Busisiwe Bhengu

Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa

BACKGROUND A supportive social environment is critical for those with HIV/AIDS. In KwaZulu-Natal, in South Africa, antiretroviral therapy is available to some HIV-positive individuals. Antiretroviral adherence is an important issue for limiting HIV infection. Adherence to therapy may be linked to social support, particularly amidst the stigma prevalent in HIV. OBJECTIVE The purpose of this study was to examine characteristics related to social support and antiretroviral medication adherence. DESIGN This cross-sectional, descriptive study explored the nature of the relationships among social support and other selected variables, including sociodemographic variables, quality of life, and adherence. SETTINGS After ethical review board approval, the sample of HIV-infected individuals who received care in outpatient clinics were recruited and completed the self-report instruments. PARTICIPANTS The sample included English and/or isiZulu-speaking (n=149) individuals over the age of 18 years receiving treatment for HIV/AIDS. A total of 149 patients with a diagnosis of HIV/AIDS agreed to participate and completed questionnaires after completing informed consent procedures. The study participants were recruited at four outpatient settings in Durban, KwaZulu-Natal province of South Africa. METHODS A descriptive, exploratory, cross-sectional design was utilized to explore the research questions: What are the characteristics of social support and the relationship to antiretroviral adherence in KwaZulu-Natal, South Africa? Descriptive statistics and regression analyses were used to answer the research questions. RESULTS Data analyses indicated that social support scores on the Medical Outcomes Study Social Support Survey were moderate (M=64.4; S.D.=14.7) among the study participants. The number of close friends and family were significantly correlated with a greater sense of social support. Despite this, the lowest scores on the quality-of-life measure using the Medical Outcomes Study Short Form 36 item survey were reported on the Social Functioning Scale. CONCLUSIONS In summary, the study findings suggest that a supportive social network is essential for those living with HIV/AIDS. However, social functioning and quality of life amidst the stigma of living with HIV in South Africa may be a concern and require further investigation.

Quality of life and physical functioning in HIV-infected individuals receiving antiretroviral therapy in KwaZulu-Natal, South Africa

KwaZulu-Natal province, South Africa, accounts for 28.7% of the HIV infection total and one-third of infections among youth and children in South Africa. The purpose of this study was to examine the variables of HIV/AIDS symptoms, social support, influence of comorbid medical problems, length of time adhering to antiretroviral therapy medications, quality of life, adherence to antiretroviral medications, and physical functioning in HIV-infected individuals. Based on our model, the combination of these variables was found to determine physical functioning outcomes and adherence to HIV medications. Significant relationships were observed between physical functioning and the dependent variables of length of time on medications, comorbid health problems, and social support. A linear regression model was built to determine the degree to which these variables predicted physical functioning. In total, these predictor variables explained 29% of the variance in physical functioning. These results indicate that those individuals who reported a greater length of time on medications, fewer comorbid health problems, and greater social support had better physical functioning.

Intensive care nursing in South Africa

Various challenges face intensive care nursing in South Africa. This article describes the health care system of South Africa, with particular attention to intensive care nursing. It also describes the current state of intensive care and the challenges facing this sub-specialty of critical care.

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

The experiences of nurses in providing psychosocial support to families of critically ill trauma patients in intensive care units - a study in the Durban metropolitan area

Background: Critically injured trauma patients are often admitted to an Intensive Care Unit (ICU), which can be a very unfamiliar and intimidating environment for their families. Health organizations have a responsibility to foster an environment that protects the physical and emotional health of the severely stressed family members who assemble in their facilities1. Purpose: The purpose of the research was to explore the experiences of ICU nurses in providing psychosocial support to families of critically ill trauma patients. Research approach: Using an interpretive hermeneutic phenomenological approach, two semi-structured interviews were conducted with each participant to explore their experiences of providing psychological support to families in ICU. The study was conducted in the surgical ICUs of 2 private hospitals and 1 public hospital in the Durban metro area. Findings: There were four main themes which emerged from the data namely; cultural awareness, communication challenges, providing assistance and lack of training. Conclusion: These findings provide implications for practice that, if applied, would improve the ICU experience for both the nursing staff and the families they support.

Fulbright Scholar opportunities for global health and women's health care in HIV/AIDS in sub-Saharan Africa

This article addresses global health opportunities related to HIV/AIDS and womens health care in sub-Saharan Africa through Fulbright Scholar and Fulbright Student Awards. Although many universities offer a gateway to the J. William Fulbright awards, some disciplines and areas of specialization, including nursing and womens health, have had fewer scholars or students as recipients of these awards. Resource-limited countries, including the countries of sub-Saharan Africa, offer rich opportunities for cross-cultural exchange and advancement of global health. Amidst the context of the shortage of health care workers, the increasing prevalence of HIV/AIDS and other infectious and chronic diseases in sub-Saharan Africa, and the challenges of public health, this article addresses an example of partnerships in global nursing that can be developed through the Fulbright programs.

Ethical, legal and cultural implications in the management of chronic kidney disease (CKD) patients: a critical review of literature

The objective of this review was to highlight the ethical, legal and cultural implications in the management of chronic kidney disease (CKD) patients. Articles were identified from online databases, namely Medline, PubMed, google scholar and grey literature. A comprehensive search was done to identify articles which highlight the cultural, ethical and legal implications regarding the management of CKD patients and 42 of them were identified. Autonomy and justice were the two main ethical principles identified and their conflicting issues with regards to renal replacement therapy (RRT). Supply and demand with kidney donation and transplantation has led to numerous ethical and moral issues among CKD patients. Although there have been developments in the legal and ethical frameworks to follow, RRT remains a controversial issue. The conflict between justice and autonomy is critical to analyse when looking at the existence of RRT for CKD patients around the world. Conflicting ethical principles could be considered to cause more harm to patients than benefits (maleficence versus beneficence) and, consequently, limited patient engagement resulting in non-adherence to management among CKD patients.

Perceptions of newly-qualified nurses performing compulsory community service in KwaZulu-Natal

Background Compulsory community service (CCS) for nurses commenced in South Africa in January 2008 after it was legislated in the new Nursing Act (Act No. 33 of 2005). Nurses completing their registered nurse programme are registered as community nurse practitioners (CNPs) during the CCS period and make up the largest number of health professionals serving CCS. Whilst health institutions have welcomed CNPs as additional resources for the shortage of nursing staff, no structured guidelines have been provided at a regional level as to how these nurses should be utilised or managed during the CCS year. To date, no large-scale study has been conducted on nurses carrying out CCS in order to generalise the findings. Objectives To establish the perceptions of newly-qualified nurses carrying out CCS in KwaZulu-Natal, South Africa. Method A quantitative survey design was used to obtain data from a randomly selected sample of the 2012 cohort of nurses carrying out CCS in KwaZulu-Natal. Results CNPs have a positive attitude toward CCS and perceive themselves as being well prepared for the year of community service in terms of knowledge, skills and ability to administer nursing care. They identified positive benefits of the year of community service. The concerns raised were limited orientation and support; and a few CNPs experienced problems of acceptance by the nurses with whom they work. Conclusion It is recommended that all health institutions who receive CNPs develop structured orientation and support for these nurses in order to promote their development, thereby enhancing their benefit to the communities they serve.

Perceived health status and adherence to haemodialysis by End Stage Renal Disease patients: A case of a Central hospital in Zimbabwe.

Poor adherence to haemodialysis among End Stage Renal Disease (ESRD) patients has been a major problem globally. Perceived physical health appears to be the major contributing factor to poor adherence to haemodialysis. Improving the adherence to haemodialysis among ESRD patients improves their quality of life. A descriptive correlational study was conducted to examine the relationship between perceived physical health and level of adherence to haemodialysis among ESRD patients. The study was conducted at a central hospital in Harare, Zimbabwe. A total of 85 ESRD patients who met the inclusion criteria were selected using simple random sampling. Data was collected using an interview schedule with three sections namely: the demographic data, adherence to haemodialysis and perceived physical health. Descriptive statistics, Pearsons correlation coefficient and linear regression were used to analyse the data. Eighty - three (97.6%) demonstrated low adherence to haemodialysis. Eighty - two (96.5%) perceived their physical health to be average. The Pearson correlation coefficient (r=-.44 p<.01) showed a weak negative significant relationship. Perceived physical health had an impact of 19.7% on adherence to haemodialysis (R 2 0.197). The findings predict that as perceived

Experiences of nurse managers in managing a workforce who are HIV and/or TB infected

Managing a workforce suffering from HIV and TB leads to management and administrative issues for nurse managers to deal with. The purpose of this study is to describe the experiences in the management of a nursing workforce suffering from HIV and TB in selected hospitals in South Africa. An interpretive constructionist ethnography using qualitative research methods was used to conduct research in selected hospitals in KwaZulu-Natal, South Africa. In-depth interviews were conducted with 17 participants in 4 hospitals; the interviews were transcribed verbatim and analysed using thematic analysis. The nurse managers’ descriptions lead to administrative, emotional, employee personal protection, and the burden of death as the categories which emerged from the data. A theme emerged regarding the ambivalence between making decisions which are best for the patients and those which are best for the ill nurse. The burden experienced by nurse managers needs to be understood and requires organizational support. Understanding the human resource management experiences of nurse managers managing HIV and TB-infected nurses in a workforce may guide nurse managers working in similar contexts, with a similar HIV and TB prevalence as that in Southern Africa.