MAPPING HIV NURSING CORE COMPETENCIES

AT THE UNDERGRADUATE LEVEL :

FRAMEWORK, PROCESS, AND OUTCOMES

Marilou Gagnon, RN, ACRN, PhD

Associate Professor, School of Nursing, U of Ottawa

Stephany Cator (nursing student)

Research Assistant, School of Nursing, U of Ottawa

In collaboration with

With substitute Presenter Greg Riehl

OUTLINE

• Background

• Position Statement

• Framework

• Mapping project

• Results

• Discussion

• Recommendations

A nurses journey in the land of HIV

BACKGROUND

• Context (CNA/CASN, 2013)

• New graduates from entry-to-practice programs per year (00-12)

BACKGROUND

• Attitudes toward PLWH

• Factors

• Knowledge

• Training

• Experience

• Consequences

• Unwillingness to care for PLWH

• Discriminatory practices

• Differential treatment

• Neglect

BACKGROUND

• Knowledge about HIV

• Issues

• No change over time

• Knowledge deficits reported

• HIV transmission and prevention

• Medications and side effects

• Adherence and viral resistance

• Feeling unprepared

• Irrational fears

• Patient perception

BACKGROUND

• Canadian Association of Nurses in HIV/AIDS Care (CANAC)

• Recognize and foster excellence in HIV/AIDS nursing through

education, mentorship and support

• Specific objectives

• Promoting education and continuous learning opportunities in

HIV/AIDS care (including education at the undergrad level)

• Encouraging research and evidence-based HIV/AIDS nursing care

• Serving as a national voice for HIV/AIDS nursing issues

• Advocating for the rights and dignity of people who are living with

HIV/AIDS or who are vulnerable to HIV infection

POSITION PAPER

• Process

• Developed by CANAC working group

• Approved at CANAC AGM in April 2013

• Published in May 2013

• Position statement

• Essential education in HIV/AIDS nursing

• Core competencies >

• Minimum of 6-12 hours in theory

• Clinical experiences with PLWH

• Elective courses in HIV/AIDS nursing

FRAMEWORK

• Based on framework by Relf et al. (2011)

• Association of Nurses in AIDS Care (US)

• Core competencies

1. Prevention / testing / treatment / care

2. Psychosocial / spiritual / ethical / legal

3. Psychomotor skills

4. Professional expectations

NURSING

Nurses are often the first point of contact in caring for those who use illicit drugs and are at risk for contracting HIV/AIDS

Nurses have a duty to provide safe, competent, ethical care

Protect dignity and choice

Enact social justice

CNA, 2007

COMPETENCY NO.1

HIV prevention, testing, treatment, and care

• HIV epidemic and epidemiology of HIV in Canada

• Risk factors and modes of transmission

• HIV prevention counselling

• Care and services for women of child bearing age

• Prevention of perinatal transmission

• Post-exposure prophylaxis

• HIV testing modalities

• Offer of HIV testing

• Pre- and post-test counselling

COMPETENCY NO.1 (CONTINUED)

HIV prevention, testing, treatment, and care

• Interpretation and discuss of HIV test results

• Antiretroviral treatment

• Laboratory values

• Adverse effects and complications of antiretroviral treatment

• Supportive care for client on treatment

• Opportunistic infections and cancers

• Consultation in complex situations

• Collaboration in health promotion activities

COMPETENCY NO.2

Psychosocial, spiritual, ethical, legal issues related to HIV

• Care sensitive to and respectful of diversity

• Culturally competent and safe care

• Holistic approach to care

• Supportive care to client living with HIV

• Trauma-informed care

• Right to be informed and make decisions

• Right to confidentiality

• Social determinants of health

• Broader social issues (including legal issues)

CONFIDENTIALITY – MORE THAN NICE TO

KNOW…HIPA identifies several rules that trustees must follow for the collection, use and disclosure

of your personal health information. Among them are:

The primary purpose for collecting personal health information must be for the benefit of the INDIVIDUAL.

Trustees should only collect, use or disclose personal health information required to provide the client with a service.

Trustees must also have practices in place that will ensure the safekeeping of personal health information.

Consider:

Who will have access to the information?

Why they would need to know particular information?

The Health Information Protection Act (HIPA)

Canadian Nurses Protective Society (CNPS®) http://www.cnps.ca/index.php

COMPETENCY NO.3

Psychomotor skills necessary to provide HIV nursing care

• Standard (routine) and transmission-based precautions

• Skills related to HIV and TB diagnosis

• Assessment skills for HIV/AIDS nursing care

• Skills related to HIV management

• Safe I.V. injection techniques (education & harm reduction)

• Safe S.Q. and I.M. injection techniques (education)

• Application and removal of condoms

COMPETENCY NO.4

Professional expectations in delivery of HIV nursing care

• Nursing core values and ethical responsibilities

• Therapeutic nurse-client relationship

• Professional and practice standards

• Evidence-informed knowledge into practice

• Collaboration with health care team

• Client involvement

• Linkages with community programs and local services

An environment that is safe for people; where there is no assault, challenge or denial of their

identity, of who they are and what they need. It is about shared respect, shared meaning,

shared knowledge and experience, of learning, living and working together

with dignity and truly listening.

(Health Q. F., 2012)

Cultural Safety

MAPPING PROJECT

•School of nursing @ University of Ottawa (U of O)

•Collaborative program offered on 3 campuses

•University of Ottawa campus

•French program (La Cité collégiale)

•English program

•Algonquin College campus

•Total number of undergraduate students: ± 1800

MAPPING PROJECT

• Sample

• U of O campus (including French and English programs)

• NSG courses : 21 (including practicums)

• Nursing professors : 31

• Nursing professors with “expertise” in HIV : 5 (16%)

• Ideal sample for the purpose of this project

• Pre-requisite courses : 7

• Anatomy (3), microbiology, and pathophysiology

• Pharmacology

• Social determinants of health

MAPPING PROJECT

• Data collection

• Course outlines for the year 2012-2013

• Personal communication with professors

• Mandatory readings and references (i.e. CNO standards)

• Data analysis

• Content analysis approach

• Structured matrix

• Course code

• Competencies based on the framework

• Notes

“We are like trees. Our roots are put down very deep.

And we take things from the four directions and we

take them into our lives. And if you pull us up by the

roots, we are lost. We have to go back and find those

roots, find those beginnings that are strong so that we

can live a good life”. Elder Betty McKenna, 2005.

DISCUSSION

• Strengths

• Framework as a tool to map the competencies

• Framework as a tool to improve HIV nursing education

• Limitations

• General competency versus HIV-specific competencies

• Course outlines versus other data collection tools

• Frequency versus actual coverage of the competencies

• Context sensitized to HIV versus “average” context in Canada

RECOMMENDATIONS

• Develop teaching materials for professors

• Downloadable textbook supplement

• Scenarios for lab evaluation

• Scenarios for professionalism and ethics course

• Develop learning materials for students

• Online modules

• Workshops with guest speakers (including PLWH)

• Promote evidence-informed, safe, and competent practice

• CANAC Best Practice Guidelines | www.canac.org

• Pocket guide for nursing students and nurses

CONTACT INFORMATION

G R E G R I E H L R N B S C N M A

Aboriginal Nursing Student Advisor

Aboriginal Nursing Student

Achievement Program

Saskatchewan Polytechnic

Regina Campus

greg.riehl@saskpolytech.ca

@griehl

M A R I L O U G A G N O N R N P H D

Associate Professor

Faculty of Health Sciences

School of Nursing

University of Ottawa

Director, Unit for Critical Research in Health

marilou.gagnon@uottawa.ca http://www.health.uottawa.ca/sn/personnel/mgagnon.htm