Chapter 1 HIV and Pregnancy

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Nursing Workforce Development Initiative Reported
by Carmen Portillo, RN, PhD and I-TECH
Nurses RWCA 2006 Meeting August 29,
2006 Washington DC

• Presented by

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Background

• Funded by HRSA in 2004
• Goal is to increase nurses competency in their
  roles as educators, advocates, and caretakers
  which is fundamental to HIV/AIDS care,
  prevention, and treatment efforts
• Nursing Workforce Development Framework

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Framework

• I-TECH professionals and their host country
  partners are developing interventions in 3 areas
  to increase the number of nurses providing HIV
  care and to support them on-the-job
•   pre service
•   preceptorship
•  capacity development

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HIV Nursing Capacity Building Model
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Countries of Focus

• Currently, I-TECH nursing activities are being
  conducted in seven countries Botswana,
  Caribbean, Ethiopia, India, Malawi, Nambia, and
  South Africa.

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Botswana

• I-TECH is supporting the MOH STI Syndromic
  Management training by providing one full time
  nurse/trainer. The vast majority of the trainers
  and the trainees for the STI syndromic management
  project are nurses.

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Caribbean Region

• Pre service Discussions are underway within
  the region to create a pan-Caribbean pre-service
  nursing curriculum. Plus, a core competency
  database is being developed detailing the list of
  competencies used in various health professional
  cadres, including nursing. The goal is
  standardize trainings across the region and to
  potentially develop a HIV certification program
  for healthcare providers.

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Caribbean Region

• Preceptorship The goal is hire more nurse
  preceptors in the Caribbean Region. ANAC/I-TECH
  will be sponsoring 10 nurses from the Caribbean
  to attend ANACs annual conference this year,
  which is seen as a mentoring strategy for these
  nurses.
• Capacity Development A Nurses Working Group
  has been developed which includes nurses from the
  whole region. This has been tremendously
  successful! This group has been meeting for the
  last two years where they address specific issues
  as they relate to pre-service, preceptorship and
  capacity development. An example of their work,
  is the adaptation of the Nurse Pocket Guide for
  HIV Management.

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India
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India

• Capacity Development infection control,
  computer, and basic HIV training of 120 nurses at
  GHTM TOT of 14 nurses sanitary workers training
  conducted by TOT group (gt200 SW and NAs). GHTM
  nurses presented at a international AIDS
  conference in India on nurses role in reducing
  HIV stigma
• 35 self selected nurses were given basic level 1
  and 2 training 12 hours of level 2 and 3
• These activities were funded by Indias country
  budget

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India

• Conducted nurse training needs assessment at
  Rural Development Trust interviewed key
  informants at RDT to assess capacity of HIV/AIDS
  in nursing and medical care
• Outcome planning to implement a training program
  for nurses at RDT
• Conducted interviews with 3 colleges of nursing
  to assess pre service curricular HIV content and
  assessed for potential collaborations with a
  private college
• Outcome Developing HIV Nurse Specialist Training
  Program and formal affiliation with private
  medical colleges
• 
  Partially
  funded by NI

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Malawi

• Pre Service conducted an assessment of nursing
  faculty at Kamuzu College of Nursing, University
  of Malawi
• Outcome developed a one week training workshop
  to empower faculty members to improve their HIV
  knowledge and incorporate curricular changes

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Malawi
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Malawi
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Namibia

• National Health Training Centre division of
  Ministry of Health and Social Services
  responsible for HIV/AIDS training of govt health
  workers 5 training sites
• Preservice1) trained and salary 10 in-service
  nurse trainers to train health workers on VCT,
  PMTCT, rapid testing, couples counseling 2) 8
  nurse tutors integrating HIV content into nursing
  curriculum have trained over 1400 nurses and
  student nurses and 3) a Namibian nurse
  consultant is working with UNAM to develop
  advanced HIV nursing practice into their
  curriculum

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Namibia

• Preceptorship a set of nurse tutors at each of
  the 5 sites provides didactic HIV training to
  local nursing staff and support visits to
  trainees to ensure that the transfer of knowledge
  has taken place.
• This past June, I-TECH held a clinical mentoring
  workshop for the tutors, which will enable the
  tutors to provide more frequent clinical
  mentoring visits to nurses in clinics where there
  is a large demand for services (e.g. PMTCT).
• Regular retreats/workshops are held with the set
  of trained tutors to share best practices in
  turn, I-TECH has the opportunity to continually
  assess their clinical and knowledge needs.

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Namibia

• Capacity Development CDC has been in discussions
  with I-TECH to assist with COP 07 activities
  focused on boosting nurse-morale.

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South Africa

• Preceptorship As part of I-TECHs Clinical
  Mentoring project (UCSD), RN/NPs have been
  members of the team training and mentoring
  nurses two RNs spent 3 weeks in the Eastern Cape
  province working on building the clinical care
  capacity of nurses

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Ethiopia

• OGAC provided focused funding for Nursing
  Initiative support in Ethiopia. This included To
  develop a HIV/AIDS Specialist Nurse Training
  Program intensive month of didactic and
  clinical followed by clinical mentoring at
  trainees hospital. Two groups of students have
  completed the program to date. Additionally, to
  develop an advocacy and leadership training
  program for the Ethiopian Nurse Association,
  which has recently been approved by the
  Association. Finally, discussions are taking
  place in how I-TECH can be supportive of Addis
  Ababa University School of Nursings first
  masters.

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Ethiopia

• Other activities supported by I-TECH have
  included training nurses in comprehensive HIV
  care developed a group of nurse TOTs provide
  on-site clinical mentoring to hospital nurse
  trainees and trainers nurses and MDs have
  participated in a 4-week clinical training
  program in Israel advocated for expanded role
  for hospital nurses building coalition with ENA
  and nursing schools 3 local nurses are salaried
  and more are being advocated for.

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Lessons Learned

• Standardize HIV/AIDS nursing education in the US
• Great efforts are being taken to standardized
  nursing HIV curriculum internationally, yet
  little is known what and how much is being taught
  in schools of nursing and at the different levels
  of education. Do we need a regulatory body that
  oversees what core competencies should be
  incorporated into curricula? Should we
  standardize nursing HIV curricula? Who would do
  it?

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Lessons Learned

• Embrace HIV/AIDS clinical nurse mentoring
  strategies to expand the expert workforce of
  nurses providing prevention, care and treatment
  in the US
• The nursing workforce is aging faculty are
  aging, specialty nurses, such as those in AIDS
  care are aging. They will be leaving the field of
  nursing and HIV/AIDS either because of retirement
  or compassion fatigue. How are we preparing the
  next generation of nurses? How are 4-year degree
  programs preparing nurses in HIV/AIDS prevention
  and care?

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Lessons Learned

• Implement nurse mentor programs
• Most often ART clinics require seasoned and
  experienced nurses in HIV/AIDS. Developing a
  nurse mentor program has the potential of
  developing nurse capacity but also standardizing
  care and treatment within the setting itself. A
  best practice example would be the Nurse Mentor
  Program in Namibia. Domestically we need to
  improve on how nurses mentor other nurses.

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Lessons Learned

• Support adherence to ART through culturally
  specific strategies
• Much has been written about adherence and
  approaches to support improved adherence to ARVs.
  Strategies range from costly ones to very
  simplistic ones. There is evidence to support the
  use of very simple programs and culturally
  specific that people can identify with.

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Challenges

• Refining our conceptual framework for the work
  that we are doing internationally.
• Working in multi-cultural, multi-lingual
  countries.
• Sustainability leaving behind what has been
  created requires knowing what the overarching
  goal is seeing what of the program elements are
  achieving the end and being creative.
  Sustainability can virtually sum all of our
  challenges from leadership, developing
  partnerships and collaboration, strategies
  planning, capacity building, evaluation, policy
  and financing.