A Mixed-Methods Outcome Evaluation of a Mentorship Intervention for Canadian Nurses in HIV Care

Abstract

We assessed the impact of an HIV care mentorship intervention on knowledge, attitudes, and practices with nurses and people living with HIV (PLWH) in Canada. We implemented the intervention in two urban and two rural sites with 16 mentors (eight experienced HIV nurses and eight PLWH) and 40 mentees (nurses with limited HIV experience). The 6-to 12-month intervention included face-to-face workshops and monthly meetings. Using a mixed-methods approach, participants completed pre-and postintervention questionnaires and engaged in semistructured interviews at intervention initiation, mid-point, and completion. Data from 28 mentees (70%) and 14 mentors (87%) were included in the quantitative analysis. We analyzed questionnaire data using McNemar test, and interview data using content analysis. Results indicated positive changes in knowledge, attitudes, and practices among nurse mentees, with qualitative interviews highlighting mechanisms by which change occurred. Mentorship interventions have the potential to engage and educate nurses in HIV treatment and care. *Correspondence to: vera.caine@ualberta.ca. DisclosuresThe authors report no real or perceived vested interests that relate to this article that could be construed as a conflict of interest. PLWH;Mill, Edwards, Jackson, MacLean, & Chaw-Kant, 2010;Mill et al., 2013). Stigma may result in people at risk for HIV delaying testing (Pottie et al., 2014) and lead to HCP providing differential care to PLWH (Mill et al., 2013). Stigma perpetuated by nurses may be related to a lack of knowledge and educational preparation about HIV clinical management and counseling, religious background, or workplace culture (Waluyo, Culbert, Levy, & Norr, 2015).HIV education for HCP is important to promote best practices. Education increases knowledge and promotes positive changes in attitudes, making it key to addressing HIV stigma in health care settings (Aggleton, Yankah, & Crewe, 2011). Despite the benefits, limited evidence exists to evaluate the impact of different approaches to HIV education for HCP (Aggleton et al., 2011). The Canadian Association of Nurses in AIDS Care (CANAC, 2013) recently highlighted deficits in education for nurses in HIV care. CANAC argued that nurses were graduating with insufficient theoretical and clinical experience in HIV care and with "… limited understanding of the broader social, cultural, and historical contexts with which HIV/AIDS is located" (CANAC, 2013, p. 2). WHO (2013) suggested that nurses were in key positions to provide HIV care, treatment, and prevention, and thus it was essential to prepare nurses at the undergraduate and graduate levels, as well as those in practice, to successfully engage in these roles. However, the impact of HIV education programming for nurses to advance knowledge, and practice and address stigma was unclear. Mentorship is one strategy to increase knowledge and skills in HCP. In order to advance education programming for nurses, we implemented and evaluated a mentorship intervention in HIV care for nu...

Opening doors: A thematic analysis of the long-term impact of community-based research in the field of HIV

“…Throughout the implementation of the intervention it became difficult to separate these elements and they often worked synergistically. The ability to focus on the design, capacity building, and relationships was important at the time of the project; [12,13] this importance was reinforced through our current findings. At the time of the initial project we did not name specific educational outcomes, but were much more focused on unfolding processes at each of our research sites.…”

“…Many of these themes confirmed those described immediately following the initial mentorship project. [2,12,13] In this paper, we have chosen to highlight findings that demonstrate the longer term impact of participation on the nurse and PLWH mentors and the nurse mentees. These findings are organized in themes related to the project design, capacity building and relationships following the project.…”

“…We reflected on the process, strengths and challenges of conducting a large CBR study [12] and we documented the improved nurses' knowledge, attitude and practices after participating in a CBR nursing intervention in HIV care. [13] The need for time and space for critical reflection for nurses (mentors and mentees) and the inclusion of PLWH mentors were considered essential for learning uptake. [13] We also affirmed that having both a nurse and PLWH mentor was perceived by all of the nurse participants as invaluable, and honored the Greater Involvement and Meaningful Engagement of People living with AIDS (GIPA/MEPA) and people at risk.…”

“…[13] The need for time and space for critical reflection for nurses (mentors and mentees) and the inclusion of PLWH mentors were considered essential for learning uptake. [13] We also affirmed that having both a nurse and PLWH mentor was perceived by all of the nurse participants as invaluable, and honored the Greater Involvement and Meaningful Engagement of People living with AIDS (GIPA/MEPA) and people at risk. [14] The purpose of the follow up study was to systematically inquire into the long-term impact of conducting community-based intervention research in HIV care.…”

Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care

“…Data collection took place at the beginning, during, and immediately after the intervention. We explored nurses' HIV education background, their experiences with the care of PLWH, and their knowledge of HIV; these findings have been reported elsewhere (Mill et al, 2014;Worthington et al, 2015). In addition, using content analysis, we analyzed e-mails, field notes, and meeting minutes from research team conversations to identify strengths and challenges during implementation of the mentorship intervention.…”