Professional Documents
Culture Documents
global HIV epidemiology, along with cultural awareness and competence to meet the needs of the diverse
and continually changing community of PLWH.
These and other pressures have placed significant
demands on educators to ensure that nurses across
a broad spectrum of settings have the awareness,
knowledge, and skills to provide best practice,
gender, sexuality, and culturally appropriate, clientcentered care to PLWH.
In Australia, HIV models of care vary across the
states and territories, but clinical services are
predominately provided in publicly funded sexual
health clinics, specialist HIV services, and primary
health care general practice settings (Savage et al.,
Judith Dean, RN, RM, BN, MPHTM, is the Sexual Health
Program Convenor, School of Nursing and Midwifery,
Griffith University and State Nurse Educator, Sexual
Health & HIV Service, Queensland Health, Australia.
Shaun Staunton, BS (Psychology), MCCJ, is the Chief
Executive Officer, Tasmanian Council on AIDS, Hepatitis
and Related Diseases, Hobart, Tasmania, Australia. Stephen Lambert, BE, MPH, is a Research Coordinator, HIV
& HCV Education Projects, School of Medicine, The
University of Queensland, Brisbane, Australia. Mary
Batch, RN, BH (Nursing), MNL, PhD, is a Clinical Nurse
Consultant, Infectious Diseases Unit, Royal Brisbane and
Womens Hospital, Queensland Health, Brisbane,
Australia. Warren Fitzgerald, RN, BA Bus (Health Admin),
MPH, is a Community Nurse, Positive Directions, Gold
Coast, Australia. Joanne Leamy, RN, BA (Soc Sci), MA
(Nursing), is a Clinical Nurse Consultant, Cairns Sexual
Health Service, Queensland Health, Australia.
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. -, No. -, -/- 2013, 1-7
http://dx.doi.org/10.1016/j.jana.2013.07.007
Copyright 2013 Association of Nurses in AIDS Care
management of side effects, adherence, and information about starting and/or switching ART; patient
education; and professional development and education of other nurses (Griffiths et al., 2006). They also
play a major role in providing advocacy and social
support for PLWH, a role that improves the ability
of an individual (and affected others) to cope with
a new diagnosis, adhere to treatment, and achieve
and maintain sexual, psychological, and emotional
well-being as s/he learns to live with HIV (National
AIDS Trust, 2011).
Research is also a core role for the HIV nurse.
While well placed to facilitate recruitment to clinical
research including trials related to HIV pharmaceutical management, the HIV nurse also plays
a fundamental role in advocating for the protection
of PLWH participating in various research programs
(ANAC & ANA, 2007). HIV nurse participation in
multidisciplinary collaborative models of research
is important for client outcomes, and HIV nurse-led
and focused research is essential in the evolving
era of HIV. Nurse-led and focused research will
ensure that HIV nursing models of care and supporting education is evidence informed and continues
to improve to meet the needs of HIV specialist nurses
and their clients, as well as generalist nurses providing care and support to PLWH accessing mainstream health care services (Rowe, 2009; Trimble,
2009).
While the role of HIV nurses is continually
evolving to meet changing HIV epidemic and resultant client needs, the physical, psychological, spiritual, and social concerns remain core to providing
client-centered care and positive outcomes. The
HIV nurse needs the knowledge and skill to provide
care to PLWH across a diverse range of health care
settings ranging from acute hospital inpatient, longterm palliative care, and outpatient ambulatory
management environments, through to communitybased nursing in settings such as home care, corrections facilities, and remote regional settings (ANAC
& ANA 2007; Trimble, 2009).
Exploring models of care that take the full scope of
HIV nursing practice and contemporary nursing theories into account is essential if services and education
programs are to successfully continue to evolve in
order to continue to meet the changing physical,
social, and cultural needs of PLWH. Nurse-based
the disease, symptoms of early and late disease, diagnostic testing and legal and ethical issues (p. 433).
Education also needs to encourage examination of
personal and cultural values. Relf et al. (2009) highlighted the need to imbue a clear understanding of the
professional ethical principles of autonomy, beneficence, non-maleficence and justice, in the context of
testing, confidentiality, disclosure, and the environment of care related to HIV and AIDS (p. 1453)
right from a nursing students entry to practice
studies. Education courses should also include information surrounding pharmaceutical developments
and current treatment options, drug side effects, the
importance of medication adherence, drug resistance,
and the role of good nutrition.
Along with an education program that encompasses the topics outlined above, HIV education
programs today need to incorporate the principles
of chronic disease management. Inclusion of these
principles will help nurses develop the knowledge
and skills needed to work within the coordinated,
multidisciplinary, patient-focused approaches necessary to address complex physical, psychological,
spiritual, social, and chronic HIV issues while
enhancing client independence and improving the
quality of life for PLWH, their care providers, and
families, and preventing avoidable hospitalizations
(Savage et al., 2009).
Education is an important feature of developing
sound attitudes and values (Pickles et al., 2009;
Relf et al., 2009) and improved nursing care
(Thompson, 2009). The education needs of nurses
providing care to people living with or at risk of
acquiring HIV will always vary from context to
context, from hospital to community setting, and
from beginner to expert. Maintaining currency of
scientific information is essential (Mijch & Vujovic,
2009). However, the challenge is to ensure that
learning is appropriate to the context and standards
of local nursing practice and has the capacity to
continually evolve to address the changing profile
of HIV. Collaboration between multidisciplinary
service providers and education networks is essential
to support continued advanced learning. Education
should be delivered in an interactive case-based
format and aim to empower participants to develop
skills and knowledge that enables them to easily
update and access support (Mijch & Vujovic, 2009).
education courses were of good quality and effectively delivered (Mijch & Vujovic, 2009). A literature
review of international and Australian evidence
helped to benchmark the existing program against
other available education. Analysis of data from
formative evaluation of the education activities and
a survey of past participants and stakeholders
involved in program delivery indicated that the
Nursing Practice Course provided high-quality
professional development to nurses in Queensland.
The use of a combination of lectures, skills practice,
interactive group work, and case discussions enabled
effective application of theory to practice.
The advisory committee of nurses and other
key local HIV experts has been actively involved in
developing, updating, and delivering the content,
and facilitating group work. The format has provided
flexibility to adapt content in response to emerging
issues and has facilitated application of knowledge
and theory to practice along with reiteration of key
points and sharing of experiences and practice tips.
The availability of a suite of courses has allowed
nurses to also participate in courses designed for
other health professionals, thus nurturing the development of multidisciplinary collaboration as participants from a range of practice areas and levels
actively engage in case scenarios and learning activities together. Advanced practice HIV nurses were
also able to participate in prescribers courses and,
although not eligible to prescribe drugs in Queensland, they developed advanced levels of knowledge
and skill necessary to meet the complex needs of
the aging PLWH population.
The Griffith University Graduate Sexual Health
Program commenced offering an online HIV course
as a core component of a Master in Advanced Practice (Sexual Health) in 2005. Instigated in 1998 in
response to changing legislative and practice standards for sexual health nurses in Queensland, the
evolution of this tertiary qualification in sexual health
and HIV reflected the changing nature of advanced
practice nursing and the need to support specialist
postgraduate levels of education (Queensland
Government, 2008). The HIV and HCV Education
Project has a long-established partnership with the
Griffith Graduate Sexual Health Program and, in
2008, a credit pathway was established between the
two programs, thereby providing opportunities for
nurses who had completed the HIV and HCV Education Projects Education Course in HIV Medicine
and the HIV Nursing Practice Course to complete
an assessment challenge and gain credit toward the
core specialty HIV course of the Griffith Master in
Advanced Practice (Sexual Health). Unpublished
formative and informative feedback from successful
credit pathway applicants has indicated that the credit
pathway is a valuable addition to HIV education in
Queensland as it has encouraged nurses to not only
gain higher education qualification but has also
provided opportunities to develop advanced levels
of reflective practice and critical thinking knowledge
and skills (HIV and HCV Education Project, 2011).
These skills have helped nurses actively participate
in quality review and improvement of models of
nursing care that are responsive to contemporary
literature and the ever-evolving continuum of HIV
care and nursing frameworks.
Conclusion
Queensland has provided a model of HIV nursing
education that not only considered the changing
patterns of HIV epidemiology and management but
also the education needs of nurses across a diverse
range of health care settings and levels of practice.
HIV specialist nursing education has evolved to
address the change from acute clinical HIV management to ambulatory primary health care of an increasingly complex chronic infectious disease. The HIV
education framework in Queensland has prepared
nurses to practice within the current context of HIV
care while providing pathways to achieving higher
education qualification and academic skills. The
model has demonstrated that collaboration between
educators and clinical experts from a range of practice areas and professions can result in education
that is responsive to the changing HIV profile and
the evolution of HIV nursing.
Collaboration between the clinical and academic
sectors promotes development of reflective practice
and critical thinking that supports research to guide
evidence-informed models of care. But it is important that nurse-led/nurse-focused research be supported to guide practice and develop education
programs that address the current context and skill
Disclosures
The authors are the providers of the education
program described in this paper. The authors report
no real or perceived vested interests that relate to
this article that could be construed as a conflict of
interest.
Acknowledgments
Funding for the external evaluation of the Queensland University, School of Medicine, HIV and HCV
Education Project was provided by Queensland
Health. This funding was not used in relation to this
article.
The authors acknowledge the support and guidance provided by the Queensland University, School
of Medicine, HIV and HCV Education Projects staff,
and members of the Nursing Advisory Committee.
The authors also wish to thank the people who volunteer their time and expertise during the HIV Nursing
education courses.
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