PAIN, NEED-DRIVEN BEHAVIORS IN DEMENTIA, AND NURSES\u27 PERCEPTIONS: AN EMBEDDED MIXED METHODS STUDY

This dissertation is an exploration of psychosocial and behavioral concepts related to the experience of pain in persons with severe dementia and whether the use of an observational pain scale would provide better pain management and comfort for these individuals. Pain has been under-detected, under-reported, and under-treated in this population mainly because persons with dementia (PWD) are unable to self-report pain. Cognitive decline associated with dementia is commonly accompanied by loss of ability to communicate and neuropsychiatric behaviors known as need-driven behaviors (NDB). Nurses must correctly interpret ‘pain behaviors’ in order to assess and treat appropriately. The overlapping of NDBs and pain behaviors presents a methodological and clinical challenge that indicates the need for more research. The reader will notice these concepts threaded throughout the dissertation. The researcher determined a gap in current evidence related to NDBs, which may be the only expressions of pain for persons with severe dementia. The first manuscript, Comparison of Pain Assessment Tools Used for Persons with Dementia, written as a state-of-the-science literature review examines the most frequently used observational pain scales (OPS) in comparison to the American Geriatric Society Guideline for Persistent Pain in Older Adults and reliability and validity. In the Eyes of the Beholder: The Historical Basis for an Integrated Model of Pain Management is the second manuscript in this portfolio dissertation. This manuscript provides a non-traditional analysis of the concept pain by providing a historical basis for an integrated pain management model. The fourth chapter presents the primary research study. Using a local memory-care organization, an embedded mixed methods study was undertaken with a hypothetical model as the foundation to determine the utility of two OPS in clinical practice. A qualitative element was included to capture the nurses’ perceptions of pain interpretation with PWD. Further analysis revealed the utility of the OPSs and the impact on NDB and pain medication administration. In completing this dissertation, the researcher was able to contribute to the extant knowledge on pain, need-driven behavior in dementia, and nurses’ perceptions

A New Dawn

BRICS is a significant player in the international arena. Thus, it is important for South Africa as a member of BRICS to explore the implications of the external and internal influences of BRICS. This includes comprehensive understanding of the international and national involvement of BRICS in education provision and introducing discovered influences in South African educational planning. The size of BRICS as international player, in different areas and on different levels, necessitates the research of its functioning and in this case the role of BRICS regarding education provisioning. Therefore, this research and analysis of the contribution of BRICS in education provision are an important addition to the field of effective Education. Through the preliminary literature reviews, we noticed that current studies often are quantitative in nature and lack comparative qualitative exploration about education development in BRICS countries. For this reason, the book titled BRICS Education: A new dawn, will contribute to the flourishment of quality education in South Africa and all BRICS nations. The book will also aim to encourage researchers to join efforts with other researchers of the five member states in order to learn from each other and to address common challenges. To that end, this research will generate scientific knowledge meant to maximize the readers, understanding of the current realities of the education aims at the national (each member state) and collective (BRICS organization) level. The authors of the book are interested in comparing the educational aims across the BRICS countries and explore how successfully these aims are being implemented on-the-ground. Through the discovering of similarities and differences in the educational aims of the five member states and the educational objectives of the BRICS-organization the readers of the book will be able to identify best practices that will allow member states to fulfill the education aims of the BRICS organization at large

Crystallography Open Database (COD): an open-access collection of crystal structures and platform for world-wide collaboration

Using an open-access distribution model, the Crystallography Open Database (COD, http://www.crystallography.net) collects all known ‘small molecule / small to medium sized unit cell’ crystal structures and makes them available freely on the Internet. As of today, the COD has aggregated ∼150 000 structures, offering basic search capabilities and the possibility to download the whole database, or parts thereof using a variety of standard open communication protocols. A newly developed website provides capabilities for all registered users to deposit published and so far unpublished structures as personal communications or pre-publication depositions. Such a setup enables extension of the COD database by many users simultaneously. This increases the possibilities for growth of the COD database, and is the first step towards establishing a world wide Internet-based collaborative platform dedicated to the collection and curation of structural knowledge

Advancing the rights of rural women with disabilities in Zimbabwe: challenges and opportunities for the twenty first century

Text in English with abstracts in English, isiXhosa and isiZuluDisability studies largely ignored or neglected the experiences of rural women with disabilities (WWD) in the Global South. This qualitative study documents the challenges faced by Zimbabwean rural WWD in the enjoyment of their fundamental rights and freedoms. Against the backdrop of various global, regional and national efforts to advance WWD’s rights, the study examines possibilities for change. Utilising a phenomenological design, data were collected through in-depth interviews with women and girls with disabilities (WGWD), and semi-structured interviews with state and non-state actors in disability rights. Augmented by observations and extensive literature and policy reviews, the research findings revealed that the majority of rural WWD are not aware of their legal rights and have limited access to productive resources, information, employment, education and food. Rural WWD face mobility challenges and are largely discriminated against in health institutions and excluded from taking part in socioeconomic and political activities. Girls with disabilities in inclusive schools battle against a myriad of attitudinal, environmental and administrative hurdles that limit their academic and social functioning. The results confirm the feminist disability theory’s view that the functioning of WGWD is heavily determined by wider contextual, social, historic and gendered power relations. The findings support recommendations for an urgent alignment of liberal national disability instruments, policies and practices to international human rights norms. The 2013 Constitution effectuates a human rights approach to disability, yet in practice the exclusion of the disabled, rural, female ‘other’ continues unabated. Transformation in this regard must include a restructuring of financial resourcing of various state institutions for advancing disability rights. Various avenues to ensure for effective disability rights mainstreaming, lobbying, advocacy, awareness raising, and capacitation of rural communities are suggested. At the heart of it all is a change in mind-sets to embrace WWD as equal human beings with rights and dignity.Izifundo zobulwelwe azikhange ziyithathele ngqalelo imeko namava abantu basetyhini abayimilwelwe behlala emaphandleni kumazwe asemaZantsi. Esi sifundo somgangatho sibhala ngemingeni ejongene nabasetyhini abayimilwelwe basemaphandleni eZimbabwe xa befuna ukuxhamla amalungelo nenkululeko eyimfanelo yabo yemveli. Ngokuqwalasela imizamo eliqela yehlabathi jikelele, yezithili neyesizwe ekuphuhliseni amalungelo abasetyhini abayimilwelwe, esi sifundo sivavanya amathuba otshintsho. Ngokusebenzisa uyilo lwezifundo ngokwenzekayo, kwaqokelelwa iinkcukacha zolwazi ngokuqhuba udliwano ndlebe olunzulu namakhosikazi namantomabazana ayimilwelwe, kwaqhutywa nodliwano ndlebe lwemibuzo engenampendulo zithe ngqo (semi structured interviews) nemibutho yoburhulumente nengeyoyoburhulumente esebenza ngamalungelo emilwelwe. Uphando olwalukhatshwa kukuzibonela nokufunda nzulu okubhaliweyo ngemigaqo nkqubo, lwaveza ukuba uninzi lwabasetyhini abayimilwelwe basemaphandleni alwazi nto ngamalungelo alo asemthethweni kwaye alufikeleli ngokwaneleyo kwimithombo eluncedo, ulwazi, imisebenzi, imfundo nokutya. Abasetyhini abayimilwelwe basemaphandleni bajamelene nemingeni yokungakwazi ukuhamba kwaye bayacalucalulwa kakhulu kumaziko ezempilo. Ababandakanywa ekuthatheni inxaxheba kwimisebenzi yezentlalo, uqoqosho nezombuso/upolitiko. Amantombazana ayimilwelwe asezikolweni zikawonkewonke asedabini nemiqobo emininzi yendlela acingelwa ngayo, indawo ewangqongileyo nolawulo, zinto ezo zikuthibazayo ukusebenza kwawo kwezemfundo nasekuhlaleni. Iziphumo zophando ziyangqinelana nengcingane yezifundo zabasetyhini ethi indlela yokwenza izinto yabasetyhini abayimilwelwe ilawulwa ikakhulu lunxulumano lweemeko ezigqubayo, ezentlalo, ezembali nezesini. Iziphumo zophando zixhasa iingcebiso ezithi makukhawuleziswe kwenziwe ungqamano phakathi kwezixhobo, imigaqo nkqubo nemisebenzi yobulwelwe esizweni nezimiselo zamalungelo oluntu kwihlabathi ngokubanzi. UMgaqo Siseko wama-2013 ubeka elubala indlela yokujongana nobulwelwe, kodwa kuyaqhubeka kona ukujongelwa phantsi kwemilwelwe, yabasemaphandleni, yabasetyhini. Inguqu kulo mbandela kufuneka iquke ukuyilwa ngokutsha kwenkxaso mali kumaziko oburhulumente ahlukeneyo ukwenzela ukuba kuqhutyelwe phambili amalungelo emilwelwe. Kucetyiswa ngeendlela ezahlukeneyo zokuqinisekisa amalungelo emilwelwe njengokwenza iinkqubo ezifanelekileyo ezingundoqo, ngokuthethathethana nokuphembelela, ngokwazisa uluntu nokuxhobisa uluntu lwasemaphandleni. Esizikithini sako konke kufuneka utshintsho lwengqondo ukwenzela ukuba bamkelwe abasetyhini abayimilwelwe njengabantu abalingana nabanye benamalungelo nesidima.Izifundo ezimayelana nokukhubazeka zivame ukunganaki noma ukungabi nandaba nokwenzeka kubantu besifazane abakhubazekile (ama-WWD) abahlala emaphandleni emazweni angakathuthuki ngokwanele (aseGlobal South). Lolu cwaningo olubheka kabanzi imininingwane engamaqiniso luqopha izingqinamba ezikhungethe abesifazane baseZimbabwe abakhubazekile abahlala emaphandleni ngenkathi bethokozela amalungelo abo asemqoka kanye nenkululeko yabo. Phezu kwemizamo eyahlukahlukene yezinga lomhlaba, lezifunda nelikazwelonke, yokuthuthukisa amalungelo abesifazane akhubazekile, lolu cwaningo lubheka amathuba akhona oguquko. Kwasetshenziswa uhlobo lokucwaninga olubheka okuthize ngokuhlola imibono yalabo abake baba sesimweni salokho okucwaningwa ngakho, ngokufaka imibuzo abesifazane kanye namantombazane akhubazekile, kanye nalabo abadlala indima kwezamalungelo abantu abakhubazekile abasebenzela umbuso nabangasebenzeli umbuso. Ngokufakazelwa kakhulu ngokubonakele kanye nokuhlaziywa kwemibhalo nenqubomgomo, imiphumela yocwaningo enohlonze iveze ukuthi iningi labesifazane abakhubazekile basemaphandleni abawazi amalungelo abo ezomthetho kanti futhi abafinyeleli ngokuphelele emithonjeni elusizo, kwimininingwane, kwimisebenzi, kwezemfundo kanye nasekudleni. Abesifazane abakhubazekile basemaphandleni babhekana nezingqinamba zokungakwazi ukuhamba kahle kanti futhi bayacwaswa ezikhungweni zezempilo, baphinde banganikwa ithuba lokubamba iqhaza kwezenhlalo-mnotho nezepolitiki. Amantombazane akhubazekile ezikoleni ezamukela zonke izinhlobo zabafundi babhekana nezimo eziningi eziyizingqinamba maqondana nendlela aphathwa ngayo, nesimo sendawo kanye nokwenziwa kwezinto okuba nomkhawulo ekwenzeni kwabo maqondana nezemfundo nezenhlalo. Imiphumela iqinisekisa umbono wenzululwazi elwela abesifazane abakhubazekile wokuthi ukusebenza kwabesifazane abakhubazekile, esikhathini esiningi, kuvame ukuvela ngenxa yengqikithi esabalele yobudlelwano bamandla maqondana nenhlalo, umlando kanye nobulili. Imiphumela yocwaningo yeseka izincomo zokuthi kumele kube khona ukulinganiswa okuphuthumayo kwempahla yokusebenza maqondana nokukhubazeka, izinqubomgomo kanye nezindlela zokusebenza ezingeni likazwelonke kanye nokuvamile ezingeni lomhlaba wonke kokuphathelene namalungelo abantu. UMthethosisekelo wonyaka we-2013 wenza kusebenze indlela yokubheka ukukhubazeka ngeso lamalungelo abantu, kodwa indlela okwenziwa ngayo iqhubeka kakhulu nokubandlulula abesifazane abakhubazekile basemaphandleni. Uguquko, maqondana nalokhu, kumele lufake ukuhlelwa kabusha kosizo lwezimali ezikhungweni ezahlukahlukene zombuso eziqhuba phambili amalungelo aba. Kuhlongozwa izindlela ezahlukahlukene zokuqinisekisa amalungelo abakhubazekile okufaka kukho ukufakwa kwemiphakathi yasemaphandleni ezinhlelweni, ukukhulumisana nayo ukuze ibambe iqhaza, ukuyilwela, ukwenza ukuba iqaphele okwenzekayo kanye nokuyinikeza amandla okwenza. Okuyiyona nto ebaluleke kakhulu, wuguquko ekucabangeni ukuze abesifazane abakhubazekile bathathwe njengabantu abalingana nabanye abanamalungelo nesithunzi.Development StudiesD. Phil. (Development Studies