The experience of Ugandan nurses in the practice of universal precautions

In Uganda, nurses do not always practice universal precautions unless they know the patients\u27 HIV status. In our study, focused ethnography was used to explore the experiences of Ugandan nurses in the practice of universal precautions while caring for persons living with HIV. In-depth interviews were completed with 16 participants from a variety of units at a large teaching hospital in Uganda. Although participants were knowledgeable about universal precautions, the primary challenge to the practice of universal precautions was the inadequate supply of resources, both material and human. Despite challenges, the nurses displayed an enthusiasm for their work and a dedication to provide the best possible care for patients. The findings highlight the urgent need for governments and institutions, particularly in resource-constrained countries, to develop and implement policies related to universal precaution practice and to provide a consistent supply of protective equipment to ensure that universal precautions are consistently used

Developing Confidence for Patient Advocacy: Reflections from an International Clinical Experience

In this article, the first author reflects on the process of developing confidence in selected nursing roles, particularly becoming a strong advocate as a new nurse and communicating effectively with patients and their families. The reflections focus on experiences throughout her four years as an undergraduate nursing student, including a final clinical practicum in Ghana in early 2017. The first author describes this reflective process in first person, while the second author assisted to reflect on and describe aspects of this learning trajectory. This clinical experience in a low income country such as Ghana provided the first author an opportunity to build confidence in her practice and refine her skills as a strong patient advocate. These learning opportunities afforded a better understanding of the relationship between global citizenship and her role as a registered nurse. &nbsp

Critical ethnography, cultural safety, and international nursing research

Critical qualitative methodology provides a strategy to examine the human experience and its relationship to power and truth. Cultural safety is a concept that has been applied to nursing education and practice and refers to interactions that acknowledge and respect the unique cultural background of patients. It recognizes power inequities between caregivers who belong to dominant cultures and patients who may belong to oppressed groups. Culture is interpreted from a critical constructivist perspective as a fluid relational process that is enacted contextually. The purpose of this paper is to examine the congruence between and among critical methodology, cultural safety, and the conduct of nursing research in low- and middle-income countries by nurses from high-income countries. It is argued that if cultural safety is important and relevant to education and practice, then it might be appropriate to address it in research endeavors

Moral distress among Ugandan nurses providing HIV care: a critical ethnography

Background: The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa. Aim: To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people. Method: A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions. Results: Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients’ wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues. Conclusions: The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructuremay result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public. copyright 2009 Elsevier Ltd. All rights reserved.Ye

HIV testing experiences of Aboriginal youth in Canada: service implications

The objective of this study was to explore HIV testing experiences and service views of Canadian Aboriginal youth in order to provide information for HIV testing services. An exploratory, mixed-method, community-based research design was used for this study. Findings reported here are from 210 survey participants who had experienced an HIV test. Youth were recruited through 11 Aboriginal organizations across Canada, including AIDS service organizations, health centers, community organizations, and friendship centers. Youth who had tested for HIV ranged in age from 15 to 30 years of age (20% were B20), and came from First Nations (75%), Me ́ tis (14%), and Inuit (9%) backgrounds. Participants lived in all provinces and one territory. Over half (62%) were female. While the majority of survey respondents indicated at their last HIV test they had been treated with care (80%), respect (77%), or kindness (76%), some reported being treated with hostility (19%), fear (12%), discrimination (11%), avoidance (10%), or being treated in a bored way (15%). When asked about information they had received, 28% of survey respondents could not remember; 23% said they were not given any information, and 24% said their questions were not answered. Emotional reactions to testing ranged from anxiety/apprehension (64% of survey respondents) to being ‘‘calm’’ (19%). When asked for suggestions to improve testing services, participants indicated emotional support, compassion, professional yet personable services, and personalized HIV information were important. Study results suggest that to facilitate HIV testing for Aboriginal youth, testing services and counseling must be respectful, compassionate, non-judgmental, and culturally responsive in order to provide emotional support and HIV information that is meaningful and memorable

Stigmatization as a Social Control Mechanism for Persons Living with HIV and AIDS

Stigmatization contributes to inequity by marginalizing persons living with HIV and AIDS (PHAs). In this study we examined the stigmatizing practices in health care settings from the perspectives of PHAs and health care providers (HCPs). A qualitative design, using a participatory action research approach, was used. Interviews and focus groups were completed with 16 aboriginal and 17 nonaboriginal individuals living with HIV (APHAs and PHAs) and 27 HCPs in Ottawa and Edmonton, Canada. We present findings to support the premise that stigmatization can be used as a social control mechanism with PHAs. Participants described both active and passive social control mechanisms: shunning and ostracizing, labeling, and disempowering health care practices. Forgiving behavior, balancing disclosure, practicing universal precautions, bending the rules, shifting services, and reducing labeling were strategies to manage, resist, and mitigate social control. The findings illustrate the urgent need for multilevel interventions to manage, resist, and mitigate stigma

Fostering Interactions: The Networking Needs of Community Health Nursing Researchers and Decision Makers

The purpose of the study on which this article is based was to determine the current extent of linkages among Canadian community health nursing researchers and decision makers and to identify perceptions around the structure and function of potential networks. A qualitative research design was utilised to develop common themes across focus groups, a workshop and key informant interviews. The findings suggest that there is a need for a formal community health network to provide an efficient and timely means to link the expertise required to tackle complex community health policy problems, and to create supports for advancing community health science with relevant and high quality research

Síndrome de la lipodistrofia asociado con la terapia antiretroviral en pacientes con VIH: consideraciones para los aspectos psicosociales

Diversos efeitos colaterais têm sido associados à terapia anti-retroviral em portadores da infecção pelo HIV, dentre esses, a síndrome da lipodistrofia apresentando hiperlipidemia e alterações na forma do corpo, com hipertrofia adiposa central e lipoatrofia periférica, relatada pelos pacientes como um visível marcador para a identificação de portadores da infecção pelo HIV. Este estudo consiste em análise da produção científica sobre aspectos psicossociais em portadores da infecção pelo HIV que apresentam lipodistrofia associada à utilização da terapia anti-retroviral. Os resultados mostram que alterações corporais podem ser suficientemente perturbadoras para o bem-estar psicossocial, afetando a qualidade de vida e aumentando o estigma da doença, ocasionando perturbações nas relações sociais. Esta revisão possibilita uma análise preliminar dos aspectos psicossocias da lipodistrofia; entretanto, outros estudos são necessários para o melhor entendimento desta complexa síndrome, trazendo novas informações a serem utilizadas no cuidado de enfermagem a portadores da infecção pelo HIV afetados por este problema.Varios efectos secundarios han sido fuertemente asociados con la terapia antiretroviral en pacientes con HIV. Entre ellos, el síndrome de la lipodistrofia se presenta con alteraciones en la forma del cuerpo con hipertrofia adiposa central y lipoatrofia periférica, las cuales son reportadas por pacientes como marcas visibles que los identifica como pacientes con VIH. En este manuscrito, presentamos un análisis de literatura actual con respecto a los aspectos psicosociales de pacientes con VIH presentándose con lipodistrofia asociado con la terapia antiretroviral. Los resultados demuestran que las alteraciones de la forma del cuerpo pueden ser inquietantes en lo que se refiere al bienestar psicosocial, afectando la calidad de vida y aumentando el estigma asociado con la enfermedad, con las consiguientes dificultades en las relaciones sociales. Este análisis provee un repaso preliminar de los aspectos psicosociales de la lipodistrofia; sin embargo, otros estudios son necesarios para entender mejor este complejo síndrome, proveyendo nueva información para ser utilizada en el cuidado de enfermería para pacientes con VIH que están afectados por este problema.Several side effects have been strongly associated with antiretroviral therapy in HIV patients. Among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as HIV patients. This manuscript presents an analysis of current literature regarding the psychosocial aspects of HIV patients with lipodystrophy associated with antiretroviral therapy. The results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. This analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for HIV patients affected by this problem

Challenging lifestyles: Aboriginal men and women living with HIV

The Aboriginal people of Canada are over-represented in the HIV and AIDS statistics, compared with the rest of the population. A participatory action research study was conducted in Alberta, Canada to examine the experiences of HIV-positive Aboriginal individuals in the period following diagnosis. The goals of the study were to identify factors that limited or enhanced risky behaviours, and to develop and implement an intervention to promote healthier lifestyles for Aboriginal persons living with HIV/AIDS (APHAs).Thirty-one Aboriginal men and women participated in the study. Receiving and adapting to a positive HIV diagnosis was a difficult process for most participants, and resulted in a number of potentially harmful behaviours and painful emotions. Gradually, most participants accepted the diagnosis and found ways to take better care of themselves. Nevertheless, they faced ongoing challenges, including stigma and discrimination, coping with histories of abuse, and confidentiality concerns. The intervention included the development and presentation of a skills-building workshop for individuals living with HIV, some of whom were study participants. In addition, members of the team visited several communities in Alberta to discuss the findings and the most appropriate strategies to assist individuals living with HIV to adopt healthier lifestyles.Ye