The high burden of HIV requires health care workers’ knowledge, willingness and confidence necessary for the provision of HIV care. The education and training of future nurses is crucial to secure nurses of the future, who will be relevant and well equipped to attend to the health of the population. The purpose of the study was to determine the level readiness among final year nursing students for provision of HIV care in one of Western Cape nursing training institutions. This study was guided by HIV care aspects adopted from the HIV competency model used as a framework, namely HIV prevention, promotion of health for people living with HIV (PLWH), evaluation of the health status of PLWH and HIV management.
Methods:
A Cross-sectional survey design was used as research design for this research study. This study was conducted at the end of the 2017 academic year at a university in the Western Cape, South Africa. For the purpose of this study, 156 nursing students in their final undergraduate nursing programme were used as a target group, as they are expected to be ready for the provision of HIV care upon graduation. Due to small target population size, an all-inclusive sampling technique was applied in the study. A pilot study was conducted with 30 final year nursing students, and 126 final year nursing students were recruited, with 103 final year nursing students completing the questionnaire. The questionnaire was developed from the literature and was divided into two parts: demographic aspects and provision of HIV care aspects, focusing on willingness, confidence and knowledge on each aspect of HIV care as per the framework adopted for the study. The respondents were recruited from their classes, and those who indicated willingness to participate were contacted outside the class individually. Completion of the questionnaire took about 20 minutes, and data collection was completed within a month. Validity and reliability were established, and all ethical principles were adhered to.
Results:
The majority of respondents (77%) were in the 20 – 29 age group, with only 10% being over 34 years. Female made the majority of respondents at 89%. These characteristics are similar to the student nurses characteristics from the South African Nursing Council register, highlighting the dominance of females in the nursing profession. Up to 15 % of the respondents indicated having had previous experience in health care before starting their training as nurses, and 41% indicated having a family member or co-worker living with HIV. In South Africa, there are over 7 million people living with HIV, hence the high possibility of having a person living with HIV in one’s social cycle. All respondents indicated having provided HIV care to PLWH during their clinical practice. The respondents were willing to provide HIV prevention care related to counselling, however slightly fewer respondents indicate willingness for HIV post-test counselling (85%) compare to the 87% who were willing to conduct pre-test counselling and 93% who were willing to conduct the HIV test. Although no significant differences were noted, the number of respondents who were confident to perform the pre-test counselling (85%) and post counselling (77%) was lower than the number of those who were willing to do so. Only 38% of respondents were correct with regard to the ART provision for infants who are breastfed, and 44% were unsure about the provision of Cotrimoxazole to prevent opportunistic infections, highlighting gaps in their knowledge. The reduction of number of respondents who are willing to provide care compared to those who were confident to provide care was also noted on some of the aspects such as counselling for positive and healthy living for PLWH (89% vs 80%); health education on how to prevent opportunistic diseases to PLWH (92% vs 85%) and assessing opportunistic infections (85% vs 80%). In this study, only 68% of the respondents indicated willingness to initiate ART and 81% willing to treat opportunistic infections. However, only 57% and 68% were confident to initiate ART and to treat opportunistic infections respectively.
Conclusion:
By the end of the final year of training, nursing students graduate and start working the following year. In South Africa, they are first registered as community service nurses, where they work under the supervision of a senior professional nurse, and gain their full registration after one year of practice. Considering that South Africa has the highest number of people living with HIV, it is crucial that graduate nurses are ready to provide care and management to PLWH. This study has looked at the final year nursing students’ readiness for the provision of HIV care, with focus to HIV prevention, promotion of health for people living with HIV (PLWH), evaluation of the health status of PLWH and HIV management. The readiness was determined based on willingness, confidence and knowledge of those aspects. A considerable large number of respondents showed knowledge on the assessed aspects, with some gaps being identified among the respondents. In this study, more respondents were willing to perform a variety of tasks related to the provision of HIV care compared to the number of final year students who reported feeling confident to perform similar tasks. This is a reflection of the novice state of final year nursing students, as confidence is usually improved with practice. Nursing education institutions are encouraged to look into the aspects where knowledge gaps were noted and make plans on how to remedy such situation in the subsequent group of nursing students. It is also recommended that student nurses are provided with more learning opportunities to increase the number of students who are confident to provide HIV care by the time they graduate. Further research is required to compare the readiness of new professional nurses to provide HIV care to be able to establish improvement from the time students completed their training.