HIV nursing consultants: patients' preferences and experiences about the quality of care

Quality of Nursing Care Perceived by People With HIV in Brazil: A Cross-Sectional Study

ABSTRACT

We evaluated the quality of care provided by the nursing team within specialized care services (SCS) from the perspective of persons with HIV (PWH). A cross-sectional study was conducted in 25 SCS selected by a single-stage cluster sampling in 21 municipalities in Brazil. Systematic sampling was performed between October 2019 and March 2020 in the reception areas of SCS locations to choose the study population ( N = 377). The adapted and validated Quality of Care Through the Patient's Eyes-HIV (QUOTE-HIV) questionnaire was used to measure the quality of perceived care, and the Mann-Whitney test to compare the scores between men and women. Of the 377 PWH, most were women (57.71%), Black or Brown (85.9%), heterosexual (67.1%), and cisgendered (96.0%); the mean age was ≥30 years (76.1%). Users' evaluation of the care provided by SCS according to scores of importance and performance of the QUOTE-HIV instrument ranged from 5.60 to 8.95 and 0.03 to 0.76, respectively. The perception of PWH about the quality of care provided by the nursing team in SCS suggests that there are opportunities to improve.

Cultural adaptation of Quality Of Care Through The Patient's Eyes -QUOTE-HIV

ABSTRACT Objective: to translate and adapt Quality of Care Through the Patient's Eyes - HIV (QUOTE-HIV) for the Brazilian population living with HIV/AIDS. Method: a methodological study, which followed the stages of translation, synthesis, back-translation, evaluation by the committee of experts and pre-test for cultural adaptation of the instrument. Results: the process of translation and cultural adaptation was considered adequate. Evaluation by the expert committee resulted in semantic, structural and grammatical adequacy of the evaluated items. 30 subjects considered the instrument to be easy to understand and suggested minor adjustments in some items. Conclusion: the Brazilian version of QUOTE-HIV has been adapted and validated in relation to its content. However, this is a study that precedes the process of evaluating the psychometric properties of the instrument, the results of which will be presented in a later publication.

Interprofessional working: adoption assessments for people living with HIV

Purpose

The purpose of this paper is to propose that interprofessional working between professionals who work with people living with HIV (PLWHIV) contributes to improvements in the health, social care needs and long-term outcomes of PLWHIV. Interprofessional working initiatives have been useful in promoting successful frameworks used towards improving various aspects of the HIV disease family planning and transmission prevention. The paper proposes that interprofessional working is important in elevating stigma and discrimination that sometimes prevent PLWHIV from successfully achieving parenthood through adoption. The objective of this study is to contribute to social work practice and literature that supports adoption.

Design/methodology/approach

This paper draws on an interpretative phenomenological analysis (IPA) study looking at the experiences of PLWHIV going through the adoption process. The study relied on in-depth interviews with six PLWHIV who had gone through the adoption process and presented views regarding a need for better collaborative working by those assessing PLWHIV going through adoption. The sample was purpose and homogeneous. Interviews were recorded, transcribed and analysed using IPA framework. Transcripts had been written up and analysed individually. Following which a cross-case analysis to create meaning and conceptual understanding that was common among all cases.

Findings

Drawing on themes around interprofessional working, this paper argues that there is a need for improved and transparent interprofessional working models within adoption systems. The paper provides conceptual understanding around interprofessional working and how this can be brought about to support the needs of PLWHIV seeking to adopt children. It proposes that working in isolation will leave PLWHIV feeling that the adoption process is ambiguous and unfair, yet efforts to combat this are evident in healthcare settings.

Research limitations/implications

Limitations to this study include an acceptable but small convenience sample within IPA methodological approaches. This is a hard to reach sample and results may not be generalisable.

Practical implications

This paper opens a dialogue for discussing issues around the adoption for PLWHIV and informing professionals about increasing opportunities for PLWHIV to adopt children where there is a high demand for adoptive parents.

Social implications

Placing the views of participants in this study within the body of knowledge could influence meaningful collaboration between adoption social workers and those supporting PLWHIV within health, social care and voluntary sectors. This may influence change and reduce stigma and barriers preventing some PLWHIV from successfully adopting children.

Originality/value

This paper meets an identified need to explore how PLWHIV can be supported to achieve parenthood. The paper expands on existing knowledge around the need to provide fertility treatment to PLWHIV. It suggests that child adoption can be promoted through child adoption and ultimately promoting normalcy around the desires of PLWHIV to achieve parenthood using non-traditional methods of conception.

A Survey of Patients' Perspectives on Outpatient HIV Care in the Netherlands

Introduction

Responding to patients’ needs and preferences is important in the delivery of outpatient care. Recent and systematically collected data reflecting human immunodeficiency virus (HIV)-infected patients’ opinions on how their outpatient care should be delivered are lacking. Our aim was to identify aspects of care that people with HIV in outpatient care in The Netherlands consider important and to evaluate the extent to which the received care meets their expectations.

Methods

We measured patient preferences and experiences in a nationwide sample of HIV-infected patients using a modified, previously validated questionnaire (QUOTE-HIV).

Results

The aspects of care that were considered most important were specific expertise of the care provider in HIV medicine, the care provider taking the patient seriously and receiving adequate information about treatment options. In addition, confidentiality of HIV status at the outpatient clinic was a major concern. Patient experiences were positive, with the majority of the respondents indicating that they always or usually received care in accordance with their preferences.

Conclusion

HIV-infected patients greatly value having care providers with HIV-specific expertise. Safeguarding the privacy of HIV status and the provision of information about treatment options are matters that deserve continuous attention in the delivery of outpatient HIV care.

Electronic supplementary material

The online version of this article (doi:10.1007/s40121-017-0164-z) contains supplementary material, which is available to authorized users.

Which aspects of health care are most valued by people living with HIV in high-income countries? A systematic review

BACKGROUND

Increasing numbers of people with HIV are living into older age and experiencing comorbidities. The development of new models of care to meet the needs of this population is now a priority. It is important that the views and preferences of patients inform the development of services in order to maintain high levels of patient satisfaction and engagement. The aim of this systematic review was to determine which aspects of healthcare are particularly valued by people living with HIV.

METHODS

We searched electronic databases and reference lists of relevant articles. The search strategy was developed to identify articles reporting on HIV positive patients' perceptions, evaluations or experiences of healthcare services and factors associated with satisfaction with care. Peer-reviewed papers and conference abstracts were included if the study reported on aspects of health care that were valued by people living with HIV, data were collected during the era of combination therapy (from 1996 onwards), and the paper was published in English. A thematic approach to data synthesis was used.

RESULTS

Twenty-three studies met the inclusion criteria. Studies used both qualitative and quantitative methods. Six studies specifically reported on relative importance to patients of different aspects of care. The valued aspects of care identified were grouped into seven themes. These highlighted the importance to patients of: a good health care professional-patient relationship, HIV specialist knowledge, continuity of care, ease of access to services, access to high quality information and support, effective co-ordination between HIV specialists and other healthcare professionals, and involvement in decisions about treatment and care. We were unable to determine the relative importance to patients of different aspects of care because of methodological differences between the studies.

CONCLUSIONS

This review identified several attributes of healthcare that are valued by people living with HIV, many of which would be relevant to any future reconfiguration of services to meet the needs of an ageing population. Further research is required to determine the relative importance to patients of different aspects of care.

How does specialist nursing contribute to HIV service delivery across England?

This study aimed to examine what specialist nursing contributes to HIV service delivery across England and how it could be optimised. A three part multi-method qualitative study was undertaken, involving (1) interviews with 19 stakeholders representing professional or service user groups; (2) interviews with nurse/physician pairs from 21 HIV services; and (3) case studies involving site visits to five services. A framework analysis approach was used to manage and analyse the data. There was substantial variability in specialist nursing roles and the extent of role development. Most hospital-based HIV nurses (13/19) were running nurse-led clinics, primarily for stable patients with almost half (6/13) also managing more complex patients. Role development was supported by non-medical prescribing, a robust governance framework and appropriate workload allocation. The availability and organisation of community HIV nursing provision determined how services supported vulnerable patients to keep them engaged in care. Four service models were identified. The study showed that there is scope for providing a greater proportion of routine care through nurse-led clinics. HIV community nursing can influence health outcomes for vulnerable patients, but provision is variable. With limited financial resources, services may need to decide how to deploy their specialist nurses for best effect.

An Integrative Review on Development of "QUality Of care Through the patients' Eyes" (QUOTE) Instruments

"QUality Of care Through the patients' Eyes" (QUOTE) instruments for measuring care quality were classified in terms of procedures, structures, and content. The content and structures of each instrument were found to include (a) participation of the client in the tool development process, (b) evaluation of the importance and performance of care based on the client's needs, and

The contribution of the HIV specialist nurse to HIV care: a scoping review

AIMS AND OBJECTIVES

To systematically identify and critically examine the evidence of the contribution of the HIV nurse specialist to provision of HIV care in the UK and other developed countries.

BACKGROUND

The HIV clinical nurse specialist role has evolved over the past two decades in response to changes in two areas of HIV care: first, changes in the treatment and care of those with HIV and second, changes and development in advanced nursing practice. The challenges facing HIV care require the development of innovative services including a greater contribution of HIV specialist nurses. A review of current evidence is required to inform developments.

DESIGN

A review.

METHODS

A broad search strategy was used to search electronic databases. Grey literature was accessed through a variety of approaches. Preference was given to UK literature with inclusion of international publications from other developed countries where relevant.

RESULTS

Fourteen articles were included. Four themes were identified: the diversity of the clinical role; a knowledge and skills framework for HIV nursing practice; the education and training role of the HIV nurse specialist; and the effectiveness of the HIV nurse specialist. The findings mainly focus on the clinical aspects of the role with little evidence concerning other aspects. There is limited evidence to indicate clinical effectiveness.

CONCLUSIONS

HIV care is facing substantial challenges, and there is a clear need to develop effective and efficient services, including expanding the contribution of HIV nurse specialists. Such developments need to occur within a framework that optimises nursing contribution and measures their impact on HIV care. This review provides a baseline to inform such developments.

RELEVANCE TO CLINICAL PRACTICE

This review of the literature details current understanding of the role of HIV specialist nurses and the contribution that they make to HIV care.

Patient-derived outcome measures for HIV services in the developed world: a systematic review

This review sought to establish the themes and approaches used in the measurement of patient satisfaction regarded by HIV service users as crucial to improving service quality. It also investigated how feedback has been measured previously and whether a gold standard instrument exists that is generalizable across HIV inpatient and clinic settings. Twelve databases and other sources yielded 1474 titles. Using a clinically-focused question and pre-defined inclusion and exclusion criteria, 32 articles were retrieved and reviewed for quality using a quality appraisal checklist. Two reviewers used a data extraction form to identify and verify key patient experiences. Thematic analysis revealed that clinic staffs' current knowledge of HIV was an essential factor in positive feedback. Treating patients with dignity and respecting their autonomy and confidentiality were also important. Developments in treatment, extended life expectancy and quality of life have altered patients' experience and level of satisfaction. Three instruments developed to assess patient satisfaction with HIV care were identified but there was no gold standard method of measuring it. There is a need to develop a specific, valid instrument that is easy to complete and analyse, and the data should be used to inform the redesign of services to promote a dynamic model of care.

Patient perspectives on the impact of Crohn's disease: results from group interviews

AIM

To understand the impact of Crohn's disease (CD) on various aspects of daily life from the perspective of patients living with CD. Awareness of the disease and biologic therapies, patient satisfaction and adherence, and physician (provider) relationships were also assessed.

BACKGROUND

CD is a chronic, inflammatory, autoimmune disorder of the gastrointestinal tract that substantially impacts patients' physical and emotional well-being. For patients eligible for biologic therapy, anti-tumor necrosis factor agents represent an important addition to the available therapies for CD.

METHODS

The study sample included biologic-naïve and biologic-experienced patients who had self-reported moderate to severe CD, were under the care of a specialist, and agreed to film a video diary and participate in a focus group. Data from the videos and group interviews were collected from May to June of 2009 and summarized qualitatively by grouping similar answers and quotations.

RESULTS

Of the 44 participants who submitted video diaries, 23 were biologic-experienced and 21 were biologic-naïve. Participants stated that CD caused fear and embarrassment, that they were reluctant to share the full impact of CD with family and providers, and that they relied on their provider for treatment decisions. Many participants accepted a new state of normalcy if their current medication helped their most bothersome symptoms without providing sustained remission. Participants receiving biologic therapy generally were more informed, more satisfied, and more likely to adhere to treatment regimens.

CONCLUSION

Participants' responses suggest a need for more patient education and more collaborative relationships between patients and providers (physicians) regarding treatment decisions.

The role of HIV nursing consultants in the care of HIV-infected patients in Dutch hospital outpatient clinics

OBJECTIVE

In the Netherlands HIV nursing consultants have participated in HIV-care since 1985; their profession has changed with developments in HIV-treatment over time. The study goal was to gather information about their role in HIV-care and to provide an useful example to other (HIV-)care settings over the world.

METHODS

Interviews were held with HIV nursing consultants from all AIDS treatment centres. Descriptive analyses and statistical tests to detect differences between centres categorized by care model (parallel/unstructured/alternating), were performed.

RESULTS

58% centres perform substitution of care. HIV nursing consultants see almost all patients at least once a year and see all patients when treatment is started/altered. The frequency of consultations for HIV-patients in stable condition varies, 2-4 times a year. Substitution leads to a slight, non-significant decrease in number of consultations. Adherence support is provided at the start of and during treatment. Regular patient discussions are common. All respondents are acquainted with the guidelines. Detailed knowledge of the adherence issues is limited: 58.3% had read the adherence chapter.

CONCLUSION

Substitution of care model is an appropriate and effective method for the management of HIV-infected patients.

PRACTICE IMPLICATIONS

Further development of and research into this new role of HIV nurse consultants is appropriate.

Assessing the impact of nurse and allied health professional consultants: developing an activity diary

AIMS

To construct and test an activity diary designed to measure the impact and explore the activities of nurse and allied health professional consultants in relation to each speciality and function of the role.

BACKGROUND

This was part of a funded feasibility study to assess the contribution of nurse and allied health professional consultants.

DESIGN

This was an exploratory study.

METHOD

Thematic analysis of guided discussions with five nurse consultants and one physiotherapy consultant identified activities which were used to construct an activity diary. The activities were grouped under the four pillars or functions of the consultant role; expert practice, leadership, research and education. Participants recorded their activities in a diary over a one-week period.

CONCLUSION

Results suggest that with some modification, this activity diary could be used to capture the impact, complexity and diversity of activities of the consultant role.

RELEVANCE TO PRACTICE

Advanced practice roles are essential to the healthcare workforce of the future. This tool provides a method for measuring the contribution and complexity of the consultant role.

An exploration of personal initiative theory in the role of consultant nurses

The aim in this paper is to investigate the contribution personal initiative theory makes in understanding the consultant nurse role. The role was introduced in the UK in 2000 to improve patient outcomes, clinical leadership and retention of experienced clinicians. A larger study used a multi-method approach to collect quantitative and qualitative data from focus groups, interviews and a questionnaire administered nationally at two time points. Findings from longitudinal telephone interviews with 30 consultant nurses are the focus of this paper.

Three consultant nurses were selected as case studies to examine the potential of personal initiative theory when applied to new nursing roles. The activities of two of the three demonstrated a high level of personal initiative in the job. They persisted in overcoming problems faced in improving practice. The third scored lower: she emerged as a reactive conformist and less likely than the other two to pursue initiatives of her own.

Personal initiative theory has potential as a framework for evaluating the consultant nurse role, although further research is needed to test it. The longitudinal analysis revealed a determination to stay in the job and overcome difficult challenges when consultants show initiative and are making progress in achieving change.

Measuring patient assessments of the quality of outpatient care: a systematic review

RATIONALE, AIMS AND OBJECTIVES

The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care?

METHODS

Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients' assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases.

RESULTS

Thirty-five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design.

CONCLUSION

Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.