asked to reflect on what needs to be observed when approaching a patient's home for the first time, the participants listed the following needs:
• To affectionately greet family members
• To introduce oneself outlining the nature of one's work and purpose of the visit
• To provide an opportunity for the family member to introduce themselves
• To be patient and wait for the family to share about their loved one who is ill
• To assure family members of confidentiality
• To wait patiently for the family to check with the sick if he/she wants to be in a company of a caregiver
• To ask for permission to make notes so as to remember what is being said
• To provide the family with your contact details before leaving their home
• To finally offer hope
Six participants then volunteered to conduct role-plays to illustrate in practice what had already been presented. In role-playing, participants adopt characters, or parts, that have personalities, motivations, and backgrounds from their own. In this context, participants were actors who were practicing the use of authentic language and appropriate behaviour of the local community. When the participants were asked to role-play home visit etiquette, the exercise drew attention to some of the practical challenges involved in caring for sick people in the home.
In a role-play that was conducted during CHBC training, participants were asked to imagine themselves as parents living with a terminally ill daughter. They then receive a visit from a voluntary caregiver who has come to offer free services.
Scenario 1
In the first role-play, the mother challenges the voluntary caregiver demanding to know who informed her of her sick daughter. This unexpected response presented a difficult situation for the voluntary caregiver who had come to provide home care.
Consequently, the voluntary caregiver had to leave the house not having had an opportunity to meet the patient who was lying in the bedroom. This particular role- play offered a real, daily challenge that voluntary caregivers are confronted with,
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however the observations revealed that the trainer was not adequately prepared to deal effectively with some of the concrete issues that surfaced during the role-plays. She responded by saying:
"The mother has been very difficult in this instance, and can we request a mother from the second role-play who is willing to cooperate with the voluntary caregiver".
Scenario 2
In the second scenario, even though the voluntary caregiver was granted permission to meet with the sick daughter, the scene posed challenges of a different nature. Since the participants had already been taught the importance of respecting the rights of patients, the mother was good in checking with her daughter if she wanted any visitors before allowing a stranger inside the house. The daughter responded by asking if the visitor was bringing any food with her. Although this unfortunately was not the case, the visitor was welcomed in. During the informal conversation with the voluntary caregiver, the sick daughter mentioned a need for HIV testing to ascertain the cause of her illness. In this scenario, the voluntary caregiver could not offer any encouragement and information available in terms of voluntary HIV counseling and testing (VCT) sites, she could only be heard saying, "it is a good idea to go for an HIV test. " The mother then objected to this idea, suggesting that their neighbour had bewitched her daughter. Once again, such misconceptions, and the implications thereof, which are so prevalent in the HIV and AIDS dilemma were left unchallenged by the trainers and other participants. Due to her mother's remarks, the sick daughter was left feeling misunderstood and alone in her distress because of the mother's ill informed views.
The next session consisted of a presentation on ways used to assist the patient with mobility and transfers. The trainer used a lecture method to explain the crucial role of a caregiver in assisting the patient with bodily movements. According to the trainer, this act helps to offer some kind of physical exercise for the patient, thus restoring strength. The session also touched on the need to transfer and re-arrange certain things in the household so as to keep everything within the patient's reach.
After lunch, the afternoon session began with a topic on nursing care symptoms, followed by issues on HIV and AIDS, record keeping and the session concluded with an evaluation of the day's work. The presentation on HIV and AIDS supplied a definition on what is meant by HIV and AIDS, outlined the three modes of transmission, that is, sexual intercourse, infected blood, and mother-to-child transmission, promotion of safer sex through condom use, being faithful to one partner, information sharing, and use safe precautions when touching bodily fluids.
The session on HIV and AIDS went further to offer ideas on creating a supportive environment for PLWHA, that is, taking care of their emotional (love), spiritual (faith), social (friendship), and physical (exercise and relaxation) needs.
Before ending the day's programme, the trainer outlined key elements of a patient's record that is well kept. She stressed the fundamental need for caregivers to focus on detail. In using an example, she emphasized a need for facilitators to be observant and use all five senses during home visits, that is, sight, hearing, smell, touch, and taste. According to the trainer, patient's records should cover all the necessary details such as detailed information on the patient's health and living conditions, including any support provided by other community groups and individuals. The participants were finally given homework on record keeping, and they were expected to present their reports the following day. The day's programme ended with an evaluation and closed with a prayer.