Factors influencing the confidence and knowledge of professional nurses prescribing antiretroviral therapy in a rural and urban district in the Western Cape

Solomons, Deborah Judy (2018-03)

Thesis (MCur)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Introduction: Since the introduction of nurse-initiated and -managed antiretroviral therapy (NIMART) in South Africa in 2010, there has been an increased demand for the training of professional nurses in Human Immunodeficiency Virus (HIV) management in primary healthcare settings. Task shifting from doctors to nurses to prescribe antiretroviral therapy (ART) became essential to ensure that more patients living with HIV are initiated on life-saving ART. Although the shifting of tasks is a timely solution for human resource constraints, the continued success of the approach is dependent on factors such as adequate training and effective support systems. However, there is limited evidence on how these factors influence the confidence and knowledge of nurses who prescribe ART in primary health care settings. Aim: The study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with HIV in rural and urban primary health care settings in the Western Cape. Methods: A quantitative research approach was used with an analytical, cross-sectional study design. The researcher, based on the literature and previous instruments, designed a self- completion questionnaire. The questionnaire measured demographic details, influencing factors, HIV management confidence and HIV management knowledge. Approval for the study was obtained from the Health Research Ethics Committee (HREC) of Stellenbosch University, the Department of Health and the City of Cape Town. Seventy-seven participants from 29 healthcare facilities completed the questionnaire. Data was entered into Microsoft Excel by the researcher, imported and analysed with a statistical analysing programme, IBM SPSS (version 23). Descriptive statistics were used to describe the data and appropriate statistical tests were used to test for relationships between variables. Results: The majority of participants had adequate HIV management knowledge and reported to be very confident or experts in the HIV management skills / competencies. With regard to the Factors influencing HIV management knowledge and confidence, the research results revealed that participants trained recently in PULSA PLUS / PACK (3years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received mentoring over a period of two weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of HIV-positive patients was also associated with higher knowledge and confidence. Conclusion: The results show that training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with sufficient opportunities for clinical practice.

AFRIKAANSE OPSOMMING: Inleiding: Sedert die bekendstelling van verpleegkundige-geïnisieerde en bestuurde antiretrovirale terapie (NIMART) in Suid-Afrika in 2010 was daar 'n toenemende vraag na die opleiding van professionele verpleegkundiges in Menslike Immuniteits gebreksvirus (MIV) bestuur in die primêre gesondheidsorg instellings. Taak verskuiwing van dokters na verpleegsters om antiretrovirale terapie voor te skryf (ART) het noodsaaklik geword om te verseker dat meer pasiënte wat met MIV leef, op lewens reddende ART begin. Alhoewel die verskuiwing van take 'n tydige oplossing vir menslike hulpbron beperkings is, is die volgehoue sukses van die benadering is afhanklik van faktore soos voldoende opleiding en effektiewe ondersteuning sisteme. Daar is egter beperkte bewyse oor hoe hierdie faktore die vertroue en kennis van verpleegkundiges beïnvloed wat ART voorskryf in primêre gesondheidsorg instellings. Doelwit: Die studie het ten doel om faktore wat die kennis en vertroue van professionele verpleegkundiges beïnvloed, te ondersoek in die bestuur van pasiënte wat met MIV leef in landelike en stedelike primêre gesondheidsorg instellings in die Wes-Kaap. Metodes: 'n Kwantitatiewe navorsings benadering is gebruik met 'n analitiese, deursnee-studie ontwerp. 'n Self evaluerings vraelys is ontwerp deur die navorser gebaseer op die literatuur en vorige instrumente. Die vraelys het demografiese besonderhede, beïnvloedende faktore, MIV- bestuursvertroue en MIV-bestuurskennis gemeet. Goedkeuring vir die studie is verkry vanaf die Gesondheidsorg navorsings etiek komitee (MHO) van die Universiteit Stellenbosch, die Department van Gesondheidsorg en die Stad Kaapstad. Sewe en sewentig deelnemers uit 29 gesondheidsorg fasiliteite het die vraelys voltooi. Data is in Microsoft Excel deur die navorser ingevoer en geanaliseer met 'n statistiese ontledingsprogram, IBMSPSS (weergawe 23). Beskrywende statistiek is gebruik om die data te beskryf en toepaslike statistiese toetse is gebruik om te toets vir verhoudings tussen veranderlikes. Resultate: Die meerderheid van die deelnemers het voldoende MIV-bestuurskennis en was baie selfversekerd of kundiges in die MIV-bestuursvaardighede. Met betrekking tot die faktore wat MIV-bestuurskennis en -vertroue beïnvloed, het die navorsings resultate aan die lig gebring dat deelnemers wat onlangs in PULSA PLUS / PACK (3 jaar gelede of minder) opgelei is, aansienlik hoër kennis tellings gehad het. Gereelde terugvoering oor kliniek en persoonlike prestasie is geassosieer met hoër MIV-bestuurskennis. Deelnemers wat mentorskap ontvang het oor 'n tydperk van twee weke, het 'n hoër gemiddelde vertroue telling in vergelyking met ander tydperke van mentorskap. 'n Hoër gevalle van MIV-positiewe pasiënte is ook geassosieer met hoër kennis en vertroue. Slot: Die resultate toon dat opleiding, mentorskap en kliniese praktykervaring geassosieer word met kennis en vertroue. Aanbevelings sluit in die bevordering van huidige opleiding en mentorskap en om te verseker dat NIMART-opgeleide verpleegkundiges genoegsame geleenthede vir die kliniese praktyk bied.

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