African Journals Online
Health SA Gesondheid : interdisciplinary research journal

Volume 7, Issue 1, March 2002
ABSTRACTS

An introduction to a postmodern approach to nursing research: discourse analysis - part 1: research

Abstract: This article serves as an introduction to discourse analysis. It therefore does not give an account for the whole research process. Due to logistical reasons, because this is a relatively new and multifaceted approach in research, this article involves only introductory remarks about discourse analysis as approach to qualitative, reflexive nursing research. Different postmodern "approaches" to qualitative nursing research derived from other disciplines are being rooted in nursing as epistemology. Discourse analysis is introduced as a Poststructuralist and Social Constructionist "approach" to nursing research developing within the postmodern line of thought. A qualitative exploratory research design was chosen that explored specific Poststructuralist and Social Constructionist literature on research by means of an in-depth literature review. The sample was chosen from Poststructuralist and Social Constructionist literature on research in general as these paradigms have not been described in South African literature on nursing research. The ideas on discourse analysis as a research "approach" of Parker (1992: 6-20) and Terre Blanche & Durrheim (1999: 154-167) are discussed. Discourse analysis could serve as a valuable "approach" in nursing research as it challenges current dominant ways of understanding or viewing the objects of study. This process opens up space for alternative reflections that could lead to change.

Hierdie artikel dien as 'n inleiding tot diskoers-analise. Dit beoog dus nie om die hele navorsingsproses breedvoerig te bespreek nie aangesien diskoers-analise 'n relatief nuwe en multifasettige benadering in navorsing is. Vanweë logistiese redes word in hierdie artikel slegs inleidende gedagtes oor diskoers-analise as benadering tot kwalitatiewe, refleksiewe verpleegnavorsing ingesluit. Verskillende postmoderne "benaderings" tot kwalitatiewe navorsing word in die verpleegkunde as epistemologie beskryf en het begin wortelskiet. Diskoers-analise word bespreek as 'n "benadering" tot navorsing wat ontstaan het uit die Poststrukturalisme en Sosiale konstruksionisme binne die postmoderne denkstroom. 'n Kwalitatiewe, eksplorerende navorsingsontwerp is gekies waardeur 'n indiepte literatuurstudie onderneem is om diskoers-analise as "benadering" tot navorsing te ondersoek. Die literatuurstudie is op die paradigmas van Poststrukturalisme en Sosiale konstruksionisme gerig en die "benadering" tot navorsing wat uit hierdie paradigmas voortvloei aangesien hierdie raamwerke nog nie in Suid-Afrikaanse literatuur oor navorsing in die verpleegkunde vervat is nie. Die sienings oor diskoers-analise as "benadering" in navorsing van Parker (1992: 6-20) en Terre Blanche & Durrheim (1999: 154-167) word bespreek. Diskoers-analise kan as 'n waardevolle "benadering" tot navorsing in die verpleegkunde dien aangesien dit huidige dominante verstaanswyses bevraagteken. Dit skep ruimte vir alternatiewe refleksies en ander verstaansmoontlikhede waarbinne die potensiaal vir verandering dan ontstaan.

The analysis of a dominant gender discourse - part 2: research

Abstract: Gender dilemmas are formed where a woman's role and identity is constructed in alternative ways, ways which do not cohere with the ways prescribed and expected within a dominant gender discourse. Gender dilemmas give birth to internal discomfort and a loss of experiencing the self as meaningful. Gender dilemmas disempower and silence women. The following questions are addressed: Which processes and powers construct women in certain ways? How are the roles and identities of women formed during these processes? An analysis of a dominant gender discourse within the South African cultural context is discussed to increase the understanding of the constructed nature of the gender identity of women and to increase the understanding of gender dilemmas that silence and disempower women. A qualitative reflexive research design was chosen where a discourse analysis is performed (Terre Blanche & Durrheim, 1999: 148 ; Mouton, 1996: 102 ; Rommetveit, 1990: 90). Texts for the analysis came from transcriptions of ten in-depth, semi-structured individual interviews with nominated women. The analysis was done by combining the ideas on discourse analysis of Parker (1992: 6-20) and Terre Blanche and Durrheim (1999: 154-167). The analysis aims at increasing the understanding of the constructed nature of femininity and to generate further ways to understand gender dilemmas. This process opens up space for alternative reflections that could lead to change.

Gender-dilemmas word gevorm waar 'n vrou se rol en identiteit gekonstrueer is op alternatiewe wyses wat nie ooreenstem met tradisionele konstruksies binne 'n dominante gender-diskoers nie. Gender-dilemmas gee oorsprong aan interne ongemak en 'n verlies aan selfsinvolheid. Vroue word daardeur verstil en ontmagtig. Die volgende vrae word aangespreek: Deur watter prosesse en kragte word die vrou gekonstrueer? Hoe word die rol en identiteit van die vrou gevorm deur hierdie prosesse? 'n Analise van 'n dominante gender diskoers binne die Suid-Afrikaanse kulturele konteks word bespreek om begrip vir die gekonstrueerde aard van die gender identiteit van vroue te genereer en om begrip te bevorder vir gender-dilemmas waardeur vroue verstil en ontmagtig word. 'n Kwalitatiewe reflektiewe navorsingsontwerp is gekies waartydens 'n diskoers- analise uitgevoer is. (Terre Blanche & Durrheim, 1999: 148 ; Mouton, 1996: 102 ; Rommetveit, 1990: 90). Tekste vir die analise is bekom uit die transkripsies van tien indiepte, semi-gestruktureerde individuele onderhoude met genomineerde vroue. Die analise is gedoen op grond van die diskoers-analise van Parker (1992: 6-20) en Terre Blanche en Durrheim (1999: 154-167). Die analise poog om begrip vir die gekonstrueerde aard van vroulikheid en om verdere verstaansmoontlikhede vir gender-dilemmas te genereer. Die potensiaal vir moontlike verandering ontstaan hierin.

Stress and the heart: a co-construction of new lifestyles after coronary heart disease (CHD): research

McKibbin, E.C.; Pretorius, H.G.

Abstract: "There are plenty of alternatives in any situation... When you attend a session of group therapy, what on earth are you going to see? That (plenty of alternatives) is what you are there for" (Freedman & Combs, 1996: 11). Using a narrative perspective, the stress construct in the lives of people with coronary heart disease is reconsidered. This permits a shift in focus in the stories of the lives of South African National Defence Force officers from the unhelpful construct of stress to one on their abilities to cope with modern-day complexity and uncertainty, including heart disease. Such reconstructions accommodate both scientific and lay theories of heart disease, and enable people to live more positively.

Die konstruk van stres in die lewe van mense met koronêre hartsiekte word deur middel van 'n narratiewe benadering heroorweeg. Dit laat 'n fokus-verandering, in die lewensstories van offisiere van die Suid-Afrikaanse Nasionale Weermag, toe. Hierdie skuif vind plaas vanaf die nie helpvolle konstruk van stres na hulle vermoëns om met hedendaagse kompleksiteite en onsekerheid, wat hartsiekte insluit, te leef. Sulke herkonstruksies akkommodeer beide wetenskaplike en leke teorieë van hartsiekte, en bemagtig mense om meer positief te leef.

The victim's experience of hijacking: an exploratory study: research

Macgregor, J.; Schoeman, W.J.; Stuart, A.D.

Abstract: This paper summarises a phenomenological study that was designed to explore the victim's lived experience of undergoing a motor vehicle hijacking. The aim of the study was to add to the knowledge and understanding of this complex phenomenon. The design of the study was qualitative. Data was collected through in-depth unstructured interviews with four people who had very recently been hijacked. The interviews were recorded on audiotape and transcribed verbatim for each subject. Both intra-individual and inter-individual analyses of the data were conducted. This paper presents a discussion of the findings of common and contrasting themes and patterns. The nature of the victim's experiences during, immediately after and in the days following the hijacking trauma is elucidated. This information can contribute towards building a theoretical framework for understanding the victim's experience of motor vehicle hijacking.

Hierdie artikel verskaf 'n oorsig oor 'n fenomenologiese studie wat ontwerp is om die slagoffer se geleefde ervaring van 'n motorkaping te ondersoek. Die doel van die studie was om by te dra tot die kennis and begrip van die komplekse verskynsel. Die ontwerp van die studie was kwalitatief. Data is versamel deur indiepte, ongestruktureerde onderhoude met vier persone wat onlangs gekaap is. Die onderhoude is opgeneem op oudioband en verbatim getranskribeer vir elke persoon. Beide intra-individuele en inter-individuele ontledings van die data is gedoen. In die artikel word die bevindings ten opsigte van gemeenskaplike en kontrasterende temas aangebied. Die aard van die ervarings tydens, direk daarna en in die dae na die kaping word bespreek. Die inligting kan bydra tot die vorming van 'n teoretiese raamwerk ten einde die slagoffer se ervaring van 'n motorkaping te verstaan.

Die terapeutiese gebruik van die scenotoets met verwysing na selektiewe mutisme: research

Abstract: Daar is min toegepaste navorsing en beskikbare literatuur oor selektiewe mutisme. Die vernaamste doel van hierdie studie is om aan te toon dat die 'Scenotest' deur Gerhild von Staabs (1991: 1) as terapeutiese tegniek gebruik kan word in die terapie van kinders met selektiewe mutisme. 'n Verdere doel is om bestaande literatuur oor die behandeling van hierdie versteuring uit te brei. Nege terapeutiese sessies met 'n dogter van nege jaar wat as selektief mutisties gediagnoseer is, is as gevallestudie in die navorsing gebruik. Die gevallestudiemetode is gebruik as navorsingstegniek omdat dit 'n omvattende beskrywing van kontekstuele faktore moontlik maak. Daar is bevind dat die toepassing van die 'Scenotest' die terapeutiese proses bevorder het, aangesien dit die navorser die geleentheid gegee het om die kind se ervaring van haar lewenswereld en ander belangrike ander mense te assesseer, sonder die hulp van die gesproke woord. Op hierdie wyse het spel die terapeutiese taal geword, wat 'n veilige omgewing geskep het waarin emosies en probleme uitgespeel kon word sonder dat die kind se gedrag 'n immobiliseerde effek op die terapeutiese proses kon hê. Dit word aanbeveel dat verdere navorsing oor die toepassingswaarde van die Scenotest in 'n multi-kulturele Suid-Afrikaanse konteks gedoen word, die rol wat die ma-kind-verhouding in die ontwikkeling van selektiewe mutisme speel ondersoek word en kennis geneem word van die beperkende invloed van "stilte" op die terapeut.

There is a paucity of applied research and available literature about selective mutism. The main aim of this study is to illustrate that the 'Scenotest', developed by Gerhild von Staabs (1991: 1), can be used as a therapeutic technique in treating children with selective mutism. A further aim is to supplement existing literature regarding the treatment of this disorder. Nine therapeutic sessions with a nine-year old girl, who was diagnosed with selective mutism, were used as a case study for the research. The case study method was employed as a research technique as it enabled a comprehensive description of contextual factors. It was found that the application of the 'Scenotest' promoted the therapeutic process as it offered the researcher the opportunity to assess how the child experienced her life-world and those meaningful 'others' that were present, without the need for verbalisation. In this way, play became the therapeutic language and it offered a safe environment in which emotions and problems could be dramatised without the child's behaviour having an immobilising effect on the therapeutic process itself. It is recommended that further research should be undertaken to establish the application benefits of the Scenotest in a multi-cultural South African context, to investigate what role the mother-child relationship plays in the development of selective mutism and to become aware of the influence of "silence" on the therapist.

Riglyne vir die respiratoriese verpleging van die kardio-torakale pasient in die post-ekstubasie fase: research

Abstract: Die kritieke sorgverpleegkundige is verantwoordelik en aanspreeklik vir hoë gehalteverpleging van die pasiënt wat koronêre vatchirurgie ondergaan net. Die gespesialiseerde respiratoriese verpleging van hierdie pasiënt in die onmiddellike post-ekstubasie fase is nog nooit nagevors nie. Die vraag ontstaan dus wat is die beste-praktykriglyne vir die respiratoriese verpleging, van 'n kardio-torakale pasiënt wat koronêre vatchirurgie ontvang het, in die onmiddellike post-ekstubasie fase. 'n Kwalitatiewe verkennende en beskrywende navorsingsontwerp is uitgevoer om die menings van kritieke sorgverpleegkundiges werksaam in kritieke sorgeenhede in privaathospitale in Pretoria, oor hierdie respiratoriese verpleging in te samel. Fokusgroeponderhoudvoering is gevoer en die data is aan geselekteerde kardio-torakale chirurge en 'n pulmonoloog vir validering voorgelê. Vervolgens is 'n literatuurkontrole onderneem en riglyne vir die respiratoriese verpleging van die kardio-torakale pasiënt, tydens die post-ekstubasie fase, is geformuleer. Vier hoofdimensies is geïdentifiseer, naamlik kliniese fisiologiese data, kommunikasie, vroeë liggaamlike aktiwiteit en beskikbare hulpbronne. Daar word aanbeveel dat hierdie riglyne nasionaal gevalideer word en dat die gehalte van respiratoriese verpleging van kardio-torakale pasiënte in die post-ekstubasie fase bepaal word.

The critical care nurse is responsible and accountable for quality nursing care of the patient that has undergone cardio-thoracic surgery. The specialised respiratory nursing care of these patients in the immediate post extubation phase, has never been researched. The question arises what are the best practice guidelines for the respiratory nursing care of the cardio-thoracic patient that has undergone coronary artery bypass, with specific reference to the immediate post extubation phase? A qualitative exploratory and descriptive research design was utilised. The views of critical care nurses working in private hospitals in Pretoria, on this specialised respiratory care of patients, were collected by means of a focus group interview. The data was exposed to two selected cardio-thoracic surgeons and one pulmonologist for validation purposes. A literature control was carried out and guidelines for the respiratory nursing care of the cardio-thoracic patient within the post extubation phase, were formulated. Four main dimensions were identifified, viz clinical physiological data, communication, early physical activities and available resources. It is recommended that these guidelines be exposed to national validation and that the quality of respiratory nursing care of the cardio-thoracic patient in the post extubation phase, be determined.

Research experiences of black adolescents who chose to terminate their pregnancies: research

Abstract: The "Choice on Termination of Pregnancy Act" (No. 92 of 1996) determines that a woman, including a 12-year old pregnant adolescent, can choose to terminate a pregnancy without the consent of parents, guardian or friends. This Act also makes provision for counseling, but research indicated that the counseling provided, focussed on the procedure of the termination, rather than on the psychological or emotional support to the woman who chose to terminate her pregnancy (Poggenpoel, Myburgh & Gmeiner, 1998: 4). Many women suffered from guilt feelings, anger, sadness and depression after they had a termination of pregnancy (Suffla, 1997: 219; Howard, 1985: 29). The researcher became interested in hearing the voices of black adolescents who chose to terminate their pregnancies and the following study emerged: A qualitative, explorative, descriptive and contextual research design was conducted to learn of the experiences of black adolescents who chose to terminate a pregnancy. A pilot phenomenological interview was conducted with a black adolescent who chose to terminate a pregnancy and who met the selection criteria. The phenomenological interviews were conducted in English and Tswana with nine black adolescents that volunteered to participate in the study and who were purposively selected. Steps were taken to ensure trustworthiness. Tesch's method of data-analysis was followed to analyse the data. The results indicated that black adolescents who chose to terminate a pregnancy, experienced emotional turmoil, physical distress and used psychological defence mechanisms as ways to cope, and some gained emotional maturity from the experience. Guidelines for supportive actions by the advanced psychiatric nurse practitioner were described in the form of therapeutic supportive counselling, but will be addressed in a separate article. Black adolescents who choose to terminate their pregnancy need support from psychiatric nurses, as well as nurses engaged in the termination of pregnancies in different health facilities, in order to promote their mental health. The focus of this article will be to describe the adolescents' experiences involved in the termination of a pregnancy.

Die "Wet op Keuse van Terminasie van Swangerskap" (No. 92 van 1996) bepaal dat 'n vrou, insluitend 'n 12-jarige swanger addolesent, kan kies om haar swangerskap te beëindig sonder haar ouers, voog of vriende se goedkeuring. Hierdie wet maak voorts voorsiening vir berading. Navorsing toon egter dat die berading op die prosedure van terminasie fokus, eerder as op die psigologiese of emosionele ondersteuning vir die vrou wat gekies het om haar swangerskap te beëindig (Poggenpoel, Myburgh & Gmeiner, 1998: 4). Baie vrouens gaan gebuk onder skuldgevoelens, woede, hartseer en depressie na die beëindiging van hul swangerskap (Suffla, 1997: 219 ; Howard, 1985: 29). Die navorser het daarin belang gestel om die stemme van swart addolesente wat hul swangerskap beëindig het te hoor. Dit het gelei tot die navorsingstudie wat gevolglik bespreek sal word. 'n Kwalitatiewe, verkennende, beskrywende en kontekstuele navorsingstudie is uitgevoer om die ervarings van swart adolessente wat kies om hul swangerskap te termineer, te verken en te beskryf. 'n Fenomenologiese loodsstudie is uitgevoer met 'n swart adolessent wat gekies het om haar swangerskap te termineer en wat aan die kriteria vir insluiting voldoen het. Die fenomenologiese onderhoude was in Engels en Tswana gevoer met nege swart adolessente wat vrywillig aan die studie deelgeneem het en doelgerig geselekteer is. Stappe is geneem om vertrouenswaardigheid te verseker. Tesch se metode van data-analise is gevolg om die data te analiseer. Die resultate dui aan dat swart adolessente wat gekies het om hul swangerskap te termineer, emosionele verwarring en fisiese ongemak ervaar en psigologiese verdedigingsmeganismes as maniere om te oorleef gebruik en sommige het selfs emosionele volwassenheid ervaar as gevolg van hul ervaring van die terminasie van hul swangerskap. Riglyne vir ondersteunende aksies deur gevorderde psigiatriese verpleegpraktisyns sal in 'n afsonderlike artikel bespreek word. Die swart adolessente wat die terminasie van hul swangerskap gekies het benodig ondersteuning van psigiatriese verpleegkundiges, sowel as verpleegkundiges van verskillende instansies, wat betrokke is by die terminasie van swangerskappe, ten einde hul geestesgesondheid te bevorder. Die artikel fokus op 'n beskrywing van swart adolessente se ervaring van die terminasie van hul swangerskap.

The views of Botswana adults towards support during childbirth: research

Abstract: The positive effect of support during labour is well documented in the literature. It is not known whether the Botswana males are interested in supporting their partners during labour, or whether the women really want them there, especially in the African culture where it may be taboo for a man to witness a delivery. In this research the views of Botswana adults regarding support during labour were explored and described in a qualitative study. Focus group discussions were conducted with groups of males and females from urban and rural areas of Botswana. The conclusion from the findings in this study is that Botswana adults of childbearing age feel that a woman in labour needs support from a relative of her own choice.

Die positiewe effek van ondersteuning tydens baring is goed gedokumenteer in die literatuur. Dit is egter nie bekend of Botswana mans hul vrouens wil ondersteun tydens baring nie, en of die vrouens hulle regtig daar wil hê nie, veral in die Afrika kultuur, waar dit taboe is vir 'n man om 'n bevalling waar te neem. In die navorsing word die menings van volwasse Botswanas aangaande ondersteuning tydens baring verken en beskryf in 'n kwalitatiewe studie. Fokusgroep onderhoude is gevoer met groepe mans en vrouens van landelike en stedelike areas in Botswana. Die gevolgtrekking is dat volwassenes in Botswana voel dat vrouens ondersteuning tydens baring nodig het van 'n familielid van hul keuse.

An analysis of referrals received by a psychiatric unit in a general hospital part 1: the need for and research design adopted to study referrals received by a psychiatric unit in a general hospital: research

Dor, M.; Ehlers, V.J.; Van der Merwe, M.M.

Abstract: In order to receive holistic health care, patients requiring psychiatric care, need to be referred to psychiatric services. The first part of this report reviews the need to analyse the referrals received by a psychiatric unit in a general hospital in the Republic of South Africa. The research design adopted to study this phenomenon will also be addressed. The research results, obtained from analysing the referred patients' records, will be discussed in Part 2 of this report.

Ten einde holistiese gesondheidsorg te ontvang, moet pasiënte, wat psigiatriese sorg benodig, na psigiatriese dienste verwys word. Deel 1 van die verslag verskaf 'n oorsig oor die noodsaaklikheid om die verwysings te ontleed, wat deur 'n psigiatriese eenheid in 'n algemene hospitaal in Suid-Afrika ontvang is. Die navorsingsontwerp wat aanvaar is om die verskynsel te bestudeer word ook bespreek. Die navorsingsresultate, wat bekom is deur die verwysde pasiënte se rekords te bestudeer, sal in Deel 2 van die verslag bespreek word.

Analysis of referrals received by a psychiatric unit in a general hospital part 2: analysis and discussion of research results: research

Dor, M.; Ehlers, V.J.; Van der Merwe, M.M.

Abstract: The study sought to analyse the referrals received by a psychiatric unit in a general hospital in the Western Cape by studying the referral letters and the referral responses. Part 1 of the report reviewed the need to analyse these referrals and described the research design adopted to study this phenomenon. The study sought to determine which departments were referring patients and which patients were being referred. The completeness and appropriateness of the referrals were also studied. This second part of the research report will present and discuss the research results. The major inferences drawn from this study are that health care workers have a poor concept of what information the psychiatric unit needs and about the scope and function of the unit. The poor feedback from the psychiatric unit to the referral source is indicative of the poor communication amongst the health care team members.

Hierdie navorsing het gepoog om verwysings te ontleed wat deur 'n psigiatriese eenheid in 'n algemene hospitaal in die Wes Kaap ontvang is. Dit is gedoen deur die verwysings briewe en verwysingsresponse te ontleed. Deel 1 van die verslag het die noodsaaklikheid aangespreek om die navorsing te doen asook die navorsingsontwerp bespreek wat aanvaar is om die verskynsel na te vors. Hierdie navorsing wou bepaal watter eenhede pasiënte verwys het en watter pasiënte verwys is. Die volledigheid en toepaslikheid van die verwysings is ook bestudeer. Die tweede deel van die navorsingsverslag sal die navorsingsresultate ontleed en bespreek. Die oorhoofse gevolgtrekkings waartoe die navorsing gekom het, is dat gesondheidsorgwerkers 'n beperkte begrip het van die inligting wat psigiatriese eenhede benodig asook van die omvang en funksies van sodanige eenheid. Swak terugvoer vanaf die psigiatriese eenheid na die verwysingsbronne het gedui op swak kommunikasie tussen die lede van die gesondheidsorgspan.