Justri Nurses Workshop

Transcription

1 Justri Nurses Workshop Marrakech, Morocco

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3 Report on Justri Nurses Workshop The nurses workshop was conducted in English and translated into French. At the start of the workshop each nurse was asked to introduce themselves, giving their name, where they work, what their role entailed and one thing they wanted to get out of the day. The following summary of their replies is brief as the workshop leaders had never utilized continuous translation and needed to adjust to the skill set required. Therefore, we did not probe or clarify our understanding of their responses. We were also conscious of time. However, the individual s introduction helped to set the scene for the day. There were 13 Moroccan nurses and 1 from the Lebanon. Apart from 1 nurse who was very new to the specialty, all of the attending nurses reported to being established in the care of HIV patients, working with either adult or paediatric nurses. All of the Moroccan nurses worked in a public or University hospital responsible for inpatient and follow up care. Only the nurse from Lebanon was community based. The Moroccan nurses were from centres across the country including Agadir, Marrakech, Casablanca, Tangier and Rabat. Five nurses described themselves as the Head Nurse and appeared to be responsible for the care delivery and operational components of their service. Some participants reported that they had access to education on HIV. All of the nurse delegates had exposure to and degrees of responsibility for managing ART including adherence, patient support and side effects. The themes that arose from the nurses expectations from the workshop were: Wanting to learn more about testing / screening for HIV Innovations in ART The management of side effects Provision of psychosocial support Four presentations had been prepared in advance of the workshop which was based on 3 returned pre-workshop questionnaires. These were on: The Nurses Role in HIV 3

4 The Nurses skills in managing someone living with HIV including ART, practical support, side effects, sexual health, disclosure The Management of a Late Presenter and the Impact of Stigma. However, due to the low number of returned pre-workshop questionnaires, the workshop leaders had designed the day to be flexible and mould the agenda according to need articulated by the attending nurses. After the introductions, the workshop agenda was tweaked to reflect the nurses articulated learning requirements. Our initial concern that some of the preprepared presentations may be too basic for the group was unfounded, as these areas were not generally discussed in education events or within their teams. The day was divided to cover the following: 1st session - The scope of the nurse s role in HIV Within this two hour session the following aspects of care were explored: Key issues for nurse in HIV management Nurses and Testing Managing patient expectations Nurses role in Stigma reduction Psychosocial support and care Disclosure and support around this Sexual and reproductive health Management of ARTs Health promotion Managing OI s Role of healthcare providers working in HIV to dispel myths, support, offer non-judgmental care, maintain knowledge & skill and challenge stigma & discrimination 4

5 2nd session Nursing skills in managing someone living with HIV This 2 hour session focused predominantly on ART. We decided that discussion on treatments and side effects should be dealt with in the second session, to afford the time to tease out what regimens were available and used; as well as the nurse s practical knowledge of these regimens. Discussion on management of side effects, strategies employed and suggestions occurred. Time was afforded to informing the nurses of newer ART and regimens. The impact these have had on improving the tolerability and ease of taking medication through reduced pill burden and frequency of dosing were explained. 3rd session Stigma & nurse education / support to manage individuals with HIV The final session commenced with a patient story illustrating stigma, peer support, the use of clinical supervision and MDT support. This real life experience and candour from the nurse, engendered great openness amongst the attending nurses that enabled the workshop leaders to delve more deeply into the cultural context of HIV within Morocco, and discussions and teaching on stigma. The key issues raised and explored during this session were: Confidentiality and disclosure, religion, clinical supervision and support, professional relationships and nurse autonomy, access to improved ART regimens and having a national nurse s organisation. Professional relationships and nurse autonomy: The nurses reported a general shortage of nurses working in or wishing to work in HIV. The nurses described their roles as key in the management of HIV patients in relation to both clinical and psychosocial management. Within the centres the nurses worked at there was no access to psychologists; although social workers are available to counsel and provide social support to patients. The nurse s relationship with medical staff was described as one of mutual respect. Whilst nurses cannot prescribe, they reported being able to influence prescribing so that it reflected the individual patient and take decisions about clinical care 5

6 independently, for example, starting an infusion for dehydration or oxygen for hypoxia. This autonomy of nurse management was only present in the public hospitals. The nurses from the University hospital in Casablanca reported that all decisions were moderated by medical staff and nurses did not act unless directed. There is currently no national organization of nurses working with HIV patients in Morocco. The nurses reported that discussions had occurred around the establishment of a nurse s network but to date, it had not moved forward. Stigma, confidentiality and disclosure: The nurses reported that the impact of stigma is significant for them and their stress levels. They felt strongly that due to the religious underpinning of Morocco, patients cannot disclose their status outside of the clinical setting. They reported that they actively advise patients not to disclose as they believe the consequences of disclosure are too great for the patients. Confidentiality was reported as keeping HIV a secret. The nurses report to bearing the brunt of this secret and would actively deny knowledge of patients in their care to fellow Health Care Workers (HCW) in order to maintain the patient s confidentiality. The nurses reported that there is a lack of awareness of HIV and indicator diseases amongst colleagues in other departments.. The persistance of this ignorance was attributed to HCW stigma concerning HIV. Patients are often referred for HIV care very late and are very sick, compromising their prognosis. They talked about the stigma that patients and they experienced from other HCW. The nurses felt that stigma is additionally a barrier to organising patient peer support as they felt that patients cannot risk being open about their diagnosis. No initiatives within the hospital clinical setting had therefore been attempted to establish peer support in spite of successful peer support work by ALCS with Female sex workers. It was unclear if the nurses perceptions of patient s fear of disclosure were actually held by their patients as the option of speaking to another person with HIV had not been offered by the nurses. There was no mention of any pressure from the nurses own families regarding working with people with HIV. 6

7 Religion Religion was seen as a huge barrier to peer support, HIV prevention work and disclosure despite awareness amongst the nurse of successful initiatives undertaken with the Imams. Religion, the nurses reported prevented discussions promoting condom use and safer sex. Clinical supervision and support The nurses had no experience of clinical supervision. They questioned whether supervision or team support could be implemented given the small number of nurses and a lack of time and opportunity. Nevertheless, the nurses thought it would be beneficial in alleviating some of the stress they experienced through the responsibility of maintenance of confidentiality and direct patient care as well as useful for improving / reflecting on their clinical care. Conclusions The workshop stimulated lively and challenging debate and with encouragement from the workshop leaders all attendees contributed to a lesser or greater amount. Whilst the workshop afforded good insight into the problems and difficulties faced by the nurses from across Morocco, it would have been helpful to visit the clinical environments to place their comments in context. The overwhelming success of the day was in enabling a safe space for the nurses to openly and freely discuss the impact of their role on them as people and how the religious context of their culture infringes how they are able to care for their HIV patients. For most, if not all of the nurses, the workshop seemed to be the first time they had had been afforded this opportunity. The ability to share mutual experiences and be able to converse, in spite of different mother tongues, through the common language of nursing was very powerful to all there. At the end of the workshop, 1 nurse thanked us and said in his 13 years of working with HIV he had attended a great number of educational events but had never experienced such an emotional and helpful day. His sentiment summed up the general feeling in the room. 7

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