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An inquiry into the organisation of care for deliberate self-harm patients in a South African hospital

dc.contributor.advisorBantjes, Jasonen_ZA
dc.contributor.authorNel, Annemien_ZA
dc.contributor.otherStellenbosch University. Faculty of Arts and Social Sciences. Department of Psychologyen_ZA
dc.date.accessioned2016-03-09T14:52:35Z
dc.date.available2016-03-09T14:52:35Z
dc.date.issued2016-03
dc.identifier.urihttp://hdl.handle.net/10019.1/98713
dc.descriptionThesis (MA)--Stellenbosch University, 2016en_ZA
dc.description.abstractENGLISH ABSTRACT : Deliberate Self-Harm (DSH) is a significant problem in South Africa. Individualsengaging in DSH have an elevated risk for a subsequent presentation of DSH and for completed suicide. DSH patients also place a burden on the health care system and have shorter life expectancies than the general population. Research suggests that hospital Emergency Departments (EDs) are a site of potential intervention for DSH patients. This study sought to investigate how an ED of a SA urban hospital responded to DSH patients. An ethnographic inquiry was employed to examine the policies, practices, attitudes and knowledge that generated the response by health care professionals. Specifically, the organisational structure of the ED was studied, both in relation to the hospital as well as in relation to the broader health care system. Three different data method collection techniques were used; observations, semistructured interviews and document analysis (pertaining hospital policies). Data was collected over a period of eight months (May – December 2014). Semi-structured interviews were conducted with 28 health care professionals. This sample included medical officers, a medical registrar, medical interns, medical students, nurses, a student nurse, psychiatry registrars, psychologists and social workers. Thematic analysis was implemented to group findings into meaningful themes. This study found that health care professionals are doing their best, under difficult circumstances, to respond to the needs of DSH patients. Nonetheless a number of barriers and opportunities to the provision of care were identified. Significant barriers included the lack of resources, a discontinuity of care, the impossibility of a relationship with the DSH patient, as well as negative attitudes and emotional responses of health care professionals, such as stigmatisation, and negative perceptions. Opportunities to the provision of care included health care professionals’ positive attitudes, such as empathy and a willingness to provide quality care to DSH patients. This research has found that an under-resourced system and negative attitudes of health care professionals prevent the ED from being optimally utilised as a space for intervening with the DSH population. The implementation of existing resources in the ED may be re-examined as to use them optimally.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING : Doelbewuste selfbeskadiging (DSB) is ’n gewigtige probleem in Suid-Afrika. Individue wat DSB beoefen loop ’n groter risiko vir ’n daaropvolgende DSB-episode, asook vir selfdood. DSB-pasiënte plaas ook druk op die gesondheidstelsel en het ’n korter lewensverwagting in vergelyking met die algemene bevolking. Navorsing stel voor ’n hospitaal se ongevalle-eenheid kan dien as ’n spasie van moontlike ingryping wat DSBpasiënte betref. Hierdie studie het ondersoek hoe ’n ongevalle-eenheid van ’n stedelike Suid- Afrikaanse hospitaal optree teenoor DSB-pasiënte. ’n Etnografiese ondersoek is geloods om die beleide, gewoontes, houdings en kennis wat tot die optrede van gesondheidspersoneel gelei het te ondersoek. Die organisatoriese struktuur van die ongevalle-eenheid, met betrekking tot die hospitaal, sowel as die groter gesondheidsisteem, is spesifiek bestudeer. Drie verskillende data-insamelingstegnieke is gebruik: waarnemings, semigestruktureerde onderhoude en dokument-analise (met betrekking tot hospitaalbeleide). Data is oor ’n tydperk van agt maande (Mei – Desember 2014) ingesamel. Semi-gestruktureerde onderhoude is gevoer met 28 gesondheidswerkers. Hierdie steekproef het die volgende mense ingesluit: mediese beamptes, ’n mediese kliniese assistent, mediese interns, mediese studente, verpleegsters, ’n studenteverpleegster, psigiatriese kliniese assistente, sielkundiges en maatskaplike werkers. Daar is van tematiese analise gebruik gemaak om die resultate te groepeer volgens betekenisvolle temas. Hierdie studie het gevind dat gesondheidswerkers onder moeilike omstandighede hulle bes doen om op die behoeftes van die DSB-pasiënte te reageer. ’n Aantal hindernisse tot en geleenthede vir die voorsiening van sorg vir DSB-pasiënte is geïdentifiseer. Betekenisvolle hindernisse sluit in: ’n tekort aan hulpbronne, ’n onderbreking in sorg, die onmoontlikheid van ’n verhouding met die DSB-pasiënt, negatiewe houdings en emosionele reaksies van gesondheidswerkers, byvoorbeeld stigmatisering en negatiewe opvattings. ‘n Geleentheid vir die voorsiening van sorg is gesondheidswerkers se positiewe houdings, byvoorbeeld empatie en ’n bereidwilligheid om gehaltesorg aan die DSB- pasiënt te voorsien. Hierdie navorsing het gevind ’n stelsel met ’n tekort aan hulpbronne in kombinasie met die negatiewe houdings van gesondheidswerkers verhoed dat die ongevalle-eenheid optimaal benut word as ’n ruimte van ingryping by die DSB-bevolking. Die implementering van bestaande hulpbronne behoort herevalueer te word in ’n poging om hierdie hulpbronne optimaal te benut.af_ZA
dc.format.extentxiv, 210 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.subjectSelf-injury interventionsen_ZA
dc.subjectParasuicideen_ZA
dc.subjectDeliberate self-harm (DSH)en_ZA
dc.subjectEmergency medical services -- Interventions --South Africaen_ZA
dc.subjectHospitals -- Emergency Departments (EDs) -- Interventions-- South Africaen_ZA
dc.subjectUCTDen_ZA
dc.titleAn inquiry into the organisation of care for deliberate self-harm patients in a South African hospitalen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch Universityen_ZA


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