The Experiences of Batswana Families Regarding Hospice Care of AIDS Patients in the Bophirima district; North West province; South Africa

The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients; with some patients; too ill to be nursed at home; being sent to hospices for continued care. The Batswana had mixed feelings about hospice care; because their beliefs on patient care are based on the ubuntu philosophy; which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative; explorative; descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising; ordering; and summarising the data; and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation; firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However; they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care

Echocardiographic Assessment of Left Atrial Size in Patients with End-Stage Renal Disease : Cardiovascular Topic

Background: Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease; silent myocardial ischaemia; complex ventricular arrhythmias; atrial fibrillation; left ventricular hypertrophy; annular mitral and aortic valve calcification; and enlargement of the left atrium; than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study; we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. Methods: We analysed data from 123 patients who were on regular haemodialysis; by means of traditional transthoracic echocardiographic examination. The usual statistical parameters; correlations and the Student's t-test were performed; with levels of significance of p 0.01 and p 0.05. Results: The most presented age group was 60 to 69 years old; with a predomination of females (56.1). We found dilated left atrium in 26.02of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Conclusion: Evaluation of left atrial size should be determined by several different measurements; and left atrial enlargement should be seen as a risk factor for advancing disease

Caring for Terminal AIDS Patients: the Experiences of Caregivers in a Palliative Care Institution

This research focused on the lived experiences of caregivers working with AIDS patients; particularly patients who die from this disease whilst resident in a formal institution. A qualitative; exploratory; descriptive; and contextual research design with a phenomenological approach to inquiry was utilised. Thirteen unstructured interviews; which were audio-taped; were conducted with caregivers working full-time in a formal institution caring for patients who are dying from AIDS. The transcribed interviews were analysed using Tesch's method of descriptive analysis (in Creswell 1994:115). One central theme emerged; namely that in their daily duty (at their place of work); caregivers experienced various challenges as a result of having to deal with the death of their patients suffering from AIDS; and five sub-themes were formulated from further analysis. The five subthemes were: Caregivers experienced emotional challenges in caring for patients dying of AIDS; Caregivers experienced a difference in death and dying of adults as apposed to children; Caregivers experienced the rationalisation of death and dying differently; Caregivers experienced that faith in God give them strength to cope with death and dying; Caregivers experienced caring for patients as fulfilling and meaningful to them despite the sadness of death and dying. The participants face the death of their patients daily; from a disease that causes untold suffering to the patients; family members and to the caregivers themselves; who wish they could prevent the anguish; the pain and the inability of the medical profession to do more than they are at present towards curing this disease. They described their emotional experiences; which included the various challenges that they face as a result of having to deal with the death and dying of their patients suffering from AIDS. The information shared by these participants formed the foundation of the broad guidelines that were developed in order to provide support for such caregivers

The Professional Nurse's Experience of Dying Process of Terminal AIDS Patient

The increase in HIV/AIDS raises international concern. Statistics indicate that South Africa has the fastest increasing HIV-infection rate in the world. Secondary infections complicate the issues and could result in hospitalisation and death of terminal AIDS patients. Nurses are increasingly exposed to this process. This directed the researchers to explore and describe the nurse's experience of the dying process of the terminal AIDS patient through a qualitative research design. Purposive; voluntary sampling was conducted followed by individual interviews. Data saturation was reached after 10 interviews. The data were then analysed involving a co-coder to ensure trustworthiness. The results indicated specific themes. Firstly; nurses experience that various factors influence the pace of the dying process. Secondly; contrasting experiences regarding medical treatment of these patients surfaced. The study indicated that the nurse experienced emotions such as powerlessness; relief and fear. Finally; the needs and behaviours of the terminal AIDS patient; and the specific behaviours of the nurses were revealed. Value judgements regarding the patient; his family; medical treatment and the nurse's conduct during the dying process were also noted. Recommendations focus on the following: nurses' personal coping with the dying process; extended coping skills in the guidance of terminal AIDS patients and their handling of specific themes during the dying process.regarding the patient; his family; medical treatment and the nurse's conduct during the dying process were also noted. Recommendations focus on the following: nurses' personal coping with the dying process; extended coping skills in the guidance of terminal AIDS patients and their handling of specific themes during the dying process