The HIV Nurse Education Project, Lusaka: initial evaluation and progress report.
The HIV Nurse Education Project was established in February 2006 as part of a new link between University Teaching Hospital (UTH), Lusaka, Zambia and Brighton and Sussex University Hospitals (BSUH), Brighton, England. This is an outline of the progress of the HIV Nurse Education Project to date, with an initial evaluation, and explains the changes to nursing practice and service delivery that have been achieved.
Needs assessment for HIV nurse education at UTH
An initial assessment was undertaken in February 2006 to consider the potential link between UTH and BSUH. During the assessment visit, one of the key areas identified by the Director of Nursing at UTH was the need for focused nurse education related to HIV patient care and particularly to the nurse's role in the administration, monitoring and support of patients on antiretroviral therapy. Communication was established between the Director of Nursing at UTH, the HIV Nurse Consultant at BSUH and the Senior Lecturer for HIV and Sexual Health at the School of Nursing, University of Brighton. A questionnaire was devised to assess the educational needs of nurses at UTH, and it was randomly distributed to 30 nurses across the hospital. The key HIV nurse education areas identified were stigma, the role of the nurse, care of opportunistic infections, pregnancy and all aspects of antiretroviral therapy (see Panel 1).
In addition there were focus groups held in Brighton with nurses who had either an interest in working overseas, or previous experience of teaching or nursing in Africa. These meetings assisted in devising culturally relevant teaching styles and in planning for course certificates and opening and closing ceremonies.
Methods of teaching
A variety of teaching methods were used in the first and subsequent courses that aimed to promote inclusive learning and maximum participation in the learning process. The range of teaching styles was intended to facilitate skills development and the application of theory to practice and included lecturing, games, demonstrations, discussion, brainstorming, case scenarios, role play and group work (see Figures 1 and 2).
To date, there have been 206 nurses trained at UTH including matrons, ward sisters and enrolled nurses. The Brighton and Zambian team continue to work together on the project with regular exchange visits to develop the project further or to support new courses such as district hospital training. Following the first course, the project was awarded 60,000 [pound sterling] from DelPHE funding (Development Project in Higher Education, administered by the British Council and the Department for International Development) to ensure that the collaborative work between the HIV nurses in Brighton and Lusaka could be continued for at least 3 years.
Methods of evaluation
Detailed written evaluations were requested from each individual using a reflective diary, with feedback relating to each of the teaching sessions presented and how the session might impact on nursing practice. In addition, verbal evaluations of the whole course were recorded on the last day. Each course included 'time for action' planning to enable participants to identify issues and challenges in their clinical areas and to formulate plans to address these issues. These action plans are reviewed at regular management meetings and most groups have been successful (with management support) in implementing the majority of actions identified, although understaffing has had an adverse effect on some implementation. The progress with action plans is evaluated by the HIV Nurse Education team when the teams from Zambia and Brighton come together.
[FIGURE 1 OMITTED]
The Project's achievements
The nursing link between Brighton/Sussex Hospitals and Lusaka University Teaching Hospital has been active for 3 years and there have been a number of achievements to date:
* The initial workshop was delivered by the Brighton team--Eileen Nixon and Sian Edwards. Now the local facilitators are able to facilitate the workshop on their own, with a lot of support from the management team at UTH and the British Council. As well as training nurses within UTH there have been attendees from three private hospitals in Lusaka. More recently, the programme was rolled out to one of the district hospitals based in Kafue, where the same model was used to deliver HIV nursing skills training. Course participants included staff from urban clinics and, for the first time, some non-nursing students such as a physiotherapist, radiographer, pharmacy technician, clinical officer and laboratory technician. Senior staff from Kafue hospital have now joined the HIV Nurse Education team at UTH to continue to develop training in their area.
* Following the first course, two clinical nurses and two tutors were trained in delivering the HIV Nurse Educating course. More recently other senior clinical nurses have been supported to teach on the course as a way of succession planning and developing a robust team of nurse educators.
* Nursing Grand Rounds have been established and are available for all nurses throughout the hospital once a month. Each department takes a turn at presenting each month, and a noticeable change in reflective nursing practice has resulted.
* In addition, five stigma workshops have been delivered by the International Aids Alliance in which 53 senior nurses and 50 enrolled nurses have been trained, and two of the Zambian team presented the project at the NHIVNA Conference in 2007. In June 2009, Evelyn Mwamba and Lasidah Mwaba were invited to speak at the conference again on their experiences of adherence issues from their practice.
* There has been considerable managerial support from the Managing Director and Director of Nursing at UTH in sustaining the delivery of the HIV Nurse Education programme and, as a result of the programme's impact, the management team has subsequently developed a training programme for non-medical hospital staff.
[FIGURE 2 OMITTED]
Outcomes and impact on practice It is worth noting the exceptional success of this relationship, and the outcomes that have clearly had a major impact on practice:
* Student nurses are now placed in the HIV clinic for one week of their training.
* In pregnancy, syphilis tests are conducted at 36 and 40 weeks, and repeat CD4 cell counts at 26 weeks, to ensure all antenatal women have access to the correct antiretroviral treatment.
* Male partners' involvement in antenatal care has improved: in September 2006, there were no male partners whereas in July 2009, 250 male partners attended.
* The HIV counselling and testing of fathers when their children are ill has greatly increased: in September 2006, 60 men tested, rising to 500 men in July 2009.
* Post-exposure prophylaxis (PEP) availability has been improved, with new policies and pathways being put in place.
* HIV rapid testing kits are available in each department, and so far 20 nurses have been trained in HIV testing and are delivering cascade training.
* A new workplace policy for HIV-positive healthcare workers, taken forward through one of the HIV Nurse Education courses, is now national policy and has been agreed by the Ministry of Health.
* The staff clinic for HIV-positive healthcare workers at UTH has been re-established.
* Stigma among the workers has reduced, especially among the nurses, after the Stigma and Discrimination Workshop sessions. HIV/AIDS-positive nurses have now started attending the ART clinic at UTH. Prior to the stigma workshops, staff would go to another clinic, even hiding their identity for fear of being recognised by colleagues. Some staff are now willing to attend the ART clinic in full nurses' uniform and with identity cards on.
Further training of Zambian partners
In December, 2008, the Zambian team--Lasidah Shawa Mwaba, Mary Jaramba, Universe Mulenga and Evelyn Mwamba--visited BSUH on an exchange programme for 2 weeks. The HIV Nurse Educators attended a mentorship course specifically designed by the School of Nursing at the University of Brighton to enable the Zambian team to set up a mentorship programme at UTH for the HIV Nurse Education Project. Further development of mentorship for nurses working with HIV patients is being undertaken in conjunction with the Centre for Infectious Diseases Research Zambia (CIDRZ).
On the same visit, the Zambian team had another very important opportunity, visiting the House of Lords to attend the Tropical Health and Education Trust (THET) Anniversary event and meeting His Excellency the Zambian High Commissioner to the UK. This was an excellent setting for the project and an occasion to be remembered by all.
Since then, further private funding has been secured for another year to extend the HIV Nurse Education project to another district, based on the same 'train the trainers' skills development model. Further links have also been established with the School of Nursing at the University of Brighton, which is developing a critical care curriculum with tutors from UTH.
The strength of the relationship that has been established between the Brighton and Zambian HIV Nurse Education teams and the friendship that exists among the women in this link has been a powerful enabler of the achievements outlined above. The level of individual involvement and strong sense of belonging is sustained by the commitment that they all clearly feel to their work, and to each other.
Although a formal outcome evaluation of the project is still to be finalised, there have been many tangible achievements to date in both professional and clinical terms and in direct and indirect benefits to patients with HIV at University Teaching Hospital in Zambia.
We thank the University Teaching Hospital, British Council, International AIDS Alliance and Sian Edwards in Australia for the support they have been giving us. We also thank the Brighton/Sussex University Hospitals staff for the support they gave us during exchange visits to the UK.
1. Philips M, Zachariah R, Venis S. Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea. Lancet, 2008, 371, 682-684.
2. Calmy A, Klement E, Teck R et al. Simplifying and adapting antiretroviral treatment in resource poor settings: a necessary step to scaling-up. AIDS, 2004, 18, 2353-2360.
3. Zachariah R, Ford N, Philips M et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg, 2009, 103, 549-558.
4. Zambian Ministry of Health. Human Resources for Health Strategic Plan (2007-2010). Printech Press, Lusaka, Zambia, 2006.
Panel 1: Aims of the project
* Deliver a sustainable HIV course to meet the educational needs of nurses at University Teaching Hospital, Lusaka and build on the knowledge and skills required in the care and treatment of patients with HIV infection;
* Increase the nurses' motivation and their self-belief that as nurses they were a vital component in meeting these needs, and would be able to make a difference;
* Deliver a 'train the trainers' programme to enable roll-out of skills development across the hospital and to include district site courses facilitated by the Zambian team.
Correspondence to: Evelyn Mwamba
Sister-in-Charge, HIV Clinic
University Teaching Hospital
Lusaka Central, Lusaka, Zambia
Evelyn Mwamba (1), Lasidah S Mwaba (1) and Eileen Nixon (2)
(1) University Teaching Hospital, Lusaka, Zambia
(2) Brighton and Sussex University Hospitals, UK
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|Author:||Mwamba, Evelyn; Mwaba, Lasidah S.; Nixon, Eileen|
|Date:||Sep 22, 2009|
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