Registered nurses' perceptions regarding nurse-led antiretroviral therapy initiation in Hhohho region, Swaziland.

BACKGROUND: Swaziland has the highest HIV prevalence globally. It faces a critical shortage of health workers for addressing the HIV pandemic. To curb this human resource challenge, Swaziland adopted a nurse-driven model for antiretroviral therapy delivery in line with the recommendations of the World Health Organization on task shifting. OBJECTIVE: The study explored the perceptions of registered nurses on the nurse-led antiretroviral therapy initiation programme in the Hhohho region of Swaziland (NARTIS). DESIGN: The study utilized a phenomenological design, specifically a phenomenographic design. SETTING: The study was conducted in ten health facilities in the Hhohho region of Swaziland. These facilities comprised eight clinics, a hospital and a health centre. PARTICIPANTS: These were registered nurses, trained and certified in the nurse-led antiretroviral therapy initiation programme. The nurses also had experience of working in a nurse-led antiretroviral therapy initiation programme. Eighteen (18) nurses were purposively selected and recruited to participate in the study. METHODS: Data were collected through open and deep individual interviews guided by a semi-structured interview schedule. The audio-recorded interviews were transcribed and analysed thematically using Sjöström and Dahlgren's approach to data analysis. RESULTS: Three major themes emerged from the study data: nurses' emotional reactions to the implementation of the NARTIS programme, and influences and overcoming barriers to the programme. CONCLUSIONS: The study findings have generated insights into this program which is useful for the provision of care to people living with HIV/AIDS in Swaziland. But nurses need support to ensure effective implementation. IMPLICATION FOR NURSING AND HEALTH POLICY: The study findings have implications for both the practice of the NARTIS programme and health policy development. The development of a health policy that alleviates the barriers to the NARTIS programme can enhance nurses' role and make care provision to people living with HIV/AIDS more effective.

The experiences of HIV-serodiscordant couples in Soweto, South Africa.

INTRODUCTION: The study was carried out in a single township in South Africa with a sample size of seven human immunodeficiency virus (HIV)-serodiscordant couples. BACKGROUND: South Africa has the highest number of HIV cases in the world, with an estimated 6.4 million of its inhabitants living with this infection. Most people in stable relationships are unaware of the HIV serostatuses of their partners. Many people with an HIV partner are also generally unaware of their own HIV serostatuses. There is a high risk of acquisition of the HIV among couples in HIV-serodiscordant relationships. Yet, there is a dearth of research on HIV-serodiscordant couples. AIM: To explore the experiences and knowledge of HIV-serodiscordant couples on HIV serodiscordance. METHODS: A qualitative design of interpretative phenomenological analysis was used. Data were collected from seven HIV-serodiscordant couples using a semi-structured interview format. Data were analysed thematically using the principles of interpretative phenomenological analysis. RESULTS: Three superordinate themes emerged from data analysis: experiences of stress, effects of HIV serodiscordance on couples and knowledge of HIV serodiscordance. The study outcomes were based on retrospective accounts of couples' experiences of HIV serodiscordance. Such accounts are subject to memory bias. CONCLUSION: HIV-serodiscordant relationships are riddled with stress. Couples and nurses' knowledge and understanding of the concept of HIV serodiscordance is limited. Such limitation may negatively influence the quality of care and support offered to couples in these relationships. IMPLICATIONS FOR NURSING AND HEALTH POLICY: HIV-serodiscordant couples need to be educated on this phenomenon. Nurses also need to be offered training on how to support and care for couples in these relationships. Such training should be shaped by couples' health-seeking behaviours and cultural norms. Specific guidelines and policy on HIV serodiscordance should be developed to ensure consistency in care provision and enhance uptake of support services.

Support needs of caregivers: case studies in South Africa.

BACKGROUND: Limpopo is one of the poorest provinces in South Africa with limited resources to support caregivers and individuals who are learning disabled. Offering support and care to children with learning disabilities can be a complex and difficult task to achieve. Caregivers carry great responsibility for ensuring the needs of children in their care are met. Such responsibility can generate great amounts of stress that may negatively impact caregivers' day-to-day functioning. Yet, research concerning how to support caregivers in meeting the needs of this group of children in Limpopo has never before been carried out. AIM: To investigate the support needs of caregivers caring for children with learning disabilities. METHODS: A case study design of three families of children with learning disabilities was used. Data were generated in two phases using a semi-structured interview format. In phase 1, participants were interviewed in their homes. Phase 2 relates to follow-up interviews of participants in a community clinic. All data were analysed using Interpretative Phenomenological Analysis. FINDINGS: The study identified a range of support needs for caregivers. Examples of these include financial, emotional, practical support, training, respite care, affiliate stigma and partnership working. DISCUSSION: Caring for children with learning disabilities was perceived as difficult and frustrating, yet rewarding. This difficulty was noted to be compounded by caregivers' lack of skills and knowledge of caring for these children. They also had experiences of stigma, which sometimes involves overt acts of discrimination and social exclusion that further added to their frustration. CONCLUSIONS: The study findings have implications for practice and policy. Regular training and support should be offered to caregivers in order to broaden their understanding of learning disabilities and enhance their caring ability. Nurses are the main source of training and support and offer these during clinic-based engagement and home visits.

Motives for self-harm: views of nurses in a secure unit.

BACKGROUND: Self-harm is a widespread behaviour among people with mental health problems. Although guidance on how to manage self-harm is offered, it is still a behaviour that is misunderstood by many nurses. Such misunderstanding is generally attributed to the perceived motives for self-harm and lack of specialized education to manage the behaviour. As a consequence, the care provided is usually inadequate and inappropriate. Yet, research concerning nurses' reasons of users' self-harming behaviours is limited. AIM: This paper reports on a study that explores nurses' explanations of the motives for self-harm in a secure adolescent unit in England. METHODS: The study utilized a phenomenological methodology with semi-structured individual interviews (n = 25). The data were analysed thematically using interpretative phenomenological analysis. RESULTS: The findings indicate that the behaviour of self-harm has multiple motives. Examples of these include affect regulation, coping with distress, averting death, regaining control and attention seeking. DISCUSSION: Self-harm is a complex behaviour commonly experienced in secure environments. Nurses assume that users who self-harm are motivated by a desire to seek attention and manipulate others. Users may find these beliefs humiliating. Such feelings may increase users' risks for further self-harm. Most adolescents who self-harm experience unbearable emotions because of their past sexual abusive encounters. They self-harm to regulate these emotions. These affect regulatory functions may act as reinforcers of self-harming behaviours. CONCLUSIONS: Improved understanding of self-harm and its motives may result in improved nurse-user relationships and thus safer and more effective care provision.