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

[摘要] 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 publichealth services. Staff morale is low and this results in turnover and poor quality ofcare. Therefore, staff need to be supported, so that they are better equipped toprovide quality care for patients.This dissertation describes a process of action research that aimed to explorepossibilities for staff-support interventions to health teams in the public PHCsector.Data were collected through in-depth interviews, group interviews, focus groupdiscussions and consultation sessions, with health staff and middle managers. Datawere analysed using a grounded theory approach, with the assistance of the Atlas.ti4.1 software package.The interpretation of data was informed by psychoanalytic andopen systems theories.Four cycles of action research were conducted. The first action stage involved aqualitative assessment of the nature of stressors in the PHC system. The secondaction stage describes the experiences of two staff teams from a health preventionclinic and a day hospital (curative service) as they prepared to merge and integrateaspects of service delivery. In the third action stage the research team explored thefeasibility of a short programme aimed at building capacity amongst middle andfacility level managers to act as containers for staff stresses. However, due toexternal factors the programme was not completed. The final action stage describesinterviews with selected participants to reflect on the effects of the current actionresearch process on them and their work.The current research suggests that a psychodynamic approach may be a usefulcomponent of action research in health settings. This approach makes room forinterpretation of unconscious processes in the stress experiences of health workers,and has the potential to move health staff and management to alternative modes offunctioning and coping.

[发布机构] Stellenbosch University