Professional nurses' perceptions of their ability to render effective nutritional care and support to people living with HIV/AIDS
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Objective: A neglected issue in literature on nutrition and HIV/AIDS is how other health professionals view their role in that arm. The purpose of this study was to understand professional nurses' perception regarding their ability to render effective nutritional care to people living with HIV/AIDS (PLWHA). Design: A qualitative approach was used. Twenty-three, in-depth, semi-structured interviews were conducted with nurses (mean age 38) working in eight (five rural and three urban) Wellness clinics within public hospitals providing antiretroviral therapy (ART) in North West Province, South Africa. Brief structured demographic questionnaires were also administered. All interviews and focus group discussions were recorded for transcription and open-coding. NVivo was used for open coding, whilst descriptive statistics were done using SPSS for windows (version 14, SPSS Inc., Chicago. IL). A research team of professionals and researchers collaboratively analysed data for emerging themes. Results: All the hospitals that participated had at most three nurses, having at least one professional nurse working in the Wellness clinic for PLWHA. More than half of the participants interviewed were diploma holders, eight (35%) were degree holders and three (13%) had certificates in nursing. Five main themes (previously guided by the interview questions) emerged during the analysis of data and these portrayed participants' perceptions regarding their ability to render effective nutritional care to PLWHA. The themes were 1) challenges faced by nurses dealing with PLWHA on a daily basis, 2) concerns of PLWHA, 3) nurses’ perception on the importance of nutrition in HIV/AIDS care, 4) nurses’ perceived ability to deal with nutritional issues in HIV/AIDS, 5) the role of traditional healers, traditional medicine in HIV/AIDS. Thirty five percent of participants mentioned poor socio-economic status of PLWHA as a barrier to the participants to talk about good nutrition to people that are food insecure. Furthermore, 13% of participants indicated that they are constantly facing the dilemma of PLWHA mixing traditional medicines and ART. Participants perceived the following skills to be important in the area of nutrition and HIV/AIDS: communication, listening and knowledge. Although knowledge could be debated as it is not a skill per se, the participants believed that on needs to acquire nutrition knowledge first and then improve on the communication and listening skills with more exposure and training. Ten (41%) of the participants interviewed rated themselves as average, 11 (48%) participants as good whilst only 4%, representing one participant, felt they were very good at giving out nutrition education. Sixty one percent of participants said they would require more knowledge, whilst 39% said they would need to acquire communication and listening skills for them to be able to render effective nutritional cart to PLWHA. In this study, participants perceived nutritional care to PLWHA as their responsibility and that lack of knowledge was influencing their inability to offer this service effectively. All the participants indicated a need for collaboration with nutrition professionals, ill-service training us well as exposure to clear communication channels for nutrition and HIV/AIDS information. Participants were concerned with the lack of policy implementation regarding nutrition and policy documents. Of the 23 participants interviewed, only two (9%) confirmed having seen and rend the South African Guidelines on Nutritional Care for People Living with TB, HIV/AIDS and other Chronic Debilitating Conditions. Conclusion: All participants interviewed believed that nutrition knowledge in the area of HIV/AIDS can be improved if poor people who are infected and affected by HIV/AIDS are food secure. Concerning practice, it is recommended that nutrition and HIV/AIDS as a topic be introduced in both undergraduate mid postgraduate training for nurses. The lack of policy implementation, level of qualification and years spent in the nursing profession may have influenced participants' perception regarding their ability, as well as confidence, to render nutritional care to PLWHA. Possible interventions to improve policy implementation could be the development of user-friendly information, education and communication materials for health institutions as these may serve as constant reminders to health care service providers. It was found that participants' perceptions regarding their ability to render effective nutritional care to PLWHA was affected by a complex number of factors which emerged as themes that need to be addressed. Participants' experience suggests that more research and inquiries are needed into traditional medicines and traditional healing, as the issue of ARVs and traditional medicine is becoming a public health dilemma, riot only to the nurses, but to every stakeholder involved in the field of HIV/AIDS. Furthermore, a need exists for nurse-specific outreach, collaboratively done by nutrition professionals and other stakeholders. This work thus provides a foundation for further exploring ways to improve the ability of other health care workers such as nurses in the nutritional care of PLWHA which will ultimately improve the quality of life of PLWHA.
- Health Sciences