Breastfeeding in the HIV Epidemic: A Midwife\u27s Dilemma in International Work

As standards develop to reduce the maternal-to-child transmission of HIV, healthcare professionals need to evaluate recommendations in the context of culturally-accepted values for the populations to be served. Breastfeeding, a central value in South African families, carries the risk of transmission in mothers that are HIV+. A dilemma faced by international workers is the sharing of information that challenges culturally-accepted practices. A nurse-midwife working with HIV positive women during the childbearing cycle in the United States is expected to implement protocols to prevent transmission of the HIV virus to the newborn. These include administration of antiretroviral medications to the women during the pregnancy and labor, as well as the policy of no breastfeeding, since breast milk contains the HIV virus and can be a source of passing the infection to the baby. Ethical dilemmas develop when the nurse-midwife is an international worker in a country which is in the midst of the HIV epidemic such as South Africa. Current South African policy regarding mother-to-child transmission recommends either exclusive breastfeeding with rapid weaning at six months, or exclusive bottle feeding. Cultural practice favors breastfeeding with the addition of cereals, in effect, mixed feeding. These practices lead to a high risk of transmission and infection in the newborn

Moving towards universal health coverage: advanced practice nurse competencies

Objetivo: o objetivo deste artigo é descrever a primeira fase de um projeto que teve como finalidade geral desenvolver um conjunto de competências de práticas avançadas de enfermagem baseadas em consenso aplicáveis em países da América Latina e, usando tais competências, produzir um protótipo curricular de práticas avançadas de enfermagem a serem adaptadas em países da América Latina. O projeto foi enquadrado em uma abordagem baseada em competências para o ensino de práticas avançadas de enfermagem. Os objetivos específicos da primeira fase do projeto descritos neste artigo foram: 1) identificar um conjunto de competências em enfermagem para práticas avançadas que serviriam como modelo para as Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina e 2) estabelecer um consenso sobre Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina. Método: as competências de enfermeiros de práticas avançadas foram derivadas de uma revisão abrangente das competências publicadas e informaram o desenvolvimento de uma pesquisa projetada para avaliar a relevância das competências de enfermeiros de práticas avançadas nos países da América Latina. A pesquisa foi distribuída entre enfermeiros líderes e enfermeiros educadores. Os dados foram analisados por meio de estatística descritiva. Resultados: foi estabelecido um consenso sobre Competências Essenciais. Conclusão: apresentam-se as Competências Essenciais de Enfermeiros de Práticas Avançadas que podem fornecer um quadro estruturado para construir programas educacionais alinhados com as necessidades do ambiente regional.Objetivo: el objetivo de este documento es describir la primera fase de un proyecto, cuyo objetivo general es desarrollar un conjunto basado en consenso de competencias de práctica avanzada de enfermería aplicables en los países de América Latina y utilizando las competencias, producir una enfermera con práctica avanzada de prototipo curricular para la adaptación en países latinoamericanos. El proyecto se encuadró en un enfoque basado en competencias para la educación de enfermería de práctica avanzada. Los objetivos específicos de la primera fase del proyecto descritos en este documento fueron: 1) identificar un conjunto de competencias potenciales de enfermería de práctica avanzada que servirían como un modelo para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos y 2) establecer consenso para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos. Método: las competencias de práctica avanzada de enfermería se derivaron de una revisión exhaustiva de las competencias publicadas e informaron el desarrollo de una encuesta diseñada para evaluar la relevancia de las competencias de práctica avanzada de la enfermera en los países de América Latina. La encuesta fue distribuida a enfermeras líderes y enfermeras educadoras. Los datos fueron analizados utilizando estadística descriptiva. Resultados: se estableció el consenso para las Competencias Básicas. Conclusión: se presentan las Competencias Básicas de Enfermería de Práctica Avanzada que pueden proporcionar un marco estructurado para construir programas educativos alineados con las necesidades del entorno regional.Objective: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. Method: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. Results: consensus for Core Competencies was established. Conclusion: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment

Key informant perspectives on policy- and service-level challenges and opportunities for delivering integrated sexual and reproductive health and HIV care in South Africa

BACKGROUND: Integration of sexual and reproductive health (SRH) and HIV services is a policy priority, both globally and in South Africa. Recent studies examining SRH/HIV integration in South Africa have focused primarily on the SRH needs of HIV patients, and less on the policy and service-delivery environment in which these programs operate. To fill this gap we undertook a qualitative study to elicit the views of key informants on policy-and service-level challenges and opportunities for improving integrated SRH and HIV care in South Africa. This study comprised formative research for the development of an integrated service delivery model in KwaZulu-Natal (KZN) Province. METHODS: Semi-structured in-depth interviews were conducted with 21 expert key informants from the South African Department of Health, and local and international NGOs and universities. Thematic codes were generated from a subset of the transcripts, and these were modified, refined and organized during coding and analysis. RESULTS: While there was consensus among key informants on the need for more integrated systems of SRH and HIV care in South Africa, a range of inter-related systems factors at policy and service-delivery levels were identified as challenges to delivering integrated care. At the policy level these included vertical programming, lack of policy guidance on integrated care, under-funding of SRH, program territorialism, and weak referral systems; at the service level, factors included high client load, staff shortages and insufficient training and skills in SRH, resistance to change, and inadequate monitoring systems related to integration. Informants had varying views on the best way to achieve integration: while some favored a one-stop shop approach, others preferred retaining sub-specialisms while strengthening referral systems. The introduction of task-shifting policies and decentralization of HIV treatment to primary care provide opportunities for integrating services. CONCLUSION: Now that HIV treatment programs have been scaled up, actions are needed at both policy and service-delivery levels to develop an integrated approach to the provision of SRH and HIV services in South Africa. Concurrent national policies to deliver HIV treatment within a primary care context can be used to promote more integrated approaches

Clinical nursing and midwifery research priorities in eastern and southern African countries

Background: Because of the profound shortage of nurse and midwifery researchers in many African countries, identification of clinical nursing and midwifery research is of highest priority for the region to improve health outcomes. Objectives: The aim of this study was to gain consensus from experts on the priorities of clinical nursing and midwifery research in southern and eastern African countries. Method: A Delphi survey was conducted among experts in the region. Criteria for “expert” included (a) a professional nurse, (b) a bachelor's degree or higher in nursing, (c) published research, (d) affiliated with a school of nursing with at least a master's level nursing program, and/or (e) identified by the African core collaborators as an expert in the region. A list of candidates was identified through searches of published and gray literature and then vetted by core collaborators in Kenya, Malawi, and South Africa. Core collaborators held leadership roles in a nursing school and a doctoral degree in nursing, had conducted and published nursing research, and resided in an included country. Results: Two rounds of the Delphi survey were required to reach consensus. In total, 40 participants completed both rounds, and at least one participant from each country completed both rounds; 73% and 85% response rates were achieved for each round, respectively. Critical clinical research priorities were infectious disease/infection control and midwifery/maternal health topics. These included subtopics such as HIV/AIDS, tuberculosis, maternal health and mortality, infant mortality, and obstetrical emergencies. Many other topics were ranked as important including patient outcomes, noncommunicable diseases, and rural health. Discussion: Areas identified as research priorities were consistent with gaps identified in current literature. As evidenced by previous research, there is a lack of clinical nursing and midwifery research in these areas as well as nurses and midwives trained to conduct research; these priorities will help direct resources to the most essential research needs

The health-related quality of life of Syrian refugee women in their reproductive age

Background Health-Related Quality of Life (HRQoL) for refugee women in reproductive age is highly affected by physical, political, psychosocial and environmental conditions in countries of asylum. HRQoL is enormously affected by the satisfaction of this vulnerable group with the physical, psychological, emotional and social care services provided in this critical time. Therefore, this study aimed toassess the HRQoL among Syrian refugee women of reproductive age living outside camps in Jordan. Methods A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee women in the host communities in Jordan.Health-related quality of life (HRQOL) was measured using the short-form 36 (SF-36) questionnaire. Results Significant negative correlations were found between SF-36 individual subscales score and the length of marriage, the number of children, parity and family income. The strongest correlations were between pain scale and length of marriage (r =  − .21), and between Energy/Fatigue and ‘number of children’ (r =  − .21). Conversely, antenatal care was positively correlated with physical, role emotional, pain, and general health. Physical functioning and general health were predicted significantly with less years of marriage, younger age at marriage, less violence and by higher family income. Conclusion This study suggests low HRQoL scores for women of reproductive age across all domains. Several factors such as years of marriage, age at marriage, the number of children, violence, antenatal care and family income affected the women’s general health. The provision of appropriate and accessible reproductive and maternal healthcare services in antenatal visits is critical for ensuring the immediate and long-term health and wellbeing of refugee women and their families