Perceived quality of clinical care provided by nurses to people living with HIV/AIDS at four TASO sites in Uganda

Abstract

The AIDS Support Organization (TASO), added antiretroviral therapy to the care package it offers to her clients in 2004. With the increasing client load and the acute shortage of medical doctors and clinicians, it was inevitable that clinical care, including antiretroviral therapy, had to be shifted to the nurses, whose primary role was to offer nursing care. This raised interest in the quality of care they provide. This study aimed at assessing the quality of clinical HIV/AIDS care provided by nurses to TASO clients. Methods A cross-sectional survey that employed both qualitative and quantitative study designs was conducted at 4 purposively selected TASO sites. Client exit interviews were conducted with 400 clients; 28 self-administered questionnaires filled by the nurses, 56 clinical care sessions observed; 51 medical charts reviewed and 4 key informant interviews conducted with the Medical coordinators. Data was analyzed with the aid of Excel version 2000 and STATA version SE/10 computer packages. Qualitative data was tape-recorded, transcribed, typed in MS word 2003 and analyzed thematically with the aid of Nvivo statistical package. Results About 92% of the clients expressed satisfaction with the services received from TASO nurses; and 95% of them said they would recommend these services to other people living with HIV/AIDS. Fifty five percent said they had not been examined by the nurse. Only two nurses expressed reservations about being involved in clinical care provision. Nurses were found competent to handle general OI care, but needed technical support to manage complex disease conditions. Only 13% of the medical charts reviewed had a record of physical examination findings. Fifty six percent of the nurses were able to write accurate ARV prescriptions; but 63% could not detect ARV side effects at all. Key informants noted that TASO nurses have positive attitudes towards people living with HIV/AIDS. They were also satisfied with the clinical skills of the comprehensive nurses. They identified coaching and mentoring in clinical skills, pharmacology and radiology as critical areas which should be focused on. Conclusions TASO nurses have positive attitudes and this seems to greatly influence patient satisfaction. Comprehensive nurses have better clinical skills than the other cadres of nurses. However, the overall nurses’ technical competence as regards clinical HIV care provision shows significant areas for improvement. Recommendations Comprehensive nurses and double-trained nurses should be allowed to participate in clerking of HIV/AIDS patients, provided there is clinical support supervision by a medical officer. The nurses should also be availed with protocols to follow during clinical care sessions. Nursing training schools should incorporate clinical HIV/AIDS care training into their curricula, and develop relevant course content that suits the nurse clinician. Gender biases among clients should be addressed. A national dialogue on task shifting should be held.