Caring for caregivers : developing a psychodynamic understanding of a process of staff support for primary health care workers

Van Wyk, Brian Eduard (2005-12)

Thesis (PhD)--University of Stellenbosch, 2005.

Thesis

ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping.

AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/50294
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