Quality of nurse led care for people living with HIV/AIDS attending the infectious diseases clinic, Mulago hospital.

Abstract

INTRODUCTION: The Infectious Diseases Clinic (IDC) has a nurse led model of care through which stable and/or asymptomatic HIV patients are managed. To enhance patient quality of life, it is important to ensure that these patients are receiving quality care. OBJECTIVE: The main objective of this study was to assess the quality of care provided by the nurses in this model based on two dimensions of quality, technical performance and interpersonal relations. The results from this study will be useful in improving the implementation of nurse led care to ensure effective patient management. METHODOLOGY: This was a cross-sectional study carried out at the IDC in Mulago hospital. 336 patients and all the 8 nurses on the nurse led model of care participated in the study. Data was collected using observation of nurse-patient interactions, patient exit interviews, key informant interviews and nurse questionnaires and analyzed using APSS. A weighing system was used to score each nurse’s performance. Analysis of variance was used to test for associations between the dependent and independent variables. RESULTS: The average performance score of the nurses was 78%. Factors significantly associated with performance were the time of time of day a patient was seen (p<0.05), duration of employment and level of training of the nurses (p<0.001), The nurse’s satisfaction with opportunities for learning, supervision and the work environment in the clinic (p<0.001). Ninety six percent of the patients reported they were satisfied with the care from the nurses. The most important factors in nurse led care from the patient’s perspective are the interpersonal relations of the nurses. Both structural and organisational issues influence patient and nurse satisfaction with the adverse visit and form the basis for their recommendations on how the nurse visits can be improved. CONCLUSIONS: In care settings where access to doctors is limited, properly trained nurses can provide quality care. These nurses should have experience in patient management. Patient’s receiving care through the nurse visit model are satisfied with the care. Structural and organisational issues do affect service delivery and both patient and nurse satisfaction with the nurse visit model. RECOMMENDATIONS: A Doctor should be assigned to sit with the nurses to offer supportive supervision and more experienced nurses should mentor less qualified nurses. Reference materials and guidelines must also be availed to the nurses.