A grounded theory inquiry: establishing communities of practice among Hiv/Aids nurse practitioners through the use of critical reflection at selected hospitals in KwaZulu-Natal.

Doctor of Philosophy in Nursing. University of KwaZulu-Natal, Durban, 2011.Introduction: Nurse practitioners in South Africa are challenged daily to provide comprehensive care under resource constrained conditions while at the same time trying to cope with the changes and care strategies related to HIV/Aids. The use of critical reflection within a shared learning space fostered by Communities of Practice is a plausible strategy to support ongoing meaningful learning that can support nurse practitioners to deal with the challenges related to the dynamic nature of HIV/Aids. Aim of the Study: This study aimed to analyze the processes of developing critical reflective skills and establishing Communities of Practice among a sample of nurse practitioners working in the field of HIV/Aids and to develop a middle range theory which explains the process of establishing Communities of Practice (CoP) among HIV/Aids nurse practitioners grounded in critical reflection. Methodology: Using a qualitative approach, a grounded theory design guided by Strauss and Corbin (1990) was used. Two district level hospitals from the province of KwaZulu-Natal, was sampled, within which a group of nurse practitioners working in the discipline of maternal and child health was sampled. Data collection was progressive over a period of seven months. The use of focus group discussion, in-depth individual interviews, reflective journals and researcher observation was used to elicit the data. Concurrent with data collection, open axial and selective coding was used to make sense of the data. Results: The results of this study revealed that there are a number of causal conditions which relates to the need for establishing a CoP and that the process of establishing a CoP requires engagement with the relevant stakeholders and members of the group. Three phases characterized the process of participants becoming critically reflective and a fully functional CoP. The concept of a CoP for HIV/Aids nurse practitioners is made up of core characteristics namely that it is an organic practice space, it promotes flexibility in learning, it is a support network where collaborative purpose driven working occurs and that it promotes learning on demand to name a few. There were also a number of intervening conditions which influenced the process of establishing the CoP and the findings of this study led to the emergence of a middle range theory which is both process and outcomes focused. This theory and its related model, demonstrates that establishing a CoP for HIV/Aids nurse practitioners occurs within a context and is made up of six major concepts namely (i) Context; (ii) Group Formation; (iii) CoP Establishment Process; (iv) Fully Functional CoP; (v) Outcomes; (vi) Sustainability and Continuity, and several sub-concepts. Conclusion and Recommendation: The recommendations of this study were classified into areas of practice, education and research, with regard to the usability of this theory in encouraging a transformed way of nursing aimed at improving nursing practice. In summary, this research lends insight into the complex challenges of nursing in a dynamic context of HIV/Aids. It further demonstrated that one of the overall outcomes was engagement in evidence informed practice and knowledge stewarding in HIV/Aids knowledge generation. Keywords: Communities of Practice (CoP); HIV/Aids Nurse Practitioners; Critical Reflection; Transformation; Knowledge Generation; Process; Outcomes

Stigma syndemics & symbolic (isms) in the context of HIV: ways of knowing in health care

The negating effect of stigma on health outcomes has been widely established. Described as a hidden burden of disease, stigma significantly influences the inequities in health. The seminal work of Sociologist, Erving Goffman’s initially published in 1963 continue to underpin our current understanding of stigma as socially influenced through the symbolic interactions of everyday experiences that influences behaviour. Within the context of HIV, stigma remains a barrier in ending the epidemic and is associated with diminished health outcomes, health seeking patterns and poor quality of life. The significant advances in HIV treatment, has increased the life expectancy of people living with HIV, and has shifted the management of HIV as a manageable chronic illness. However the negative stigma outcomes experienced by people living with HIV remains. Moreover, the interactions of other syndemics (that is the co-existence of another disease/s, or social factors) further contributes to the stigma experienced by people living with HIV. This may refer to the co-existence of TB, depressive or other mental health disorder, younger woman, pregnancy, and occupations or work type industry, such as mini-bus taxi drivers, sex workers to name a few syndemics. Central to the health are the values and attributes of caring, towards the restorative process for sustained health and improved wellbeing. To enable care, there is a need for health care professionals to know how to care. Patterns of Knowing or Ways of Knowing developed by nurse theorist Barbra Carper (1975, 1978) and extended by Chinn and Kramer (2008) has become widely applied in nursing and health professions education and training. Ways of knowing acknowledges five inter related facets (empirical, ethical, personal, aesthetic and emancipatory) inherent in the provision of holistic care. The lecture will reflect on the syndemics associated with HIV related stigma, and the symbolic interactions with health care; in the provision of health care and in education and training of health care professionals. This will be framed against ways of knowing, how health care professionals know how to care, the inherent and learnt symbolic meanings in how care is provided, and its potential to demystify and eliminate the perpetuated HIV related stigma

Stigma syndemics & symbolic (isms) in the context of HIV: ways of knowing in health care

The negating effect of stigma on health outcomes has been widely established. Described as a hidden burden of disease, stigma significantly influences the inequities in health. The seminal work of Sociologist, Erving Goffman’s initially published in 1963 continue to underpin our current understanding of stigma as socially influenced through the symbolic interactions of everyday experiences that influences behaviour. Within the context of HIV, stigma remains a barrier in ending the epidemic and is associated with diminished health outcomes, health seeking patterns and poor quality of life. The significant advances in HIV treatment, has increased the life expectancy of people living with HIV, and has shifted the management of HIV as a manageable chronic illness. However the negative stigma outcomes experienced by people living with HIV remains. Moreover, the interactions of other syndemics (that is the co-existence of another disease/s, or social factors) further contributes to the stigma experienced by people living with HIV. This may refer to the co-existence of TB, depressive or other mental health disorder, younger woman, pregnancy, and occupations or work type industry, such as mini-bus taxi drivers, sex workers to name a few syndemics. Central to the health are the values and attributes of caring, towards the restorative process for sustained health and improved wellbeing. To enable care, there is a need for health care professionals to know how to care. Patterns of Knowing or Ways of Knowing developed by nurse theorist Barbra Carper (1975, 1978) and extended by Chinn and Kramer (2008) has become widely applied in nursing and health professions education and training. Ways of knowing acknowledges five inter related facets (empirical, ethical, personal, aesthetic and emancipatory) inherent in the provision of holistic care. The lecture will reflect on the syndemics associated with HIV related stigma, and the symbolic interactions with health care; in the provision of health care and in education and training of health care professionals. This will be framed against ways of knowing, how health care professionals know how to care, the inherent and learnt symbolic meanings in how care is provided, and its potential to demystify and eliminate the perpetuated HIV related stigma

Social support and health behaviour in women living with HIV in KwaZulu-Natal

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV.The sample size was 262 women, 165 from urban area and 97 from rural area. Data were collected using 3 instruments, namely a demographic questionnaire, the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71% of women had disclosed their HIV status to someone, while in the rural area 49% had done so.A total of 77% of the women indicated that they were sexually active – 21% had 2 partners and 20% indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16% said that they currently received counselling, which was significantly more frequent in the rural sample (27%) than the urban (11%).The membership of support groups is at 12% among the participating women, and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use, support group attendance and taking vitamins. However, receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own.The higher social support was not associated with increased disclosure. Keywords: HIV, health behaviour, social support, rural/urban, women. Résumé Cet article va à la découverte de la relation entre le soutien social et le comportement sanitaire des femmes rurales et urbaines qui vivent avec le VIH en Afrique du Sud. Notre étude était une enquête descriptive d'un groupe de femmes enceintes et non enceintes vivant avec le VIH. L'échantillon était de 262 femmes, 165 originaires d'un milieu urbain et 97 d'un milieu rural. Les données ont été recueillies par le biais de trois utiles, notamment un questionnaire démographique, un barème du comportement sanitaire et l'Enquête du Soutien Social de l'Étude Médicale de Résultats. Les résultats significatifs de recherche démontrent que dans le milieu urbain 71% de femmes avaient révélé leur statut séropositif à quelqu'un alors que seulement 49% du milieu rural l'ont fait. 77% de femmes ont signalé qu'elles avaient des rapports sexuels – 21% avaient deux partenaires et 20% ont signalé qu'elles ont eu au moins une épisode de maladies sexuellement transmises depuis qu'elles ont découvert leur statut séropositif. 16% de ces femmes ont dit qu'elles sont actuellement en consultation psychologique. Les consultations se sont passées plus fréquemment auprès de l'échantillon rural (27%) par rapport à l'échantillon urbain (11%). 12% de femmes participantes fait partie des groupes de soutien. Le soutien social ainsi qu'appartenir à un groupe de soutien étaient plus importants dans le groupe rural que dans le groupe urbain. Un bon soutien social a démontré un lien avec l'utilisation de préservatifs, l'assister au groupe de soutien et la prise des vitamines. Cependant, être en consultation psychologique et appartenir à un groupe de soutien ont démontré une association forte à un comportement sanitaire positif beaucoup plus que le soutien social en tant que tel. Le soutien social plus élevé n'a pas été associé aux révélations augmentées. Mots clés:VIH, comportement sanitaire, soutien social, rural/urbain, femmes

“Sisonke - Together We Canâ€: Conceptualisations of Critically Reflective Communities of Practice Nurses Caring for Women Living with HIV

The dynamic nature of HIV care in the context of South Africa challenges nurses to continually keep abreast of changes in treatment and care policies.  Communities of practice (CoPs) are considered an effective method of promoting lifelong learning, enhancing professional development and clinical reasoning through reflective practice. This paper reports on the conceptualisations and meanings that emerged from a critically reflective CoP established among nurses caring for women living with HIV. Based on social constructivismand underpinned on grounded theory, four themes emerged which conceptualised the meaning of a critically reflective CoP, namely: (i) a practice and learning community, (ii) a support network, (iii) collaborative, purposive-driven working to make a difference and (iv) a space that fosters self-determination. The findings of this paper enhance the understanding of organisational learning strategies that can support nurses working in various settings through ongoing learning embedded in evidence-based practice through critical reflection and CoPs

Nursing Recommendations for the Management of HIV and Hypertension in a rural Primary Health Care Setting, Eastern Cape, South Africa

South Africa has an increased number of people living with the human immunodeficiency virus (PLWH). In addition, older PLWH are prone to developing non-communicable diseases (NCDs) as co-morbid illnesses, in particular hypertension. South Africa is experiencing a dual burden of care, that being the co-morbidity of HIV and hypertension. The integration of HIV and non-communicable disease management is needed towards a synergised and comprehensive approach within primary health care (PHC) settings. This article presents nursing recommendations yielded by a descriptive phenomenological study on the management of HIV and hypertension in a rural PHC context. A qualitative research approach, using Husserl’s descriptive phenomenology, was employed, and data were gathered using semi-structured interviews. The interviews were conducted by the first author at Sakhisizwe sub-district clinics, Eastern Cape. Purposive sampling was used to select nine participants. Giorgi’s phenomenological steps underpinned data analysis. Six nursing recommendations were developed to support professional nurses in the management of the co-morbidity of HIV and hypertension: 1) disease-specific health education as opposed to generic health education; 2) utilisation of existing programmes on the integration and management of chronic illnesses; 3) creating social support platforms or spaces; 4) referral pathways; 5) surveillance and monitoring; and 6) management of disease-related stigma. Professional nurses working in PHC clinics have several guidelines to manage chronic illnesses. However, there are limited nursing recommendations on how to manage the co-morbidity of HIV and hypertension. This study focused on a smaller sample of nine participants, in one sub-district and in one district.

Women living with HIV in Nigeria: Predictive influence of hardiness on perceived stress

Background: Women living with HIV experience severe HIV-related stress in sub-Saharan Africa. But evidence shows that individuals with high levels of the psychological hardiness characteristic who accept stressful situations as meaningful experience may withstand psychological stress. However, the literature on associations between hardiness and HIV-related stress among women living with HIV is scarce. The objective of this study was to investigate the relationship between hardiness and HIV-related stress among women living with HIV in Niger State, Nigeria.Methods: This study used a cross-sectional design. A systematic sampling technique was used to recruit 748 participants from three selected hospitals in Niger State. The perceived stress scale and the health-related hardiness scale were used for data collection. A total of 676 questionnaires were returned in usable form and were analysed using hierarchical regression analysis.Results: Pearson’s correlation analysis showed that there is a statistically significant association between perceived stress and subscales of hardiness (p < 0.001). Hierarchical regression analysis results showed that hardiness significantly predicted perceived stress among the study sample with R2 = 0.286, F(3, 669) = 90, p < 0.001.Conclusion: The finding of this study that higher hardiness is associated with lower perceived stress suggests the potential helpfulness to women living with HIV of this personality for coping. The finding also suggests that nurses and other health care workers may facilitate the development and/or improvement of hardiness characteristics through cognitive behavioural interventions among women living with HIV to ameliorate HIV-related stress. Keywords: adversity, coping, resilience, sub-Saharan Africa, trait

Experiences of Nurse Graduates of an Integrated HIV Curriculum from a Selected University in South Africa

Nurses remain a crucial part in the management and care of HIV, especially in resource constrained settings where they fulfil a variety of roles and functions. Competent HIV healthcare providers, especially nurses who provide and support the first line of healthcare in South Africa, are needed to achieve optimal clinical outcomes for all people living with HIV. The integration of HIV-related competencies in an undergraduate nursing curriculum is critical to maintain continuity of HIV related knowledge, skills and competencies within undergraduate nursing programmes from the first year of training, as it builds on foundational levels of understanding to promote critical thinking and skills for continuing learning in the area of HIV care. Against this background, this article reports on the experiences of the first cohort of student nurses who were exposed to the integration of HIV nursing competencies within a four-year Bachelor of Nursing programme. A descriptive exploratory design using a focus group discussion underpinned the study and was considered appropriate to explore the graduated student nurses experiences of the integration of HIV competencies within a four-year Bachelor of Nursing programme and how the integrated HIV programme prepared them for their practice in the management of HIV nursing care. Three themes emerged from the study, namely, evidence informed nursing care, innovative problem-solving skills, and confident to practise. The results showed an overall positive experience from the participants in their ability to independently practise and fulfil a range of HIV-related nursing care. The findings have demonstrated that the first cohort of nurse graduates from an integrated HIV Bachelor of Nursing curriculum showed success in the participants’ experience of the HIV related content and their ability to transfer the knowledge, attitudes and skills to meaningfully and effectively manage HIV-related nursing care