Page 251 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 7 Original Research

Competency has been described as the knowledge, Although there is substantial evidence that nurses can
perceptions, skills, attitudes and standards that an individual provide high-quality treatment and care, several challenges
develops or acquires through education, training and work have been identified, such as shortages of essential drugs,
experience, which can be used to depict particular salary concerns, excessive workload, lack of practice
occupational roles or functions against which personal standards, access to mentoring and infrastructural
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performance may be assessed. Although it is ideal that all barriers. 4,11,15,16 This therefore highlights the need for
health professionals should be competent to undertake the continuous quality assurance in settings where NIMART is
tasks they perform, competency may be difficult to assess. being implemented. 17,18
The assessment of competency in the form of subjective,
multiple-choice and standardised patient assessments may No published studies could be found that specifically
underemphasise significant domains of professional investigated the factors that influence the knowledge and
capability such as the integration of knowledge and skills, confidence of nurses currently prescribing ART. Evaluating
the framework of care, cooperation and patient–provider the HIV management confidence and knowledge of
associations. It is even more challenging to assess the professional nurses who prescribe ART may help to improve
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competency of clinicians in practice. In this study, self- ongoing NIMART training interventions. This study
assessment was used to measure how confident nurses are in therefore aimed to determine the factors that influence the
performing HIV management skills. Knowledge questions HIV management confidence and knowledge of professional
were used to provide an objective assessment. Self-assessment nurses prescribing ART in a rural and urban district in the
is often used to help practising clinicians to identify their Western Cape province.
own strengths and weaknesses for continuous professional
development. However, the process of assessing oneself is Methods
complex and never completely objective. Self-assessment can Research design and setting
therefore not be used as an accurate measure of competency,
but it can be used to help individuals identify gaps in their A quantitative cross-sectional and analytical research design
clinical performance. One such study conducted in the was used because NIMART training has been operational
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Eastern Cape province of South Africa found satisfactory for several years and is in its implementation phase. The
self-efficacy in the clinical performance of NIMART amongst study was conducted in one urban and one rural district –
358 trained nurses, with some limitations in their abilities the City of Cape Town (City Health) and the Cape Winelands
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regarding clinical evaluation. Care provided by providers districts.
with low levels of self-rated expertise who treat low numbers
of HIV and AIDS patients tends to lead to less favourable Population and sample
patient outcomes. 10 Based on a list obtained from the Department of Health,

there were 256 nurses who were authorised to prescribe
Factors such as training, mentoring and clinical experience NIMART in the two districts. Of the five subdistricts in the
have been found to influence the competency of healthcare Cape Winelands, three districts gave permission for the
providers. A systematic review revealed better clinical research and two declined. The assessable population,
outcomes for patients treated by a provider with more determined by contacting facilities, was 146 (67 in the City
training in HIV and AIDS care. There is very little research of Cape Town and 79 in the Cape Winelands). All the nurses
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available on the evaluation of the different NIMART training authorised to prescribe NIMART for a period of 1 year were
courses and training outcomes. One study found that 62% of invited to participate in order to account for the clustering
nurses who had been trained in NIMART were initiating effect in the subdistricts. In the Cape Winelands, 49 (69%)
patients on ART in the clinics where they were working, yet participants completed the questionnaires, 18 (25%) refused
some of these nurses did not pass the open book exam after to participate and four (6%) were absent, on leave or not
the training. In KwaZulu-Natal province, knowledge scores available when the research was conducted. In the City of
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of nurses increased significantly after NIMART training, Cape Town, 28 (42%) participants completed the
with a median post-test knowledge score of 77%. However, questionnaires, 22 (33%) refused to participate and 17 (25%)
the majority of nurses were not confident enough to practise were absent, on leave or not available when the research
their skills, which emphasised the need for continuous was conducted.
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mentorship. A study in Khayelitsha, South Africa, showed
an increase in the confidence of nurses to manage patients on
ART after mentorship. Similarly, a study evaluating 5 years Instrumentation
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of NIMART mentorship in South Africa identified improved A self-completion questionnaire was used that was designed
knowledge, attitudes and confidence perceived by nurses by the researcher based on the literature and previous
who received NIMART mentoring, but highlighted the need instruments. The questionnaire measured demographic
for mentoring to continue in light of continuous changes to details, influencing factors, HIV management confidence and
treatment guidelines. In addition to mentoring, provider HIV management knowledge. The questionnaire was
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experience in HIV and AIDS care has shown to improve the available in English only. In addition, facility statistics related
quality of care. to caseload were collected.
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http://www.sajhivmed.org.za 244 Open Access