Evaluation of a Brief Intervention to Improve the Nursing Care of Young Children in a High HIV and AIDS Setting

Linda M Richter,Celia Hsiao,Thembelihle H Zuma,Tamsen J Rochat

doi:10.1155/2012/647182

Abstract

The HIV epidemic in South Africa is putting great strain on health services, including the inpatient care of young children. Caregivers and young children (107 pairs) and 17 nurses participated in an intervention to improve the care of young children in hospital in a high HIV and AIDS setting. The intervention addressed caregiver expectations about admission and treatment, responsive feeding, coping with infant pain and distress, assistance with medical procedures, and preparation for discharge and home care. Following a preparatory and piloting phase, measures of nurse burnout, caregiver physical and emotional well-being, and caregiver-child interaction were made before and after intervention. No changes were found between before and after intervention on assessments of caregiver wellbeing. However, mothers in the postintervention phase rated nurses as more supportive; mother-child interaction during feeding was more relaxed and engaged, and babies were less socially withdrawn. While the intervention proved useful in improving certain outcomes for children and their caregivers, it did not address challenging hospital and ward administration or support needed by caregivers at home following discharge. To address the latter need, the intervention has been extended into the community through home-based palliative care and support.

Highlights

HIV and AIDS have detrimental effects on children’s lives in South Africa, a country that has the largest number of people living with AIDS
In order to standardize exposure and intervention dose effects, research staff ensured that all nurses working in the ward during the intervention period had received training in delivering the intervention videos, and that they introduced the intervention to caregivers as part of routine practice in the ward; due to high levels of staff rotations in the hospital, many nurses who participated in the preintervention phase of the study were not able to participate in the postintervention phase
Type of caregiver income differed across the two groups, such that caregivers in the preintervention phase tended to have a single source of income, while those in the postintervention phase reported having multiple sources of income

Summary

Introduction

HIV and AIDS have detrimental effects on children’s lives in South Africa, a country that has the largest number of people living with AIDS. HIV/AIDS is the leading cause of death among children under the age of 5 [1], with approximately 330.000 children presently living with HIV/AIDS [2]. In KwaZulu-Natal, the worst affected province in the country, and where the current study was undertaken, approximately 93,000 children under the age of 15 were living with HIV in 2006 [3]. It was estimated that in 2005 only 10 percent of children in KwaZulu-Natal in need of antiretroviral treatment received it [3]. Without access to such treatment, the rapidly debilitating health of children living with HIV leads to multiple hospital admissions before they succumb to illness and die

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Conclusion