Caring for AIDS patients in a rural hospital setting : nurses' perspectives.

Abstract

The aim of the study was to explore nurses' experiences, attitudes and perceptions regarding the care of patients with the Acquired Immunodeficiency Syndrome (AIDS) before and after the introduction of Anti-Retroviral Therapy (ART) in a rural KwaZulu-Natal hospital .. A secondary aim was to investigate psychosocial stressors that nurses experience and the support they receive in this regard. A qualitative study was conducted and three focus group discussions were conducted before the introduction of ART and five individual interviews were used for in-depth exploration of the health care workers' perceptions of caring for AIDS patients after the introduction of ART. Special attention was paid to nurses' experiences with AI DS patient care and with attention to stress and coping. The AACN Synergy Model was used as a broad theoretical framework for the study to guide the exploration regarding the influence of both nurse and patient characteristics influence the care process within a rural South African context. The findings suggested that before the introduction of ARV-therapy most patients had limited knowledge and understanding of HIV/AIDS disease and its processes. They and other significant others who could be a family member or even friends were marginally involved in the care process. Voluntary Counseling and Testing (VCT) seemed to impact negatively on this situation, and patients were not willing to test and disclose their status to health workers. The knowledge around HIV/AIDS among nurses seemed to be inadequate due to the lack of support and training. They reported being inadequately equipped to deal effectively with caring for their AIDS patients. After the introduction of ARV-therapy, greater involvement of patients on ARV treatment was noted. The participation of significant others in patient management also improved possibly due to their involvement as treatment associates, a requirement of the ART programme. However, the nurses still reported inadequate knowledge not only around AIDS in general but also pertaining ART as well as in the provision of psychosocial support to their patients. The study also revealed that the Synergy Model for patient care, which compares the patient characteristics to nurse competencies can be used to gain insight into patient care and its demands. This model has also suggested weaknesses in nurses' training that need attention. Nurses are expected to use insight into patients needs to improve their competencies to meet the challenges of AIDS patient care and to fulfill their mandate as the key stakeholders on patient care. Lazarus and Folkman's (1984) views on stress and coping were useful in identifying the nurses' coping strategies. The study highlighted specific areas in need of intervention. Formal and informal teaching for both nurses and the patients on HIV and AIDS management needs to be introduced. Patients and families' involvement in decision making and HIV/AIDS disease management should be expanded. HIV counseling and all its components, which are pre- and post-counseling as well as on-going disease management counseling needs to be re-evaluated. There is a need to advocate for a more patient orientated counseling rather than test orientated counseling. Psychosocial support to nurses should be a priority to help them cope with their stressful AIDS caring work. Advocacy for a worker friendly Employee Assistance Program (EAP) should be encouraged by the managers of the institution. Intra-disciplinary and inter-disciplinary communication needs to be improved through innovative strategies. The address of the AI DS stigma within the healthcare system remains a priority and this aspect needs to be incorporated at different levels i.e. basic training, in counseling and within the psychosocial support efforts directed at nurses.