Nurses’ experiences of self-management support for adults with tuberculosis and human immunodeficiency virus coinfection

Background: Professional nurses provide self-management support to adults (18 years and older) living with tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection to enable them to mitigate its impact on their lives. However, the experiences of professional nurses providing self-management support to adults with TB-HIV coinfection remain unclear. Aim: This study explored and described the experiences of professional nurses on the provision of self-management support to adults living with TB-HIV coinfection in Greater Accra, Ghana. Setting: Three public primary health facilities in Greater Accra, Ghana. Methods: An exploratory, descriptive qualitative design was used. Twenty-two purposively sampled professional nurses were interviewed face-to-face individually using an interview guide. Interviews were recorded with participants’ permission, transcribed and analysed thematically using MAXQDA software. Results: The three themes generated revealed that the: (1) self-management problems of adults living with TB-HIV coinfection included their recurring physical, mental and social problems, (2) the support provided to adults with TB-HIV coinfection included symptom, nutritional, medication and psychosocial self-management support, (3) the factors related to providing self-management support showed that self-management support was influenced by patient, nurse and health facility-related factors but was feasible, equitable and acceptable to patients and stakeholders. Conclusion: Professional nurses’ self-management support practice entailed improvising limited resources to address the recurring problems of adults living with TB-HIV coinfection. Nurses require adequate resources to provide comprehensive self-management support. Contribution: The contextual evidence provides insight into the self-management problems of adults with TB-HIV coinfection and the factors influencing professional nurses’ self-management support

Achieving excellence in private intensive care units: The effect of transformational leadership and organisational culture on organisational change outcomes

Orientation: Organisational change outcomes in private intensive care units are linked to higher patient satisfaction, improved quality of patient care, family support, cost-effective care practices and an increased level of excellence. Transformational leadership and fostering a positive organisational culture can contribute to these change outcomes. Research purpose: The study determined whether transformational leadership and a supportive organisational culture were evident in six private intensive care units in the Eastern Cape, South Africa. A conceptual framework to investigate the relationship between transformational leadership, organisational culture, and organisational change outcomes, was proposed and tested. Motivation for the study: The prevalence of transformational leadership, a positive organisational culture and their effect on organisational change outcomes in private healthcare industries require further research in order to generate appropriate recommendations. Research design, approach and method: A positivistic, quantitative design was used. A survey was conducted using a questionnaire which, in previous studies, produced scores with Cronbach’s alpha coefficients greater than 0.80, to collect data from a sample of 130 professional nurses in private intensive care units. Main findings: Transformational leadership and a positive organisational culture were evident in the private intensive care units sampled. A strong, positive correlation exists between transformational leadership, organisational culture, and organisational change outcomes. This correlation provides sufficient evidence to accept the postulated research hypotheses. Innovation and intellectual stimulation were identified as the factors in need of improvement. Practical or managerial implications: The findings of the study may be used by managers in intensive care units to promote organisational change outcomes, linked to transformational leadership and a positive organisational culture. Contribution: The study provides evidence of the way in which transformational leadership and a positive organisational culture affect organisational change outcomes in the context of private healthcare in South Africa, thereby addressing a research gap in this area

Experiences of patients living with HIV and AIDS on antiretroviral therapy in Accra, Ghana

Background: The human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) pandemic has greatly affected Africa, particularly Ghana. The pandemic remains a public health concern, particularly in terms of accessing essential medication and improving quality of life for people living with the disease. Objectives: This study aimed to explore and describe the experiences of persons diagnosed and living with HIV who are on antiretroviral therapy. Method: A qualitative, exploratory, descriptive, and contextual design was used. The research population included persons diagnosed with HIV who were receiving antiretroviral therapy at three public hospitals in Ghana. Data saturation was achieved after conducting 15 semi-structured interviews. Creswell’s six steps of data analysis were used to analyse the data, which resulted in the emergence of one main theme and six sub-themes. Results: The main theme identified by the researchers highlighted the participants’ diverse experiences of being diagnosed and living with HIV. It was found that the study participants expressed shock, disbelief, surprise, and fear of death after being diagnosed with HIV. The participants also experienced stigmatisation, discrimination, and rejection. Conclusion: There is a need for further research on the extent of discrimination and stigmatisation and the effect on optimal adherence to antiretroviral therapy. Continuous public education on HIV is required to limit the extent of discrimination and stigmatisation. Contribution: The study has highlighted the various emotions related to stigma and discrimination expressed by persons living with HIV (PLHIV). The findings will guide policy on eliminating discrimination and stigmatisation for people living with HIV

Is the association between knee injury and knee osteoarthritis modified by the presence of general joint hypermobility?

Objective: To evaluate whether joint hypermobility modifies the association between knee joint injury and knee osteoarthritis (OA) among adults. Methods: Data were from three studies: Genetics of Generalized Osteoarthritis (GOGO; N=2,341), Genetics of Osteoarthritis (GO; N=1,872), and the population-based Johnston County Osteoarthritis Project (JoCoOA; N=1,937). Knee injury was defined as a self-report of prior fracture or severe injury to either knee. OA was defined using three variables: knee pain (pain, aching, or stiffness of the knee on most days), radiographic OA (rOA; Kellgren-Lawrence grade 2-4), and symptomatic OA (sxOA; knee rOA with knee pain). Joint hypermobility was defined as Beighton score ≥4. For each study, separate logistic regression models, stratified by joint hypermobility, were used to estimate the association of knee injury with knee pain, rOA, and sxOA, adjusting for age, sex, body mass index, and race (JoCoOA only); statistical interactions between injury and hypermobility were assessed (p-value<0.10). Results: In all three studies, knee injury was associated with OA variables of knee pain, rOA, and sxOA (adjusted odds ratios [aOR] range 1.83-3.75). The association of knee injury with rOA and sxOA was magnified among individuals with vs. without joint hypermobility in GOGO: rOA aOR 11.0, 95% confidence interval [CI] 4.0-30.1 vs. 2.7, 95% CI 2.0-3.6, p=0.009; sxOA aOR 9.2, 95% CI 3.5-24.3 vs. 3.3, 95% CI 2.4-4.4, p=0.032. Interactions were not statistically significant in GO or JoCoOA. Conclusions: In a general adult population, the presence of joint hypermobility may not modify the strong association between knee injury and OA

Association between general joint hypermobility and knee, hip, and lumbar spine osteoarthritis by race: a cross-sectional study

Abstract Background Osteoarthritis (OA) prevalence differs by race. General joint hypermobility (GJH) may be associated with OA, but differences by race are not known. This community-based study examined the frequency of GJH and its relationship with knee, hip, and lumbar spine OA by race (African American vs. Caucasian). Methods Data were from the Johnston County OA project, collected 2003–2010. GJH was defined as Beighton score ≥4. OA symptoms were defined as the presence of pain, aching, or stiffness on most days separately at the knee, hip, and lower back. Radiographic OA (rOA) of the knee or hip was defined as Kellgren-Lawrence grade 2–4. Lumbar spine rOA was disc space narrowing grade ≥1 and osteophyte grade ≥2 in ≥ 1 at the same lumbar level. Lumbar spine facet rOA was present in ≥ 1 lumbar levels. Separate logistic regression models stratified by race were used to examine the association between hypermobility and rOA or OA symptoms at each joint site, adjusting for age, sex, previous joint injury, and body mass index (BMI). Results Of 1987 participants, 1/3 were African-American and 2/3 were women (mean age 65 years, mean BMI 31 kg/m2). Nearly 8% of Caucasians were hypermobile vs. 5% of African-Americans (p = 0.03). Hypermobility was associated with lower back symptoms in Caucasians (adjusted odds ratio (aOR) 1.54, 95% confidence interval (CI) 1.00, 2.39), but not in African-Americans (aOR 0.77, 95% CI 0.34, 1.72). Associations between hypermobility and other knee, hip, or lumbar spine/facet OA variables were not statistically significant. Conclusions General joint hypermobility was more common in Caucasians than African-Americans. Although there were no associations between hypermobility and rOA, the association between hypermobility and lower back symptoms may differ by race

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings

Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers

Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmissio

The lived experience of patients on mechanical ventilation: research

Patients connected to a mechanical ventilator have to endure various experiences and emotions, which are unique to each patient. These patients are subjected to physical and emotional stress, which is related to the unfamiliar surroundings of the intensive care environment and the limitations caused by the process of ventilation. Factors that hamper the optimal functioning of patients on the mechanical ventilator include the inability to communicate, the fear of impending dependency and the reality of being faced with their own mortality. The purpose of this study was to identify, explore and describe the experiences of patients who were connected to a mechanical ventilator. A non-probability, purposive sampling method was used. This sampling method was selected because the researcher had to involve patients who were willing and able to communicate their experiences. This was done by means of a conscious selection of patients who had to meet the requirements of sampling criteria set out by the researcher. Data was obtained by means of phenomenological interviews with respondents. Once data was collected, interviews were transcribed verbatim. Data was then analysed according to Tesch's method as described in Creswell (1994: 152). An independent coder verified the identified major themes, namely: experiences of patients related to the process of ventilation, as well as their experiences of the environment while connected to the ventilator. A literature control was also done to compare similarities and differences found in data analysis. Ethical principles were maintained throughout the study. The identified experiences formed the basis for the formulation of guidelines to assist the registered nurse in the accompaniment of patients during the ventilation process. Pasiënte wat aan 'n meganiese ventilator gekoppel is, moet verskeie emosies en ervarings deurmaak, wat aan elke persoon uniek is. Hierdie pasiënte word onderwerp aan fisiese en emosionele stres wat verband hou met die onbekende omgewing van die intensiewesorgeenheid, asook die beperkinge wat die proses van ventilasie meebring. Faktore wat op die optimale funksionering van pasiënte inbreuk maak, sluit die volgende in: die onvermoë om effektief met andere te kommunikeer, vrees vir die ontwikkeling van totale afhanklikheid en die realiteit om van hul eie mortalitiet bewus te word. Die doel van hierdie navorsingstudie was om die belewenis van pasiënte wat aan die ventilator gekoppel was, te identifiseer, verken en te beskryf. Data is deur middel van fenomenologiese onderhoudvoering met respondente ingesamel. Na insameling van data is onderhoude verbatim getranskribeer. Data-analise is daarna volgens Tesch se metode, soos in Creswell (1994: 152) beskryf, uitgevoer. 'n Onafhanklike kodeerder het die geïdentifiseerde hooftemas geverifeer, naamlik: ervarings van pasiënte met betrekking tot die ventilasie proses, asook hulle ervarings van die omgewing terwyl hulle aan die ventilator gekoppel is. 'n Literatuurkontrole is gedoen om ooreenkomste en verskille in data uit te wys. Etiese beginsels is deurgaans in die studie gehandhaaf. (Health SA Gesondheid : interdisciplinary research journal: 2002 7(4): 24-37

The lived experience of patients on mechanical ventilation

Patients connected to a mechanical ventilator have to endure various experiences and emotions, which are unique to each patient. Opsomming Pasiënte wat aan ‘n meganiese ventilator gekoppel is, moet verskeie emosies en ervarings deurmaak, wat aan elke persoon uniek is. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text