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Worldwide, the health care delivery is provided by various health care professionals, and more so for the care of HIV and AIDS. The health priorities as stated by the South African department of health include reduction of maternal and child mortality as well as fighting against HIV and AIDS among others (Department of Health, 2010; Johnson, 2012). The 2015 UNAIDS report estimates about 6.8 million of people living with HIV in South Africa, with more than 3 million people being initiated on ART (UNAIDS, 2014a, UNAIDS, 2015). With the recent approval of Pre-exposure Prophylaxis (PrEP) for HIV in South Africa, as well as the 90-90-90 target for HIV, the number of people initiated, monitored and maintained on ART is to increase. The process of establishing how PrEP can be included in the care of those at risk of HIV infection is underway (UNAIDS, 2014b, Medecines Control Council, 2015).
As nurses form the majority of health care professionals, their role in the provision of care in the fight against HIV is undisputable. Nurses’ ability to provide high quality care to those at risk or living with HIV and AIDS depend on the training received, which will provide competent nurses (Callaghan et al., 2010).
With the PHC re-engineering in South Africa, the training of nurses needs to adapt to the way care is provided, ensuring relevance and increased opportunity for student nurses to be well prepared to function on completion of their training. The holistic provision of care for people at risk or living with the HIV infection depends on coordinated care from various professions, and the training of nurses need to provide nursing students the opportunity to develop competencies in being members of a multidisciplinary team. This paper will present how the interdisciplinary approach competency related to HIV and AIDS has been developed to be integrated into the training of nurses in one university in South Africa.
Methods:
The study applied Intervention research: Design and development through three distinct phases. The first phase focused on developing the HIV and AIDS related competencies, and data were collected through nominal group technique sessions and individual interviews with various stakeholders such as nurse educators, recent graduates, people living with HIV, nurses in clinical practice, as well as members of the nursing governing body. With the second phase, curriculum development workshops were conducted with nurse educators, while the third phase was conducted as a validation workshop with nurse educators, nurses in the clinical setting, recent graduates, and people living with HIV. The collected data were recorded and transcribed verbatim for data analysis. The data were analysed following the steps used in the analysis of multiple group data analysis for NGT and content analysis (Van Breda, 2005; Elo and Kyngäs, 2007). Ethical clearances were obtained from all relevant institutions, and consents were obtained from all participants. Measures such as member check and prolonged engagement were applied to ensure trustworthiness, and the researcher abided by all ethical principles (Klopper & Knobloch, 2010).
Results:
A total of 112 people contributed to the study, with 12.8% of the participants being involved in more than one phase of the study. The developed interdisciplinary approach competency related to HIV and AIDS was extracted from content analysis of the nominal group technique sessions and the interviews. The competency relates to participating and implementing the interdisciplinary approach correctly and appropriately. The participants emphasised that collaboration with other health care providers enhances the provision of effective and quality care and provides the opportunity to render holistic care for HIV and AIDS. Although nurses form the bulk of health care providers, they are not the only ones, hence the need and necessity to work with the other disciplines. This core competency comprises of three specific competencies presented below, namely community engagement, referral systems, and support systems.
The community engagement specific competency is required to provide not only the insight, but also the opportunity to participate in community activities directed towards the fight against HIV and AIDS in terms of prevention and management. This necessitates collaboration with various organizations. The aspects that are essential in the development of this competency include the understanding of community engagement and community participation, ensuring collaboration as opposed to a one-sided intervention where the implementers have little communication and agreement with the group that is being served. Collaboration in this competency involves the nurses’ role and the opportunity to support the various organizations that are involved in the provision of care and management of HIV and AIDS in the community, such as assisting in training of health care workers and home-based carers, especially with the implementation of ward based PHC outreach teams. This aspect was also indicated in the competencies mentioned in the literature relating to community involvement, collaboration with other members of the multidisciplinary team and understanding the role of the multidisciplinary team (Relf et al., 2011). Participating in campaigns in the community was another activity that was mentioned, which has potential to develop this competency. In addition, nurses need to be able to create and maintain links with the various resources.
The second part of the interdisciplinary approach core competency related to HIV and AIDS include referral systems specific competency, which relates to knowledge about the referral pathways and referring patients living with HIV and AIDS that are in the nurse’s care appropriately, correctly and timeously. To be timeous, one must be able to assess when the referral is needed, recognize how long the management can continue in one’s own practice, and know and appreciate which service will be able to provide the best care to the patient living with HIV and AIDS in order to prevent complications and ensure a positive outcome. Similar aspects were noted in literature, as documented by Relf et al. (2011) and CANAC (2013) with regard to knowing where to refer to, to link with services and to make appropriate referrals by following the proper referral pathways. The aspect of referral systems requires nurses to be comprehensive and to give patients living with HIV and AIDS enough information so that they are able to access the services they are being referred to. One needs to follow up and establish if the patient has been able to access the services they have been referred to, as well as the outcome of that visit, an aspect that was also indicated by Knebel et al. (2008). Failure to do the follow-up may result in the patient not obtaining the required services, and the nurse will not be able to establish the effectiveness of the intervention that has been implemented in the care and management of the person living with HIV and AIDS. The timeous referral is closely linked to the ability to assess and to recognize the presenting problem. This is important because late referral may hinder the patients’ outcome.
Those who provide care for HIV and AIDS are not always health care professionals; there are many organizations in the community that provide support to patients living with HIV and AIDS. Nurses need to be able to identify such organizations, the services that they offer, and link and assist patients to access such support systems, hence the third specific competency of support systems. The literature also indicates aspects that relate to support systems in the care and management of HIV and AIDS. Knebel et al. (2008) indicate a competency related to linking patients to support services and support of vulnerable groups of people affected or infected with HIV, while CANAC (2013) includes linking patients to support, with Relf et al. (2011) indicating a competency that relates to mobilizing support for patients living with HIV and AIDS.
Conclusion:
The interdisciplinary approach competency related to HIV and AIDS includes nurses’ involvement in community organization, referral, and support systems. Nurses need to develop the competency in community engagement during their training, and opportunities to do so are limitless. For example, De Wet et al. (2013) noted about the nurses’ involvement in community, that during training, student nurses could be participating in endeavours to provided information to patients living with HIV and AIDS.
Pruitt and Epping-Jordan (2005) indicated the need to train health care workers to attain competencies that will improve tackling the problems of the 21st century. They emphasise that effective health care for patients who experience long-term illnesses, such as HIV and AIDS, needs to be continued across the various health care settings. There should be continuous collaboration amongst the various health care providers, hence the importance of the interdisciplinary approach competency developed in this study. With this competency, nurses will be able to participate and remain engaged in the various community organizations and programmes, with the aim of providing comprehensive care and management for HIV and AIDS. This will not only address the curative aspect of health care, but also the preventative and rehabilitation aspects. With the developed specific competencies, exit level and year level outcomes were developed, and they could be integrated into the new nursing program in South Africa.