Faculty of Health Sciences

While chronic diseases are amongst the major health burdens of older South Africans, the responsibilities of caring for grandchildren, by mostly grandmothers, may further affect older people’s health and well-being. There is a paucity of information about chronic disease self-management for older people in the context of grandchildren caregiving in sub-Saharan Africa. Guided by the Self-Management Framework, the purpose of this qualitative methods study was to explore the chronic disease self-management practices and challenges of grandparent caregivers in rural KwaZulu-Natal, South Africa. Eighteen repeat in-depth interviews were carried out with six grandparent caregivers aged 56 to 80 years over 12 months. Thematic analysis was conducted based on the Self-Management Framework. Pathways into self-management of chronic illnesses were identified: living with a chronic illness, focusing on illness needs, and activating resources. Self-perceptions of caregiving dictated that grandmothers, as women, have the responsibility of caring for grandchildren when they themselves needed care, lived in poverty, and with chronic illnesses that require self-management. However, despite the hardship, the gendered role of caring for grandchildren brought meaning to the grandmothers’ lives and supported self-management due to the reciprocal relationship with grandchildren, although chronic illness self-management was complicated where relationships between grandmothers and grandchildren were estranged. The study findings demonstrate that grandchildren caregiving and self-management of chronic conditions are inextricably linked. Optimal self-management of chronic diseases must be seen within a larger context that simultaneously addresses chronic diseases, while paying attention to the intersection of socio-cultural factors with self-management.

Introduction and background: Chronic illness is an illness, disease or disorder that persists for a long period, often for the remainder of the person’s lifetime. Post-basic nursing (PBN) students are at greater risk of having chronic illness because of their age compared to the younger basic nursing students. Usually students in PBN courses experience challenges balancing life and school demands and end up having elevated stress levels. The situation is compounded when the student is also ill, especially when the illness is chronic and uncontrolled. Aim of the study: The aim of the study was to explore and describe the experiences of the PBN students with chronic illness in in selected campuses of the KwaZulu-Natal College of Nursing (KZNCN). The objectives of the study were to: Explore and describe the experiences of PBN students with chronic illness in selected campuses of the KZNCN, identify the challenges if any that are experienced by PBN students with chronic illness in selected campuses of the KZNCN, and to determine the support measures that are essential to facilitate academic performance and achievements for PBN students with chronic illness in selected campuses of the KZNCN. Method: A qualitative research design using an exploratory descriptive approach was used to conduct the study. The Health Behaviour Model was used to explore and describe the experiences of the PBN students with chronic illness. The study identified the predisposing factors, enabling factors and need factors, which, according to Andersen’s Health Behaviour Model, are the three dynamic characteristics that influence behaviour. The sample size was guided by data saturation, which was reached after ten interviews and confirmed with five additional interviews. Data was collected from PBN students who were doing their training in the two main campuses of KwaZulu-Natal Nursing College in eThekwini District between July and August 2018 using one-on-one semi-structured interviews. Data was analysed using thematic analysis guided by Tesch’s method of data analysis. Findings: The six themes that emerged from the interviews were: additional demands on the life of the student, fear and anxiety, acceptance and support received, discrimination and lack of confidence, other compounding and some motivating factors. These findings reflected the challenges that were experienced by the PBN students with chronic illness. These, together with the motivational factors, guide the determination of support measures that are essential to facilitate academic performance and achievements for PBN students with chronic illness. Conclusion: Both the demands of training and that of chronic illness cause added stress on a PBN student and have the potential to adversely affect both the studies and the health of the PBN student. PBN students with chronic illness suffer from emotional stress caused by trying to balance between the effects of illness, the side effects of medication and the demands of the PBN programme. Support from various sources including family, peers, employers, education institutions and educators is important to facilitate the academic achievement of these students. Recommendations: Recommendations are made in relation to policy formulation and implementation, service delivery, nursing education and research. Protocols on care management and support of PBN students with chronic illness should be available in academic institutions so as to guide the educators in supporting such students. The PBN students with chronic illness and the education institutions need to work together to establish and continue good communication to facilitate and maintain a clear understanding of what is required to support them and to be clear on what can, and cannot, be done so that expectations are possible and realistic. The unique issues related to students with chronic illness can be addressed through pre-service and in-service training programmes for educators to make them understand how to handle the situation. A broader study involving other provinces, educators and peers is recommended. In addition to further research on PBN students with chronic illness, research on technological resources essential to support students with chronic illness is recommended.

Faculty of Health Sciences

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