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A ‘good hospital’: nurse and patient perceptions of good clinical care for HIV-positive people on antiretroviral treatment in rural Zimbabwe— a mixed-methods qualitative study

Campbell, Catherine, Scott, Kerry, Madanhire, Claudius, Nyamukapa, Constance and Gregson, Simon (2011) A ‘good hospital’: nurse and patient perceptions of good clinical care for HIV-positive people on antiretroviral treatment in rural Zimbabwe— a mixed-methods qualitative study. International Journal of Nursing Studies, 48 (2). pp. 175-183. ISSN 0020-7489

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Abstract

Background: Antiretroviral treatment for HIV is gradually being made available across sub- Saharan Africa. With antiretroviral treatment, HIV can be approached as a chronic, manageable condition rather than a shorter-term issue of palliative care. This treatment involves repeated interaction between health staff and patients for ongoing check-ups and prescription refills. Objective: This study aimed to understand patient and healthcare staff perceptions of good clinical antiretroviral treatment care. Design: Over 100 h of ethnographic observation at healthcare sites; interviews and focus groups with 25 healthcentre workers (mostly nurses), 53 HIV-positive adults taking ARVs and 40 carers of children on ART. The data were analyzed using thematic content analysis. Setting: Three healthcare sites providing free antiretroviral drugs in rural Zimbabwe, where the adult HIV infection rate is approximately 20%. Results: Contrary to reports of poor antiretroviral treatment adherence and task-oriented rather than patient-oriented nursing, our study found great patient commitment to adherence, outstanding nurse dedication and a pervasive sense of hope about coping with HIV. Within this context however there were some situations where patients and nurses had different expectations of the medical encounter, leading to stress and dissatisfaction. Patients and staff both emphasized the importance of nurse kindness, understanding, confidentiality and acceptance (i.e. treating HIV patients ‘like normal’) and patient adherence tomedical directions. However, nurses at times overlooked the negative effects of long wait times and frequent hospital visits. Further, nurses sometimes conflated medical adherence with general patient obedience in all aspects of the nurse–patient relationships. Patients and staff were frustrated by the ambiguity and unpredictability surrounding key elements of hospital visits such as how much patients had to pay for service, how long it would take to be served, and whether drugs or the doctor’s services would be available.

Item Type: Article
Official URL: http://www.elsevier.com
Additional Information: © 2010 Elsevier Ltd. This is an Elsevier "Sponsored Article", allowing open access re-distribution of this article. Full terms and conditions of use can be found here: http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms
Library of Congress subject classification: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Social Psychology
Research centres and groups > LSE Health
Rights: http://www.lse.ac.uk/library/usingTheLibrary/academicSupport/OA/depositYourResearch.aspx
Date Deposited: 16 Feb 2011 11:04
URL: http://eprints.lse.ac.uk/32177/

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