Use of a human-centered design approach to adapt a nurse-led cardiovascular disease prevention intervention in HIV clinics.

Stakeholder-informed strategies addressing cardiovascular disease (CVD) burden among people living with HIV (PWH) are needed within healthcare settings. This study provides an assessment of how human-centered design (HCD) guided the adaptation of a nurse-led intervention to reduce CVD risk among PWH. Using a HCD approach, research staff guided two multidisciplinary "design teams" in Ohio and North Carolina, with each having five HCD meetings. We conducted acceptability and feasibility testing. Six core recommendations were produced by two design teams of key stakeholders and further developed after the acceptability and feasibility testing to produce a final list of 14 actionable areas of adaptation. Acceptability and feasibility testing revealed areas for adaptation, e.g. patient preferences for communication and the benefit of additional staff to support patient follow-up. In conclusion, along with acceptability and feasibility testing, HCD led to the production of 14 key recommendations to enhance the effectiveness and scalability of an integrated HIV/CVD intervention.

Challenges of primary healthcare nurses regarding the integration of HIV and AIDS services into primary healthcare in Vhembe district of Limpopo province, South Africa.

BACKGROUND:  Integration of human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) services into primary healthcare (PHC) is a key public health approach to achieving universal access to antiretroviral therapy (ART). Despite the government's efforts of integrating HIV services into PHC, an insufficient number of PHC staff and inadequate infrastructure are challenging when integrating HIV and AIDS services into PHC. This study explored the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. OBJECTIVES:  The aim of the study was to explore the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. METHOD:  An exploratory, descriptive and contextual qualitative research design utilising face-to-face semi-structured interviews was conducted with 12 PHC nurses from selected clinics and health centres in the Vhembe district of Limpopo province. RESULTS:  Two main themes emerged from data analysis which included challenges related to healthcare recipients and challenges related to healthcare providers. CONCLUSION:  Clear policies on the integration of HIV and AIDS services into PHC should be available and should include strategies to promote HIV testing and counselling, adherence to ART and scheduled appointments, disclosure of HIV status as well as revising the human resource policy to reduce workload.

Integrative review of literature: nursing care to aged people with HIV.

OBJECTIVE: To identify evidences in scientific Brazilian literature on nursing care to aged people with HIV. METHOD: Integrative review of literature from databases: Latin American and Caribbean Literature on Health Sciences (LILACS), Scientific Eletronic Library Online (SciELO), Cochrane and the Nursing Database (BDENF). The applied inclusion criteria were publications that were fully available from 2001 to 2015 and answered to the guiding question of this study. RESULTS: We included 13 studies; and the categories that allowed a better presentation of the scientific evidence on nursing care to aged people with HIV carrier were: Epidemiological profile, perceptions and experiences of aged people with HIV and nursing care to aged people with HIV. CONCLUSION: The studies address nursing care from a clinic that follows NANDA diagnoses of strong individualizing approach and low consideration of social aspects.

Accommodating Indigenous Nurse-Initiated and Managed Antiretroviral Therapy (NIMART) Reporting in a Developing Country Context.

Financial reporting represents a critical tool in eliminating HIV across Papua New Guinea (PNG). Using the tenets of the theory of indigenous alternative reporting, this paper considers how the PNG Nursing Council may accommodate nurse-initiated and managed antiretroviral therapy (NIMART) reporting. Textual analysis of indigenous reporting expectations placed on the PNG Nursing Council are examined in a NIMART context to examine levels of reporting compliance exercised by council administrators from year-end reports (1980 to 2016) to accommodate NIMART reporting. The study revealed that the 2014 annual report of the PNG Nursing Council generated a 40% NIMART compliance rate, offering encouraging signs of financial reporting that could make room for NIMART reporting. The study suggested that local mechanisms could be used to meet local indigenous reporting expectations in order to adopt NIMART reporting. The study also has far-reaching implications for other developing country nursing councils wanting to develop NIMART reporting.

Integrative review of literature: nursing care to aged people with HIV / Revisión integrativa de la literatura: asistencia de enfermería a la persona anciana con VIH / Revisão integrativa da literatura: assistência de enfermagem a pessoa idosa com HIV

ABSTRACT Objective: To identify evidences in scientific Brazilian literature on nursing care to aged people with HIV. Method: Integrative review of literature from databases: Latin American and Caribbean Literature on Health Sciences (LILACS), Scientific Eletronic Library Online (SciELO), Cochrane and the Nursing Database (BDENF). The applied inclusion criteria were publications that were fully available from 2001 to 2015 and answered to the guiding question of this study. Results: We included 13 studies; and the categories that allowed a better presentation of the scientific evidence on nursing care to aged people with HIV carrier were: Epidemiological profile, perceptions and experiences of aged people with HIV and nursing care to aged people with HIV. Conclusion: The studies address nursing care from a clinic that follows NANDA diagnoses of strong individualizing approach and low consideration of social aspects.

RESUMEN Objetivo: Identificar en la literatura brasileña las evidencias científicas sobre la asistencia de enfermería al anciano portador del VIH. Método: Revisión integrativa de la literatura, realizada en las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Scientific Eletronic Library Online (SciELO), Cochrane y la Base de Datos en enfermería (BDENF). Los criterios de inclusión aplicados fueron las publicaciones que estuvieron disponibles en la versión completa, en el período de 2001 a 2015, y que respondiera la cuestión orientadora del estudio. Resultados: Fueron incluidos 13 estudios; y las categorías que permitieron una mejor presentación de las evidencias científicas sobre la asistencia de enfermería al anciano portador del VIH, fueron: El Perfil epidemiológico, las percepciones y las vivencias de los ancianos portadores de VIH y la Asistencia de enfermería delante el anciano seropositivo. Conclusión: Los estudios abordan la asistencia de enfermería todavía a través de una clínica basada en los diagnósticos de NANDA con fuerte abordaje individualizante y baja consideración de los aspectos sociales.

RESUMO Objetivo: Identificar na literatura brasileira as evidências científicas sobre a assistência de enfermagem ao idoso portador do HIV. Método: Revisão integrativa da literatura, realizada nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Eletronic Library Online (SciELO), Cochrane e a Base de Dados em Enfermagem (BDENF). Os critérios de inclusão aplicados foram publicações que estivessem disponíveis na íntegra, no período de 2001 a 2015, e que respondesse a questão norteadora do estudo. Resultados: Foram incluídos 13 estudos; e as categorias que permitiram uma melhor apresentação das evidências científicas sobre a assistência de enfermagem ao idoso portador do HIV, foram: Perfil epidemiológico, percepções e vivências dos idosos portadores de HIV e Assistência de enfermagem frente ao idoso soropositivo. Conclusão: Os estudos abordam a assistência de enfermagem ainda através de uma clínica baseada nos diagnósticos da NANDA com forte abordagem individualizante e baixa consideração dos aspectos sociais.

Impaired religiosity and spiritual distress in people living with HIV/AIDS. / Religiosidade prejudicada e sofrimento espiritual em pessoas vivendo com HIV/aids.

OBJECTIVE: To verify the inference of Nursing Diagnoses, Impaired religiosity and Spiritual distress in people living with HIV/AIDS. METHODS: This is a cross-sectional study with a quantitative approach, performed in a specialized Service CenteR of Recife, Pernambuco, from June to November 2015. The results related to 52 people living with HIV/AIDS and that were interviewed were analyzed by three nurse judges. RESULTS: Spiritual distress was estimated at 73.1% (38), Impaired religiosity at 36.5% (19), with an average number of defining characteristics of 3.88 ± 2.05 and 2.55±0.69. The main defining characteristic for Impaired religiosity was: "reports a need to reconnect with previous beliefs" (92.3%); and for Spiritual distress, it was: "Expresses a lack of purpose in life/expresses lack of meaning in life" (86.5%). CONCLUSIONS: The results point to the need to consider the religious-spiritual dimension in care protocols and research in nursing.

Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary.

The Promise of Integrative Nursing.

The U.S. health care system requires transformative changes that reduce risk and improve overall well-being while increasing access, quality, safety, and affordability. Integrative nursing can serve as a road map to care that is culturally safe, personalized, and meaningful. Using exemplar case studies, we explore both opportunities and challenges to care that advances the health and well-being of persons, families, and communities through caring/healing relationships.

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

BACKGROUND: Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. OBJECTIVE: This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. METHOD: An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. RESULTS: Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. CONCLUSION: Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

Community health nurses' HIV health promotion and education programmes: a qualitative study.

BACKGROUND: Globally, nurses practice in many settings with people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), taking an increasing share of the professional burden of care and helping to reduce morbidity and mortality. International literature is sparse about Thai community nurses providing primary healthcare programmes for people with HIV. AIM: This study aimed to describe background, experiences and strategies of community nurses regarding their design and delivery of programmes for people living with HIV and AIDS in Chiang Mai Province, Thailand. DESIGN: This study used a qualitative mixed-methods study employing a qualitative survey and in-depth interviews. METHODS: Twenty community health nurses from 18 small community hospitals completed a survey comprising demographic data and 13 open-ended questions. Four of them later engaged in in-depth interviews using the same questions. Survey, interview data and field notes were analysed using interpretive content analysis. FINDINGS: Four themes and six sub-themes portrayed participants' rich experiences and knowledge of HIV health promotion and education; challenges of daily work, discrimination and ethical issues; success through programme diversity comprising promotion of community volunteerism, networking and relationships; and holistic connections with Thai cultural traditions and Buddhism. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings help to recognize the diversity, uniqueness and contributions of Thai community nurses regarding culturally appropriate health promotion and education programmes for people living with HIV and AIDS. Findings inform nurses and health officials in and outside of the country to complement innovation in future HIV health promotion and education programmes. LIMITATIONS: Our sample came from one province of Thailand. Findings might not be reflective of nurses elsewhere. IMPLICATIONS FOR HEALTH AND NURSING POLICY: Three decades of collective experience in providing holistic and multifaceted HIV and AIDS nursing care, education and health promotion by community health nurses have the potential to effect new and existing policies and protocols on HIV community care in Thailand, but more research is required for this.

The feasibility of a holistic wellness program for HIV/AIDS patients residing in a voluntary inpatient treatment program.

The purpose of this project was to examine the feasibility of an ongoing holistic wellness program in a residential facility treating persons with HIV/AIDS. The goal was to create a voluntary, four week holistic wellness intensive within the established inpatient behavioral health treatment program. Participants were given practicable holistic self care tools to effectively manage HIV related symptoms, general medical issues, addiction, depression, stress and anxiety. The program incorporated evidence-based holistic activities including yoga, therapeutic dance, meditation, Reiki, and reflective journaling. Narrative survey results and post-program evaluation support that an ongoing holistic wellness program within the existing treatment model is feasible and could have numerous potential beneficial effects. This project clearly exemplified the ideal opportunity for holistic nurses to implement innovative holistic interventions within the current healthcare delivery system. It is the author's observation that future studies with a larger participant group to further examine measurable benefits can lend valuable information and insight into the future development of holistic wellness programs for residential treatment facilities.

Midwives' perspectives on male participation in PMTCT of HIV and how they can support it in Lusaka, Zambia.

OBJECTIVE: the purpose of this study is to describe midwives' perspectives on (1) male participation in Prevention of Mother-To-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) and (2) the methods that could be used to improve male participation in the Lusaka District, Zambia. DESIGN: a qualitative descriptive study. Data were collected using 10 open-ended questions. SETTING: 25 public antenatal clinics in the Lusaka District, Zambia. PARTICIPANTS: midwives (n=45). FINDINGS: content analysis highlighted that a male partner can prevent his wife and his infant from being exposed to HIV by preventive behaviour in their intimate relationship and by utilising health-care services. Several barriers to male participation were identified. These were linked to the male partner himself, to health-care services and to society. Stigma as a multifaceted barrier was considered to permeate every level. The sources of the resources that a male partner needs to prevent Mother-To-Child Transmission (MTCT) were the male partner himself, health-care services and society. The methods that midwives can use to improve male participation were the following: first, influencing individuals, the community, employers and health personnel; second, intervening in risk behaviour; and third, providing disease intervention services. KEY CONCLUSION: male participation in PMTCT of HIV is diverse, not only in HIV testing at the beginning of pregnancy, and it is influenced by various dimensions. Midwives' methods to improve male participation were broad, extending outside the antenatal clinic. A shortage of midwives and other typical issues of limited resources of developing countries pose challenges to male participation in PMTCT of HIV. IMPLICATION FOR PRACTICE: the study showed that cultivating a male-friendly approach in antenatal care is urgent to protect infants.

Outcomes of integrated treatment for tuberculosis and HIV in children at the primary health care level.

BACKGROUND: Little is known about the integration of tuberculosis (TB) and human immunodeficiency virus (HIV) treatment in pediatric populations. METHODS: Prospective cohort of 31 HIV-infected children aged 3-18 years initiating anti-tuberculosis treatment at five primary health care (PHC) clinics in Kinshasa, Democratic Republic of Congo, to describe survival, clinical and immunological outcomes of nurse-centered integrated TB-HIV treatment. RESULTS: Almost all of the children (87.1%) were diagnosed with HIV during TB diagnosis. Most (87.0%) were successfully treated for TB. Two (6.5%) died during anti-tuberculosis treatment; both presented with low CD4 counts (36 and 59 cells/mm(3) compared to a median of 228 cells/mm(3) in the entire cohort). Most (74.2%) initiated antiretroviral therapy (ART) during anti-tuberculosis treatment. Overall, a median CD4 count increase of 106 cells/mm(3) was observed (P = 0.014), an increase of 113 cells/mm(3) among children on ART and of 71.5 cells/mm(3) in those not on ART (P = 0.78). Median body mass index increase during anti-tuberculosis treatment was 2.1 kg/m(2) overall (P = 0.002), 2.2 kg/m(2) among children on ART and 0.72 kg/m(2) in those not on ART (P = 0.08). CONCLUSION: Integrated, nurse-centered, pediatric TB-HIV treatment at the PHC level in highly resource-limited settings is feasible and effective in achieving successful outcomes, including high ART uptake, low mortality, and immunological and clinical improvement.

Integrating HIV care into nurse-led primary health care services in South Africa: a synthesis of three linked qualitative studies.

BACKGROUND: The integration of HIV care into primary care services is one of the strategies proposed to increase access to treatment for people living with HIV/AIDS in high HIV burden countries. However, how best to do this is poorly understood. This study documents different factors influencing models of integration within clinics. METHODS: Using methods based on the meta-ethnographic approach, we synthesised the findings from three qualitative studies of the factors that influenced integration of HIV care into all consultations in primary care. The studies were conducted amongst staff and patients in South Africa during a randomised trial of nurse initiation of antiretroviral therapy (ART) and integration of HIV care into primary care services - the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial. Themes from each study were identified and translated into each other to develop categories and sub-categories and then to inform higher level interpretations of the synthesised data. RESULTS: Clinics varied as to how HIV care was integrated. Existing administration systems, workload and support staff shortages tended to hinder integration. Nurses' wanted to be involved in providing HIV care and yet also expressed preferences for developing expertise in certain areas and for establishing good nurse patient relationships by specialising in certain services. Patients, in turn, were concerned about the stigma of separate HIV services and yet preferred to be seen by nurses with expertise in HIV care. These factors had conflicting effects on efforts to integrate HIV care. CONCLUSION: Local clinic factors and nurse and patient preferences in relation to care delivery should be taken into account in programmes to integrate HIV care into primary care services. The integration of medical records, monitoring and reporting systems would support clinic based efforts to integrate HIV care into primary care services.

Motivation, management, and mastery: a theory of resilience in the context of HIV infection.

BACKGROUND: Clients with HIV infection have been conceptualized as a resilient population. Although a few researchers have documented resilience among clients with HIV infection, a theory of resilience in the context of HIV infection has not been developed. The purpose of this study was to describe the process by which resilience occurs for clients in the context of HIV infection. METHOD: Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews with adults with HIV infection. Data were collected until saturation was reached. RESULTS: A theory, motivation, management, and mastery, a description of the process by which resilience occurs in the context of HIV infection, emerged from the data. CONCLUSION: Many clients living with HIV infection are resilient, despite the physical, psychological, and social challenges of this chronic illness. Nursing interventions to promote resilience among clients with HIV infection should be directed toward identification of client motivation factors and disease management strategies that may influence health outcomes of people living with HIV infection.

Reflection on care in recurrent sexually transmitted co-infections.

Reflection is a skill that nurses are expected to practise to help them continually re-evaluate their personal effectiveness in problem solving. This skill is necessary when caring for patients who are experiencing the complex challenges linked to psychosexual and psychosociological behavioural changes associated with HIV infection and recurrent sexually transmitted co-infections (STC-I). The Johns model of structured reflection was used in the reflection described here to aid the critical thinking process in helping a nurse to manage and deliver up-to-date, effective care and to develop a strong nurse-patient therapeutic relationship. A holistic approach is key to delivering care to patients with recurrent STC-I. This involves taking a sexual health history and establishing the correct diagnosis, followed by the administration of pharmaceutical and psychotherapeutic treatments to facilitate psychosexual, psychosocial, and psychological changes. This article uses a reflective learning experience in caring for a patient with recurrent STC-I to give insights on psychosexual and psychosociological behavioural strategies. Used with a diagnosis and pharmacological intervention, these strategies can be put into nursing practice and enhance the quality of nursing care.

Spiritual support for people living with HIV/AIDS: a Brazilian explorative, descriptive study.

In this exploratory and descriptive research, we identified the meaning of religion and spirituality in the experience of patients at a public health service for treatment of HIV/AIDS in a Brazilian upcountry town. Eight participants were selected through theoretical sampling. Data were collected through semistructured interviews, and analyzed by means of qualitative content analysis. The emerging themes were religion: a path to support, and God is everything. Religion, as a path that leads patients to different sources of support, included exploration of different churches, acknowledgment of guilt, and finding strength to cope with the disease, rationalization of the disease process, meeting other churchgoers, and finding God and faith. God, an important source of support, was present in prayers, in the belief in healing through faith, and in the feeling of comfort and relief. Because spirituality and religion were seen as important sources of support, in this study we that health professionals include these aspects in care planning.

Attitudes of Turkish midwives and nurses working at hospitals towards people living with human immunodeficiency virus/acquired immune deficiency syndrome.

Health professionals caring for people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) show poor or negative attitudes because of fear of contagion. Therefore, it is important to know the attitudes of midwives' and nurses' towards people living with HIV/AIDS. The aim of this descriptive and cross-sectional study is to assess the attitudes of Turkish midwives and nurses working at hospitals to people living with HIV/AIDS and to identify factors that affect these attitudes. A group of 46 midwives and 192 nurses working in hospitals were included in the study. Data were collected through AIDS Attitude Scale. Age, professional experience, number of children and marital status influenced the attitudes of the participants towards people living with HIV/AIDS. We concluded that higher level of education appear to positively influence the attitudes of the participants. Education programmes including evidence-based nursing implications might be planned to improve positive attitudes and to prevent stigmatization of people living with HIV/AIDS.

An integrated approach for antiretroviral adherence and secondary HIV transmission risk-reduction support by nurses in Kenya.

Ongoing antiretroviral therapy (ART) adherence and secondary HIV transmission-risk reduction (positive prevention) support are needed in resource-limited settings. We evaluated a nurse-delivered counseling intervention in Kenya. We trained 90 nurses on a brief counseling algorithm that comprised ART and sexual-risk assessment, risk-reduction messages, and health-promotion planning. Self-reported measures were assessed before, immediately after, and 2 months post-training. Consistent ART adherence assessment was reported by 29% of nurses at baseline and 66% at 2 months post-training (p < .001). Assessment of patient sexual behaviors was 25% at baseline and 60% at 2 months post-training (p < .001). Nurse practice behaviors recommended in the counseling algorithm improved significantly at 2 months post-training compared with baseline, odds ratios 4.30-10.50. We found that training nurses in clinical counseling for ART adherence and positive prevention is feasible. Future studies should test impact of nurse counseling on patient outcomes in resource-limited settings.