Enrolled nurses' experiences of caring for patients living with HIV in a South African rural hospital.

BACKGROUND: Most public hospitals in African countries are overpopulated with patients suffering from conditions related to HIV and AIDS. These patients increase the burden on healthcare providers, among which are enrolled nurses. AIM: To explore enrolled nurses' experiences of caring for patients living with HIV and AIDS at a public rural community hospital in the Vhembe district of Limpopo Province, South Africa. DESIGN: The study was underpinned by the interpretative phenomenological design. PARTICIPANTS: A total of 11 purposively selected enrolled nurses who met the inclusion criteria participated in the study. The sample size was based on data saturation. METHOD: Data were collected through semi-structured individual face-to-face interviews guided by an interview guide. Interviews were audio-recorded; and field notes were also taken. Data were analysed thematically following a framework for interpretative phenomenological analysis. RESULTS: The study revealed that enrolled nurses are working without adequate resources. They also experience minimal support despite the negative circumstances they are exposed to in the process of caring for patients admitted with HIV-related illnesses. CONCLUSIONS: A lack of resources, limited support and inadequate skills have a negative impact on the health care that enrolled nurses provide to patients admitted in hospital with HIV-related ailments. Researchers recommend the importance of supporting and equipping enrolled nurses to provide quality care to patients living with HIV. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings have highlighted the challenges faced by enrolled nurses while caring for patients with HIV. The identified gaps will assist the Department of Health in developing policies to enhance the support offered to enrolled nurses and improve the care provided to patients with HIV-related conditions that are admitted to rural hospitals.

Registered nurses' perceptions regarding nurse-led antiretroviral therapy initiation in Hhohho region, Swaziland.

BACKGROUND: Swaziland has the highest HIV prevalence globally. It faces a critical shortage of health workers for addressing the HIV pandemic. To curb this human resource challenge, Swaziland adopted a nurse-driven model for antiretroviral therapy delivery in line with the recommendations of the World Health Organization on task shifting. OBJECTIVE: The study explored the perceptions of registered nurses on the nurse-led antiretroviral therapy initiation programme in the Hhohho region of Swaziland (NARTIS). DESIGN: The study utilized a phenomenological design, specifically a phenomenographic design. SETTING: The study was conducted in ten health facilities in the Hhohho region of Swaziland. These facilities comprised eight clinics, a hospital and a health centre. PARTICIPANTS: These were registered nurses, trained and certified in the nurse-led antiretroviral therapy initiation programme. The nurses also had experience of working in a nurse-led antiretroviral therapy initiation programme. Eighteen (18) nurses were purposively selected and recruited to participate in the study. METHODS: Data were collected through open and deep individual interviews guided by a semi-structured interview schedule. The audio-recorded interviews were transcribed and analysed thematically using Sjöström and Dahlgren's approach to data analysis. RESULTS: Three major themes emerged from the study data: nurses' emotional reactions to the implementation of the NARTIS programme, and influences and overcoming barriers to the programme. CONCLUSIONS: The study findings have generated insights into this program which is useful for the provision of care to people living with HIV/AIDS in Swaziland. But nurses need support to ensure effective implementation. IMPLICATION FOR NURSING AND HEALTH POLICY: The study findings have implications for both the practice of the NARTIS programme and health policy development. The development of a health policy that alleviates the barriers to the NARTIS programme can enhance nurses' role and make care provision to people living with HIV/AIDS more effective.

The experiences of HIV-serodiscordant couples in Soweto, South Africa.

INTRODUCTION: The study was carried out in a single township in South Africa with a sample size of seven human immunodeficiency virus (HIV)-serodiscordant couples. BACKGROUND: South Africa has the highest number of HIV cases in the world, with an estimated 6.4 million of its inhabitants living with this infection. Most people in stable relationships are unaware of the HIV serostatuses of their partners. Many people with an HIV partner are also generally unaware of their own HIV serostatuses. There is a high risk of acquisition of the HIV among couples in HIV-serodiscordant relationships. Yet, there is a dearth of research on HIV-serodiscordant couples. AIM: To explore the experiences and knowledge of HIV-serodiscordant couples on HIV serodiscordance. METHODS: A qualitative design of interpretative phenomenological analysis was used. Data were collected from seven HIV-serodiscordant couples using a semi-structured interview format. Data were analysed thematically using the principles of interpretative phenomenological analysis. RESULTS: Three superordinate themes emerged from data analysis: experiences of stress, effects of HIV serodiscordance on couples and knowledge of HIV serodiscordance. The study outcomes were based on retrospective accounts of couples' experiences of HIV serodiscordance. Such accounts are subject to memory bias. CONCLUSION: HIV-serodiscordant relationships are riddled with stress. Couples and nurses' knowledge and understanding of the concept of HIV serodiscordance is limited. Such limitation may negatively influence the quality of care and support offered to couples in these relationships. IMPLICATIONS FOR NURSING AND HEALTH POLICY: HIV-serodiscordant couples need to be educated on this phenomenon. Nurses also need to be offered training on how to support and care for couples in these relationships. Such training should be shaped by couples' health-seeking behaviours and cultural norms. Specific guidelines and policy on HIV serodiscordance should be developed to ensure consistency in care provision and enhance uptake of support services.

Patients' perceived quality of care and their satisfaction with care given for MDR-TB at referral hospitals in Ethiopia.

BACKGROUND: There is presently dearth of evidence in Ethiopia on patients' perception on quality of care given for multi-drug resistant tuberculosis (MDR-TB) and their satisfaction with the care and services they receive for the disease. Moreover, there is no evidence on the experiences and practices of caregivers for MDR-TB regarding the functionality of the programmatic management of MDR-TB at referral hospitals in Ethiopia. Thus, this study was conducted to address these gaps. Evidence in these areas would help to institute interventions that could enhance patient satisfaction and their adherence to the treatment given for MDR-TB. DESIGN AND METHODS: This study employed an inductive phenomenological approach to investigate patients' perception of the quality of care given for MDR-TB, level of their satisfaction with the care they received for MDR-TB and the experiences and practices of caregivers for MDR-TB on the functionality of the programmatic management of MDR-TB at referral hospitals in Ethiopia. The data were analysed manually, and that helped to get more control over the data. RESULTS: The majority of the patients were satisfied with the compassionate communication and clinical care they received at hospitals. However, as no doctor was dedicated exclusively for the MDR-TB centre of the hospitals, patients could not get timely medical attention during emergent medical conditions. Patients were dissatisfied with the poor communication and uncaring practice of caregivers found at treatment follow-up centres (TFCs). Patients perceived that socio-economic difficulties are both the cause of MDR-TB and it has also challenged their ability to cope-up with the disease and its treatment. Patients were dissatisfied with the poor quality and inadequate quantity of the socio-economic support they got from the programme. Despite the high MDR-TB and HIV/AIDS co-infection, services for both diseases were not available under one roof. CONCLUSIONS: Socio-economic challenges, inadequate socio-economic support, absence of integrated care for MDR-TB and HIV/AIDS, and the uncaring practice of caregivers at treatment follow-up centres are found to negatively affect patients' perceived quality of care and their satisfaction with the care given for MDR-TB. Addressing these challenges is recommended to assist patients' coping ability with MDR-TB and its treatment.

Treatment outcomes of patients with MDR-TB and its determinants at referral hospitals in Ethiopia.

BACKGROUND: There is limited empirical evidence in Ethiopia on the determinants of treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) who were enrolled to second-line anti-tuberculosis drugs. Thus, this study investigated the determinants of treatment outcomes in patients with MDR-TB at referral hospitals in Ethiopia. DESIGN AND METHODS: This study was underpinned by a cross-sectional quantitative research design that guided both data collection and analysis. Data is collected using structured questionnaire and data analyses was performed using the Statistical Package for Social Sciences. Multi-variable logistic regression was used to control for confounders in determining the association between treatment outcomes of patients with MDR-TB and selected predictor variables, such as co-morbidity with MDR-TB and body mass index. RESULTS: From the total of 136 patients with MDR-TB included in this study, 31% had some co-morbidity with MDR-TB at baseline, and 64% of the patients had a body mass index of less than 18.5 kg/m2. At 24 months after commencing treatment, 76 (69%), n = 110), of the patients had successfully completed treatment, while 30 (27%) died of the disease. The odds of death was significantly higher among patients with low body mass index (AOR = 2.734, 95% CI: 1.01-7.395; P<0.048) and those with some co-morbidity at baseline (AOR = 4.260, 95%CI: 1.607-11.29; p<0.004). CONCLUSION: The higher proportion of mortality among patients treated for MDR-TB at Adama and Nekemte Hospitals, central Ethiopia, is attributable to co-morbidities with MDR-TB, including HIV/AIDS and malnutrition. Improving socio-economic and nutritional support and provision of integrated care for MDR-TB and HIV/AIDS is recommended to mitigate the higher level of death among patients treated for MDR-TB.