Page 255 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 6 of 7 Original Research

80 cases are required to be seen by a nurse in consultation These may nonetheless still have an impact on overall service
with a mentor, according to the Clinical Mentorship delivery and quality of patient care.
Guideline for Integrated Services, in order for the nurse to
be authorised in NIMART. In the present study, all nurses Recommendations based on the study findings include
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had received NIMART mentoring. The findings from this regular guideline updates to reinforce HIV management
study support a 2-week NIMART mentoring period. It may knowledge. Methods to strengthen mentoring should
be that a 2-week mentoring period is more intense. Perhaps be engaged such as dedicated roving mentors or access
those who were mentored for a longer period, for example, to telephonic consultations. Dedicated mentoring may
14
for more than 2 months, did not have intensive contact be costly and therefore non-governmental organisation
sessions and case studies or the contact sessions may have support may be required to ensure mentor capacity.
13
been too far apart. A study conducted by Orner et al. found NIMART-trained nurses should be offered sufficient
16
that nurses and doctors were too busy for mentoring, which opportunities to practise their skills. As not all nurses may
may result in less frequent contact sessions. A longer period be exposed to a high caseload because of the PHC approach
of mentoring may therefore not translate to the acquisition of providing integrated services, especially in rural settings,
of more knowledge and confidence in practice. This, those with low caseloads need access to updated guidelines
however, needs to be explored further. Having an assigned and mentors to assist them when they initiate patients or
mentor or the frequency of contact sessions with the mentor encounter complex cases.
were not associated with the participants’ level of confidence
or knowledge. However, other studies have found
mentoring to improve nurses’ confidence, improving Limitations
institutional barriers and the quality of patient care. 13,14 Study limitations include the small sample size and high
refusal rate, which limits the generalisability of the findings.
Although mentoring was not associated with the The small sample size further limits the power of the
participants’ knowledge in the present study, participants statistical tests to detect significant differences. As mentioned
who received regular feedback about their personal and before, self-assessment may not accurately measure
clinical performance (classified in this study as part of confidence. The cross-sectional nature of the study implies
quality assurance) had significantly higher knowledge that no cause and effect relationships between the variables
scores (75.2%) compared to those with limited or no explored can be inferred. Further, the knowledge and
feedback (67.9%). Feedback was mostly received from the competency items assessed were delimited to adult HIV care.
clinic manager or HIV and AIDS, STIs and TB coordinator.
Regular feedback provided about individual and clinic Conclusion
performance related to the provision of ART is likely to
influence nurses’ HIV management confidence. However, This study investigated various factors that influence
4
the Clinical Mentorship Manual for Integrated Services the knowledge and confidence of professional nurses
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distinguishes between clinical mentorship and supportive prescribing ART in an urban and rural setting, and gave an
account of what is currently happening at the healthcare
supervision. Although both have similar goals and some facilities that partook in the study. The majority of
overlapping activities, supervision tends to emphasise participants had adequate HIV management knowledge
health facility management and is more hierarchical, and reported being very confident or experts in the HIV
whereas mentoring is more focused on the enhancement management skills and competencies. Training, mentorship
of the skills of the mentee. Mentoring should therefore and clinical practice experience are associated with
be more effective in improving the confidence and knowledge and confidence. Recommendations include
knowledge of nurses than feedback from supervisors. The the strengthening of current training and mentoring
above mentioned results may mean that mentoring is not programmes and ensuring that NIMART-trained nurses are
currently being implemented or practised effectively.
provided with regular updates and sufficient opportunities
for clinical practice.
Knowledge and confidence of the clinicians should increase
as they gain experience. In this study, the HIV management Acknowledgement
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confidence and knowledge scores were the same across all
categories of experience. However, the average number of Competing interest
patients living with HIV seen or the caseload may be an The authors have declared that no competing interests exist.
indication of the intensity of experience and was associated
with both HIV management confidence and knowledge. It
therefore appears that the total years of experience does not Author contributions
influence confidence and knowledge, rather it is more clinical D.J.S. wrote the proposal and conducted the study as part of
practice experience, for example, the patients living with her Master of Nursing degree. T.C. supervised the study and
HIV caseload, that influences confidence and knowledge. developed the initial draft of the article. A.S.v.d.M.
None of the other health system influencing factors were cosupervised the study, and T.M.E. provided statistical
associated with HIV management confidence and knowledge. support. The article was reviewed by all the authors.

http://www.sajhivmed.org.za 248 Open Access