresses of their role. For carers at the other end of the spectrum, resilience is likely to take on a substantially different meaning. Under these circumstances, caring for a loved one is not considered a burdensome task; rather, the positive impact of the role is pre-eminent. This point of view suggests that carers are resilient, not only in terms of an ability to thrive despite adversity, but in prospering to the extent that adversity is not considered to exist. The attitudes and approaches of services, support networks, and governments towards carers should remain flexible enough to acknowledge the wide variety of caring circumstances that exist. The continuum of care provides a framework through which certain aspects of caring and variations in resilience can be interpreted, as well as the type of support required by individual carers. Furthermore, it must be noted that caring circumstances can change – either gradually or suddenly – with the extent to which carers experience adversity, coping or prosperity also changing. Any attempts to provide support to carers or acknowledge their resilience should demonstrate an awareness of the potential for such fluctuation. The fundamental view that carers always have the potential to move towards more positive outcomes has the potential to reframe perceptions of carers as victims, or as simply coping, to one that embraces the personal strengths and resilience of the individual. As such, carers can be supported when faced with adversity, and to flourish beyond that position. This in turn has the potential to safeguard against any detrimental effects of adversity that may arise in the future. References Aldridge, Jo. "All Work and No Play? Understanding the Needs of Children with Caring Responsibilities." Children & Society 22.4 (2008): 253-264. Andreouli, Eleni, Morten Skovdal, and Catherine Campbell. "‘It Made Me Realise That I Am Lucky for What I Got’: British Young Carers Encountering the Realities of Their African Peers." Journal of Youth Studies (2013): 1-16. Baker, Bruce L., et al. "Behavior Problems and Parenting Stress in Families of Three-Year-Old Children with and without Developmental Delays." American Journal on Mental Retardation 107.6 (2002): 433-44. Barlow, J. H., L. A. Cullen-Powell, and A. Cheshire. "Psychological Well-Being among Mothers of Children with Cerebral Palsy." Early Child Development and Care 176.3-4 (2006): 421-428. Barnett, Douglas, et al. "Building New Dreams: Supporting Parents' Adaptation to Their Child with Special Needs." Infants and Young Children 16.3 (2003): 184. Bayat, M. "Evidence of Resilience in Families of Children with Autism." Journal of Intellectual Disability Research 51.9 (2007): 702-714. Bekhet, Abir K., Norah L. Johnson, and Jaclene A. Zauszniewski. "Resilience in Family Members of Persons with Autism Spectrum Disorder: A Review of the Literature." Issues in Mental Health Nursing 33.10 (2012): 650-656. Benzies, Karen, and Richelle Mychasiuk. "Fostering Family Resiliency: A Review of the Key Protective Factors." Child and Family Social Work 14 (2009): 103-114. Carers NSW. Carers NSW Strategic Directions 2012-2015. 2012. Cassidy, Tony, and Melanie Giles. "Further Exploration of the Young Carers Perceived Stress Scale: Identifying a Benefit-Finding Dimension." British Journal of Health Psychology 18.3 (2013): 642-655. Cheshire, Anna, Julie H. Barlow, and Lesley A. Powell. "The Psychosocial Well-Being of Parents of Children with Cerebral Palsy: A Comparison Study." Disability and Rehabilitation 32.20 (2010): 1673-1677. Dunn, Michael E., et al. "Moderators of Stress in Parents of Children with Autism." Community Mental Health Journal 37.1 (2001): 39-52. Earley, Louise, Delia Cushway, and Tony Cassidy. "Children's Perceptions and Experiences of Care Giving: A Focus Group Study." Counselling Psychology Quarterly 20.1 (2007): 69-80. Early, Louise, Delia Cushway, and Tony Cassidy. "Perceived Stress in Young Carers: Development of a Measure." Journal of Child and Family Studies 15.2 (2006): 165-176. Ekas, Naomi V., Diane M. Lickenbrock, and Thomas L. Whitman. "Optimism, Social Support, and Well-Being in Mothers of Children with Autism Spectrum Disorder." Journal of Autism and Developmental Disorders 40.10 (2010): 1274-1284. Faso, Daniel J., A. Rebecca Neal-Beevers, and Caryn L. Carlson. "Vicarious Futurity, Hope, and Well-Being in Parents of Children with Autism Spectrum Disorder." Research in Autism Spectrum Disorders 7.2 (2013): 288-297. Gallagher, Stephen, et al. "Predictors of Psychological Morbidity in Parents of Children with Intellectual Disabilities." Journal of Pediatric Psychology 33.10 (2008): 1129-1136. Gardiner, Emily, and Grace Iarocci. "Unhappy (and Happy) in Their Own Way: A Developmental Psychopathology Perspective on Quality of Life for Families Living with Developmental Disability with and without Autism." Research in Developmental Disabilities 33.6 (2012): 2177-2192. Glidden, L. M., F. J. Billings, and B. M. Jobe. "Personality, Coping Style and Well-Being of Parents Rearing Children with Developmental Disabilities." Journal of Intellectual Disability Research 50.12 (2006): 949-962. Hastings, Richard P., et al. "Coping Strategies in Mothers and Fathers of Preschool and School-Age Children with Autism." Autism 9.4 (2005): 377-91. Heiman, Tali. "Parents of Children with Disabilities: Resilience, Coping, and Future Expectations." Journal of Developmental and Physical Disabilities 14.2 (2002): 159-171. Johnson, Douglas C., et al. "Development and Initial Validation of the Response to Stressful Experiences Scale." Military Medicine 176.2 (2011): 161-169. Jurkovic, GregoryJ, Alison Thirkield, and Richard Morrell. "Parentification of Adult Children of Divorce: A Multidimensional Analysis." Journal of Youth and Adolescence 30.2 (2001): 245-257. Kaplan, Carol P., et al. "Promoting Resilience Strategies: A Modified Consultation Model." Children & Schools 18.3 (1996): 158-168. King, G. A., et al. "A Qualitative Investigation of Changes in the Belief Systems of Families of Children with Autism or Down Syndrome." Child: Care, Health and Development 32.3 (2006): 353-369. Knight, Kathryn. "The Changing Face of the ‘Good Mother’: Trends in Research into Families with a Child with Intellectual Disability, and Some Concerns." Disability & Society 28.5 (2013): 660-673. Kuhn, Jennifer C., and Alice S. Carter. "Maternal Self-Efficacy and Associated Parenting Cognitions among Mothers of Children with Autism." American Journal of Orthopsychiatry 76.4 (2006): 564-575. Lach, Lucyna M., et al. "The Health and Psychosocial Functioning of Caregivers of Children with Neurodevelopmental Disorders." Disability and Rehabilitation 31.8 (2009): 607-18. Lloyd, T. J., and R. Hastings. "Hope as a Psychological Resilience Factor in Mothers and Fathers of Children with Intellectual Disabilities." Journal of Intellectual Disability Research 53.12 (2009): 957-68. Luthar, Suniya S., Dante Cicchetti, and Bronwyn Becker. "The Construct of Resilience: A Critical Evaluation and Guidelines for Future Work." Child Development 71.3 (2000): 543-62. Masten, Ann S., and Jelena Obradović. "Competence and Resilience in Development." Annals of the New York Academy of Sciences 1094.1 (2006): 13-27. Midence, Kenny, and Meena O’Neill. "The Experience of Parents in the Diagnosis of Autism: A Pilot Study." Autism 3.3 (1999): 273-85. Monin, Joan K., et al. "Linguistic Markers of Emotion Regulation and Cardiovascular Reactivity among Older Caregiving Spouses." Psychology and Aging 27.4 (2012): 903-11. O'Dwyer, Siobhan, Wendy Moyle, and Sierra van Wyk. "Suicidal Ideation and Resilience in Family Carers of People with Dementia: A Pilot Qualitative Study." Aging & Mental Health 17.6 (2013): 753-60. Pennebaker, James W., Tracy J. Mayne, and Martha E. Francis. "Linguistic Predictors of Adaptive Bereavement." Journal of Personality and Social Psychology 72.4 (1997): 863-71. Rasmussen, Heather N., et al. "Self-Regulation Processes and Health: The Importance of Optimism and Goal Adjustment." Journal of Personality 74.6 (2006): 1721-48. Simon, Joan B., John J. Murphy, and Shelia M. Smith. "Understanding and Fostering Family Resilience." The Family Journal 13.4 (2005): 427-36. Singer, George H. S. "Meta-Analysis of Comparative Studies of Depression in Mothers of Children with and without Developmental Disabilities." American Journal on Mental Retardation 111.3 (2006): 155-69. Skovdal, Morten, and Eleni Andreouli. "Using Identity and Recognition as a Framework to Understand and Promote the Resilience of Caregiving Children in Western Kenya." Journal of Social Policy 40.03 (2011): 613-30. Sörensen, Silvia, et al. "Dementia Care: Mental Health Effects, Intervention Strategies, and Clinical Implications." The Lancet Neurology 5.11 (2006): 961-73. Stein, Judith A., Mary Jane Rotheram-Borus, and Patricia Lester. "Impact of Parentification on Long-Term Outcomes among Children of Parents with Hiv/Aids." Family Process 46.3 (2007): 317-33. Tompkins, Tanya L. "Parentification and Maternal HIV Infection: Beneficial Role or Pathological Burden?" Journal of Child and Family Studies 16.1 (2007): 108-18. Turnbull, Ann P., et al. "Conceptualization and Measurement of Family Outcomes Associated with Families of Individuals with Intellectual Disabilities." Mental Retardation and Developmental Disabilities Research Reviews 13.4 (2007): 346-56. Vitaliano, Peter P., Jianping Zhang, and James M. Scanlan. "Is Caregiving Hazardous to One's Physical Health? A Meta-Analysis." Psychological Bulletin 129.6 (2003): 946-72. Walsh, Froma. "Family Resilience: A Framework for Clinical Practice." Family Process 42.1 (2003): 1-18. Whittingham, Koa, et al. "Sorrow, Coping and Resiliency: Parents of Children with Cerebral Palsy Share Their Experiences." Disability and Rehabilitation 35.17 (2013): 1447-52. Wrosch, Carsten, et al. "Giving Up on Unattainable Goals: Benefits for Health?" Personality and Social Psychology Bulletin 33.2 (2007): 251-65. Wrosch, Carsten, et al. "The Importance of Goal Disengagement in Adaptive Self-Regulation: When Giving Up Is Beneficial." Self and Identity 2.1 (2003): 1-20. Yamada, Atsurou, et al. "Emotional Distress and Its Correlates among Parents of Children with Pervasive Developmental Disorders." Psychiatry and Clinical Neurosciences 61.6 (2007): 651-57. Zauszniewski, Jaclene A., Abir K. Bekhet, and M. J. Suresky. "Resilience in Family Members of Persons with Serious Mental Illness." Nursing Clinics of North America 45.4 (2010): 613-26.

Acquired Immunodeficiency Syndrome (AIDS) is primarily identified as a metropolitan disease. However, it has suggested that the Centers for Disease Control may underestimate the prevalence of AIDS in the population of higher socioeconomic status, overstate the relative prevalence of AIDS in the minorities, and understate the prevalence of the disease in the Midwest (Laumann, Gagnon, Michaels, Michael, & Coleman, 1989). The problem addressed in this study was to determine whether groups of urban and rural perioperative registered nurses differ in their attitudes of tolerance toward AIDS patients. The attitudes of rural and urban perioperative nurses were examined in a comparative descriptive design. It is important to identify nurses' attitudes toward AIDS patients because nurses must interact with AIDS patients on an increasing basis.Lazarus and Folkman's (1984) Theory of Cognitive Emotion was used for the framework. A convenience sample of 77 perioperative registered nurses was obtained for the study. Five midwestern hospitals were used to collect the data. Two urban hospitals and three rural hospitals were used as collection sites. The AIDS Attitudes Scale (AAS) was used as the tool to collect the data (Shrum, Turner, and Bruce, 1989). The AAS consists of a fifty-four item questionnaire designed to measure attitudinal tolerance towards the AIDS patient. Validity and reliability of the tool were established with a resulting reliability score of .94.Findings revealed significant differences among urban and rural perioperative registered nurses in attitudes toward AIDS patients (p=.0387), with urban perioperative nurses being more tolerant of AIDS patients. Item-by-item analysis indicated that although urban perioperative nurses were more tolerant, an urban perioperative nurse would be more uncomfortable around a patient with AIDS (p=.0082). However, more rural perioperative nurses indicated that they would move out if a roommate had AIDS (p=.0030). Rural perioperative nurses indicated more often that no one deserved to have a disease like AIDS (p=.0057). Demographic profiles of registered perioperative nurses demonstrated similar backgrounds in relation to age, educational level, and gender.Conclusions of this study indicated urban perioperative registered nurses hold more tolerant attitudes toward HIV/AIDS patients than do rural perioperative registered nurses.
School of Nursing

Thesis (MCur)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: Mental health is still the step-child of Health Services, although many studies show the serious negative impact it has on the mother, baby and the family. Knowledge about Postnatal Depression (PND) and associated risk factors which influence the development of PND is vital for early detection and intervention. Worldwide PND affects on average 10-15% of women after giving birth regardless of socio-economic status, race or education. Studies also reveal that the prevalence of PND is as high as 40-60% amongst women after giving birth. The goal of the study was to investigate the prevalence and factors influencing PND in a rural setting, in the Witzenberg Sub-district. The objectives included determining the prevalence of PND and identifying the contributing risk factors associated with PND. A descriptive explorative research design with a quantitative approach was applied. The target population was (N=1605) mothers, 18 years and older who gave birth in this Sub-district in one year, a convenience sampling method was used to select the study sample of (n=159/10%) participants who met the criteria and who gave voluntary permission to take part in the study. Validity and reliability was supported through the use of validated questionnaires EPDS and BDI including a questionnaire based on demographical, psychosocial and obstetrical data. In addition experts in statistics, nursing and psychiatry were consulted including language experts who validated the correctness of the Afrikaans and Xhosa translated questionnaires. A pilot study was conducted to test the feasibility of the study and all data was collected personally by the researcher with the support of two trained field workers. Ethics approval was obtained from Stellenbosch University and permission from the Department of Health, Provincial Government of the Western Cape, including informed written consent from each participant. The data was analysed with the assistance of a statistician and are presented with histograms and frequency tables. The relationship between continuous response variables and nominal input variables was analysed using analysis of variance (ANOVA). Various statistical tests were applied to determine statistical associations between variables such as the chi-square tests using a 95% confidence interval. Non-parametric tests such as the Mann-Whitney U–test or Kruskal-Wallis test were used for randomised design. Levene’s test was used for Homogeneity of Variance and the Bonferonni test of probability. The study revealed that 50.3% of the mothers, who participated in the study, had PND. Various risk factors were determined in this study that influences the development of PND. Results include statistical associations between PND and the following: - unplanned babies and unwelcome babies (p=<0,01) - life events (p=0.01) - partner relationship (p=<0.01) - family and social support (p=<0.1) Furthermore, the majority of the participants (53.8%) with PND (n=80) had a history of a psychiatric illness which was shown with significance (p=<0.01), the majority of the participants (63.5%) were unmarried and 23.8% were teenagers who suffered from PND. Recommendations include promoting healthy lifestyles, empowerment of women, prevention of teenage pregnancies, early and holistic assessment for symptoms of PND and approriate referral. In conclusion the prevention and promotive measures, early detection of PND and appropriate referrals and treatment are critical in managing maternal, child and family well being.
AFRIKAANSE OPSOMMING: Geestesgesondheid blyk die stiefkind van gesondheidsdienste te wees, ten spyte daarvan dat navorsing die negatiewe impak wat dit op moeder, baba en die gesin het bevestig. Kennis van postnatale depressie (PDN) en verwante risiko faktore wat die ontwikkeling van PND beïnvloed is van uiterste belang vir die vroeë opsporing en ingryping daarvan. PND affekteer gemiddeld 10%-15% van vroue wêreldwyd wat dit ervaar nadat hulle geboorte geskenk het, ongeag sosio-ekonomiese status, ras of opleiding. Navorsing dui daarop dat die voorkoms van PND so hoog is soos 40%-60% onder vrouens nadat hulle geboorte geskenk het. Die doel van hierdie studie was om die prevalensie van PND en die faktore wat PND beïnvloed in ’n landelike nedersetting in die Witzenberg Subdistrik te ondersoek. Die doelwitte sluit die bepaling van die prevalensie van PND in en die identifisering van die risiko faktore wat daartoe aanleiding gegee het. ’n Beskrywende verkennende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep was (N=1605) moeders, 18 jaar en ouer wat geboorte geskenk het in hierdie subdistrik binne een jaar. ’n Gerieflikheidssteekproef metode is gebruik om die deelnemers (n=159/10%) te selekteer wat aan die kriteria voldoen het en vrywillig toestemming gegee het om aan die studie deel te neem. Geldigheid en betroubaarheid is gerugsteun deur die gebruik van geldige vraelyste, naamlik EPDS en BDI wat ’n vraelys insluit wat gebaseer is op demografiese, psigososiale en verloskundige data. Hierbenewens is deskundiges in statistiek, verpleegkunde en psigiatrie geraadpleeg, asook taalkundiges wat die taalkorrektheid van Afrikaans en Xhosa vertaalde vraelyste nagegaan het. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die navorsing te toets en alle data is persoonlik deur die navorser met die hulp van ’n opgeleide veldwerker ingesamel. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch en toestemming van die Departement Gesondheid, die Provinsiale Regering van die Wes-Kaap, asook skriftelike toestemming van elke deelnemer. Die data is ontleed met die bystand van ’n statistikus en is deur frekwensie tabelle aangebied. Die verhouding tussen volgehoue/aaneenlopende respons veranderlikes en nominale inset/invoer veranderlikes is ontleed deur gebruik te maak van die analise van variansie (ANOVA). Verskeie statistiese toetse is toegepas om die statistiese assosiasies tussen veranderlikes vas te stel soos die chi-kwadraat toetse deur ’n 95% betroubaarheidsinterval te gebruik. Nie-parametriese toetse soos die Mann-Whitney U-toets of Kriskal-Wallis toets is gebruik vir ewekansige ontwerp. Levene se toets is gebruik vir homogeniteit van variansie en die Bonferonni toets vir waarskynlikheid. Die toets het bewys dat 50.3% van die moeders wat aan die studie deelgeneem het, het PND. Verskeie risiko faktore is in hierdie studie vasgestel wat die ontwikkeling van PND beïnvloed. Resultate sluit statistiese assosiasie tussen PND en die volgende in: - onbeplande babas en onwelkome babas (p=<0,01) - lewensgebeure (p=0.01) - lewensmaat verhoudings (p=<0.01) - familie en maatskaplike ondersteuning (p=<0.1) Vervolgens het die meeste van die deelnemers (53.8%) met PND (n=80) ’n geskiedenis van ’n psigiatriese siekte met ’n beduidenis (p=<0.01), die meeste van die deelnemers (63.5%) is ongetroud en 23.8% is tieners wat aan PND ly. Aanbevelings sluit die bevordering van gesonde leefstyle, die bemagtiging van vrouens, voorkoming van tienerswangerskappe, vroeë en holistiese assessering van simptome van PND in en die aangewese verwysing. Daar kan tot die slotsom gekom word dat voorkoming- en bevorderingsmaatstawwe, vroeë opsporing van PND en aangewese verwysings en behandeling, krities is in die hantering van moeder-, kind- en gesinswelstand.

A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

This study attempted to identifj and explore the role the building plays in the organisation culture of nursing homes. To do this a research plan was formulated in which the central plank was a case-study of a seventy-five bed high care nursing home. As part of the case-study, interviews were conducted at the nursing home with ten members of staff, two residents and a daughter of a resident. The study was also informed by interviews with two architects, who specialise in the design of nursing homes and aged care facilities. A theoretical model entitled the 'Conceptual Framework' was developed prior to the case-study. It was tested by applying it to findings related to the physical context and the organisation culture of the case-study venue. The hypothesis that the building does influence the culture of the nursing home environment was explored by studying the manner in which the building influenced the lives of those who work in the nursing home and those who live there. This challenge was met with the use of theoretical contributions from organisation theory and psychodynamics, which together provided a vehicle for analysis of the culture and the building's role in it.